Cervical Spine Syndromes

Question 1

lifetime prevalence of neck pain

Answer 1

70%

Question 2

trauma causes of cervical spine pain

Answer 2

Whiplash Associated Disorder (WAD): # VB, ligt sprain, muscular strain

Question 3

degenerative causes of cervical spine pain

Answer 3

Spondylosis
Spondylolisthesis,
Facet Joint arthrosis
Cervical Myelopathy
Discogenic Neck pain

Question 4

inflammatory causes of cervical spine pain

Answer 4

Ankylosing Spondylitis
Rheumatoid Arthritis

Question 5

other causes of cervical spine pain

Answer 5

mechanical - cervicogenic headache, TMJ dysfunction
Cervical artery dysfunction/vertebrobasilar insufficiecny
torticollis/dystonia
infections
tumours

Question 6

types of red flags in patients presenting with neck pain

Answer 6

vascular compromise
structural integrity
cord compromise

Question 7

causes of compromise in structural integrity of the cervical spine

Answer 7

Trauma
Cancer
Infection
Congenital anomalies
Inflammatory disorder
Metabolic disease

Question 8

symptoms of cord compression/cervical myelopathy

Answer 8

Hyperreflexia, (+) Babinski signs
Numbness in hands / feet
Weakness in legs (difficulty walking) & arms (difficulty using hands)
Ataxic gait
Bilateral limb pain

Question 9

symptoms of rheumatoid arthritis

Answer 9

Occipital numbness/paraesthesia, headaches, vertigo, tinnitus, visual disturbances

Question 10

biomechanics of whiplash

Answer 10

hyperextension and hyperflexion
sprain or strain of cervical tissue

Question 11

whiplash associated disorder definition - WAD

Answer 11

Whiplash is an acceleration-deceleration mechanism of energy transfer to the neck. It may result from motor vehicle collisions. The impact may result in bony or soft tissue injuries, which in turn may lead to a variety of clinical manifestations

Question 12

possible injuries in whiplash associated disorder - WAD

Answer 12

Ant. Long. ligt sprain
Disc pathology – cervical & lumbar (shear)
Articular facet capsule sprain
Nerve root traction injury (especially side-on impact)
Muscle strains – SCM, longus colli, Scalenes etc.
fracture/dislocation

Question 13

symptoms of whiplash associated disorder - WAD

Answer 13

Headaches
Pain in the Shoulders and Arms
Dizziness
Altered sensation (P&N) or numbness
Motor weakness
Visual and auditory symptoms
Dysphagia
TMJ pain
Concentration difficulties (cognitive function)

Question 14

Classification of whiplash associated disorder - WAD

Answer 14

grade 0 = no complaint about neck, no physical signs
grade 1 = neck pain, stiffness or tenderness. no physical signs
grade 2 = neck complain + MSK signs e.g reduced ROM, tenderness
grade 3 = neck plaint + neurological signs e.g. reduced or absent DTR, weakness and sensory deficits
grade 4 = neck complaint + # or dislocation

Question 15

risk stratification of whiplash associated disorder

Answer 15

age under 36 = low risk, predicted full recovery
of any age with hyperarousal = medium risk
above the age of 35 and no hyperarousal = high risk

Question 16

clinical pattern in postural neck pain

Answer 16

mild to moderate pain
fine in the a.m worse in the EOD
aggravating factors - sustained load e.g computer/desk or repetitive tasks
stretching massage, heat helps
deep neck flexors weak
trapezius and levator scapula tight
tight pectorals
weak rhomboids and serratus anterior

Question 17

physical exam for patient with postural neck pain

Answer 17

ROM
PPIVMs
PAIVMs
PNF
Muscle length tests
Muscle control
DNF

Question 18

clinical pattern for acute locked neck

Answer 18

Sudden onset
sudden movement – instant pain
AM
Pt ‘stuck’ in side flexion +/- flexion = Position of Ease
Most common level C2/3
all movements pain (ext & ipsi LF) + regional spasm ++
Theories
Meniscoid entrapment / extrapment in facet joint
Natural Hx: spontaneous recovery over few days

Question 19

clinical pattern of cervical spondylosis

Answer 19

Central / unilateral neck pain +/- arm pain +/- radiculopathy
Pain worse EOD
Stiffness worse a.m.
PAIVM – hypo not reactive

Question 20

headache classification

Answer 20

migraine
tension type
cervicogenic headache

Question 21

features of migraine

Answer 21

builds to crescendo
headache before neck pain
photophobia
aura may precede

Question 22

features of tension type

Answer 22

bilateral tightening pain
not aggravated by physical
activity
no associated symptoms

Question 23

subjective findings of cervicogenic headache

Answer 23

unilateral/dominant side
neck/suboccipital pain
neck pain before headache
commonly moderate
other symptoms e.g. nausea, dizziness, visual disturbance
reduced functional ROM
Painful segmental dysfunction C0-3
reduced AROM flex/ext
muscle tightness
reduced DNF muscle control

Question 24

clinical pattern discogenic neck pain

Answer 24

wok hx - prolonged cervical flexion, cumulative, traumatic
disc herniation
often causes pain

Question 25

signs of cervical radiculopathy

Answer 25

varying degrees of sensory,
motor and reflex change
dysesthesias
paresthesias related to nerve root(s) without evidence of spinal cord dysfunction (myelopathy)
radiating pain in arm with motor reflex and/or sensory changes

Question 26

diagnostic criteria for cervical radiculopathy

Answer 26

Positive ULNT1
Positive Spurling’s A test
Limited cervical rotation to affected side (<60degs)
Positive distraction test
Positive arm squeeze test