C/S Patho Pt 2 (14) Flashcards by Alyssa H

What is a Jefferson’s fx

burst fx of C1 under axial load

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MOI of Jefferson’s fx

compression with flex or ext

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What is Hangman’s fx

bilateral fx of pars interarticularis at C2

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MOI for Hangman’s fx

distraction w/ hyperext or forceful hyperext centered on chin (contact sports, diving, falling)

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Type 1 dens fx

-avulsion fx
-stable
-tip of dens broken off

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Type 2 dens fx

-fx base of dens
-unstable

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Type 3 dens fx

-fx through body of C2
-unstable
-may involve facets C1 and 2

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what motion does orthoses control the most

flexion, better than ext

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What is a halo for? What’s the lowest segment it can go to?

-for unstable cervical and thoracic fx and dislocation
-T3

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3 indications for halo

-all dens fx
-C1 fx w/ transverse lig rupture
-SCI

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what % of flex and ext is limited by a halo

90-96%

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How long is a halo used for

3 months

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What happens if a halo has improper fit

can allow 31% norm spine motion

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What is used after the removal of a halo

head cervical orthoses (HCO)

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Contraindications for halo (2)

-severe skin probs
-psychological (anxiety, claustropobia)

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Primary ROM limitations with halo (brief descriptions)

-rot completly restricted
-SB very limited
-flex/ext limited ~10% norm ROM

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indications for Philadelphia collar (HCO; 3)

-immob after surgery
-cervical strain/sprain
-post trauma immob

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2 contraindications for philadelphia collar

-severe skin probs
-severe cervical instab

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primary ROM limitations with philadelphia collar (%)

-flex/ext limited to 65-70% norm
-SB limited 30-35%
-rot limited to ~50% norm

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3 indications for soft collar

-mild cervical strain/sprain
-post trauma cervical pain
-recovery from non-surg interventions (ex/ manual)

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2 contraindications for soft collar

-long term use (lead to atrophy)
-not for pts who need rigid immob

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primary ROM limitations for soft collar

-flex/ext mild restrict ~50% norm
-SB slight limit, ~60% norm
-rot limited 50-60% norm

Describe what structures a philadelphia collar supports

-upper portion supports lower jaw and occiput
-lower portion covers upper thoracic

4 specific injuries/procedures that indicate philadelphia collar *don’t stress too much

-ant cervical fusion
-dens type 1 fx
-ant discectomy
-halo removal

% range of flex/ext motion restriction with philadelphia collar

65-70%

3 primary HCO

-philadelphia -miami -malibu

what are 3 purposes of cervicothoracic orthoses (CTO)

-provide more motion restriction in mid to low c/s -used in minimally UNSTABLE fxs -upper c/s has less motion restriction

3 indications for hard collar

-head support for ACUTE neck pain -relief minor mus spasm from spondylosis -psychological comfort

% range of flex/ext restriction with hard collar

20-25%

When can people go back to work after total disc

2-6 wks

What do you have to wait for after total disc? What does it restrict when this occurs?

Endplates to secure to bone Restricts pts into hyperext

How does anterior cervical discectomy and fusion affect tx seg and adjacent lvls

-eliminates natural motion at tx seg -induce hypermobility and increase intradiscal pressures at adjacent lvls

Indications for anterior cervical discectomy and fusion

Herniation causing radiculopathy or myelopathy

SE or contraindication to act for ACDF

adjacent seg degeneration

SE or contraindication to act for ACDF at 4-6 wks

-sitting < 30-45 min -no lift/push >20lbs for 3 months -avoid end ROM

SE or contraindication to act for ACDF at 6wk - 3 months

-no OH reach until wk 8 -gentle motion until 12 wks

SE or contraindication to act for ACDF at 3-6 m’s

-increase wt limit 5lb every other wk -slowly incorporate OH act

SE or contraindication to act for ACDF at 6 months

Return baseline fxn

Rehab timeline for ACDF at wk 1

-sit < 30 min -lift < 10 lbs -walk 30 daily

Rehab timeline for ACDF at wk 2-6 wks

Gradual return to ADLs, begin PT 4-6 wks

Rehab timeline for ACDF at month 1-3

Progressive strength and mobility

PT interventions for ACDF (5)

-posture re-ed -scap strength -ROM -strengthen deep neck flex and ext -fxnal training

What does cervical disc arthoplasty do for motion

Preserves segmental motion and normal spinal kinematics

Indications for cervical disc arthroplasty

-degenerative disc disease w/ symptomatic radiculopathy or myelopathy in SINGLE LVL -preservation of seg and physiological motion

3 contraindications for cervical disc arthroplasty

-multilvl cervical disease -poor bone quality -significant facet jt arthritis

When can sedentary occupation pt return to work after cervical disc arthroplasty? Manual laborer?

1-6 wks 6-16 wks

PT interventions for cervical disc arthroplasty (3)

-similar to ACDF but focused on dynamic motion ex and strength -improve fxnal acts w/ cervical mob -proprioception and jt pos sense ex

Indication for posterior cervical laminoforaminotomy

Foraminal stenosis or radiculopathy w/ n root compression

Limitations after posterior cervical laminforaminotomy

Minimal to no limitations depending on the amount of bone cut away

Rehab timeline after laminoforaminotomy wk 2-6

Gradual reintroduction of ADLs

Rehab timeline after laminoforaminotomy month 1-3

Strengthen neck and neuro re-ed

PT interventions after laminoforaminotomy

-stx and nerve glides -strengthen neck and upper back -post re-ed -avoid agg act