Week 9 Task Sheet - Cx Spne Flashcards
What is the structure of the Nucleus Pulposus?
3D lattice of the collagen fibres - combined with hydrophilic proteoglycan gel
What is the structure of the annulus fibrosus?
20 annular bands running around the nucleus - fibres arranged in alternate directions - blurs with the NP
How does the resting state of the IV disc promote stability?
Hydrostatic pressure within the disc ‘pushes’ apart the vertebral bodies - causing the surrounding ligaments to remain under tension
How does the IV disc cause stability when asymmetric forces are applied?
causes the NP to move away from the area of force - causing tension in the AF
How does the IV disc cause stability when axial forces are applied?
Stretching of AF, compression of NP - NP pushes back on the AF causing tension and limiting movement
How does the size of the IV disc relate to segmental movement?
Larger the disc = greater the movement
Define Whiplash
Neck injury due to forceful, rapid back-and-forth movement of the neck - usually following RTA but also in sporting accidents
What is a grade I whiplash injury?
Pain, stiffness and tenderness in the neck without any physical signs
What is a grade 2 whiplash injury?
Pain, stiffness and tenderness in the neck with decreased ROM and tenderness on palpation
What is a grade 3 whiplash injury?
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
What is a grade 4 whiplash injury?
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
What is the MOI of whiplash in a rear-ending RTA?
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
What anatomical structures are damaged in a whiplash injury? (6) NB: not muscles
Hyperextension followed by hyperflexion:
- ALL
- Anterior AF
- Facet joints & capsule
- Ligamentum Flavum
- Interspinous ligament
- Ligamentum Nuchae
What muscles could be damaged in a whiplash injury?
Excessive eccentricc loading of:
- Sternocleidomastoid
- Longus Colli
- Trapezius
- Levator Scapulae
- Scalenes (anterior, middle and posterior)
Why is pain delayed in onset during WAD?
Adrenaline release as part of traumatic MOI - suppresses the inflammatory process and doesn’t occur until a few hours after injury
Why is there morning pain and stiffness in WAD?
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
Why do patients with WAD sometimes get pins and needles?
May have stretched and put increased tension on the following during excessive flexion:
- Ventral & dorsal nerve routes,
- DRG,
- spinal nerve
- greater occipital nerve
What is a forward head posture?
hyper-extension of upper Cx spine and flattening of lower Cx spine - increases space in facet joints
What causes a patient to have FHP?
Poor posture (slouching) or spending too long on a computer looking downwards - weakness of semispinalis cervicis and Longus cervicis
Why does FHP cause pain?
Increased flexion increases the work of semispinalis capitus and Longus capitis = ischeima and pain
Compression of posterior facet joints and narrowing of intervertebral foramen
What is a yellow flag?
Signs, symptoms, beliefs and attitudes that are thought to increase the risk of acute pain developing into a disabling chronic pain condition.
What are examples of yellow flags?
- Psychological impact of insurance claim/compensation factors may increase timeline for recovery
- Post-injury anxiety
- Catastrophising
- Severe post-injury pain
- Cold hyperanalgesia
