Task 1

Question 1

The student is able to name risk factors for non-specific neck complaints.

Answer 1

• Trauma
• Higher age
• Female gender
• Genetic predisposition
• Poor psychological health
• High (work) stress
• To smoke
• Low job satisfaction
• Wrong working posture

Question 2

The student is able to name prognostic factors for non-specific neck complaints.

Answer 2

• Younger patients, (better prognosis)
• Previous episodes of neck pain
• Poorer health
• Psychological factors: anxiety, worry, frustration
• Active coping and optimism
• Work-related complaints (absenteeism) and trauma-related neck pain

Question 3

The student is able to name the goal and the method of the screening process

Answer 3

To exclude serious pathologies
Indication for physiotherapeutic examination

• Registration
• Request for help
• Worrisome or not
• Inform and advice

Question 4

The student is able to sum up 4 profiles within the screening based on the guideline physiotherapeutic file-keeping 2016.

Answer 4

• a recognizable for the physiotherapist and within the competences of the individual physiotherapist falling profile
• a profile that is not recognizable to the physiotherapist (recommendation: patient to GP for second opinion)
• a profile recognizable to the physical therapist, with recognition of potentially serious pathology (advice: patient to GP);
• a profile recognizable to the physiotherapist that is better performed by another care provider can be treated (advice: patient to another care provider).

Question 5

The student knows the red flags of the neck area

Answer 5

• fracture: advanced age, trauma in medical history, use of corticosteroids, osteoporosis
• cervical arterial dysfunction: cerebrovascular symptoms such as dizziness, double vision, nausea, vomiting, weakness of the limbs, and papillary changes
• damage to spinal cord or cervical myopathy: neurological symptoms, including widespread neurological signs in both arms and/ or legs, such as sensory disorders, loss of muscle strength in extremities, bowel and bladder dysfunction
• infection (including urinary tract infection or skin infection) : symptoms and signs of infection (e.g. fever, night sweats), risk factors for infection (e.g. underlying pathological process, in the case of immunosuppressants, an open wound, intravenous drug use, exposure to infectious diseases)
• malignant tumors: cancer in medical history, no improvement in symptoms after 4 weeks of treatment, unexplained weight loss, age >50 years, trouble swallowing, headaches, vomiting
• systemic diseases (herpes zoster, spondylitis ankylosis, inflammatory arthritis, rheumatoid arthritis) : headache, fever, unilateral skin rash, burning pain, itching

Question 6

The student is able to explain how non-specific neck complaints can be categorised according to Binder.

Answer 6

Nonspecific (simple neck pain is the commonest cause of neck symptoms and results from postural and mechanical causes. It includes pain following whiplash injury provide there is no bony injury or objective neurological deficit.

→ Non-specific neck complaints.

→ Specific:
• Metastases
• Radiculopathy
• Stenosis
• Spondylolisthesis

→ Differential diagnosis of nonspecific neck pain:

• Soft tissue lesions (acute neck strain, acute torticollis)
• Fibromyalgia and psychogenic causes
• Mechanical lesions (disc prolapse, diffuse idiopathic skeletal hyperostosis)
• Inflammatory (rheumatoid, ankylosing spondylitis, polymyalgia rheumatica)
• Metabolic (Paget’s disease, osteoporosis, gout, pseudo-gout)
• Infective (osteomyelitis, TB)
• Malignancy (primary tumors, secondary deposits, myeloma)
• Adjacent pathology (shoulder or acromioclavicular disease)

Question 7

The student is able to explain how non-specific neck complaints can be categorised according to Neck Pain Task Force.

Answer 7

→ Grade 1: No signs of major pathology and no or little interference with daily activities.

→ Grade 2: No signs of major pathology, but interference with daily activities.

→ Grade 3: Neck pain with neurological signs or symptoms.

→ Grade 4: Neck pain with signs of major pathology

Question 8

The student is able to explain how non-specific neck complaints can be categorised according to Waddell.

Answer 8

• Specific → Radicular-type, Other severe problems

* Non-specific neck complaints → At risk of developing chronicity, No risk of developing chronicity

Question 9

The student is able to name symptoms of neck complaints and assess whether they are categorised as specific or non-specific neck complaints.

Answer 9

Grade 3 signs: Reduced tendon reflexes, muscle weakness, or sensory disorders.

Symptoms:
•Sensory symptoms in the arm, such as paresthesia, numbness, reduced sense of touch.
•Restricted cervical range of motion, defined as rotation <60 degrees or limited and painful rotation.
•Reduced muscle strength or muscle control.
•Radiating pain in the arm.

Question 10

The student is able to identify the tests that can diagnose a specific neck complaint based on psychometric characteristics.

Answer 10

Confirmation of Grade III neck pain:
A positive Spurling’s test and/or
A positive traction/distraction test
A positive shoulder abduction test

Exclusion of Grade III neck pain:
A negative Upper Limb Tension Test (ULTT)* for the brachial plexus and median nerve

Mobility: Stenvers C7&T1
Stability: Lanser
Stabiltiy coordination deep neck flex: CCFT