WAD & Headache - Exam 2 Flashcards
Alar ligamentous tears:
– runs from?
– weaker than?
– unique S&S?
– dens up and lateral to foramen magnum
– transverse ligament
– splinting, particularly with SB due to immediate tension on ligament. Possible cord S&S due to loss of dens stability
Transverse ligament tears:
– stronger than?
– keeps dens from moving ___ & contacting ___
– unique S&S?
– dens
– keeps dens from moving posterior and contacting cord
– splinting and likely cord S&S with forward nodding
what is a rim lesion?
horizontal tear of anterior annulus close to end plate - think of ligament rupture
rim lesion is often misdiagnosed as?
rare anterior disc herniation
what is the cause of rim lesion?
excessive hyperextension
unique S&S of rim lesion
splinting, particularly with extension due to tension on torn anterior annulus
pain with compression (end plate) and distraction (annulus)
what are symptoms of WAD?
- trauma with acute neck and interscapular referred P!
- potential trigeminocervical nucleus (TCN) symptoms
what would you notice in a scan for WAD?
– observation:
– ROM:
– resisted/MMT:
– neuro:
– stress tests:
– likely splinting
– limited with empty and painful end feels in several if not all directions
– weak and painful in several directions
– + findings, including cord or cranial n involvement
– + for involved tissue
what would a biomechanical exam show with immobilization/disuse?
joint hypomobility with accessory motion
fibrotic scarring
- excessive scarring –> hypomobile
what would a biomechanical exam show if no prolonged immobilization or fibrotic scarring?
hypermobility due to laxity
what is trigeminocervical nucleus (TCN)?
-___________ may develop
-location?
-the interaction of?
nociplastic P! may develop
located at C2, 3
interaction of sensory nerve fibers of trigeminal nerve and upper cervical spinal nerves
in TCN, what areas experience symptoms from inflammation and/or sensitization?
head, face and neck
describe the symptoms at each of the 8 areas TCN causes symptoms
1 - mandibular n.
2. ophthalmic n.
3. maxillary n.
4. CV region (C1-3 spinal n.)
5. head (C1-3 spinal n)
6. face (C1-3 spinal n)
7. jaw (C1-3 spinal n)
1 - tongue - altered taste/tingling
- ear - P!/tinnitus/hypersensitivity to sound
2. eye - P!/conjunctivitis without red eye/visual deficits
3. tooth ache/P!
4. upper cervical P!
5. headache aka cervicogenic HA
dizziness aka cervicogenic dizziness
paresthesia’s
6. p!/paresthesia’s
7. TMJ P!
TCN also receives sensory input from what nerve? where is its nucleus?
vagus N
C3, 4
What does the vagus nerve promote with TCN? (3)
What symptoms of parasympathetic system dysfunction? (6)
calmness, relaxation, digestion
irregular HR, lack of sweating, dyspnea, nausea, indigestion, GI S&S
——coordination can be influenced too
general Rx for WAD:
1 - POLICED (soft collar)
2 - improve joint mechanics and stabilize
- cervical & thoracic JM/manipulation
- deep neck flexor and scapular stabilizer exercises
- if nociplastic P!: body awareness and stabilization exercises
– 90 minute sessions, 2x/wk, 10-16 weeks
if a younger individual with a low disability at baseline presents with WAD, what is their prognosis?
~50% P! free at 6 months and 8/10 fully recovered
true or false. following MVA, 50% report symptoms of WAD up to 2 years
true
HA with other suspicious S&S (dizziness) require what type of referral?
all other HA - perform what?
urgent or even emergency
perform MSK scan and biomechanical exam
primary HA are due to what? what are the 3 types of primary HA?
due to HA condition itself
tension, migraine, cluster
what are secondary HA due to? what is the type?
another source
cervicogenic
symptoms of tension headaches?
BAND
bilateral band-like tightness
anxiety/stress etiology
no migraine S&S - milder
dull pressure
tension HA:
- prevalence:
- cause:
- ~40% of HAs
- anxiety/stress can have associated muscle tension
what would a PT do for a tension HA?
address anxiety/stress
moderate quality evidence for MET plus biofeedback
oscillations or manipulations (tension doesn’t like prolonged tension)
what are symptoms of a migraine?
POUNDS
pulsating
out of commission (mod-severe P! up to 3 days)
unilateral
N&V
dromes - constitutional S&S
sensational auras with visual and/or auditory sensitivity
migraine:
- prevalence
- cause:
- 10-15% of headaches
- temporal artery vasodilation
trigeminal n. nociplastic P! with CV dysfunction
what would a PT do for a migraine?
address CV dysfunction
vasoconstriction of temporal arteries - caffeine
increase water intake - 1.5 L/day
2-3 mg melatonin prior to bedtime
nociplastic P! MET
what are symptoms for a cluster HA?
CRUSHING
comes and goes
retro-orbital and temporal regions
unilateral
sudden and severe P!
horners syndrome
intense
grumpy
how common are cluster headaches?
not common
< 1% of HA
cervicogenic headaches:
- prevalence:
- pathophysiology:
- 15-20%
- C2 and/or C3 joint dysfunction due to trigeminal cervical influence
what are symptoms of cervicogenic headaches?
unilateral
starting in neck/occipital region, progressing to fronto-ocular region
provoked by neck motion (movement of spine)
mild to mod pain
non-throbbing/pulsating
what are signs of a cervicogenic headache?
limited and painful A/PROM
possible + combined motion
possible + neuro hypersensitivity
C2 and C3 joint dysfunction
- hypo and/or hypermobility: + linear stress test
+ cervical flexion rotation test
+ TTP (tenderness to palpation) in O-C3 region
what should a PT do to treat cervicogenic headaches?
address cervical dysfunction – address what we find
dry needling - not recommended as stand alone Rx, use with MT and exercise
