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Ortho (spine) > Pathoanatomical Diagnoses of C-Spine > Flashcards

Pathoanatomical Diagnoses of C-Spine Flashcards

1
Q

What are the 4 clinical practice guidlines available for neck pain?

A
  1. neck pain with mobility deficit
  2. neck pain with headache
  3. neck pain with movement
  4. neck pain with radiating pain
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2
Q

What are some signs of cervical radiculopathy?

A
  1. neck and radiating pain to arm
  2. numbness, sensory deficits
  3. myotome distribution in neck and arm
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3
Q

When does cervical radiculopathy occur?

A
  • compression
  • irritation
  • traction
  • herniated disc
  • foraminal narrowing
  • degenerative spondylitic change
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4
Q

What are the 4 criteria considered predictive of the presence of cervical radiculopathy?

A
  1. (+) ULTT:
    - IL neck SB decreases sx, CL neck lateral flex increases sx
    - >10 deg elbow ext difference
  2. involved side cervical rotation ROM
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5
Q

What are the 4 types of cervical disc diseases?

A
  1. protrusion & bulging
  2. Prolapse
  3. Disc extrusion
  4. Sequestration
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6
Q

Describe what occurs with disc protrusion and bulging

A

no AF rupture, NP bulges

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7
Q

Describe what occurs with disc prolapse

A

outermost fibers of AF contain the nucleus

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8
Q

Describe what occurs with disc extrusion

A
  • AF is perforated

- discal material moves to epidural space

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9
Q

Describe what occurs with disc sequestration

A

-discal fragments from AF & outside the disc proper

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10
Q

describe the symptoms that occur with central posterior herniations

A

pain radiates into limbs BL and myelopathic sx

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11
Q

describe the symptoms that occur with posterior/posteriolateral herniations

A
  • pain/aching
  • decreased c-spine ROM
  • UL UE radicular pain
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12
Q

define directional preference

A
  • specific direction of trunk movement or posture that alleviates or decreases the pain
  • with or without the pain changing location and/or improving a limitation of movement
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13
Q

Define cervical spine instability

A
  • increase in the neutral zone of 1 or more cervical spine segments
  • lack of control of neutral zone WITHOUT compromise of the vascular or neural structures
  • poor motor control of ROM
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14
Q

What are the primary causes of instability?

A
  1. degeneration & mechanical injury of the cervical stabilization components
  2. trauma, surgery, systemic disease or tumors
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15
Q

What are signs of instability

A
  1. aberrant motion

2. poor motor control of deep core muscles

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16
Q

What is the proposed intervention for c-spine instabilty

A

cervo-thoracic stabilization exercises

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17
Q

What is the definition of spinal stenosis?

A

narrowing of the spinal canal (usually degeneratively), IV foramina or radicular canals due to bony or soft tissue encroachment space b/t SP cord & vertebral elements is compromised

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18
Q

What is the normal A-P cervical SP Canal diameter?

A

17-18 mm

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19
Q

What is a A-P cervical canal diameter of

A

congenital stenosis

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20
Q

What is a ratio of A-P transverse diameter

A

substantial SP cord flattening

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21
Q

What is the most frequently used form of imaging for spinal stenosis?

A

MRI

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22
Q

What two forms of electrodiagnosis distinguish cervical radiculopathy from other UE problems?

A
  1. EMG

2. Nerve Conduction

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23
Q

What does somatic sensory evoke potentials look for?

A

cervical myelopathy

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24
Q

What parts of the SC are affected with a transverse lesion?

A

corticospinal, spinothalamic & posterior cord tracts

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25
Q

What parts of the SC are affected with a motor system lesion?

A

corticospinal tracts and anterior horn cells

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26
Q

What parts of the SC are affected with central cord syndrome?

A

more pronounced UE deficits > LE

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27
Q

What parts of the SC are affected with Brown-Sequard Syndrome?

A

motor deficits on IL side, CL sensory deficits

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28
Q

What parts of the SC are affected with brachialgia & cord

A

radicular UE pain occurs with motor and/or sensory long-tract signs

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29
Q

what are the signs and symptoms of spinal stenosis when it’s primarily the nerve root that’s involved?

