Week 1 & 2 Flashcards
Yes or No: Biopsychosocial refers to the fact that 85% of people with neck pain have psychological disorders or adverse social features.
No
What are some social factors that increase the risk of neck pain?
female, emotional issues, work type/awkward/repetitive work postures, smoking, poor work satisfaction, poor physical work environment
Yes or No: The biopsychosocial components can vary over time within an individual patient.
Yes
Compare and contrast the cervical and lumbar spine.
Cervical:
focus on mobility
small vertebrae
discs are thin
disc degeneration happens earlier
Lumber:
focus on stability
large vertebrae
discs are thick
disc degeneration happens later
Yes or No: 80% of the neck’s stability is provided by the joints and ligaments.
No
How much of the cervical neck is stabilised by muscles vs ligaments?
80% muscular stability vs 20% ligamentous stability (only at EOR)
What are the three functional regions of the cervical spine?
cranio-cervical complex (C0-C2, does head on neck movement)
cervical region (C2-C7, does neck movement)
cervico-thoracic junction (C7-T4, does neck on thorax movement)
What is the origin, insertion and movements of the scalene muscles?
anterior= transverse process of C3-C6 to 1st rib
medius= transverse process of C2-C7 to 1st rib
posterior= transverse process of C5-C7 to 2nd rib
flexion and ipsilateral rotation (+ elevate 1st rib)
Name the 4 deep cervical muscles responsible for flexion.
longus capitus (transverse process C3-C6 to the occipital bone)
longus colli/cervicis (C3-C7 vertebral bodies/transverse processes)
rectus capitis anterior (C1 to the occipital bone)
rectus capitus lateralis (transverse process C1 to occipital bone)
Name the 2 deep cervical muscles responsible for extension.
semispinalis cervicis
multifidus
How do the uncinate processes affect lateral flexion in the cervical spine?
due to the increased height of the uncinate processes, the cervical segments must medially translate while laterally flexing (opposite to in the lumbar spine where they laterally translate during lateral flexion)
What are the primary restraints for cervical flexion?
alar ligament, posterior short and long ligaments, short occipital extensors and dura mater
What are the primary restraints to cervical extension?
transverse ligament of the atlas (+neck flexors)
Yes or No: The majority of cervical rotation range is at C1/2.
Yes
How much cervical rotation comes from the C1/2 segment?
~50%
Yes or No: Rotation is coupled with ipsilateral lateral flexion in all joints in the cervical spine.
No
Rotation is coupled with what movement at C0-2
contralateral lateral flexion (as opposed to ipsilateral in the rest of the cervical spine)
What structures are likely to be involved if the patient is experiencing limitations in extension & rotation?
the facet joints
In the thoracic spine, where do rib tubercles articulate?
at the transverse process of the corresponding number vertebrae (called the costotransverse joint)
In the thoracic spine, where do rib heads articulate?
with the corresponding number vertebrae as well as the vertebrae above (called the costovertebral joint)
Describe each anterior rib attachement site.
rib 1 to the manubrium
rib 2 to the manubrium & sternum
ribs 3-7 to the sternum
ribs 8-10 via the common fused costal cartilage
ribs 11-12 free floating
What are the functional divisions of the thoracic spine?
C7-T4 cervicothoracic
T4-T8 mid thoracic
T8-L1 thoracolumbar
Is there movement coupling at the thoracic spine?
yes- axial rotation with ipsilateral lateral flexion (however it is weak)
Yes or No: Reduced thoracic mobility at T1-4 can affect neck rotation range.
Yes
What is the clinical implication of hypomobility throught the thoracic spine?
neck movements rely on some extension at the C7-T4 thoracic spine therefore stiffness here can affect the neck movements
bilateral arm elevation requires thoracic extension so this can also be affected
Yes or No: Unilateral arm movement requires 20 degrees of T4-8 rotation.
No
How much T4-8 thoracic extension is needed to achieve arm elevation?
15 degrees
What movement occurs in the ribs during thoracic flexion, lateral flexion and exhalation?
anterior rib rotation + superior glide
What movement occurs in the ribs during thoracic extension, rotation & inhalation?
posterior rib rotation + inferior glide
What should your first question to your patient be?
why have you come for treatment today?
