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Orthopaedic Conditions > Cervical conditions > Flashcards

Cervical conditions Flashcards

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1
Q

Causes of cervical strain

A

Rear ended car collision, sports trauma, receptive occupational injuries
Hx of overuse or trauma

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2
Q

Risk factors of cervical strain

A

Radiographic image used to rule out more severe injuries

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3
Q

Clinical presentation of cervical strain

A

Treat only as diagnosis of exclusion
Inspect neck for skin integrity, edema (swelling), ecchymosis (bruising), or asymmetry
Palpate tenderness- SPs –> paraspinal soft tissue
Assess ROM if Pt able to

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4
Q

Cervical strain DDX

A

Cervical sprain
Facet syndrome
Meniscoid entrapment

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5
Q

Physical findings of cervical strain

A

Palpable bogginess of posterior neck muscles, cervical tissue oedema (not pitting- application of pressure causes indentation), limited ROM

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6
Q

What is cervical strain

A

Whiplash
Result of sudden hyperextension followed by hyeprflexion of neck
Muscles and ligaments stretch beyond capacity = inflammation in local tissues

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7
Q

Associated symptoms of cervical strain

A

Persistent stiffness, trapezoidal pain, back pain, muscle spasm, headache
Symptoms begin acutely, hours after injury

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8
Q

Prognosis of cervical strain

A

Initially causes distress, minimal long term sequela (condition which is a consequence of previous injury)

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9
Q

Degeneration

A

Accumulated wear and tear that occurs over a long period of time

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10
Q

Degenerate age group

A

Elderly people

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11
Q

Risk factors for degeneration

A

Aging, hard manual labour, contact sports

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12
Q

Clinical presentation of degeneration

A

Neck pain/stiffness, inflexibility, limited ROM
Pt >50 years
Gradual onset
Crepitus
Morning stiffness
Dull achy P

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13
Q

Associated symptoms of degeneration

A

Numbness, tingling, potential weakness in neck, arms or shoulders because nerves in cervical region become irritated or pinched

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14
Q

Prognosis for degeneration

A

Treatment involves rest, pain medication, NSAIDs (non-steroid anti-inflammatory drugs), and physical therapy
Goal of physical is to increase flexibility, postural training and strengthen parapsinal muscles
Restoring flexibility prevents further repetitive microtrauma from poor movement patterns

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15
Q

Herniation

A

Tear or rupture of fibrocartilagneous material (annulus) that surrounds interverebral disc
Most common spinal levels- L4-5, L5-S1 (95-98% of all herniations)

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16
Q

Patho herniation

A

Secondary to disc degeneration (annulus fibrosis)
External protrusion of gelatinous nucleus pulposus through annular fibres potentially causing compression of spinal nerve segment (radiculopathy)
In addition to damage and comp, there is also potential chemical irritation from the release of inflammatory products and local oedema

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17
Q

Epidemiology of herniation

A

Traumatic events, many cases occur spontaneously

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18
Q

Herniation- age groups affected

A

Young adults

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19
Q

Herniation risk factors

A

High contact sports

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20
Q

Herniation clinical presentation

A

Can be mistaken for shoulder/forearm pathology (assess to rule out)
Complaints of weakness, numbness, and tingling in shoulder region down to fingers
Limited ROM
Bicep weakness, numbness in thumbs and index fingers
Symptoms vary dependent on which nerve roots
Unilateral symptoms, unless central herniation

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21
Q

Associated symptoms of herniation

A

Frequent headaches, pain originating in paraspinal muscles radiating down upper extremity

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22
Q

Prognosis of herniation

A

Should improve over time and symptoms become less intense following manual therapy

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23
Q

Stenosis

A

Narrowing of spaces in spine which can compress spinal cord

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24
Q

Age groups affected by sternosis

A

50+ due to osteoarthritic symptoms beginning leading to changes in spinal structures

