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MSK 2 > UCS Classification/Diagnoses > Flashcards

UCS Classification/Diagnoses Flashcards

1
Q

Non-Ischemic Vertebral Artery S/Sx

A
  • Ipsilateral posterior neck pain/occipital HA
  • C5/6 cervical root impairment (rare)
  • Non-ischemic Sx can precede ischemic events by a few days to several weeks
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2
Q

Internal carotid Artery

A
  • 80% of blood flow to brain
  • bifurcates from common carotid at C3
  • influenced by cervical motion (mostly extension)
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3
Q

A-O Dislocation

A
  • 100% Fatal
  • Shear force of occiput on atlas
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4
Q

Fracture of posterior arch of atlas

A
  • Result of vertical compression
  • massive suboccipital HA
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5
Q

A-A Dislocation

A

Rupture of transverse ligament

(RA, Downs Syndrome)

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6
Q

Ear

A
  • O-C1 Facet
  • C2-3 Disc
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7
Q

Eye and jaw

A
  • C1-2 Facet
  • C2-3 Facet
  • C2-3 Disc
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8
Q

Cap-Like Headache

A

-C5-6

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9
Q

Vague, encompassing whole head

A

T4 & Lower Lumbar

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10
Q

Examples of Causes of

Referred, Radicular Sx

A

Occipital Neuralgia

Cord Compression

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11
Q

Profile:

Cord Compression

A

Onset after 50 years old

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12
Q

Cord Compression

A
  • Tumor pressing and irritating a neural structure of spinal cord or meninges
  • bone, connective tissue, accumulation of blood, abscess
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13
Q

Body Chart:

Cord Compression

A

Radicular pain with coughing, paralysis

  • non-traumatic strong spasm
  • non-traumatic strong pain in elderly patient
  • may also complain of fever and weight loss
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14
Q

History:

Cord compression

A
  • Persistant or progressive arm pain lasting >6-9months
  • Pain worsening after 1 month
  • previous HA history but this episode new or different
  • OE signs worse than symptoms
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15
Q

ROM:

Cord Compression

A
  • non-traumatic capsular pattern
  • Empty end feel
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16
Q

Neurological Exam:

Cord Compression

A
  • Radial deviator weakness
  • thumb flexor weakness
  • intrinsic hand muscle weakness/atrophy
  • >1 level involved
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17
Q

Vasculogenic Referred Pain

A
  • From venous congestion or arterial deprivation to MS areas
  • Ex. Cervical Artery Dysfunction
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18
Q

Cervical Artery Dysfunction Cause

A
  • Trauma
  • Atherosclerosis

(associated with HTN, hypercholesterolemia, hyperlipidemia, hyperhomocystemia, DM, genetic clotting factors)

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19
Q

5 D’s

3 N’s

1 A

A

Dizziness, Diplopia, Dysphagia, Dysarthria, Drop Attack

Nausea, Numbness, Nystagmus

Ataxia

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20
Q

Dizziness

A

CN VIII

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21
Q

Diplopia

A

Descending Spinal Tract

Descending Sympathetic Tract

CN V (??)

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22
Q

Dysphagia

A

CN IX

CN X

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23
Q

Dysarthria

A

CN XII

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24
Q

Drop Attack

A

Reticular Formation

Rostral Pons

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25
Q

Nausea

A

CN VIII

Vestibular Nucleus

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26
Q

Numbness

A

CN V

Ascending Spinothalamic (body)

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27
Q

Nystagmus

A

Lower Vestibular nuclei + others

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28
Q

Ataxia

A

Inferior Cerebellar Peduncle

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29
Q

Internal Carotid Artery

Non-Ischemic (local) S/Sx

A
  • head/neck pain with temporal HA
  • Horner’s Syndrome,
  • pulsatile tinnitus
  • CN palsies (common: IX thru XII)
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30
Q

Internal Carotid Artery

Less Common Local S/Sx

A
  • ipsilateral carotid bruit
  • scalp tenderness
  • neck swelling
  • CN VI palsy
  • Orbital pain
  • anhidrosis (facial dryness)
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31
Q

Internal Carotid Artery

Ischemic (cerebral/retinal) S/Sx

A

SEVERE

  • TIA
  • Ischemic stroke (usually MCA territory)
  • Retinal Infarction
  • Amaurosis Fugax (loss of vision in one eye due to temporary lack of blood flow to retina; sign of impending stroke)
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32
Q

4 Headaches

A
  • Migraine (vascular)
  • Cluster (Vascular)
  • Tension-Type (muscular)
  • Cervicogenic
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33
Q

Body Chart:

Migraine

A

Unilateral

May change sides between attacks

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34
Q

Pain:

Migraine

A

Throbbing

Nausea

phono/photophobia

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35
Q

Intensity:

Migraine

A

Severe

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36
Q

Body Chart:

Cluster HA

A

Unilateral

may change sides between attacks

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37
Q

Intensity:

Cluster HA

A

Excruciating

begins suddenly and builds up in short time

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38
Q

Body Chart:

