Pathologies Flashcards
What is cervical spondylosis?
Degenerative disc disorder affecting the facet joints. - Lower spine most affected ( C5-6,C6-7 and C4-5) -Age group 45+ - Onset - Insidious or traumatic.
What are the patho-anatomical changes related to cervical spondylosis?
- Loss of disc heigh due to disc dehydration/degeneration
- Vertebrae approximate
- formation of marginal osteophytes
- Increased weight bearing on facet joints
- Possible nerve root entrapment and spinal cord compression due to degenerative changes
What are the symptoms of Cervical spondylosis?
- Bilateral/unilateral neck pain
- referred pain into shoulder, arm or head - this can be somatic or radicular referred pain
- Neck stiffness
What are the signs of cervical spondylosis?
- Decreased cervical ROM
- pain on PAIVM of involved levels
- Altered posture
- Dermatomal changes if nerve root involved
- Degenerative changes on xray
What would you observe on an xray of cervical spondylosis?
- Disc space narrowing
- Anterior osteophyte formation
- Lipping and irregularity of vertebral bodies.
What is the cause of cervical disc herniation?
- Caused by degenerative weakness of annulus with the nucleus prolapsing through.
- Affects individuals in 30s
- male:female 1:1
- C6-7 and C5-6 most common levels
What are the risk factors of disc herniation?
- Age
- Smoking
- Lifting heavy objects
- Driving
However uncommon , less common than disc prolapse in the lumbar spine.
What would you observe in a pro-section of disc herniation?
- Source of pain =
Tear of outer annulus and inflammatory process - Disc prolapse =
Centrally, posterolaterally and bulge.
What are the symptoms of cervical disc herniation?
- Acute and rapidly worsening neck pain , central or unilateral
- referred pain in scapula
- pain worse on coughing and sneezing
- antalgic posture - head head in flexion
- if posterolateral/ spinal nerve involved = radicular referred pain into the arm and hand
- Paraesthesias / anaesthesia into the UL
- Myelopathy , central cord stenosis
What is facet joint osteoarthritis?
- Degenerative disorder
- more common over 65
- Pathology - Synovitis. disintegration of articular cartilage, osteophyte formation, joint space narrowing.
what are the symptoms of Facet OA ?
- Local , often unilateral neck pain
- somatic pain referral into shoulder,scapula region depending on levels affected
- stiff neck
What are the signs of facet OA
- Decreased ROM into facet closed pack position ( extension, ipsilateral side flexion and ipsilateral rotation)
- Pain reproduced on PAIVM of affected levels
- degenerative changes on xray
What would you see on an x-ray for facet OA
- cartilage destruction of facet joints
- Loss of joint space
- Osteophyte formation around joint margins
- IVD and vertebral bodies normal.
What is cervical radiculopathy?
Cervical radiculopathy, commonly called a “pinched nerve,” occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal cord. This may cause pain that radiates into the shoulder and/or arm, as well as muscle weakness and numbness
What is lateral canal stenosis?
- narrowing of I-V foramina
- Causes nerve root compression and irritation
- Neurological changes
What are the common causes of irritation of the IV formina usually in the medial half ( narrowest)
- Inflammation
- Postero-lateral disc prolapse
- degenerative changes of facet joints e.g osteophytes
- Most commonly impacting C6,7,5 levels
What are the signs and symptoms of cervical radiculopathy (lateral canal stenosis)?
- Acute severe arm pain in dermatomal distribution
- Altered sensation in dermatomal distribution
- Referred pain below ( Clowards signs)
- Myotomal/reflex changes
- Neck pain
- Pain worse on compression movements of foramina IV
- Night pain
- Antalgic posture
What is cervical myelopathy?
Compression of the spinal cord by
- Severe central degenerative changes e.g osteophytes
- large disc prolapse
What are the signs and symptoms of cervical myelopathy ( central canal stenosis)
- Chronic neck pain
- associated symtoms- mild gait disturbances / numb clumsy hands
- other signs - bladder dysfunction, gait disturbance, LL dysfunction.
- Symptoms aggravated with movements or postures that decrease size of spinal canal e.g extension.