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25
Stenosis clinical presentation
Neck and arm pain Vague nonspecific neurological symptoms Upper extremity- Pt may feel clumsy/drop things Lower- difficulty walking, imbalance Bowel + bladder incontinence
26
Stenosis prognosis
Nothing can be done to stop progression as due to daily wear and tear Physical therapy, medication and injections aid treatment
27
Cervical facet syndrome
Osteoarthritis of facet (degeneration) Can be caused by whiplash Non age group specific
28
Risk factors of cervical facet syndrome
Sedentary jobs at computer (poor posture), history of trauma, degenerative disc disorder
29
Clinical presentation of cervical facet syndrome
Unilateral pain, rarely radiating past shoulders Pain with pressure on facet Potential painful/limited extension and/or rotation Inc P with ext (loading facets)
30
Cervical artery dysfunction
Involves internal carotid and/or vertebral 5Ds, 3Ns
31
Clinical presentation of cervical artery dysfunction
Headache- unilateral and in frontotemporal or occipital region. May be described as constant, throbbing, or sharp Facial numbness- ataxia (raised suspicion)
32
Trigger points
Discrete, focal, hyper irritable spots located in taut band of skeletal muscle
33
Epidemiology of trigger points
Acute trauma or repetitive micro trauma Lack of exercise, prolonged poor posture, vitamin deficiency, sleep disturbance Occupational or recreational activities that produce repetitive strain on specific muscle group
34
Group affected by trigger points
Sporty people/those who have contact stress on certain muscle group
35
Risk factors of trigger points
Factors causing chronic overuse or stress on muscles
36
Clinical presentation of trigger points
Regional persistent pain --> limited ROM Tension headaches, tinnitus Pain in shoulders Pain in quads, calves, limited ROM in knee/ankle Active TPs cause pain at rest, tender to palpation, with referred pain (differentiation of tender points)
37
Prognosis of trigger points
Dry needling, massage, acupuncture, etc all cause improvements over time
38
Acute disc prolapse
Slipped disc- do not use term in clinic Nucleus pulposus bulges out of outer disc
39
Epidemiology of acute disc prolapse
Unguarded flexion and rotation Local strain/injury
40
Risk factors of acute disc prolapse
X-ray shows narrowing of disc space, MRI confirms diagnosis
41
Clinical presentation of acute disc prolapse
Potential pressure on posterior longitudinal ligament = pain and stiffness, referred pain to upper arm/scapular region Pain and parasthesia in one upper limb, radiating to outer elbow, back of wrist and to index/middle finger Neck may title forwards/sideways
42
Prognosis for acute disc prolapse
Heat and analgesics soothe
43
Chronic disc degeneration age groups
Degeneration fairly common from middle age onwards 40+
44
Chronic disc degeneration clinical presentation
Neck stiffness Pain may radiate to occiput, scapula muscles and down one or both arms Weakness, clumsiness Tenderness in soft tissue Limited ROM
45
Prognosis for chronic disc degeneration
During painful episodes- heat + massage, some benefit from restraining collar Gentle passive manipulation + exercise eases Reduction in discomfort but doesn't necessarily improve
46
Pyogenic infection
Bacteria reaches spine via blood stream, initially deconstruct changes are made to disc space and adjacent parts of vertebral bodies Abscess formation, pus may extend into spinal cord/soft tissue
47
Clinical presentation for pyogenic infection
Neck pain, often associated with muscle spasm and stiffness Limited ROM
48
Prognosis for pyogenic infection
Early stage treatment through antibiotics= improvement
49
Tuberculosis
Infection localises intervertebral disc and anterior part of adjacent vertebral bodies As Csp collapses into kyphosis, retropharyngeal abscess forms and points behind SCM
50
TB age groups
Usually children
51
Clinical presentation of TB
Neck pain and stiffness If neglected retropharyngeal abscess may cause problems swallowing or swelling in posterior triangle Tender and extremely restricted
52
Prognosis for TB
Antituberculosis drugs and immobilisation of neck for 6-18 months
53
Rheumatoid arthritis
Autoimmune inflammatory disease usually affecting women
54
Clinical presentation of rheumatoid arthritis
Neck pain Restricted ROM Root compression symptoms may be present in upper limb May be symptoms of vertebrobasiler insufficiency (limited blood flow to posterior part of brain): vertigo, tinnitus, visual disturbance
55
Ankylosing spondylitis
Type of arthritis which causes inflammation in joints and ligaments of spine
56
Ankylosing spondylitis causes
Genetic HLA B27
57
Instability Hx
Recurrent neck P Clicking or clunking sensations
58
Instability clearing Qs
- H/As? - Feeling like you need to hold your head up? - Reluctance to move head? - 5Ds, 3Ns, A
59
Instability causes
Age related changes Trauma Overuse injuries Trauma (e.g., RTA) Genertic conditions (e.g., Down syndrome)
60
Instability SSx
Inc RPOM Spongy end feel
61
Instability DDX
Cervical sprain OA
62

Orthopaedic Conditions (11 decks)

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