Week 9 Task Sheet - Cx Spne

Question 1

What is the structure of the Nucleus Pulposus?

Answer 1

3D lattice of the collagen fibres - combined with hydrophilic proteoglycan gel

Question 2

What is the structure of the annulus fibrosus?

Answer 2

20 annular bands running around the nucleus - fibres arranged in alternate directions - blurs with the NP

Question 3

How does the resting state of the IV disc promote stability?

Answer 3

Hydrostatic pressure within the disc ‘pushes’ apart the vertebral bodies - causing the surrounding ligaments to remain under tension

Question 4

How does the IV disc cause stability when asymmetric forces are applied?

Answer 4

causes the NP to move away from the area of force - causing tension in the AF

Question 5

How does the IV disc cause stability when axial forces are applied?

Answer 5

Stretching of AF, compression of NP - NP pushes back on the AF causing tension and limiting movement

Question 6

How does the size of the IV disc relate to segmental movement?

Answer 6

Larger the disc = greater the movement

Question 7

Define Whiplash

Answer 7

Neck injury due to forceful, rapid back-and-forth movement of the neck - usually following RTA but also in sporting accidents

Question 8

What is a grade I whiplash injury?

Answer 8

Pain, stiffness and tenderness in the neck without any physical signs

Question 9

What is a grade 2 whiplash injury?

Answer 9

Pain, stiffness and tenderness in the neck with decreased ROM and tenderness on palpation

Question 10

What is a grade 3 whiplash injury?

Answer 10

Pain, stiffness and tenderness in the neck WITH decreased ROM and tenderness on palpation
AND neurological signs e.g. decreased reflexes, muscle weakness and sensory loss

Question 11

What is a grade 4 whiplash injury?

Answer 11

Pain, stiffness and tenderness in the neck WITH decreased ROM and tenderness on palpation
AND neurological signs e.g. decreased reflexes, muscle weakness and sensory loss
AND fracture or dislocation

Question 12

What is the MOI of whiplash in a rear-ending RTA?

Answer 12

Single cycle posterior to anterior acceleration and loading

Initial insult to upper back and shoulders

Head makes contact with head rest (due to forceful extension of lower Cx spine)

Subsequent acceleration of the head forwards with rebound – Cx flexion

Question 13

What anatomical structures are damaged in a whiplash injury? (6) NB: not muscles

Answer 13

Hyperextension followed by hyperflexion:

• ALL
• Anterior AF
• Facet joints & capsule
• Ligamentum Flavum
• Interspinous ligament
• Ligamentum Nuchae

Question 14

What muscles could be damaged in a whiplash injury?

Answer 14

Excessive eccentricc loading of:

• Sternocleidomastoid
• Longus Colli
• Trapezius
• Levator Scapulae
• Scalenes (anterior, middle and posterior)

Question 15

Why is pain delayed in onset during WAD?

Answer 15

Adrenaline release as part of traumatic MOI - suppresses the inflammatory process and doesn’t occur until a few hours after injury

Question 16

Why is there morning pain and stiffness in WAD?

Answer 16

Overnight, an inflammatory process is occurring to try and heal the damaged structures - during this time there is no ROM - allows for the accumulation of inflammatory cytokines within and around the joints - activating chemical nociceptors

Stiffness due to increased viscosity and decreased volume of synovial fluid

Question 17

Why do patients with WAD sometimes get pins and needles?

Answer 17

May have stretched and put increased tension on the following during excessive flexion:

• Ventral & dorsal nerve routes,
• DRG,
• spinal nerve
• greater occipital nerve

Question 18

What is a forward head posture?

Answer 18

hyper-extension of upper Cx spine and flattening of lower Cx spine - increases space in facet joints

Question 19

What causes a patient to have FHP?

Answer 19

Poor posture (slouching) or spending too long on a computer looking downwards - weakness of semispinalis cervicis and Longus cervicis

Question 20

Why does FHP cause pain?

Answer 20

Increased flexion increases the work of semispinalis capitus and Longus capitis = ischeima and pain
Compression of posterior facet joints and narrowing of intervertebral foramen

Question 21

What is a yellow flag?

Answer 21

Signs, symptoms, beliefs and attitudes that are thought to increase the risk of acute pain developing into a disabling chronic pain condition.

Question 22

What are examples of yellow flags?

Answer 22

• Psychological impact of insurance claim/compensation factors may increase timeline for recovery
• Post-injury anxiety
• Catastrophising
• Severe post-injury pain
• Cold hyperanalgesia