Cervical II

Question 1

Whiplash

Answer 1

. #1 reason for patients to present w/ neck pain
. Hyper-extension injury w/ secondary hyper-flexion injury then occur as head snaps back onto the thorax
. Ant. Longitudinal ligament or cervical mm. May be stretched or torn
. Light weight, tall people at higher risk
. 50% patients w. Whiplash still have symptoms after 1 yr
. Soft tissue, muscle energy, indirect techniques work

Question 2

Carotid aa.

Answer 2

. Bifurcate into internal and external carotid
. Carotid sinus contains nerve receptors for baroregulation
. Occlusion of carotid aa. Can precipitate rapid dec. in bp

Question 3

Wallenberg test

Answer 3

. Screens for vertebral a. Insufficiency
. Pt supine, cradle head and neck w/ hands
. Introduce extension of cervical spine and rotation of neck in both directions
. Pos test: dizziness, nausea, syncope, dysarthria, dysphagia, hearing or vision issues, or paresis caused by reduction of blood flow to vertebral a.

Question 4

Cervical spine imaging

Answer 4

. High index of suspicion for obtaining imaging
. Acute neck pain in people over 60 or under 15 should be considered for X-ray
. Patients w/ blunt trauma, high speed MVAm and sports-related injuries
. Don’t want to miss fracture, tumor, spinal cord compromise

Question 5

Cervical spinal nerves

Answer 5

. Exit spine through neural foramina
. Largest at C2 and smallest at c7
. Cervical flexion inc. neural foramina diameter, extension dec. it

Question 6

Cervical disc disease

Answer 6

. Disc protrusion/herniation compress cervical n. Root below it
leading to radiculopathy
. Do not do HVLA at that level

Question 7

Cervical intradiscal pressure

Answer 7

. Lowest in supine w/ head supported

. Greatest in cervical hyper-extension

Question 8

Post. Longitudinal ligament

Answer 8

. Cervical lordosis maintained
. Runs from C2 to sacrum
. Weaker than ant. Longitudinal ligament
. Presents risk for disc herniation esp. in lower cervical region

Question 9

Cervical raiduclopathy

Answer 9

. Cause pain, weakness, numbness, or parenthesias
. Usually follow specific nerve root pattern
. Most common cervical nerve root herniation is C6-7 disc affecting C7 nerve root
. Produces a reflex x hange in interscapular area that can lead to recalcitrant upper back pain and arm symptoms
. Look for sensory loss, motor weakness, or loss of DTR
. Symptoms can be intermittent and not produce a neurologic deficit

Question 10

Spurling’s test

Answer 10

. Tests for cervical n. Root compression
. Sidebend, extend, compress (in stages)
. Pos. Test: reproduces radioulnar symptoms
. 93% specific
. 30% sensitive

Question 11

Intrascapular pain can be referred from the ___

Answer 11

Neck

Question 12

Cervical spinal stenosis

Answer 12

. Narrowing spaces w/in spinal column form OA can put pressure on nerve roots or spinal cord
. May be asymptomatic but worsens over time
. Symptoms: pain, numbness, mm. Weakness, difficulty walking

Question 13

Cervical sympathetics

Answer 13

.arises from intermediolateral cell columns of spinal cord
. N. Fibers travel via white rami
. Cervical sympathetics come from T1-4
. 3 fused ganglia innervates area
. Only postganglionic fibers present in cervical region

Question 14

T/F treat thoracic before cervical

Answer 14

T

Question 15

Motion of typical cervical vertebrae

Answer 15

. Rotation/sidebending motions to same side alway even if in neutral in C2-6
. C7 follows thoracic mechanics due to its facet joints resembling T1

Question 16

Steps to cervical diagnosis

Answer 16

. Motion test rotation
. Motion test lat. translation
. Add flexion, extension, retests

Question 17

Cervical motion pattern exceptions

Answer 17

. Tight muscles may pull SB and rotation to opposite sides, treat tight mm. First then retest joint motion
. Advanced joint/disc disease can lead to segmental instability and collapse of column so dysfunction can occur in any direction

Question 18

Guidelines for OMM treatment

Answer 18

. Rule out urgent condition
. Dec. muscle tension in neck and upper back
. Cervical and thoracic soft tissue is essential
. Treat fascia, thoracic, ribs, and shoulder girdle
. Use least invasive techniques when possible
. Consider patient’s ability to response
. Primary goal: maximize function not resolve all pain

Question 19

Benefits of cervical manipulation

Answer 19

. Inc. ROM, dec. pain, improved activities of daily living, shortened disability time
. Secondary benefits: reduced reliance on meds, improved postural efficiency
. May dec. need and cost for PT and prevent injections or surgery
. Good for patients w/ acute neck pain and headache
.

Question 20

HVLA absolute contraindications

Answer 20

. Fractures in area
. Osteoporosis in area 
. Bone metastasis in area 
. Severe RA lead to unstable atlantoaxial joint 
. Down syndrome for laxity in ligaments 
. Osteomyelitis

Question 21

HVLA relative contraindication

Answer 21

. Acute whiplash
. Herniated nucleus pulposus/radiculopathy
. Vertebral a. Ischemia
. Hyper-mobile patients
. Dizziness, nausea, nystagmus w/ cervical extension/rotation

Question 22

Arterial insufficiency

Answer 22

. Combo of extension, rotation, and SB can compromise vertebral a. In some at risk patients
. If any concerns in history/exam stop
. Monitor patient during treatment and reassess after

Question 23

Type of patients at high risk for vertebral a. Adverse event

Answer 23

. Morbidly obese patients 
. Older arthritic patients 
. Young hypermobile patients 
. Patient’s w/ necks over 18 inches in diameter 
. Patient’s w/ asthma