Tension HA

A

Bilateral

band-like pain forehead to occiput

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39
Q

Pain:

Tension HA

A
  • Tightness, pressure, dull ache
  • no nausea
  • mild photo/phonophobia
40
Q

Intensity:

Tension HA

A

mild to moderate

41
Q

Body Chart:

Cervicogenic HA

A
  • unilateral, unilateral with spread, or bilateral
  • Unilat>bilat
  • No side shift
  • frontal, retro-orbital, temporal, occipital
  • associated with suboccipital neck pain
42
Q

Pain:

Cervicogenic HA

A
  • Referred from source in neck
  • pain starts in neck and spreads to face/head
  • described as aching, deep boring pain
  • less often throbbing/pulsing
  • crepitus is common complaint
43
Q

Intensity:
Cervicogenic HA

A
  • Mild to moderate
  • can be severe
44
Q

Agg Factors:

Migraine

A
  • Not affected by neck movements
  • worse with exercise
  • 24 hour pattern: rarely awakens pt, occurs upon arising
45
Q

Agg factors:

Cluster

A
  • Not affected by neck movements
  • worse with exercise
46
Q

Agg Factors:

Tension HA

A
  • Not affected by neck movements
  • worse with exercise
  • 24 hour pattern: cyclic groupings 30-60 min, 3-4x/day
47
Q

Agg factors:

Cervicogenic HA

A

Neck movement or sustained postures and stress

  • 24 hour: may wake with Sx due to sleeping posture or busy previous day.
  • often present when wakes +morning CS stiffness
48
Q

Ease Factors:

Migraine

A
  • Reclining dark room
  • cold compress to temples
  • immediate injection of analgesic at first sign of attack
49
Q

Ease Factors:

Cervicogenic HA

A
  • Change of posture
  • Lie down
  • ice, heat
  • massage
  • simple analgesics in early stages
50
Q

History:

Migraine

A
  • HTN, Anxiety, Menstruation, Food types
  • onset of HA in adolescence/young adult life
  • HA lasts several hours to full day
  • Diagnosis only made if pt has history of 5-6 attacks that last >/=4 hours
  • 75% of migraine pts have 1st degree relative with migraines
  • extensive physical and neurological examinations clear
51
Q

Duration of Attack:

Migraine

A

4-72 hours

52
Q

Duration of Attack:

Cluster

A

Varies

-periords free of HA then HA in clusters

53
Q

Duration of Attack:

Tension HA

A

30min-7days

54
Q

Duration of Attack:

Cervicogenic

A

Gradual onset with movement

55
Q

Headaches with Aura

A

Migraine

(visual, sensory, motor or speech Sx)

56
Q

Physical Exam:

Migraine

Cluster HA

Tension HA

A

may have an element of cranial vertebral dysfunction

57
Q

Location Sx:

Cervicogenic HA

0-1 Facet

A
  • Occipital (can be bilat/one side worse)
  • supraorbital
  • ear pain
58
Q

Location of Sx:

Cervicogenic HA

C1-C2 Facet

A
  • Sub-occipital (starts in back, progresses to front–forehead, into/behind eye)
  • temporal pain/band of pain around head
59
Q

Location Sx:

Cervicogenic HA

C2-3 Facet

A
  • Pain like C1/2
  • Anterior neck pain
60
Q

Location Sx:

Cervicogenic HA

C2-3 Disc

A
  • Pain like C1/2
  • Anterior Neck pain (into throat)
  • into ears
  • may have cloward sign
61
Q

Location Sx:

Instability

A

catching, unilateral pain, head feels heavy, feel need to hold up head

62
Q

Location Sx:

Hypermobility

A

+/- pain (central/unilateral)

63
Q

Agg Factors

Cervicogenic HA

0-1 Facet

C1-2 Facet

C1-2 Disc

A
  • Neck movements or sustained head positions
  • May not know pattern
  • stress/tension
  • 24 hour: wake with Sx due to sleeping posture or busy previous day
  • often present upon waking + morning c/s stiffness
64
Q

Agg Factors:

Cervicogenic HA

C2-3 Disc

A

Flexion/extension

65
Q

Agg Factors:

Instability/Hypermobiity

A

Depends on severity of injury/Sx

66
Q

Ease Factors:

Cervicogenic HA

0-1 Facet

C1-2 Facet

C2-3 Facet

C2-3 Disc

A
  • Change posture
  • Lie down
  • ice/heat
  • massage
  • simple analgesics
67
Q

History:

0-1 Facet

C1-2 Facet

C2-3 Facet

C2-3 Disc

A
  • Sudden Onset: consider acute subarachnoid hemorrhage, spontaneous dissections, vertebral/carotid Aa
  • Gradual Onset: microtrauma (posture/work/previous injury), 50% will relate onset to head/neck trauma
  • History can be weeks-years
  • Begins in neck and spreads to head
  • HA’s may be semi-continuous or follow pattern
  • Don’t respond to migraine drugs
68
Q

