W9 Flashcards
what is the most serious adverse event associated with cervical manipulation therapy
cervical arterial dissection (CAD)- tear in the artery wall, most common in vertebral than carotid
symptoms of cervical arterial dissection
Acute, sudden onset of unfamiliar headache or neck pain. (typical in younger patients under 55)
Check for: balance, gait disturbances, Horner’s syndrome
What is Vertebrobasiliar insufficiency (VBI)
Result from insufficient blood supply to the hindbrain. Associated with long standing neck pain and stiffness
Positional tests for VBI
sustained rotation of Cx in sitting, wait 10secs in neutral before rotating to the other side
positive test: dizziness, nystagmus (that doesn’t settle after few secs), loss of conscious or feeling faint, any of 5 Ds
treatment of someone with VBI
never provoke dizziness or other VBI symptoms, avoid end range Cx movements or positions
5 Ds and 3 Ns
the 5 Ds are typical symptoms of VBI
dizziness
Diplopia- double vision
Dysarthria/ Dysphasia- speech difficulties
Dysphagia- difficulty swallowing
Drop attacks- sudden fainting
Nystagmus
Nausea/ vomiting
Numbness or paraesthesia (altered nose and mouth sensations)
Red flags for Cx treatment
Regular red flags
infection
Night pain
Ischemic heart attack (left sided pain)
Not typical neural signs
Neoplasm (cancer, unexplained weight loss, failure to improve, night pain)
fractures (trauma, elderly)
Cervical Zygapophyseal joint dysfunction Sx presentation
Pain: longstanding, local or referred, unilateral or bilateral
Aggs: rotation, extension, UL scap loading
often inflam pattern (stiff morn, eases)
Cervical Zygapophyseal joint dysfunction physical examination
- active movements (pn reproduction)
- PAVIM for Cx jnts (abnormal end feel, pn)
- motor control impairment (deep muscles weak or inhibited, superficial muscles overactive)
Cervical Zygapophyseal joint dysfunction treatment
- improve mobility (PAVIMS, PPIVMs, HEP)
- address motor control (scap control, cranio-cervical, cervico thoracic)
Cervical Zygapophyseal joint dysfunction medical managment
Anti-inflams (make sure they’re not on any anti-coagulants)
Analgesics- short term relief
CT guided steroid injections
medial branch blocks
radiofrequency denervation
Wry neck Sx
- sudden or unguarded movement
- just after waking or movement wakes
- neck may feel locked
- severe, localised, unilateral Cx pn, intermittent
- imaging is rarely ordered
Wry neck Ox
- expected aggs: ipsilateral rotation, lateral flexion, and extension
- multisegmental muscle guarding on palpation
- segmental restriction on PAVIMs and PPIVMs
Wry neck treatment
- manual therapy (decrease muscle spasm, contralateral rotation, manual traction, localised manipulations, unilateral p.a’s in prone
- heat and movement into pn
- exercise to maintain ROM
- usually better in 3-4 days if not reassess diagnosis
neck pain: disc as nocioceptive driver Sx
- pn can be bilateral, unilateral or central
- may be accompanied by interscap or thoracic pn
- onset after sustained positions (sleep) or strenuous UL activity
- significant inflammatory pattern if acute