Scenario 4

Question 1

C4 facet joint osteoarthritis on the R side
No information on which movement causes increased pain

Which movement would you expect to cause pain

Answer 1

Closing most likely for Facet issue

IF pain during R side flexion/rotation suggests a closing problem of the facets on R side (more likely as OA)

IF pain during side flexion/rotation to the L suggests could be an opening problem

Question 2

what is OA?

Answer 2

Pain, Stiffness, Functional Impairment and Crepitus

Cells in the articular cartilage release enzymes (chondrocytes) which break down collagen

Absorption of too much water followed by fibrosis then causes splitting of the cartilage

The cartilage surface then becomes rough, friction increases and cartilage thins

The joint self repairs forming osteophytes leading to inflammation and effusion in the joint, may lead to stretching of the capsule

Question 3

What assessment technique will you use?

Answer 3

Unilateral PAIVMs on TP/facet joints at C4

PPIVM to assess closing of the facet joints – side flexion or R rotation (pt in L side lying)

Question 4

What Treatment choices do you have?

Answer 4

Unilateral PAIVMs on facet joints

PROMs and AROMs to maintain/increase movement

Lateral glides on R side to facilitate closing on R side (restore/increase movement and reduce pain)

MWM’s/SNAGS - mobs on R side on facet joint (unless SIN factor too high) as pt rotates head to the R to help facilitate closing of facet joints

Traction as good for all cervical pain

Question 5

What exercises could you use?

Answer 5

Maintain ROM with R and L rotation

Keep muscles strong to support upper cervical joints (without overloading) e.g in suping lying, lift head up off plinth hold and back down.

If the pt a has a directional preference, use McKenzie and apply that physiological movement as the exercise/treatment.

Question 6

what would this patients Problem list look like

Answer 6

Severity – dull ache 4/10 low to moderate (Is she on pain killers?)

Irritability – increases on movement to 6/10 moderate (eases? 24hr pattern?)

Nature – degenerative - dull ache suggesting inflammation if constant

Objective markers taken from PROM, AROM and accessory mobs.