What information in the patient interview would raise your suspicion of possible underlying cancer?
night pain
past history of bowel or breast cancer
unexplained weight loss
Name some red flags that may come up in a patient interview regarding neck pain.
anterior neck pain suggesting heart issues
bilateral symptoms with multiple joints involved/inflammatory indicators
generally unwell, raised temperature suggesting infection
non-mechanical pain/night pain/unexplained weight loss suggesting cancer
acute onset severe, unusual pain suggesting arterial dissection
craniovertebral anomalies as seen in downsyndrome or congenital absence of ondontoid peg leading to instability at C2
If a patient reports long-term use of steroid medication, why would this raise concerns for treating their neck or thoracic spine?
osteoporosis which would contraindicate manual therapy
pathological fractures which would need further investigation
Compare typical features of nociceptive and neuropathic sources of pain.
articular= localised, pain increased with movement towards side of pain/compression, ipsilateral blocks to movement, referral patterns
muscular= spreading pain, prologned positions, movements away from side of pain/stretch, worse with repetitive movement/tiring of muscle
discogenic= localised or diffuse, cloward’s sign, pain associated with loading/towards end of day
neural= sharp/burning/p&n, dermatomal, irritable, latency, worse with nerve tension
Yes or No: Plain Xrays are best because they have less radiation and can see soft tissue and nerves.
No
Yes or No: If a person cannot rotate their neck 45 degrees post trauma, they need an Xray?
Yes
What effects does exposure to long-term ionising radiation have?
deterministic effects (risk of skin damage)
stochastic effects (risk of cancer)
How much radiation are we exposed to normally in a year?
2mSv
Name 2 rules that can be used to determine the need for a cervical spine plain Xray?
Nexus, Canadian C spine.
What are the Canadian C Spine rules?
Yes for xray=
high risk factors (>65 years, dangerous mechanism or paresthesias in extremities)
unable to safely examine ROM
unable to rotate neck 45 degrees
What are the benefits to using Xray over other imaging?
most available, cost-effective, quick, physio can refer (for spine & hips)
What are the benefits to using CT over other imaging?
good for multiple views/positions that are uncomfortable to xray due to #, good bone detail, some soft tissue detail (though still not as good as MRI), fine slice better than MRI
What are the benefits to using MRI over other imaging?
best soft tissue views (though expensive, long wait times and only specialist can refer with rebate)
What are T1 and T2 MRI techniques used for?
T1= anatomical detail i.e. bony
T2= nerve/spinal cord detail (water in tissues)
What are the contraindications for an MRI?
Pacemaker, metal in eye, metallic stents, some aneurysm clips, neural stimulators, cochlear implants.
Yes or No: MRI can give better views of the bony structures than CT scan.
No
Yes or No: Denis 3 column refers to 3 columns used to determine instability.
Yes
more than 1 column damaged= instability
Lateral Xray film is important first when considering instability.
Yes
Generally how thick should the anterior neck soft tissue be in a lateral view of an MRI?
at C2= ~6mm
at C6= ~2cm
What is the power ratio and what is it exploring?
a ratio that describes the stability or instability of the craniocervical junction
if the ratio is >1, this indicates anterior instability (i.e. the head has moved forward on the neck)
if the ration is <0.8, this indicated posterior instability (i.e. the head has moved backward on the neck)
What is the rule of twelves (Harris’ Measurements) and what is it exploring?
a set of measurements that describe the stability or instability of the craniocervical junction
there should be ~12mm between the top of the dens and the base of the skull, and ~12mm between the base of the skull to the imaginery line running up from the front of the vertebral body
more than this suggests ligament disruption/instability
What are the 3 types of odontoid fracture?
type 1= tip of the dens (odontoid), rare, stable
type 2= base of the dens, common, unstable
type 3= through dens & into lateral mass of C2, relatively stable if not displaced, best prognosis due to large surface area for healing
Compare neuropathy and mechanosensitivity.
neuropathy involves issues with nerve conduction due to mechanical compression or chemical irritation, whereas mechanosensitivity involves issues with how the nerve glides through surrounding tissues
