(5.2) Cervical Spine Pathologies Flashcards
(38 cards)
What is the diagnostic triage of neck pain?
- Non-specific neck pain
- Radicular syndrome
- Serious pathology
What are the 4 categories of grades?
I - no signs serious illness/injury
II - no signs serious illness/injury but difficulty in activities
III - signs nerve injury
IV - signs major illness/injury
What is an acute neck trauma?
Encompasses a wide range of potential injuries to ligaments, muscle, bone and spinal cord.
What is the Canadian C-Spine Rule?
It is used to determine whether or not the patient is in need for radiography
What is non-specific neck pain?
Neck pain without an underlying disease causing the pain, where no abnormal pain or anatomic structure is found
What is indicates that the patient needs radiography in the Canadian C-Spine Rule?
- If they are at a high risk that mandates radiography
- If there is not a low enough risk to allow safe assessment and ROM
- If they are not actively able to rotate their neck
What are the causes of non-specific neck pain?
- Mechanical / postural/ degenerative
- Discogenic / facet joint / ligamentous
What is cervical radiculopathy?
Pain in a radicular pattern in one or both upper extremities caused by compression and/or of the cranial nerves
What causes cervical radiculopathy?
- Non-traumatic > traumatic
- C7 n root most common
- Disc herniation
- Spondylosis
How does cervical radiculopathy occur?
Mechanical compression:
- localised ischemia
- nerve damage
Nucleus pulposus-nerve:
- pro-inflammatory cascade
What can be seen on clinical examination of cervical radiculopathy?
- neck + arm pain
- parasthesia / numbness / weakness etc
- altered ROM
- dermatomal / myotomal / reflex changes
- +ve cervical distraction test
- +ve brachial plexus tension test
How is cervical radiculopathy treated?
Usually resolves spontaneously 4-6/12
What causes cervical spondylosis?
Degenerative changes:
- discs
- facet joints
- osteophytes
- ligament thickening
- inflammation
What can be seen on clinical examination in a patient with cervical spondylosis?
- pain (agg: movement)
- stiffness
- crepitus
- functional impairment
- decreased ROM
- segmental tenderness
What is Degenerative Cervical Myelopathy (DCM)?
Injury or compression to the spinal cord
How does DCM occur?
- decreased diameter spinal canal with compression
- advanced degenerative changes
- central disc herniations
- congenital narrowing spinal canal
What are the symptoms of DCM?
- neck pain/stiffness
- unilateral/bilateral limb pain
- upper limb weakness & numbness
- paraesthesia
- bowel or bladder incontinence
- imbalance/unsteadiness
What would be found on clinical examination of DCM?
- extensors > flexors
- limb hyperreflexia
- spasticity
- clonus
- +ve Hoffmans and Babinski
- sensory loss
- gait disturbance
- Lhermittes sign
What is Whiplash Associated Disorder (WAD)?
- An acceleration-deceleration mechanism of energy transfer to the neck
- Describes constellation of neck-related clinical symptoms manifesting post RTA etc
What are the various soft tissue injuries that may occur following a WAD?
Facet Joint:
- haemarthrosis, capsular tears and damage
Spinal Nerve Root:
- ligamentous, disc, muscle injury
What are the different classifications of WAD?
I - Neck complaint pain, stiffness or tenderness
II - Neck complaint, decreased ROM, point tenderness
III - Neck complaint and neuro signs
IV - Neck complaint and fracture or dislocation
What can be seen on clinical examination of WAD?
- varying pain
- stiffness
- upper limb paraesthesia
- headaches
- heavy head
- psychological distress
- decreased ROM
- abnormal movement
- localised tenderness
What is Acute Torticollis?
- aka ‘Wry Neck’
- abnormal, asymmetrical head or neck position
What causes Acute Torticollis?
Cause is currently unknown
(unusual posture?)