A

pain, sensory, reflex & motor distribution of involved nerves (will lok like neuropathy)

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30
Q

what are the signs and symptoms of spinal stenosis when it’s primarily the SC that’s involved?

A
  • clinical presentation will depend on area that’s compressed
  • insidious onset
  • difficulty with use of hands
  • possible balance difficulties
  • awkward gait
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31
Q

Interventions for spinal stenosis include:

A

Goal= improve function & pain

  • stretching
  • cardiovascular exercise
  • specific strengthening
  • postural re-ed
  • scapular stabilization
  • joint manipulation/mobilization
  • training in ADL’s
32
Q

List of primary headaches

A
  1. migraine
  2. tension type-headache (muscular origin)
  3. cluster headache & other trigeminal autonomic cephalalgias
33
Q

List of secondary headaches

A
  1. cervicogenic
  2. head/neck trauma
  3. cranial/cervical vascular disorder
  4. substance/withdrawal
  5. infection
  6. homeostasis disorder
  7. HA or facial pain
34
Q

Migraine w/o auro has at least 5 attacks of the following:

A
  1. attacks lasting 4-72 hours
  2. has ≥2 characteristics of:
    - UL location
    - pulsating
    - mod-severe pain
    - avoidance of routine Physical activity
  3. During headache, ≥ 1 of:
    - nausea/vomitting
    - photophobia or phonophobia
35
Q

What happens with a migraine w/ aura

A

recurrent attacks

  • lasting minutes
  • UL fully reversible visual, sensory, or other CNS sx that usually develop gradually
  • followed by HA & associated migraine sx
36
Q

When does aura occur?

A

before the migraine (like a signal)

37
Q

what is scotoma?

A

area of diminished vision moving across visual field

38
Q

What are the 4 stages of a migraine?

A
  1. Prodrome= sx of light and sound sensitivity, depression, irritability, and lack of appetite
  2. Aura: occur up to 1 hr prior to headache
  3. Headache: pain can be mod-severe, lasting up to 3 days
  4. Postdrome: “migraine hangover”
39
Q

What are some ways to manage migraines?

A
  1. modification of risk factors
  2. treatment of associated co-morbidities
  3. check for medication overuse
  4. treatment of acute migraine attacks
  5. preventative therapy (strengthening/education)
  6. no evidence of benefit of manual therapy
40
Q

What are some modifiable risk factors for migraine?

A
  1. medication overuse
  2. obesity
  3. depression
  4. stressful life events
  5. snoring
41
Q

What are cervicogenic headaches?

A

HA assoicated with neck pain and stiffness

  • can be UL or BL
  • frequent TMJ relation
  • may occur with trigger point palpation
  • aggravated by sustained neck positions
  • normal imaging
42
Q

What is the proposed pathophysiology of CGH?

A

convergence of sensory input from the upper c-spine into the trigeminal spinal nucleus, including input from:

  1. upper cervical facets and muscles
  2. C2-C3 intervertebral disc
  3. vertebral & internal carotid arteries
  4. dura mater of the upper SC
  5. posterior cranial fossa
43
Q

if a patient with a headaches comes into clinic, what might you find in their postural assessment?

A
  1. upper crossed syndrome
  2. forward head
  3. weakness and decreased endurance of deep neck flexors
44
Q

if a patient with cervicogenic headaches comes into clinic, what might you find in their manual assessment?

A
  1. impaired C1/C2 rotation

2. AA rotation to side of HA is half of CL side

45
Q

What is a whiplash-associated disorder?

