Week 7 b (Clinical reasoning in management of cervical spine disorders)

Question 1

Questions to ask for hypothesis generation

Answer 1

Is it a recognisable pathology/does it have a typical pattern

2. Is there trauma involved
3. Do the features fit together?
4. Is it overuse/misuse/abuse/disuse?
5. Does it have more than one component?

Question 2

Young age: implication of cervical pathology

Answer 2

congenital, trauma, acute wry neck

Question 3

older age: implication of cervical pathology

Answer 3

disc, degenerative changes, trauma

Question 4

occupation: indications of cervical pathology

Answer 4

postural overload/ repetitive work, work in awkward positions

Question 5

What are different indications of cervical pathologies?

Answer 5

age, occupation, onset, MOI, main problem

Question 6

What health questions should you ask cervical spine pt?

Answer 6

Cancer metastases from lung Ca, breast Ca
Recent illness - URTI
Congenital problems - klippel feil syndrome, torticollis

Question 7

p/e cervical spine patient components

observe:

;

Answer 7

functional quick tests, active movements +/- OP, repeated, sustained, combined movts
screening tests: other joints (e.g. shoulder)
special tests: vertebral artery, thoracic outle, carpal tunnel
NTPT’s ( upper quarter)
Neurological examn (PNS/CNS)

Question 8

p/e cervical spine patient components

palpate:

Answer 8

PAIVMS
PPIVMS
motor control examination - specific postural & movement control test; specific muscle tests (as indicated)

Question 9

What are the 5 D’s (vertebral artery)

Answer 9

Dizziness
Dysarthria
Dysphagia
Diplopia
Drop attacks

Question 10

Why are recent URTIs relevant to cervical spine?

Answer 10

known to have an association with instability in the upper cervical spine secondary to weakening of the capsulolegamentous structures due t the nearby vertebral venous plexus and the nearby infectious processes.

Question 11

How is assessment sequences in cervical pt?

Answer 11

logical sequence of st, sit, supine, side ly & prone - minimise position changes

Observation and functional tests almost always completed first
Sequence may alter pending pt presentation and priority of Ax

Question 12

What is the aim of treatment for movement impairment disorders?
What is the most common pattern

Answer 12

Assist recovery of normal spinal function - mobility

Compressive patterns

Question 13

In cervical spine pt, selection of techniques based on

Answer 13

dominance of findings on motion palpation
tissue sensitivity
ability of pt to adopt treatment position
pattern of movement restriction not as important as in Lx

Question 14

Likely order of improvement in Cx compressive patterns

Answer 14

rotation (away) 1st, followed by LF and Ext

Question 15

Special considerations for management of torticollis

Answer 15

high levels of pain and impairment of movement and function
brief duration of symptoms
inability to adopt some Ax and Rx position
Difficulty changing position when taking weight of head

Question 16

What is the aim of treatment of torticollis

Answer 16

enhance pt’s natural recovery by correcting any deformity and assisting recovery of movement

Question 17

Initial management of torticollis

Answer 17

Heat/gentle massage to reduce m/s spasm/guarding

Active/assisted movements (rotation away, gentle lateral flexion, lateral glides)) in supine (non WB) + heat
(Grade 3 techniques- slow- avoid spasm/pain)

Manual traction at point of pain onset ( in rotation)

Address joint restrictions at other joints

Reassurance and explanation (they are going to get better, not life threatening)

Question 18

Progression Rx torticollis

Answer 18

Rx in WBing (sitting)
physiological rot mobilation techniques
SNAGs
active exercises

Question 19

What is whiplash?

Answer 19

A mechanism of injury - not a diagnosis