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MUP > W9 > Flashcards

W9 Flashcards

1
Q

what is the most serious adverse event associated with cervical manipulation therapy

A

cervical arterial dissection (CAD)- tear in the artery wall, most common in vertebral than carotid

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2
Q

symptoms of cervical arterial dissection

A

Acute, sudden onset of unfamiliar headache or neck pain. (typical in younger patients under 55)
Check for: balance, gait disturbances, Horner’s syndrome

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3
Q

What is Vertebrobasiliar insufficiency (VBI)

A

Result from insufficient blood supply to the hindbrain. Associated with long standing neck pain and stiffness

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4
Q

Positional tests for VBI

A

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

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5
Q

treatment of someone with VBI

A

never provoke dizziness or other VBI symptoms, avoid end range Cx movements or positions

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6
Q

5 Ds and 3 Ns

A

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)

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7
Q

Red flags for Cx treatment

A

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)

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8
Q

Cervical Zygapophyseal joint dysfunction Sx presentation

A

Pain: longstanding, local or referred, unilateral or bilateral
Aggs: rotation, extension, UL scap loading
often inflam pattern (stiff morn, eases)

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9
Q

Cervical Zygapophyseal joint dysfunction physical examination

A
  • active movements (pn reproduction)
  • PAVIM for Cx jnts (abnormal end feel, pn)
  • motor control impairment (deep muscles weak or inhibited, superficial muscles overactive)
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10
Q

Cervical Zygapophyseal joint dysfunction treatment

A
  • improve mobility (PAVIMS, PPIVMs, HEP)
  • address motor control (scap control, cranio-cervical, cervico thoracic)
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11
Q

Cervical Zygapophyseal joint dysfunction medical managment

A

Anti-inflams (make sure they’re not on any anti-coagulants)
Analgesics- short term relief
CT guided steroid injections
medial branch blocks
radiofrequency denervation

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12
Q

Wry neck Sx

A
  • sudden or unguarded movement
  • just after waking or movement wakes
  • neck may feel locked
  • severe, localised, unilateral Cx pn, intermittent
  • imaging is rarely ordered
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13
Q

Wry neck Ox

A
  • expected aggs: ipsilateral rotation, lateral flexion, and extension
  • multisegmental muscle guarding on palpation
  • segmental restriction on PAVIMs and PPIVMs
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14
Q

Wry neck treatment

A
  • 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
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15
Q

neck pain: disc as nocioceptive driver Sx

A
  • 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
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16
Q

neck pain: disc as nocioceptive driver Ox

A
  • movement limitation
  • not in regular pattern
  • flexion often worst
  • unilateral PAVIM often not consistent with degree of motion restriction
17
Q

neck pain: disc as nocioceptive driver treatment

A
  • Z joint mobes
  • physiological mobes into pn
  • traction
  • mobilise adjacent stiff areas/ levels
  • tape
  • avoid aggs
  • NSAIDs, oral steroids, soft collar (try not to tho as they can become dependant on it, a hot towel on neck is a better alternative)
18
Q

difference between Z joint/ disc Cx symptoms

A

Z joint
- regular pattern of motion loss or symptom reproduction
- PAVIMs: abnormal end feel, pain provocation

Disc
- midline or bilateral pn

  • they can both coexist though
19
Q

difference between radicular pain and radiculopathy

A

radicular pn: pain derived from a nerve that is irritated/ damaged
radiculopathy: disturbance of the function of the nerve, neurological loss

Can have radiculopathy without radicular pain

20
Q

Cx radicular pain/ radiculopathy Sx

A

pain: worst distally, shooting pn, often irritable
- no specific MOI, often UL loading,
- may wake with symptoms
- aggs: UL load, sustained positions, moevemnts that decrease foraminal diameter
- ease: support arm, rest, sleep sitting up, craddle arm above head

21
Q

does the Cx foraminae diameter increase or decrease with flexion/ extension

A

flexion: increase diameter
extension: decrease diameter

22
Q

Cx radicular pain/ radiculopathy Ox

A
  • posture
  • carful with ext, ispilateral rot, LF as closes the Cx foraminae diameter
  • test for cord involvement (LL DRTs, clonus, plantar reflexes, Hoffman’s)
    -Neurodynamic testing
23
Q

indications for anterior cervical decompression and fusion (ACDF)

A
  • non resolving/ debilitating radicular pain > 6-12 weeks
  • progressive functional motor loss
  • not resolving cord signs and symptoms
  • imaging consistent with presentation
23
Q

Cx radicular pain/ radiculopathy treatment

A
  • education
  • correct posture
  • mannual techniques to open IVF (contralateral rot, PPIVMs, manually traction)
  • inhibition of scalenes (massage, side glides)
  • unload affected segments (mobilise)
  • thoracic manipulations
  • tape
  • neural mobilsation

imaging not necessary: unless cord signs, no progress

24
Q

Cx radicular pain/ radiculopathy non-physio treatment

A
  • medication: anti-inflams, oxycodone, membrane stabilisers
  • epidural injections
  • surgery
25
Q

Cervicogenic headache

A
  • pn referred from a source in the neck
  • evidence of a lesion within cervical spine or soft tissues of the neck
  • headache resolved within 3 months after successful treatment of the lesion
  • unilateral pain
  • restricted ROM of neck
26
Q

Migrane without aura

A
  • recurrent
  • lasts 4-72 hours
  • unilateral (usually alternating)
  • pulsating quality
  • mod to severe
  • associated with nausea, vomiting and photophobia
27
Q

migrane with aura

A

-10-30% migrane sufferers
- reversible neurological defcit
- preceding or accompanying attack (visual disturbances)
- lasts 5-60mins
- depolarisation of cortical areas (spreading depression)

28
Q

tension type headache

A
  • bilateral occipito-frontal
  • pressing, tight (non-pulsing)
  • mild to mod pain
  • lasts 30mins to 7days
  • not aggravated by routine PA
  • May have one of photophobia (light sensitivity) or phonophobia (sound)
  • no nausea
29
Q

physiotherapy headache management

A
  • educate
  • address musculoskeletal impairment
  • interdisciplinary referral if not responding to treatment
30
Q

manual therapy dosage based on iritability, pain, stiffness

A

pain irritable: Grade I or II, shorter duration (30s), fewer resp (2-3)
pain non-irritable: Grade III, IV: longer duration (60s, 4 reps)
stiffness: Grade III, IV (60s, 4-6 reps)

MUP (12 decks)

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