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
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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
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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
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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
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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
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6
Q

What are the mid-csp specialisations?

A
  • bony shape
  • myofascial balance
  • neurovascular health
  • adaptation
  • all can be come dysfunctional
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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

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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

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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)
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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
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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
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12
Q

What are the 3 types of TOS?

A
  • costoclavicular (Edens) syndrome
  • Scalenes-anticus syndrome
  • Hyperabduction syndrome
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13
Q

What happens in costoclavicular (Edens) syndrome?

A
  • clavicle compresses vessels and nerves from neck (between clavicle + 1st rib)
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14
Q

What happens in scalènes anticus syndrome?

A
  • scalenes compressing artery and nerves from the neck (between anterior + middle scalene)
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15
Q

What happens in hyperabduction syndrome?

A
  • pectoralis minor compressing vessels and nerves from neck (pec minor + 2nd rib)
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16
Q

What are the diagnostic types of TOS?

A
  • vascular TOS => arterial + venous
  • neurological TOS => true neurological TOS + Symptomatic TOS
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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
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18
Q

Where are the 3 potential areas of entrapment of TOS?

A
  • interscalene (anterior + middle)
  • costoclavicular lesion (clavicle + 1st rib + subclavius)
  • infraclavicular lesion (hyperabdcution syndrome) (pec minor + 2nd rib)
19
Q

What happens in TOS?

A
  • compression of major blood vessels + nerves/plexus
  • vaso-nervorum compressed
  • dynamic or static
20
Q

Match the names of TOS for the 3 different locations where this can occur

A
  • costoclavicular space = costoclavicular syndrome (clavicle + first rib + subclavian MM)
  • inter scalene triangle = scalene anticus syndrome (anterior + middle scalenes + 1st rib)
  • hyperabduction syndrome = intrapectoral space (pec minor + 2nd rib)
21
Q

What are the diagnostic tests for TOS?

A
  • Adson’s => intermittent claudication test
  • Roo’s => pain, swelling, cyanosis, paraesthesia
22
Q

What are the cervical ligaments and MMs concerned with structure and function of csp?

A
  • ligamentus attachments of viscera:

—> from cranial base to mandible
—> support and control hyoid
—> run to shoulder + thorax

  • MM of anterior csp:

—> longus colli
—> longus capitis
—> scalenes

23
Q

What are pain sensitive structures of the csp?

A
  • apophyseal joints = zygapophyseal = facet joint
  • nerve root sheaths = vaso-nervorum + nervi-nervorum
  • meninges = dura, pia mater, arachnoid mater
  • outer fibres of IVD
  • uncovertebral joints (joints of van luschia) = uncinate joints (lost in side bend first)
  • myotendons structures
24
Q

What happens to longus colli + capitis in neck pain?

A
  • ischaemia
  • metabolites
  • trigger points
  • sensitisation
25
When longus colli + capitis are in pain, what does this lead to?
- contracture - fibrosis - wasting - poor head control
26
How do you perform the craniocervical flexion test?
- PT supine - biofeedback unit inflated to 20mmHg under PT cspine - Stage1: PT performs headnod until increase of 2mmHg for 2-3 secs (performed on exhalation if epical breathing pattern) - observe: —> analyse motion of headnod (should see increase in flexion from OA) —> PPT scalene + SCM muscles (should only see these work in the last stages of the test) - stage2: —> performed if PT can achieve stage 1 —> isometric endurance of deep cervical flexors —> 3 x 10 sec hold @ 22mmHg Observe: —> jerkiness of hold or reduced pressure
27
What is Suprling’s test for?
- cervical nerve root compression
28
How is Spurling’s test performed?
Spurlings A test: - PT sitting + OP behind - Lateral flexion of PT cspine + 8kg force down by hand + OP opposite hand on torso to stabilise - +ve test is reproduction of symptoms Spurlings B test: - same PT + Op position as above - Lateral flexion + contralateral rotation away of PT cspine + OP opposite hand on torso to stabilise - +ve test is reproduction of symptoms Has been performed @ C1-C2 to C6-C7
29
What is whiplash?
- compression/decompression (sigmoid deformation) - NOT flexion/extension injury - Rear, front or side on TA OR diving and sports - Distraction at anterior disc, where annulus fibres coverage, possibly leading to tearing of disc - compaction at posterior aspect particularly compounding facet joints and synovial folds
30
Which vertebrae is normally impacted by whiplash injuries?
- C5 compresses onto C6 in extension
31
What are the biomechanics of whiplash?
- usually rear impact TRA (PT unaware = relaxed) - MM off guard => ligaments increase in direct stress - primary injury => cspine extension affecting OA - apex C4/C5 - as CSP flexes => posterior protection => tearing of MM + ligaments - mid CSP key centre of flexion severely affected - increase damage to transverse cruciate ligament + tectorial membrane (spinal cord) - Affected areas: OA, mid CSP, C1-C2 if rotation involved
32
What is the Whiplash grading (Whiplash Associated Disorders)?
- Grade 0 = no complaints/physical signs - Grade 1 = CSP complaints (pain, tenderness, stiffness) + no physical signs - Grade 2 = CSP complaints + MSK signs (decreased ROM + MM weakness) - Grade 3/4 = CSP complaints + neuro signs (sensory deficit) e.g. fracture/dislocation
33
What are the guidelines for WAD?
- Case Hx - Grades 1 => 5 => X ray - If +ve for fracture => immediate referral for A&E/specialist surgeon - If -ve for fracture => reassure, encourage activity, manage pain
34
What are the stages for a non-fracture WAD recovery?
- 7 days => if not resolving, reassess + consider manual/physical therapies - 3 weeks => if not resolving seek specialist advice - 6 weeks => if not resolving => multidisciplinary pain team/rehab provider evaluation
35
What is the Canadian CSP rule? (CCR)
- are the following NOT true: —> +65, mechanism of onset dangerous, numbness or tingling in extremities - are the following present: —> simple rear-end motor vehicle collision —> PT ambulatory at any time since injury —> delayed onset of CSP pain —> PT in sitting position in emergency department —> absence of midline cervical spine tenderness - is PT able to actively rotate CSP 45 degrees L + R
36
What is Whiplash Associated Disorder (WAD)?
- whiplash injury with no demonstrable changes on imaging => pain without tissue damage
37
What symptoms are associated with WAD?
- dizziness - HAs - TMJ - Tinnitus - May run in a 1-2 year period of recovery - Also called Late Whiplash Syndrome (LWS)
38
In a rear end RTA collision, what are the primary injuries?
- CSP extension - OA joint primarily affected due to momentum of head - mid apex = C4/C5
39
What initiatives should be undertaken to prevent and rehabilitate PT with WAD?
- educate car user - seat + head restraints - education of PT - pro-active funded TTT - protocols for management - quick compensation/lower costs
40
What movement happens in neural tissue in WAD?
- rotation + side bending results in stenosis of intervertebral foramen (IVF)
41
What is the biggest predictor of non-recovery in WAD?
- insurance claims => yellow flag for recovery
42
Provide a way of testing craniocervical flexion test?
- anatomical markers position on Tagus of ear + medial protuberance of mandible + lateral aspect of CSP - digital image taken + software used to calculate craniocervical flexion ROM
43
What other test are available to assess CSP?
- lift head off table and perform nodding movement - can PT flex upper and lower CSP? - if PT can’t get head off plinth => positive craniocervical test