W4: MC Flashcards by Caitlin O'Farrell

Explain what grade I neck pain is?

neck pain and associated disorders with no signs or symptoms of major structural pathology and no/minor interference with ADLs

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Explain what grade II neck pain is?

Neck pain with no signs or symptoms of major structural pathology but with major interference in ADLs

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Explain what grade III neck pain is?

Neck pain without major structural pathology but with the presence of neurologic signs such as decreased deep tendon reflexes, weakness or sensory deficits

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Profile A neck pain
- What grade?
- Features?
- Treatment options?

Grade I/II (normal course)
Features: typical recovery expected without complications
Treatment options: education on natural course of neck pain, simple exercises (or home exercises)

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Explain what grade IV neck pain is?

Neck pain with signs or symptoms of major structural pathology, including conditions like fracture, vertebral dislocation, spinal cord injury, infection, neoplasm, or systemic disease

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Profile B neck pain
- What grade
- Features
- Treatment options

Grade I/II (delayed course without dominant psychosocial influence)
Features: slower recovery, possibly due to physical factors
Treatment options: mobilisation, manipulation, exercise therapy, patient education

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Profile C neck pain
- What grade
- Features
- Treatment options

Neck pain grade I/II, delayed course with dominant psychosocial influence
Features: delayed recovery primarily influenced by psychosocial factors
Treatment options: cognitive-behavioural treatments, graded activity, exercise, multidisciplinary care if needed

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Profile D neck pain
- What grade
- Features?
- Treatment options?

Grade III
Features: Presence of neurologic signs
Treatment options: Treatment similar to profile B; a cervical collar may be considered for pain reduction (short-term only)

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According to the clinical practice guidelines for physical therapy assessment and treatment for those with non-specific neck pain what treatments are considered ineffective?

Dry needling, electrotherapy, low-level laser therapy, ultrasound & traction

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What is the most likely source of a patients neck pain?

Non-specific neck pain

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C1
- Also known as the….
- What features does it lack?
- Role?

Atlas
A vertebral body and spinous process
Supports the skull and allows the nodding motion of the head

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C3-C6
- Are these typical/atypical?
- Body type?
- Shape & size of vertebral foramina
- How is the spinous process shaped?
- What is the transverse foramina?

Typical cervical vertebrae
Small bodies
Large triangular vertebral foramina
Bifid (split spinous process)
Openings in the transverse process for the passage of vertebral arteries

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C2
- Also known as….
- What is its unique feature?
- What direction does the above feature protrude?
- Role of the above feature?

Axis
Distinctive odontoid process (dens)
Protrudes upwards
Provides a pivot for the atlas and skull, enabling head rotation

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What is the C7 known as? What is it characterised by?

Vertebra prominens
Characterised by a longer and more prominent spinous process, which can be felt at the base of the neck

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Role of the superficial and intermediate neck muscles?

Maintain equilibrium of external forces, move the neck

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Deep muscles - name and role?

Craniocervical flexors
Are a sleeve that surround the cervical column to provide support and stability

**Learn diagram from MC.

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What movement do the longus colli and longus capitis perform?

Neck flexion

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What movement do the rectus capitis perform

Small muscles that assist in head flexion (At the atlantooccipital joint) and stabilisation

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Suboccipital muscles - provide 2 examples and their role?

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EG rectus capitis major and minor and the obliquus capitis superior and inferior.

They control fine head movements

Ligament: Anterior longitudinal ligament?
- Where does it run & what does it prevent?

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Runs along the anterior surface of the vertebral bodies, preventing hyperextension.

Ligament: Posterior longitudinal ligament?
- Where does it run and what does it prevent?

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Runs along the posterior surface of the vertebral bodies inside the vertebral canal, preventing hyperflexion.

Ligament: Flavum?
- What does it connect and what is its role?

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Connects the laminae of adjacent vertebrae, providing stability and elasticity.

Interspinous and supraspinous ligaments?
- What does it connect and what is its role?

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Connect the spinous processes, contributing to the stability of the spine.

Global prevalence and incidence of neck pain?

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Global prevalence is reported at 3551 cases per 100,000 population
Global incidence is reported at 806.6 per 100,000 population.

One of the top 4 global burdens of disease worldwide

Prevalence is higher for neck pain in females or males?

* Prevalence is higher in females

Does the prevalence of neck pain increase with age? What is the peak age group?

* The prevalence of neck pain increase with age, peaking at the 70-74 age group

Chronicity of neck pain?

