PT4 - Cspine Flashcards
1
Q
When is it ok to treat non-specific csp pain (NSCSP)?
A
- unilateral presentation
- no red flags e.g. neuro - HAs, dizziness, changes in special senses
- possible radiations
- mechanically aggravated
2
Q
What happens in the upper CSP regarding movement?
A
- OA/AA supports head
- OA minimal movement => results in quick translation to CSP
- C1-C2 => mostly rotation (around Odontoid peg), NO discs, 50% rotation, has a lot of ligaments (cruciate, transverse, alar), very bursa rich to lubricate, common site of RA
- C3-C5 => mainly flexion + extension + SB
- C6-C7 => transition to thorax => reduced movement
3
Q
What will movement feel like in the neck if you suspect RA/instability?
A
- lag between head coming off pillow and csp coming off pillow => CAUTION => ligaments have lost resiliance + stretching (hence lag) suspect instability in OA/AA => inspect hands + wrists for sign of RA
- can also feel similar in Spondylosis
4
Q
What are common presentations of NSCSP?
A
- HAs
- Radiations to side/shoulder
- Be moderately careful on first TTT
- Common to twist further than available in cape e.g. reaching backwards in car => acute MM response => facet “lock” as joint capsule stretched => intense hypertonicity (segmentation overstrain) => MM spasm prevents movement (tends to happen in mid-csp) => PT wakes with pain
- Whiplash is a type of NSCSP => common in RTA from behind. First => flexion => seat hits thorax => extension through C3-C5, ligamentus strain => recoil => adrenaline rush => MM tearing posteriorly => mild enough not to be felt at the time => present with NSCSP the following day with symptoms. Good care position => head in contact with headrest => fully depresses levers, diminishes impact => modern car that crumples (don’t want to be turning a corner). Seatbelts => rotational injuries (driver seat => worse on left hand side). If hit from front => MM tearing as preparing for impact (can see it coming)
- Sporting injuries e.g. rugby/boxing => usually minor, no symptoms at the time => MM tearing + PPW pain the following day => ligament (facet compression) => very straight csp + facet joints compressed
5
Q
What are the 3 divisions of the neck (for healthy function)?
A
- upper csp: orientation sense organs + cranial base => stable base for head + face function
- mid csp: rotation
- lower csp: dissipation of forces into thorax
6
Q
What are the mid-csp specialisations?
A
- bony shape
- myofascial balance
- neurovascular health
- adaptation
- all can be come dysfunctional
7
Q
What functions happen at the lower csp?
A
- CTJ provides:
—> dissipation of forces
—> protection of viscera and neurovascular structures
—> lower csp movement on first rib
—> aids movement of shoulder girdle
8
Q
What is the function of the clavipectoral fascia?
A
- anterior fascia
- scalenes are part of force dissipation
- cervical fascia blends with deep fascia sandwiched between pectoralis major + minor => large clavipectoral band => can be tightened => fibrotic impacting thoracic outlet
-
9
Q
List key anomalies of a cervical rib
A
- failure of normal ossification
- 1% incidence
- 2:1 F:M
- transverse apophysomegaly more common @ 3% (transverse process grows longer to join with a rib from cervical spine)
10
Q
What are the symptoms of thoracic outlet syndrome?
A
- pain and fatigue
- numbness and tingling
- weakness and wasting
- pallor/cynosis
- swelling
- loss of pulse
11
Q
Where and what is carpel tunnel syndrome?
A
- median nerve impacted (major nerve between hand + brain)
- flexor tendons => fibrous tissues connecting muscle to bone => slide back and forth as fingers move
- transverse carpal ligament => tough ligament (scaphoid + trapezium => pisiform + hamate) => roof of carpal tunnel
- tendon sheath => protective outer covering => lets tendon move easily
- carpal bones => u shaped group of bones => hard floor + sides of carpal tunnel
12
Q
What are the 3 types of TOS?
A
- costoclavicular (Edens) syndrome
- Scalenes-anticus syndrome
- Hyperabduction syndrome
13
Q
What happens in costoclavicular (Edens) syndrome?
A
- clavicle compresses vessels and nerves from neck (between clavicle + 1st rib)
14
Q
What happens in scalènes anticus syndrome?
A
- scalenes compressing artery and nerves from the neck (between anterior + middle scalene)
15
Q
What happens in hyperabduction syndrome?
A
- pectoralis minor compressing vessels and nerves from neck (pec minor + 2nd rib)
16
Q
What are the diagnostic types of TOS?
A
- vascular TOS => arterial + venous
- neurological TOS => true neurological TOS + Symptomatic TOS
17
Q
What are the main causes of compression in TOS?
A
- anatomical defects
- poor posture, overuse of the scaleni
- trauma
- repetitive activity and sports
- traction trauma