History:

Instability/Hypermobility

A

Ask about Hx of RA

69
Q

Posture:

Cervicogenic HA

A

Forward head

70
Q

ROM:

Cervicogenic HA

0-1 Facet

C1-2 Facet

A

Protraction

retraction

71
Q

ROM:

Cervicogenic HA

C2-3 Facet

A

Cervical rotation vs cervical SB

72
Q

ROM:

Cervicogenic HA

C2-3 Disc

A

Cervical flexion/SB

73
Q

ROM:

Instability/Hypermobility

A
  • depends on stage of disorder
  • may have extreme limitations or excessive movement
  • non-traumatic capsular pattern with RA, ankylosing spondylitis and neoplasm
74
Q

Provocation Tests

0-1 Facet

A

Protraction/retraction + SB

75
Q

Provocation tests:

C1-2 Facet

A

Protraction/Retraction + Rotation

76
Q

Provocation tests:

C2-3 Facet vs UVJ

A

Facet: Rotation + SB

UVJ: SB + Rotation

77
Q

Special/Provocation tests:

Instability

A

+ Alar and/or transverse ligament

78
Q

Palpation:

Cervicogenic HA

0-1 Facet

C1-2 Facet

C2-3 Facet

C2-3 Disc

A

0-1 Facet: C1 unilat PA in neutral

C1-2 Facet: C1 & C2 Unilat PA in rotaion

C2-3 Facet: C2 unilat PA in neutral

C2-3 Disc: C3 Central PA stiff/pn (careful palp of C2 PA)

79
Q

Palpation:

Instability/Hypermobility

A
  • Pain/spasm with central PA
  • stiffness to adjacent segments
80
Q

Muscle Length/Strength

UCS Disorders

A

Length:

  • Suboccipital
  • Upper trap
  • levator scapulae
  • scalenes

Strength:

-deep cervical flexors

81
Q

Neurological Testing

UCS Disorders

A

May have +ULNT

Cord Compression: paresis, paresthesia, hyperreflexia, babinski, clonus

82
Q

Location of Sx:

Whiplash

A
  • Pain (suboccipital, neck, shoulder, scapula, back, unilat/bilat, frontal HA, retro-orbital pn, face, throat
  • Patches of numbness/paresthesia
  • laryngeal disturbances

Patchy/dermatomal

83
Q

Factors influencing recovery of Whiplash Associated Disorders

A
  • Direction of force (extension worst)
  • Velocity of Impact (8mph=concussion; 30mph=intra-cranial bleeding)
  • Curvature of CS (straight/kyphotic=worse injury)
  • Position of head/neck
  • Symptoms immediate=worse
  • Impact expected/not
84
Q

Structures Impacted in Whiplash

A

Facets, disc, Mm, Lig, C vertebrae, brain, meninges, Aa, nervous system

85
Q

Special Questions:

Whiplash

A
  • hearing/vision disturbances
  • dizziness
  • feelings of instability
  • depression/fatigue
  • irritability
  • Insomnia
  • light-headedness
86
Q

Diagnostic Tests:

Whiplash

A
  • CT, myelography, EMG (only if neuro signs present)
  • X-ray to r/o fracture (transoral x-ray)
87
Q

OE Findings

Acute Whiplash

A
  • Pain dominant complaint
  • cautions/apprehensive movements of neck, shoulders, arms
  • c/o dizziness with active movements
  • palpation deferred
  • difficult to perform neuro or neurodynamic tests
  • VA usually deferred
88
Q

OE Findings

Sub-Acute Whiplash

A
  • Active movement to end range (limited/stiff/spasm)
  • Complete neuro
  • increased c/o thoracic/lumbar pain (inflam of NS)
  • Hyper/hypomobility with PAIVMs or cervical stability testing
89
Q

OE Findings:

Chronic Whiplash

A
  • Sx may be intermittent
  • Limited active movements
  • weak Mm
  • Palpation findings
  • Neurodynamic tests performed
90
Q

Treatment of Whiplash

A

Phase 1: pain, immobility, protection, mobility

Phase 1-3: Exercise

91
Q

Fractures

A
  • A-O Dislocation: Fatal
  • A-A Dislocation
  • Fx of posterior arch of atlas
  • Jefferson Fx
  • Dens Fx
  • Hangman’s Fx

Rotary A-A Subluxation

92
Q

Jefferson Fx

A
  • Fx of ant and post arches of C1
  • break in 4 places
  • usually blow to back of head
93
Q

Dens Fx

A
  • Common in MVA
  • Picked up with open mouth x-ray
94
Q

Hangman’s Fx

A
  • Fx of C2 pedicles with dislocation of the body of C2 on C3
  • results in dens into brainstem
  • not always fatal
95
Q

Rotary A-A Subluation

A

Face mask injury

96
Q

Different stabilizing braces

A
  • Aspen
  • Philadelphia
  • Soft Collars (reversed)
  • Minerva
97
Q
A

MSK 2 (16 decks)

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