A
  1. term used to describe the mechanism of injury
  2. effects of sudden acceleration-deceleration forces on the neck and upper trunk as a result of external forces exerting a “lash-like” effect
46
Q

Describe Grade 0 for modified quebec task force

A

no complaints about neck pain, no physical signs

47
Q

Describe Grade I for modified quebec task force

A

no c/o of pain or physical signs, stiffness or tenderness only

48
Q

Describe Grade IIA for modified quebec task force

A
  • neck complaint
  • motor impairment= decreased ROM; altered muscle recruitment patterns
  • sensory impairment= local cervical mechanical hyperalgesia
49
Q

Describe Grade IIB for modified quebec task force

A

everything in IIA + psychological impairment

50
Q

Describe Grade III for modified quebec task force

A

Grade IIB+ now some SNS disturbances, sensory hypersensitivity, neurologic signs of conduction loss, psycholgoical impairment

51
Q

Describe Grade IV for modified quebec task force

A

fracture or dislocation

52
Q

At 12 months, what percent of WAD patients continue to have pain/disability

A

12-84%

53
Q

What are risk factors for poor outcomes for patients with WAD (strong evidence)

A
  1. high baseline neck pain intensity
  2. presence of headache on intake
  3. no post secondary education
  4. WAD grade 2 or 3
54
Q

What are risk factors for poor outcomes for patients with WAD (moderate evidence)

A
  1. catastrophizing= over exaggeration
  2. no seat belt in use at time of accident
  3. history of neck pain prior to accident
  4. female
55
Q

if the MOI is osteoligamentous in a WAD, what happens during the early phase?

A
  • cervical spine flexes
  • torso motion occurs, lower–> upper vertebrae
  • C & T spinal straightening
56
Q

if the MOI is osteoligamentous in a WAD, what happens during the second phase?

A
  • cervical spine extends

- C6 moves first (before upper vertebrae)

57
Q

if the MOI is osteoligamentous in a WAD, what happens during the middle phase?

A
  • Axis of Rotation is moved from C6 to C5
  • open book motion= vertebrae separate anteriorly & zygapophyseal impact occurs posteriorly
  • impingement of inflamed synovial folds in zygapophysial joints
58
Q

If a rear-end impact occurs, what muscles are affected?

A
  • SCM activated more and most

- SCM injured before other injuries

59
Q

If lateral impact occurs, what muscles are affected?

A

opposite splenius capitis is contracted significantly

60
Q

Does awareness of the impact increase or decrease the muscle response?

A

decreases muscle response

61
Q

describe the hierarchical model of what is affected with a WAD

A

muscles–> ligaments–> facet joints–> brain

62
Q

What are the most common sx with a WAD?

A
  • sub-occipital heachace
  • neck pain that is constant or motion induced
  • up to 48 hr delay of sx onset from initial injury
63
Q

What percent of WAD recover within 6 months?

A

85%

64
Q

what joint is the most common source of pain in chronic WAD?

A

Zygapophyseal joint

65
Q

What are the indications for gentle approach in patients with WAD?

A
  1. recent trauma ≤ 6 weeks
  2. acute capsular pattern
  3. severe movement loss
  4. paresthesia
  5. segmental or multisegmental hypo or areflexia
  6. constant pain
  7. mod- severe radiating pain and/or headaches
  8. dizziness
66
Q

What does a high initial pain intensity on VAS indicate?

A

extended recovery for WAD patients

67
Q

What do high NDI scores initially predict?

A

high NDI scores @ 2-3 years post injury & mod-severe pain/sx

68
Q

What are some forms of passive treatment for WAD patients

A
  1. cervical collar
  2. physical modalities
  3. rest
  4. inactivity
69
Q

What are some forms of active treatment for WAD patients?

A
  1. exercise
  2. normal activities
  3. mobilization/manipulation
70
Q

What is the most effective for improved pain and ROM in WAD patients?

A

mobilization

71
Q

What is the goal for Phase 1 of WAD intervention?

A
  • decrease pain
  • provide info
  • explain consequences of WAD
72
Q

What are the interventions for Phase 1 of WAD?

A
  • pt education
  • active CROM
  • NSAIDS (consult MD)
73
Q

What is the goal for Phase 2 of WAD intervention?

A
  • provide info
  • improve function
  • return patient to normal activities
74
Q

What are the interventions for Phase 2 of WAD?

A
  1. education
  2. exercise therapy
  3. functional activities
75
Q

What is the goal for Phase 3 of WAD intervention?

A
  1. provide info
  2. explain consequences of whiplash
  3. improve function
  4. increase activities
76
Q

What are the interventions for Phase 3 of WAD?

A
  1. education
  2. exercise therapy
  3. functional activities

Ortho (spine) (4 decks)

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