Spinal Cervical Orthotic Management

Question 1

Evaluation of cervical injury (4)

Answer 1

Position of head prior to injury
Expectation of impact
Direction of impact
Intensity of impact

Question 2

Whiplash (2)

Answer 2

Hyperextension and flexion injuries

Acceleration / deceleration force to unrestrained head/neck

Question 3

Whiplash syndrome (15)

Answer 3

Soft tissue injury
-disc
-nerve root
-muscles/ligaments
   -elongate
      -microscopic tears
      -haemmorage
      -oedema
Fractures
-avulsion of spinous process
-chip vertebral body
Dislocation
-of atlas
-spondylosisthesis 
(X ray necessary)

Question 4

Whiplash symptoms (10)

Answer 4

Neck ache
Headache
Shoulder pain (interscapular) 
Neck tenderness
Spasm
Blurred vision
Light headed
Restriction of motion
Swallowing problem
Difficult to lift head from pillow

Question 5

Whiolash symptoms must consider trauma to spinal cord (3)

Answer 5

Numbness of trunk and/or extremities
No involuntary movement
If movement coordination impaired

Question 6

Csm management (2)

Answer 6

Surgical (if spinal cord involvement)
Conservative management (depending on symptoms)

Question 7

Csm conservative management (10)

Answer 7

Medication
Immobilisation
-orthosis
Mobilisation
-manipulation
-exercise
Reeducation
-posture
-adl
Psychological intervention

Question 8

Ra cervical spine changes (5)

Answer 8

Ligamentous distension rupture
Synovitis
Destruction of articular cartilage
Osteoporosis
Bone erosion

Question 9

Ra results of pathological changes (6)

Answer 9

Pain
Dislocation of c4,5; c5,6
Transverse lig rupture will result in flexion instability
-extension limited by dens
Once dens no longer intact unstable in all planes
Spinal cord can be damaged

Question 10

Ra cervical management aims (3)

Answer 10

Reduce pain
Minimise joint destruction
Enhance cervical stability

Question 11

Ra cervical management options (7)

Answer 11

Therapy
-education
-heat/ice
-exercise regime
Orthoses
Medication
Surgery

Question 12

Torticollis (2)

Answer 12

Twisted neck typically caused by contracted sternocleidomastoid muscle (scm)
Head to affected side, rotation of chin to opposite side

Question 13

Congenital torticollis (5)

Answer 13

Grisels syndrome
Positioning in utero results in ischaemic injury
During birth
Palpable enlargement of muscle
Facial deformity due to sleeping position

Question 14

Acquired torticollis (9)

Answer 14

Trauma
-atlantoaxial subluxation
-birth complications
Disease
Idiopathic (25-55) ist
Unilateral stiffness of muscles
Pressure on accessory nerve
Twitching (spasm) 
Head/neck pain

Question 15

Congenital torticollis management (4)

Answer 15

Exercise
Heat
Orthoses for serial positioning
Surgery

Question 16

Acquired torticollis management (5)

Answer 16

Must address underlying cause
Therapy
Orthosis
Surgery (if due to subluxation)
Medication

Question 17

Orthotic treatment for torticollis (1)

Answer 17

Fillauer?

Question 18

Muscle trauma of cervical spine (6)

Answer 18

Vascular pain
-sustained contraction occludes arterial flow
-tms/ tension myositis syndrome (sarno)
Sprain (lig) / strain (muscle/tendon)
-elongation resulting in tears
-forceful contraction resulting in tear at origin/insertion

Question 19

Whiplash management ( soft tissue injury) within hours (7)

Answer 19

Immediate rest
-orthosis
Ice
-decreases acute inflammation
   -decreases bv dilation
   -decreases pain
   -decreases haemmorhage/oedema

Question 20

Whiplash management (13)

Answer 20

Heat
-commence after 1 day
-removes accumulated nociceptors
-prevents collagen binding
-causes vasodilation
   -wash out toxins
Discontinue orthosis
-after several days
Gentle mobilisation
-ultrasound/massage
Traction
Exercises
Medication

Question 21

Cervical fractures (8)

Answer 21

Jeffersons fracture
-ring of atlas
Hangmans fracture
-axis (hyperextension) 
Teardrop fracture
-extreme flexion with compression
Fracture of dens
Fracture of the spinous process (clay shovelers fracture)

Question 22

Pathologies of cervical spine (6)

Answer 22

Cervical spondylosis
-disc herniation
Inflammatory arthritis
Torticollis 
Neoplasm
Congenital

Question 23

Spondylosis (6)

Answer 23

Degenerative disc disease
Pathological changes (c3-c7) 
-narrowing of disc height
-osteophytes at disc margins
   -sensory root irritation more common
-oa changes in posterior joints

Question 24

Spondylosis associated problems (3(

Answer 24

Spinal stenosis
Spondylolisthesis
Symptoms of these include pain, altered sensation and muscular weakness

Question 25

Disc herniation of cervical area (5)

Answer 25

Nucleus herniates
Annulus bulges
-contact post long lig and/or nerve root (sensory) 
-neck and arm pain
-may contact spinal cord

Question 26

Cervical spondylotic myelopathy (6)

Answer 26

Unsteady gait
Trunk numbness/hypersensitivity
Limb weakness
Atrophy
Spasticity
Bladder sphicter dysfunction

Question 27

Cervical orthoses categories (6)

Answer 27

Collars
-soft
-hard
Poster type
Cervicothoracic
Halo

Question 28

Negative factors following prolonged use of spinal orthosis (7)

Answer 28

Muscle atrophy
Soft tissue contractures
Skin irritation
-heat
-infections
Psychological dependence
Compensatory movement/snaking

Question 29

Philadephia collar (2)

Answer 29

Cervical spine

Reinforced plastazote

Question 30

Snaking (3)

Answer 30

Proximal cervial spine extension
Distal cervical spine flexion
Head flexion restrained by orthosis