Week 2- Neck Pain Treatment-based Classification Flashcards
Diagnosis
Process of determining the CAUSE of a patient’s illness or discomfort
Classification
Process of classifying clinical data into named categories for the purpose of making clinical decisions
Clinical decision making process for evaluating neck pain
- Component 1: medical screening
- Component 2: classify patient
- Component 3: determination of condition stage
- Component 4: intervention strategies for strategies for patients with neck pain
Component 1: medical screening
Red, yellow, green flags
Component 2: classify patient
- Neck pain w/ mobility deficits
- Neck pain w/ movement coordination impairments (WAD)
- Neck pain w/ headache (cervicogenic)
- Neck pain w/ radiating pain (radicular)
Component 3: determination of condition stage
- Acute
- Subacute
- Chronic
Component 4: intervention strategies for strategies for patients with neck pain
Ranging from manipulation to stretching/strengthening, to mobilization or traction
Common symptoms of neck pain w/ mobility deficits
- Central and/or unilateral neck pain
- Limitation in neck motion that consistently reproduces symptoms
- Associated (referred) shoulder girdle or UE pain may be present
Expected exam findings for Neck pain w/ mobility deficits
- Limited cervical ROM
- Pain reproduced at end AROM and PROM
- Restricted cervical and thoracic segmental mobility
- Intersegmental mobility restriction
- Neck and referred pain reproduced by provoking involved segments or musculature
- Deficits in strength/motor control in patients w/ subacute or chronic neck pain
Common symptoms of neck pain w/ movement coordination impairments (WAD)
- MOA linked to trauma or whiplash
- Referred shoulder girdle or UE pain
- Varied nonspecific concussive S/S
- Dizziness/nausea
- Headache, concentration, or memory difficulties
- Confusion
- Hypersensitivity to stimuli
- Heightened affective distress
Expected exam findings for neck pain w/ movement coordination impairments (WAD)
- cranial cervical flexion test
- neck flexor muscle endurance test
- pressure algometry
- Strength/endurance deficits of neck muscles
- Pain in mid-range –> worsens at end-range
- Point tenderness may include myofascial trigger points
- Altered muscle activation, proprioception deficit, postural balance/control
Common symptoms of neck pain w/ headache (cervicogenic)
- Noncontinuous, unilateral neck pain w/ referred headache
- Headache precipitated/aggravated by neck movements or sustained positions/postures
Expected exam findings for neck pain w/ headache (cervicogenic)
- cervical flexion-rotation test
- Headache reproduced w/ provocation of involved upper cervical segments
- Limited cervical ROM
- Restricted upper cervical segmental mobility
- Strength, endurance, and coordination deficits of the neck muscles
Common symptoms of neck pain w/ radiating pain (radicular)
- Neck pain w/ radiating pain in the involved extremity
- UE dermatomal parethesia/numbness
- UE myotomal muscle weakness
Expected exam findings for neck pain w/ radiating pain (radicular)
- Pain reproduced or relieved w/ radiculopathy testing
- test cluster (UE nerve mobility, Spurling’s test, cervical distraction, cervical ROM)
- UE sensory, strength, DTR deficits in the involved nerve roots
Acute phase characteristics
- Usually highly irritable
- Pain experienced at rest OR initial to end-range movement (BEFORE tissue resistance)
Subacute phase characteristics
- Moderate irritability
- Pain w/ mid-range motion –> worsening to end-range (w/ tissue resistance)
Chronic phase characteristics
- Low irritability
- Pain worse w/ sustained end-range spinal movement (overpressure into tissue resistance)
Intervention strategies for neck pain w/ mobility deficits
- Thoracic manipulation
- Cervical manip/mob
- ROM/stretching/strengthening
Intervention strategies for neck pain w/ movement coordination impairments (WAD)
- Education/advice
- Minimize collar use
- AROM/strenghening
- Proprioceptive exercise
- Cervical mob
- Ice/heat/TENS
Intervention strategies for neck pain w/ headache (cervicogenic)
- C1-2 self-SNAG
- CT mob/manipulation
- ROM/stretching/strengthening
Intervention strategies for neck pain w/ radiating pain (radicular)
- Intermittent traction
- Centralizing exercises
- Strength exercises
- CT mob/manip
