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YEAR 2 Common cervical pathologies > Pathologies > Flashcards

Pathologies Flashcards

1
Q

What is cervical spondylosis?

A 
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.
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2
Q

What are the patho-anatomical changes related to cervical spondylosis?

A
  • 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
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3
Q

What are the symptoms of Cervical spondylosis?

A
  • Bilateral/unilateral neck pain
  • referred pain into shoulder, arm or head - this can be somatic or radicular referred pain
  • Neck stiffness
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4
Q

What are the signs of cervical spondylosis?

A
  • Decreased cervical ROM
  • pain on PAIVM of involved levels
  • Altered posture
  • Dermatomal changes if nerve root involved
  • Degenerative changes on xray
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5
Q

What would you observe on an xray of cervical spondylosis?

A
  • Disc space narrowing
  • Anterior osteophyte formation
  • Lipping and irregularity of vertebral bodies.
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6
Q

What is the cause of cervical disc herniation?

A
  • 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
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7
Q

What are the risk factors of disc herniation?

A
  • Age
  • Smoking
  • Lifting heavy objects
  • Driving

However uncommon , less common than disc prolapse in the lumbar spine.

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8
Q

What would you observe in a pro-section of disc herniation?

A
  • Source of pain =
    Tear of outer annulus and inflammatory process
  • Disc prolapse =
    Centrally, posterolaterally and bulge.
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9
Q

What are the symptoms of cervical disc herniation?

A
  • 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
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10
Q

What is facet joint osteoarthritis?

A
  • Degenerative disorder
  • more common over 65
  • Pathology - Synovitis. disintegration of articular cartilage, osteophyte formation, joint space narrowing.
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11
Q

what are the symptoms of Facet OA ?

A
  • Local , often unilateral neck pain
  • somatic pain referral into shoulder,scapula region depending on levels affected
  • stiff neck
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12
Q

What are the signs of facet OA

A
  • 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
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13
Q

What would you see on an x-ray for facet OA

A
  • cartilage destruction of facet joints
  • Loss of joint space
  • Osteophyte formation around joint margins
  • IVD and vertebral bodies normal.
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14
Q

What is cervical radiculopathy?

A

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

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15
Q

What is lateral canal stenosis?

A
  • narrowing of I-V foramina
  • Causes nerve root compression and irritation
  • Neurological changes
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16
Q

What are the common causes of irritation of the IV formina usually in the medial half ( narrowest)

A
  • Inflammation
  • Postero-lateral disc prolapse
  • degenerative changes of facet joints e.g osteophytes
  • Most commonly impacting C6,7,5 levels
17
Q

What are the signs and symptoms of cervical radiculopathy (lateral canal stenosis)?

A
  • 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
18
Q

What is cervical myelopathy?

A

Compression of the spinal cord by

  • Severe central degenerative changes e.g osteophytes
  • large disc prolapse
19
Q

What are the signs and symptoms of cervical myelopathy ( central canal stenosis)

A
  • 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
20
Q

What is the mechanism of whiplash?

A
  • 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
21
Q

List the possible lesions in whiplash

A
  • 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
22
Q

What is the typical duration of symptoms for whiplash?

A

Duration of Symptoms

  • On average 6weeks- 1 year
  • 10% of patients will go on to develop chronic pain.
23
Q

What are the biological symptoms of whiplash?

A
  • pain
  • stiffness
  • headaches
  • nausea
  • dizziness
  • referred pain
  • paraesthesia
  • blurred vision
  • difficulties swallowing
24
Q

what are the psychological symtoms of whiplash?

A
  • Depression
  • Anxiety
  • anger
  • loss of job and income
  • marital and family
  • PTSD
  • fear of driving.
25
Q

what is whiplash association disorder (WAD) classification?

A
  • 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
26
Q

What are postural dysfunction signs?

A
  • Poor upper quadrant posture
  • FHP - forward head posture
  • Trigger points
  • May have full AROM and absence of joint signs
27
Q

What are the symptoms of postural dysfunction?

A
  • 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.
28
Q

What is a Cervicogenic headache?

A
  • Irritation of trigeminal nuclei (TGN) or within cranial nerve.
  • A dysfunction in an upper cervical spine structure which refers pain into the head.
29
Q

What are the S&S form upper cervical - cervicogenic headache

A
  • 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.
30
Q

What are the special questions for the neck ( 5Ds) and 2Ns)?

A
  • Dysphasia
  • Dysphagia
  • Drop attacks
  • Dizziness
  • Diplopia
  • Nystagmus - shacking of the eyes
  • Nausea

-links to circulatory examination.

31
Q

What are factors should we investigate with a cervicogenic headache - history

A
  • onset - trauma, postural strain , degenerative disease?
  • precipitating factors- sustained neck postures of movements
  • Pathomechanics- referred pain from upper spine structures ( convergence theory)
32
Q

Describe the underlying pathology of CAD( Cervical Arterial Dysfunction

A
  • Arteries narrowed due to plaque formation
  • Trauma- whiplash , intubation
  • Connective tissue abnormalities- Spontaneous arterial dissection
  • Upper cervical instability- RA or acute whiplash
33
Q

Risk factors for CAD

A
  • Hypertension
  • Hypercholesterolemia
  • Diabetes
  • High BMI
  • Family history
  • Upper cervical instability
  • Infections
  • Smoking
34
Q

Give the signs and symptoms of CAD - 2ns and 5ds

A
  • Nystagmus
  • Nausea
  • Dizziness
  • Drop attacks
  • Diplopia
  • Dysarthria
  • Dysphagia
  • Cerebral or cerebellar signs e.g. ataxic gait
35
Q

Give the subjective signs and symptoms of cervical instability

A
  • 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
36
Q

How was you objectively assess a patient with signs and symptoms of cervical instability

A
  • AROM&PROM limited
  • Hypertrophy of anterior neck musculature
  • Overactive SCM

YEAR 2 Common cervical pathologies (1 decks)

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