* Chronicity: 50-85%

What is the natural course of neck pain

There is a significant decrease in pain intensity within the first few weeks, dropping to around 40 (out of 100 - average starting intensity was 80) by week 4. This suggests an acute phase where the pain intensity reduces quickly.

Risk factors for neck pain

Trauma Higher age Female gender Genetic predisposition Poor psychological health High (work) stress levels Smoking

What are the two key tools used to determine if an x-ray is required?

Canadian-C spine rules Nexus

What are the nexus rules?

Cervical spine radiography is indicated for patients with neck trauma unless they meet ALL of the following criteria: - No posterior midline cervical spine tenderness - No evidence of intoxication - A normal level of alertness (score of 15 on the Glasgow Coma Scale) - No focal neurologic deficit - No painful distracting injuries

C-spine Rules

Any high risk factors (eg over 65, dangerous mechanism mechanism , paresthesias)? If yes patient should get a radiography. If no are there any low risk factors? Simple rear ended MVC< sitting position in ED, delayed onset of neck pain, absence of midline c-spine tenderness or ambulatory at any time. If no then they aren't low risk and require radiography. If yes can they rotate neck actively (45 deg to left and right). If no they aren't low risk = radiography. If yes no radiography.

What is the vertebral artery test for? What movement does it assess? Why is this important?

* The vertebral artery test is used to test the vertebral artery blood flow, searching for symptoms of vertebral artery insufficiency. Assesses extension and rotation to compress the vertebral artery. Vertebrobasilar insufficiency can lead to death.

Is the vertebral artery test got a higher sensitivity or specificity? What does this mean?

High specificity (better at ruling in ie true positive)

What is the test for cervical instability?

7 different tests - sharp purser test used most often (high specificity) The Sharp Purser Test is a symptom reduction test to assess the integrity of the transverse ligament which fixates the dens of C2 to the atlas.

In terms of prognostic/diagnostic factors what are the 5 main areas?

1. Trauma related neck pain 2. Work related neck pain 3. Neck pain 4. Cervicogenic headache 5. Cervical radiculopathy

Effective treatments based off the guidelines for neck pain?

- Education - Exercise - Manipulations/mobilisations

What is the purpose of patient education for those with neck pain? What should patient education include?

A process of enabling individuals to make informed decisions about their personal health-related behaviour Advice: - Act as usual/advice to stay active - Information (on prognosis)/reassurance - Self-management strategies

Structured patient education alone is .....

Equally effective as other conservative interventions in improving the recovery

What is the view of exercise for acute neck pain vs chronic neck pain?

Acute neck pain = no evidence (it tends to have a strong natural history on its own, without any intervention) Chronic neck pain: moderate certainty evidence for strength endurance/stabilising exercises

Craniocervical flexion vs cervical flexion * Minimal activation of the ..... ..... during craniocervical flexion (nodding action)

Superficial neck flexors

In terms of exercise for neck pain how is it different to back pain?

For back pain – pilates/Mckenzie works better but in general all exercise works. For neck pain its more specific and specialised eg motor control/stabilisation exercises are better than general exercise

* Studies investigating neck pain disorders (including whiplash and cervicogenic headache) have shown that impairments in motor control ..... * Specific training is required to restore ...... control of the ..... neck flexors * Specific neuromuscular control exercises reduced .... and ..... (Falla et al., 2007, O’Leary et al., 2007, Jull et al., 2002)

Does not recover automatically, even with resolution of neck pain Neuromuscular control of the deep neck flexors Pain & disability

Manual therapy findings - level of evidence - Cervical manipulation vs mobilisation - Cervical manipulation vs inactive treatment - Thoracic manipulation vs inactive treatment Conclusion based off the above?

- Moderate certainty of no evidence - Low certainty evidence of small effect - Moderate certainty of large effect * Mobilisation/manipulation - Cervical spine --> side effects! Avoid! - Thoracic spine --> safest option (+ education and exercise)

Adding SMT (mobilisation + manual therapy) to exercise is.....

Not clearly better than exercise alone (Study: manual therapy, exercise therapy or combined treatment in the management of adult neck pain)

Treatments with unknown or conflicting evidence for neck pain?

* Cervical collar? * Massage * Neural tissue management * Pillow * Kinesiotape * Thermal agents * Workplace interventions CMN TW PK (C'MN trigger warning pale kitten)

Treatments that are not effective for neck pain?

* Dry needling * Low-level laser therapy * Electrotherapy * Ultrasound * Traction

W4: MC Flashcards

(47 cards)