The Cervical Spine Flashcards
Red flag: risk factors for spinal fractures
Age greater than 50
History of trauma
History of osteoporosis
History of steroid use
Red flag: Signs and symptoms of cord compression
Clumsiness of hands- fine motor skills
Stumbling or unsteady gait
Unilateral or bilateral paresthesia or anaethesia
Bowel or bladder dysfunction
Red flag: risk factors/signs for Cancer
Age greater than 50
Previous history of cancer
Unexplained weight loss- 5-10% in 3-6months
Fatigue
What are the 5 D’s And 3 N’s for VBI and CAD signs?
Dizziness, Diplopia, Dysarthria, Dysphagia, Drop attacks
Ataxia
Nausea, Nystagmus, Numbness
Horners syndrom- signs and symptoms
- Dropping of upper eyelid, decreased pupil size, sweating
1st order neurons- unilateral symptoms on body
2nd order neurons- unilateral symptoms on face and neck
3rd order neurons- unilateral symptoms on forehead area
What risk factors to be aware of from PMH that puts the patient at risk of CAD or VBI?
Any cardiovascular issues
What is Cervical Arterial Dysfunction?
An umbrella term including all known vascular pathologies and anatomical structures that may be compromised by movement or manual therapy
- Does the patient have vascular pathologies causing the pain and are they at risk of developing a pathology during assessment
What is Vertebrobasiliar insufficiency?
A condition characterized by poor blood flow to the posterior portion of the brain
Observational assessment for cervical spine, what to look for:
- Posture
- Asymmetry
- Lumps/bumps
- Swelling
- Redness
- Temperature changes
- Deformities
- Hypertrophy/atrophy
- Gait
Neural mobilisations: What are they used for?
To restore slide and glide of the nerves and reduce symptoms
Which accessory movements for the cervical spine do we need to know?
Anterior/posterior movement
Posterior/anterior movement
What is cervical myelopathy?
Compression of the spinal cord at the cervical level
Causes of Cervical Myelopathy?
- Trauma
- Tumour
- Ossification (hardening) of the ligaments around the spinal cord
- Osteoarthritis
- Spondylosis
- Stenosis
Common symptoms of Cervical Myelopathy
- Dexterity issues, clumpsy hands
- Unsteady gait
- Glove and stocking like numbness/paresthesia not usually in a dermatomal pattern
- Bladder and bowel dysfunction
- Weakness in arms and hands
What is mechanical neck pain?
Risk factors?
Neck pain that cannot be attributed to a specific pathoanatomical structure or cause
- highly demand careers
- poor postures or sedentary work position
- increasing age
- previous history of neck pain
Causes of Mechanical neck pain
- Onset usually has no specific reason identified
- Sustained postures
- Anxiety and depression
- Sleeping awkwardly
- Following activities
- Cervical spondylosis and OA (common)
Common signs and symptoms of mechanical neck pain
- Mechanical: aggr by movements, postures or activities and can be predicted
- Pain can be local but can radiate in a non-dermatomal distribution into head, shoulder, arm and scap
- NO dermatomal or myotomal objective deficit
- Pain can be associated with paraesthesia
- Tenderness on palpation of intervertebral joints
Management of mechanical neck pain
(0-12 weeks)
Self care advice
Physio: stretch, strength, ROM, manual therapy
(more than 12 weeks)
Provide multidisciplinary management
Research says:
- Multimodal approaches seem to have the greatest impact
- low quality evidence for manipulations or mobilisations
Ian D Coulter
What is cervical radiculopathy
Condition that results in neurological dysfunction caused by compression and inflammation of any of the nerve roots of your cervical spine.
Affecting the function of the nerve root itself
Symptoms of cervical radiculopathy
- Apparent dermatomal deficits
- Apparent mytomal deficits
- Apparent reflex deficits
- Symptoms may occur gradually
- Most common nerve root affected C7
Risks and causes of cervical radiculopathy
- Lifting heavy objects
- Repetitive neck motions
- Strenuous activities that put high stress of C-spine
Management of cervical radiculopathy
(less than 4-6 weeks)
Advice and reassurance
Physiotherapy- stretching, strengthening, ROM, manual therapy
(more than 4-6 weeks)
Refer for MRI
Referral for injections
Research: Warren Magnus
- little evidence for surgery over non-surgical treatment
- anti-inflammatory drugs are good
- physical therapy
- epidural steroid injections
What are whiplash associated disorders?
People suffering with neck pain related to sudden extension, flexion or rotation of the neck
Grade 0= Complains of neck pain
Grade 1= Neck complaints- pain, stiffness
Grade 2= Neck complaints and objective signs
Grade 3= Grade 2 plus neuro signs
Grade 4= signs of fracture/dislocation
Risk factors/ causes of WAD
- Trauma
- Intense sudden flexion/extension of neck
Common symptoms of WAD
- Neck pain with referred pain to shoulder and arms
- Headaches
- Stiffness
- Dizziness
- Pain on palpation of neck/shoulder
Management of WAD
- Reasurance and advice (usually recover in 2-3 months)
- Physio: stretching, strengthening, ROM, manual therapy
- Direct to GP
- Discourage use of cervical collars
- Maintatin normal activities if possible
Research: Michele Sterling
- Best advise is to return to normal activity gradually
- There is only modest evidence available supporting activity/exercise for acute WAD
- Strong evidence that immobilisation (collars, rest) is ineffective for the management of acute WAD
What is minor cervical instability?
The inability of the spine under physiological loads to maintain its normal pattern of displacement so that there is no neurological damage or irritation, no development of deformity, and no incapacitating pain
Causes/risk factors of minor cervical instabilit
- Trauma
- Ankylosing Spondylitis, Rheumatoid arthritis
- Congenital collagenous compromise (e.g. syndromes: Down’s, Ehlers-Danlos, Grisel, Morquio)
- WAD leading to atlantoaxial instability
Symptoms of Minor Cervical Instability
- Catching/locking/giving way
- Poor muscular control
- Neck weakness
- Altered ROM
Management of minor cervical instability
Self care
- Advise
- Reassurance (resolves within a few weeks)
- Direct to GP
- Advise against collars
If symptoms persist
- Physio: ROM, strengthening, emphasis on motor control exercises
- Pain management
Research: Hannah Tolsen et al
Conservative treatments is generally indicative in patients without severe pain, no neuro deficits and no vertical translocation
-Includes pain control, immobilization with bracing and activity modification
-Braces used for minimum 3 months until reassessment of condition with repeat imaging
Upper cervical instability
It indicated a major instability within the cervical spine which causes compromise, compression or impingement of neural and vascular structures
red flag
Symptoms include:
- Pain radiating into areas of the head
- Restricted ROM
- Pins and needles
- Brisk reflexes
- Coordination issues with gait
How would you treat a patient with neck pain and mobility deficits or restricted movements
Manual therapy: SNAG, central PA, unilateral
Pain deficit: grade 1 + 2
Restriction deficit with no pain restriction: grade 3 + 4
Exercises: ROM, hold in full range to reduced restriction
How would you treat a patient with neck pain with radicular pain or cervical radiculopathy
Neural dynamics
What are the red flags to look out for in cervical spine assessment?
- Spinal fractures
- Cord compression
- Cervical Arterial Dysfunction and vertebrobasillar insufficiency
- Horner’s syndrome