MEDICAL EMERGENCY
What is the mechanism of whiplash?
- Whiplash is an acceleration-deceleration mechanism , may result from rear end of side impact , may result in bony or soft tissue injuries.
- Rear end collision mechanism- Hyperextension followed by hyperflexion, with the hyperextension phase being the most damaging( anterior cervical features) and the hyperflexion phase being limited by chin:chest or forehead:steering wheel
List the possible lesions in whiplash
- Muscle strain:SCM, scalenes/precervical muscles
- Capsule sprain or fracture
- Ligament sprains/tears ALL,PLL,IVL
- IVD Prolapse , annular tears , clefts in endplates
- Vertebral arteral ischaemia
- Concussion
- Thoracic outlet syndrome
- PTSD management vital for recovery
What is the typical duration of symptoms for whiplash?
Duration of Symptoms
- On average 6weeks- 1 year
- 10% of patients will go on to develop chronic pain.
What are the biological symptoms of whiplash?
- pain
- stiffness
- headaches
- nausea
- dizziness
- referred pain
- paraesthesia
- blurred vision
- difficulties swallowing
what are the psychological symtoms of whiplash?
- Depression
- Anxiety
- anger
- loss of job and income
- marital and family
- PTSD
- fear of driving.
what is whiplash association disorder (WAD) classification?
- WAD1- neck pain
- WAD2A- neck pain , altered movements , local mechanical hyperalgesia
- WAD2B- above plus psychological impairment
- WAD2C- above plus generalized hyperalgesia.
- WAD3- above plus neuro signs
- WAD4- fracture/dislocation
What are postural dysfunction signs?
- Poor upper quadrant posture
- FHP - forward head posture
- Trigger points
- May have full AROM and absence of joint signs
What are the symptoms of postural dysfunction?
- Widespread neck pain radiating into shoulders and neck
- Worsened by prolonged postures , e.g sitting at a computer or driving
- Often easier in morning and worse at the end of the day.
What is a Cervicogenic headache?
- Irritation of trigeminal nuclei (TGN) or within cranial nerve.
- A dysfunction in an upper cervical spine structure which refers pain into the head.
What are the S&S form upper cervical - cervicogenic headache
- Does the pain occur in relation to neck symptoms - leading the neck assessment for limitations in AROM and PROM
- headaches
- Face,eye,TMJ,ear pain
- Nausea
- dizziness
- FHP
- postive joint findings
- weakness in deep neck flexors
- trigger points.
What are the special questions for the neck ( 5Ds) and 2Ns)?
- Dysphasia
- Dysphagia
- Drop attacks
- Dizziness
- Diplopia
- Nystagmus - shacking of the eyes
- Nausea
-links to circulatory examination.
What are factors should we investigate with a cervicogenic headache - history
- onset - trauma, postural strain , degenerative disease?
- precipitating factors- sustained neck postures of movements
- Pathomechanics- referred pain from upper spine structures ( convergence theory)
Describe the underlying pathology of CAD( Cervical Arterial Dysfunction
- Arteries narrowed due to plaque formation
- Trauma- whiplash , intubation
- Connective tissue abnormalities- Spontaneous arterial dissection
- Upper cervical instability- RA or acute whiplash
Risk factors for CAD
- Hypertension
- Hypercholesterolemia
- Diabetes
- High BMI
- Family history
- Upper cervical instability
- Infections
- Smoking
Give the signs and symptoms of CAD - 2ns and 5ds
- Nystagmus
- Nausea
- Dizziness
- Drop attacks
- Diplopia
- Dysarthria
- Dysphagia
- Cerebral or cerebellar signs e.g. ataxic gait
Give the subjective signs and symptoms of cervical instability
- Feeling of instability - head may fall off
- Neck/shoulder pain
- Symptoms of VBI/CAD
- Chronic headaches
- Episodes of locking
- Lump in throat
- Metallic taste
- Paraesthesia of lips,tongue,bilateral hands and feet
How was you objectively assess a patient with signs and symptoms of cervical instability
- AROM&PROM limited
- Hypertrophy of anterior neck musculature
- Overactive SCM
