Week 4: Triage, Neck Pain and VBI

Question 1

What therapies do not work for neck pain

Answer 1

Dry needling, low level laser, electrotherapy, ultrasound, traction, corticosteroids and cervical collar
Want to avoid surgery

Question 2

Grade I Neck Pain

Answer 2

Neck pain and less influence on physical function and activities of daily living and no major structural pathology

Question 3

Grade II Neck Pain

Answer 3

Neck pain and more influence on physical function but no structural pathology

Question 4

Grade III Neck Pain

Answer 4

Neck pain without structural pathology but with neurological signs - Radiculopathy

Question 5

Grade IV Neck Pain

Answer 5

Major structural pathology (red flags)

Question 6

Profile A Neck Pain
(Features, Treatment options)

Answer 6

Neck pain grade I/II, Normal course

Features: Typical recovery expected without complications

Treatment: education on natural course of neck pain, simple exercises

Question 7

Profile B Neck Pain
(Features, Treatment options)

Answer 7

Neck pain grade I/II, Delayed course without dominant psychosocial influence

Features: Slower recovery, possibly due to physical factors

Treatment: Mobilisation, manipulation, exercise therapy, patient education

Question 8

Profile C Neck Pain
(Features, Treatment options)

Answer 8

Neck pain grade I/II, delayed course with dominant psychosocial influence

Features: delayed recovery primarily influenced by psychosocial factors

Treatment: CBT, graded activity, exercise, multidisciplinary care

Question 9

Profile D Neck Pain
(Features, Treatment options)

Answer 9

Neck Pain Grade III

Features: presence of neurologic signs

Treatment: Mobilisation, manipulation, exercise therapy, patient education, cervical collar may be considered for pain reduction in short term

Question 10

Treatment plan for Grade III neck pain (Radiculopathy)

Answer 10

Education: What is radiculopathy, how it happens and expected course of recovery. Provide reassurance that conservative management is effective and most cases improve with non-surgical treatment. Surgery is only considered if conservative management fails

Pain management: avoid activities that exacerbate symptoms, encourage maintaining regular activity within her pain tolerance. Use NSAIDs if needed initially (minimum dose and avoid long term use)

Exercise therapy: gradual strengthening program focused on deep neck flexors and scapular stabilisers

Manual therapy: Mulligan with movement

Guided return to activity: gradually resume normal activities like work and exercise, as symptoms improve. Educate on pacing and avoiding sudden increases in activity that could exacerbate symptoms

Follow up/monitor: used Neck Disability Index (NDI) to track improvements in pain and function

Question 10

What muscles are responsible for neck flexion

Answer 10

Mainly: longus capitis and longus colli

Also
- SCM
- Scalenes

Question 11

What muscles are responsible for neck extension

Answer 11

Mainly: Erector Spinae

Also
- Traps
- Levator Scapulae
- Splenius Capitis

Question 12

Risk factors for neck pain

Answer 12

Trauma
Higher age
Female gender
Genetic predisposition
Poor psychological health
High stress levels
Smoking

Question 13

Which profile for neck pain is work related and how do you treat it

Answer 13

D

Education, ergonomic adjustment at work, manual therapy and exercises

Question 14

What criteria are used if C Spine injury is suspected

Answer 14

Canadian C spine rules or NEXUS

Question 15

What does the vertebral artery do

Answer 15

brings blood to the brain

Question 16

What test is used to look for signs of VBI

Answer 16

Extension-rotation test (compresses the vertebral artery)

Question 17

Why do we do vertebral artery tests

Answer 17

to screen for risk of any complications of VBI after spinal manipulation

Question 18

Prognostic factors of neck pain

Answer 18

Age >40
Higher pain intensity
Concommitant back pain
Previous episode of neck pain
accompanying headaches
Passive coping style (poor self efficacy)

Question 19

Education for neck pain

Answer 19

Act as usual / advice to stay active

Information (on prognosis) / reassurance

Self management strategies

Question 20

Atlanto-occipital joint ROM (C0-C1)

Answer 20

Flexion-Extension: 15-20 degs
Rotation: Negligible
Lateral Flexion: 5-10 degs

Question 21

Atlanto-axial joint ROM (C1-C2)

Answer 21

Flexion-Extension: 10 degs
Rotation: 40-45 degrees
Lateral Flexion: 5 degs

Question 22

Intracervical region ROM (C2-C7)

Answer 22

Flexion-Extension: 105 degs (more extension)
Rotation: 45 degs
Lateral Flexion: 35 degs

Question 23

What are you looking for in a VBI Test (5Ds and 3Ns)

Answer 23

Dizziness
Diplopia (double vision)
Dysarthria (difficulty in speech)
Dysphagia (difficulty speaking)
Drop attack (faintness)

Nystagmus (spinning of eyeballs)
Nausea
Numbness

Question 24

What does spurlings test do

Answer 24

Extension + lateral flexion + compression

Looking for nerve compression

Question 25

Aim of cervival PAIVMs (passive accessory intervertebral movement)

Answer 25

localise area of pain, assess excursion of vertebral units to identify hypomobility (or hypermobility) in relation to vertebrae above and below

Question 26

Risk factors for VBI

Answer 26

Neck pain, headache or trauma
Cardiovascular risk factors: hypertension, smoking, elevated cholesterol
Recent infections
Old age (arteries less elastic with age)

Question 27

What constitutes a positive VBI test

Answer 27

Occlude artery by putting them in extension or rotation to see if it reproduces the 5 D’s or 3Ns
Dizziness
Diplopia
Dysarthria
Dysphagia
Drop attacks
Nystagmus
Nausea
Numbness

Question 28

What is diplopia

Answer 28

double vision

Question 29

What is Dysarthria

Answer 29

Difficulty in speech

Question 30

What is dysphagia

Answer 30

Difficulty speaking/swallowing

Question 31

What is nystagmus

Answer 31

Spinning of the eyeballs