Flashcards in Cervical Spine Deck (35)
Cervical strain/sprain injuries are usually combined injuries involving...
What are some causes of cervical strain/sprain?
Forced mvmt past end range
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
What are some non-trauma reasons to order x-rays in a pt presenting with neck pain?
>50 with new sxs
mod-severe neck pain >6wks
progressive neuro findings
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?
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
(-) no pain with axial loading, neuro exam usually norm
Tx for cervical strain/sprain/whiplash?
soft cervical collars
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
Presentation of cervical facet dysfunction?
MC insidious onset
Sharp in c-spine
“Achey” in referral zone
Focal facet TTP
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
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
What can cause cervical radiculopathy?
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:
Typically resolve quickly
Disc bulge / herniation
May not present initially → serial exams important
As degree of narrowing increases potential for deficits increases
Tx of cervical radiculopathy?
anti-inflammatories: oral steroid
PT: cervical traction, postural education
Neuro/PMR consult if no getting better