Week 4: Triage, Neck Pain and VBI Flashcards
What therapies do not work for neck pain
Dry needling, low level laser, electrotherapy, ultrasound, traction, corticosteroids and cervical collar
Want to avoid surgery
Grade I Neck Pain
Neck pain and less influence on physical function and activities of daily living and no major structural pathology
Grade II Neck Pain
Neck pain and more influence on physical function but no structural pathology
Grade III Neck Pain
Neck pain without structural pathology but with neurological signs - Radiculopathy
Grade IV Neck Pain
Major structural pathology (red flags)
Profile A Neck Pain
(Features, Treatment options)
Neck pain grade I/II, Normal course
Features: Typical recovery expected without complications
Treatment: education on natural course of neck pain, simple exercises
Profile B Neck Pain
(Features, Treatment options)
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
Profile C Neck Pain
(Features, Treatment options)
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
Profile D Neck Pain
(Features, Treatment options)
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
Treatment plan for Grade III neck pain (Radiculopathy)
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
What muscles are responsible for neck flexion
Mainly: longus capitis and longus colli
Also
- SCM
- Scalenes
What muscles are responsible for neck extension
Mainly: Erector Spinae
Also
- Traps
- Levator Scapulae
- Splenius Capitis
Risk factors for neck pain
Trauma
Higher age
Female gender
Genetic predisposition
Poor psychological health
High stress levels
Smoking
Which profile for neck pain is work related and how do you treat it
D
Education, ergonomic adjustment at work, manual therapy and exercises
What criteria are used if C Spine injury is suspected
Canadian C spine rules or NEXUS
What does the vertebral artery do
brings blood to the brain
What test is used to look for signs of VBI
Extension-rotation test (compresses the vertebral artery)
Why do we do vertebral artery tests
to screen for risk of any complications of VBI after spinal manipulation
Prognostic factors of neck pain
Age >40
Higher pain intensity
Concommitant back pain
Previous episode of neck pain
accompanying headaches
Passive coping style (poor self efficacy)
Education for neck pain
Act as usual / advice to stay active
Information (on prognosis) / reassurance
Self management strategies
Atlanto-occipital joint ROM (C0-C1)
Flexion-Extension: 15-20 degs
Rotation: Negligible
Lateral Flexion: 5-10 degs
Atlanto-axial joint ROM (C1-C2)
Flexion-Extension: 10 degs
Rotation: 40-45 degrees
Lateral Flexion: 5 degs
Intracervical region ROM (C2-C7)
Flexion-Extension: 105 degs (more extension)
Rotation: 45 degs
Lateral Flexion: 35 degs
What are you looking for in a VBI Test (5Ds and 3Ns)
Dizziness
Diplopia (double vision)
Dysarthria (difficulty in speech)
Dysphagia (difficulty speaking)
Drop attack (faintness)
Nystagmus (spinning of eyeballs)
Nausea
Numbness
What does spurlings test do
Extension + lateral flexion + compression
Looking for nerve compression
Aim of cervival PAIVMs (passive accessory intervertebral movement)
localise area of pain, assess excursion of vertebral units to identify hypomobility (or hypermobility) in relation to vertebrae above and below
Risk factors for VBI
Neck pain, headache or trauma
Cardiovascular risk factors: hypertension, smoking, elevated cholesterol
Recent infections
Old age (arteries less elastic with age)
What constitutes a positive VBI test
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
What is diplopia
double vision
What is Dysarthria
Difficulty in speech
What is dysphagia
Difficulty speaking/swallowing
What is nystagmus
Spinning of the eyeballs
