Cervical Spine Flashcards

1
Q

Cervical strain/sprain injuries are usually combined injuries involving…

A

Ligamentous structures

Cervical musculature

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2
Q

What are some causes of cervical strain/sprain?

A

Forced mvmt past end range

Sudden contraction

Violent high velocity mvmt

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3
Q

Presentation of cervical strain/sprain?

A

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

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4
Q

PE findings in cervical strain/sprain?

A

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

ROM limitations

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5
Q

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

A

> 50 with new sxs

constitutional sxs

mod-severe neck pain >6wks

progressive neuro findings

infectious risk

hx of malignancy

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6
Q

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

A

Canadian C-spine rules**

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

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7
Q

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

A

> 65

dangerous mechanism of injury

paresthesias in extremities

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8
Q

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?

A

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

(if able= no x-ray)

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9
Q

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

A

muscle strain/ligament sprain

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10
Q

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

A

muscle spasm

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11
Q

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

A

NO

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

check spurling’s test

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12
Q

Why would you perform a spurling’s test?

How is this performed?

A

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

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13
Q

How do whiplash injuries occur?

A

sudden movement of the neck

MC stopped vehicle that is rear-ended

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14
Q

classic presentation of whiplash injury?

A

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

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15
Q

PE findings in pt presenting with whiplash?

A

TTP over involved muscle, facet joint and/or ligaments

ROM limitations

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

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16
Q

Tx for cervical strain/sprain/whiplash?

A

soft cervical collars

NSAIDS

muscle relaxers

  • Cyclobenzaprine
  • Metaxalone
  • Carisoprodol (Soma)

cervical pillow

Heat or ice

PT

17
Q

What is cervical facet dysfunction?

A

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

18
Q

What causes cervical facet dysfunction?

A

Prolonged positional stress

Traumatic injury

19
Q

Presentation of cervical facet dysfunction?

A

MC insidious onset

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

Focal facet TTP

ROM limitations

20
Q

What ROM limitations are seen in cervical facet dysfunc?

A

Ipsilateral → sharp pain which significantly increases with added cervical extension

Contralateral → tightness

21
Q

Tx of cervical facet dysfunc.?

A

NSAIDS & muscle relaxers

early referral to PT/DC/DO

22
Q

What is a complication of cervical manipulation?

A

Cerebral artery occlusion / dissection

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

23
Q

What is cervical radiculopathy?

A

Neurogenic pain in the distribution of cervical root(s)

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

24
Q

what are some causes of cervical radiculopathy?

A

Traumatic stretching of nerve root / brachial plexus

Cervical disc bulge / herniation (young & old adults)

Cervical foraminal narrowing (older adults)

25
Q

How do brachial plexus injuries occur?

A

sports: stretching, trauma, compression

child birth

26
Q

What can cause cervical radiculopathy?

A

herniated disc

bone spurs

thickened ligamentum flavum

27
Q

Presentation of cervical radiculopathy?

A

abrupt onset: young or old

gradual onset: old

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

28
Q

What neuro deficits can be seen in cervical radiculopathy?

A

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

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

Foraminal narrowing
As degree of narrowing increases potential for deficits increases

29
Q

Tx of cervical radiculopathy?

A

1st x-rays,

anti-inflammatories: oral steroid

PT: cervical traction, postural education

Neuro/PMR consult if no getting better

30
Q

What is cervical spondylosis?

A

Degenerative disease:

  • Osteophyte formation
  • Ligamentum flavum thickening
  • Disk space narrowing
  • Vertebral subluxation

problem that affects the spinal cord itself

31
Q

What cervical levels are MCly affected by cervical spondylosis?

A

C5-C6

C6-C7

32
Q

Presentation of cervical spondylosis?

A

Progressive ROM loss / stiffness

Pain is intermittent at initial onset but can become chronic: aching neck/shoulder/upper back pain

Cervical crepitus

Focal or defuse tenderness along spinous processes and facet joints

33
Q

sxs of myelopathy?

A
  • Weak hands / atrophy of hand musculature
  • Leg weakness
  • Unsteady gait
  • Loss of bladder control
  • Hyper-reflexia
  • Lhermitte’s sign
34
Q

What is Lhermitte’s sign?

A

Electric shock-like sensation down the center of the back following flexion of the neck

35
Q

Tx of cervical spondylosis?

A

NSAIDS

Duloxetine (Cymbalta)

Amitriptyline- may help with sleep

Neurontin (gabapentin)

NO narcodics

others: cervical pillow, PT, surg