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Flashcards in Cervical Spine Deck (35)
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Cervical strain/sprain injuries are usually combined injuries involving...

Ligamentous structures

Cervical musculature


What are some causes of cervical strain/sprain?

Forced mvmt past end range

Sudden contraction

Violent high velocity mvmt


Presentation of cervical strain/sprain?

Non-radicular, non-focal neck pain, \anywhere from the base of the skull to the cervicothoracic junction

c/o neck stiffness/limited ROM

+/- cervicogenic HA pattern


PE findings in cervical strain/sprain?

TTP over involved muscle, facet joint, &/or transverse process

ROM limitations


What are some non-trauma reasons to order x-rays in a pt presenting with neck pain?

>50 with new sxs

constitutional sxs

mod-severe neck pain >6wks

progressive neuro findings

infectious risk

hx of malignancy


What can you use to determine if you should order cervical x-rays in a pt with hx of recent trauma?

Canadian C-spine rules**

Nexus low risk criteria
-no X-rays if all 5 criteria met


What are some high risk factors that mandate x-ray in Canadian c-spine rules?


dangerous mechanism of injury

paresthesias in extremities


According to the Canadian c-spine rules, if a pt presents with any low risk factors, what should be checked prior to ordering x-rays?

if pt is able to actively rotate neck 45deg to right and left

(if able= no x-ray)


If pt c/o of sharp pain with ROM, indicates?

muscle strain/ligament sprain


If pt c/o tightness followed by pain, indicates?

muscle spasm


In a pt presenting with cervical strain/sprain, will they have pain with axial loading? Neuro exam?


Usually norm :
C5-T1 (myotomes, dermatomes and reflexes)

check spurling's test


Why would you perform a spurling's test?

How is this performed?

help dx cervical disc herniation's or cervical spondylosis

Pt rotates and laterally flexes to the affected side, light downward (axial) compression is applied

(+) if pain


How do whiplash injuries occur?

sudden movement of the neck

MC stopped vehicle that is rear-ended


classic presentation of whiplash injury?

Delayed onset of cervical pain and stiffness (12-24 hrs)

Pain peaks at 3-5 days post injury

Pain/stiffness with flexion and extension
-ROM loss can be dramatic


PE findings in pt presenting with whiplash?

TTP over involved muscle, facet joint and/or ligaments

ROM limitations

(-) no pain with axial loading, neuro exam usually norm


Tx for cervical strain/sprain/whiplash?

soft cervical collars


muscle relaxers
-Carisoprodol (Soma)

cervical pillow

Heat or ice



What is cervical facet dysfunction?

Shift in vertebral alignment leads to “locking” of facet joint


What causes cervical facet dysfunction?

Prolonged positional stress

Traumatic injury


Presentation of cervical facet dysfunction?

MC insidious onset

Unilateral pain:
Sharp in c-spine
“Achey” in referral zone

Focal facet TTP

ROM limitations


What ROM limitations are seen in cervical facet dysfunc?

Ipsilateral → sharp pain which significantly increases with added cervical extension

Contralateral → tightness


Tx of cervical facet dysfunc.?

NSAIDS & muscle relaxers

early referral to PT/DC/DO


What is a complication of cervical manipulation?

Cerebral artery occlusion / dissection

s/s: cervical/suboccipital pain, dizziness, N/V
vision loss


What is cervical radiculopathy?

Neurogenic pain in the distribution of cervical root(s)

w/ or w/o assoc. numbness, weakness or loss of reflexes


what are some causes of cervical radiculopathy?

Traumatic stretching of nerve root / brachial plexus

Cervical disc bulge / herniation (young & old adults)

Cervical foraminal narrowing (older adults)


How do brachial plexus injuries occur?

sports: stretching, trauma, compression

child birth


What can cause cervical radiculopathy?

herniated disc

bone spurs

thickened ligamentum flavum


Presentation of cervical radiculopathy?

abrupt onset: young or old

gradual onset: old

Cervical pain increased with extension, lateral flexion and rotation to involved side → increase radicular pain


What neuro deficits can be seen in cervical radiculopathy?

based on deg of nerve root compression/inflammation:
Burner-stinger syndrome:
Typically resolve quickly

Disc bulge / herniation
May not present initially → serial exams important

Foraminal narrowing
As degree of narrowing increases potential for deficits increases


Tx of cervical radiculopathy?

1st x-rays,

anti-inflammatories: oral steroid

PT: cervical traction, postural education

Neuro/PMR consult if no getting better


What is cervical spondylosis?

Degenerative disease:
-Osteophyte formation
-Ligamentum flavum thickening
-Disk space narrowing
-Vertebral subluxation

problem that affects the spinal cord itself