Week 3 & 4 Flashcards
What is the importance of trapezius and serratus anterior in neck pain?
they keep the scapular aligned and moving efficiently to reduce extra load being transferred to the cervical spinal segments
List the impairments in muscle function that often arise with neck pain.
1) changes in muscle behaviour/motor control strategies (timing/synergy & directional specificity)
2) loss of feed-forward response
3) morphological changes (type 1 to type 2, first seen in flexors, reduced CSA, fatty infiltration in trauma)
4) loss of muscle support in posture and movement (increased extensor demand with forward head posture)
5) loss of strength & endurance
Describe the relationship between the deep cervical flexors and SCM.
activation of the DCF generally occurs in opposition to SCM i.e. if the DCF are working the SCM shouldn’t need to but in painful patients the SCM often works overtime while the DCF do not
Do altered muscle control patterns resolve when painful episodes resolve?
No- this has implications for recurrence in the future due to poor movement patterns, morphological changes and strength/endurance of deep & superficial muscles
What are the formal tests used for cervical muscles?
3 phases of the CCFT (craniocervical flexion test)
1) passive ROM of upper cervical flexors + mechanosensitivity
2) analyse the CCFT action (patients ability to accurately moved from 20mmHg to each stage and back again)
3) staged performance test of 22, 24, 26, 28, 30mmHg (5 second holds at each until unable to continue)
What should the normal population be able to achieve in the CCFT?
10 repetitions of 10 second holds
3 types of neural injury mechanisms.
musculoskeletal injury & peri-neural inflammation (chemical irritation)
nerve entrapment and compression
traumatic nerve injury
How do you recognise neuropathic pain?
history of injury (stretch injury), high levels of pain, protective postures, some degree of functional impairment, quality of pain i.e. burning, cold, P&Ns, itching, numbness, weakness
can use questionnaires i.e. LANSS, sLANSS, neuropathic pain questionannaire (NPQ), pain DETECT
What is cervical myelopathy?
commonly a degenerative condition in older patients and presents with canal stenosis due to disc degeneration, thickened anterior longitudinal ligament, tumour, or hypermobility
this compression can lead to spinal cord ischemia and degeneration
What are the clinical signs of cervical myelopathy?
gait imbalance
loss of hand dexterity
numbness/paraesthesia in UL or LL
bladder/bowel dysfunction
atrophy of hand muscles
Lhermitte’s sign (electric shock on neck flexion)
hyperreflexia of plantar reflexes
What are some causes of cervical radiculopathy?
cervical spondylosis
intervertebral disc herniation
tumour of the spine, spinal infection, synovial cyst (uncommon but important red flags)
Somatic referred pain vs radicular referred pain?
somatic referred pain is generally well-loclised and results from the activation of peripheral nociceptors without injury to the peripheral nerves
it often has a more vague distribution than radicular pain (which often follows dermatomes)
a neurological and neurodynamic test will be normal with somatic referred pain
Describe the upper limb neurodynamic test.
neurodynamic test for the median nerve
shoulder girdle fixation
shoulder abduction to 100 degrees
wrist extension
forearm supination
shoulder external rotation
elbow extension
+/- laterally flex the neck towards to ease or away to provoke
What is the general prognosis of cervical radiculopathies?
favourable with the majority of patients improving substantially within 3 months
surgery if pain is poorly controlled or sequested fragment on imagine
