C/s Patho (13) Flashcards by Alyssa H

Most common etiology of acute facet dysfxn/syndrome

Spondylosis and age

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Less common etiology of acute cervical facet dysfxn/syndrome

Trauma from sport or MVA

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MOI of acute cervical facet dysfxn

Sudden backward, SB, or rot

Sustained pos

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S/s of acute cervical facet dysfxn/syndrome

-sudden one-sided local neck pain
-may radiate lower neck and upper back
-motion restricted w/ closing or down gliding of mid cervical facet

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Exam findings for acute cervical facet dysfxn/syndrome

-painful AROM (ext, ipsilateral SB and rot)
-unilateral PA on involved side
-local mm guarding/spasm

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How long does acute facet dysfxn take to resolve? What is common with it?

1-2 wks

Recurrence

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Tx for acute facet dysfxn

-control pain and symps
-jt mob combining flex or ext with rot traction (initially in pain free direction)
-strength with full AROM

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Cervical Z jt pain map

C2-3 is R upper suboccipital
C3-4 is L mid neck
C4-5 is R base of neck
C5-6 is L base of neck and UT
C6-7 is R UT

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What mus are shortened in FHP

-sub occ
-pecs
-sub scap
-Scaleni
-SCM

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What mus are lengthened with FHP

-trap
-rhomboids
-deep cervical flexors and extensors

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MOI of FHP

Insidious onset (not acute)

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Mgt for FHP

-decrease mus tension w/ ergonomic cuing and tx trigger pts
-tx mus imbalances (stx and strengthen)
-postural re edu

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What causes cervical mus HA

-postural static loading of neck
-FHP

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Exam findings for cervical mus HA

-neuro screen clear
-subocc mus tension, tenderness
-unilateral or bilateral OA flex limitations

Possible pain in upper back, neck, base of head, above ears, jaw, and above eyes

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Tx for cervical mus HA

-soft tissue mob sub occ
-jt mobs
-postural and ergonomic re edu

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Exam findings for HNP protrusion w/o nerve root

-increased pain with sitting and neck flex
-lack ext
-ext causes increased centralization of pain and lessen peripheral pain
-FHP

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Tx for HNP protrusion w/o nerve root

-maintain correct posture
-Stx and strengthen
-“head back and chin in” progress to ext

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What is a common cause for HNP protrusion w/ nerve root

DDD

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What is the most common segmental for HNP w/ nerve root? Which nerve root involved?

C5-6

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What is used to dx HNP w/ nerve root

MRI/CT

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Exam findings for HNP protrusion W/ nerve root

-pain central base at neck, then spread to sh and arms
-pain can refer to upper thoracic
-Cloward’s areas (inter scap pain)
-ext may increase peripheral s/s

Tx for HNP protrusion w/ nerve root

-decrease protrusion
-restore norm posture
-manual traction w/ passive axial ext and/or passive backward bending ex

MOI of whiplash traumatic cervical strain/sprain

Accelerating injuries
-acute SOFT TISSUE trauma involving hyperext

What 2 mus most common for whiplash

Longus colli and SCM

When do symps get worse for whiplash?

12-24 hrs post injury

How does whiplash associated disorder occur

-transfer energy into neck -may result from rear-end or side impact collision

What are the 5 stages of Quebec Task Force

WAD 0 - no complaints or physical signs WAD 1 - neck complaints only, but no physical signs WAD 2 - neck complaints and MSK signs WAD 3 - neck complaints and neuro signs WAD 4 - neck complaints and fx/dislocation

Associated symps of whiplash traumatic cervical strain/sprain

-local and referred pain, paresthesia -diffuse mus tension, tender, wk -movement restrictions in upper quadrant -HA -blurred vision -dizziness -dysphagia

What percentage have continued symps for 2 years with whiplash

10-25%

Mgt philosophies for whiplash

-reduce mus spasm -passive modalities initially -soft collar -counseling/CBT PRN (pt edu, cog and affective factors)

What are the 3 high risk factors for Canadian c/s rule for X-ray

-age greater than or equal to 65 years -dangerous mechanism -paresthesia in extremities

What are the 5 low risk factors that allow safe assessment of ROM for Canadian c/s Rule? What if they are no?

-simple rearend MVC -sitting pos in ED -ambulatory at any time -delayed onset of neck pain -absence of midline c/s tenderness If no, X-ray

What ROM for Canadian c/s rule requires X-ray

Unable to rot 45 degrees L and R

Agg factors of RA

morning and inactivity

What is RA

Overactive immune system attacks jts, causes pain, stiff, and swell

Precautions for RA

High neck instab

Mgt of RA

-hands off neck -modalities; STM to proximal sh regions -gentle mid range postural awareness -iso strength -positional support for ADLs

What is affected in cervical spondylosis

-spinal canal (n roots and/or SC) -cervical vertebral bodies (degen facets) -intervertebral discs, narrow

Clinical present of cervical spondylosis

-initial hypermob then progress to chronic hypomob -disc bulge outward -angle of tension on ligs changed -WB develops uncinate processes ant-lat -decreased SB initially, sagittal plan in later stages

S/s of cervical spondylosis

-slow onset -exacerbated by minor trauma -pain and mus guarding (local and referred) -neuro = radiculopathy -long term, hypomob and progressive stiff

Tx for cervical spondylosis

-traction for chronic -estim for pain -molded cervical pillows -collar if n root irritation significant -manual (stx, ROM, iso and cervical stab)

Risk factor for stenosis

50+ yo

Agg for stenosis

-ext -ext causes 20% narrowing -flex widens spinal canal by 31%

Symps of stenosis

-neck pain -pain, wk, numb in sh, arms and legs -hand clumsiness -burning, tingle, pins and needles in involved extremity

What is cervical myelopathy

Disorder in cervical region of SC that disrupts normal transmission of neural signs

3 major mechs of cervical myelopathy

-direct compress of SC -ischemia by compromised vascular supply of cord -repeated trauma secondary to norm flex and ext

3 risk factors of cervical myelopathy

-90% of 70+ -most common SC dysfxn in 55+ -M > W

S/s cervical myelopathy

-neck pain, HA, dizziness -radicular arm pain -may only have bilateral LE s/s -bowel and bladder disturbances -hyperreflexia, clonus -multisegmental wk and/or sensory changes -intrinsic wasting and sensory disturbance of hands -Hoffman’s and Babinski Loss dexterity 0wide based unsteady gait

Mild stage of myelopathy

Hand and arm symps but doesn’t affect ADLs

Mod stage of myelopathy

Considerable difficulty using arms and legs, affects ADLs

Severe stage of myelopathy

Require AD, often bed/chair/home bound

5 tests for myelopathy

-gait deviation - + Hoffman’s - inverted supinator sign - + Babinski - > 45 yo