Cervical Spine TBC 5

Question 1

Acute torticollis: What is it?

Answer 1

sustained involuntary contraction of neck muscles

Question 2

Acute torticollis: Typically unknown pathogenesis but two hypotheses (broad categories)

Answer 2

• Genetics
• Trauma

Question 3

Acute torticollis: Typically unknown pathogenesis but two hypotheses

Genetics

Answer 3

significant % of first degree relatives of pts with focal dystonia/tremor also have it

Question 4

Acute torticollis: Typically unknown pathogenesis but two hypotheses

Trauma: Prevalence of patients with cervical dystonia related to trauma is

Answer 4

15-21%

Question 5

Acute torticollis: AKA

Answer 5

• cervical dystonia
• spasmodic torticollis

Question 6

Acute torticollis: 75% of the time, pt presents with

Answer 6

• head rotation to one side
• pain

Question 7

Acute torticollis: types of spasms that may be present

Answer 7

• intermittent
• clonic
• tremulous

Question 8

Acute torticollis: In addition to pain and head rotation to one side, what may also be seen?

Answer 8

• lack of postural control
• spasms
• alterations in vestibular function and perception of body orientation

Question 9

Acute torticollis: How direction of torticollis named?

Answer 9

by direction of rotation

Question 10

Movement coordination impairments: chronicity

Answer 10

> 12 weeks

Question 11

Movement coordination impairments: management evidence

Answer 11

• coordination, strengthening, endurance exercises
• effective exercise methods: proprioceptive and dynamic resisted exercises
• strengthening of neck and shoulder muscles
• patient education and counseling
• stretching

Question 12

Pain control: may present with varying degrees of

Answer 12

• motion loss
• HA
• emotional disturbance
• cold hyperalgesia
• high disability score
• post-traumatic stress

Question 13

WAD: Strain results in

Answer 13

• secondary edema
• hemorrhage
• inflammation

Question 14

WAD: MOI

Answer 14

• MVA
• sports injury
• child abuse
• blow to head from falling object
• similar acceleration-deceleration injury

Question 15

WAD: most common symptoms

Answer 15

• sub-occipital HA
• pain that is either constant or motion induced

Question 16

WAD: May have delay in onset of symptoms up to

Answer 16

48 hrs

Question 17

WAD: In addition to delayed onset of pain, may also present with these symptoms

Answer 17

• cervical instability
• neuro symptoms
• dizziness
• tinnitus
• visual disturbances
• difficulty sleeping
• TMD
• difficulty with concentrating/memory issues

Question 18

WAD: acute

symptoms last no longer than

Answer 18

2-3 mos

Question 19

WAD: chronic symptoms last over

Answer 19

3 mos

Question 20

WAD: (%) recover within 6 mos

Answer 20

85%

Question 21

WAD: up to (%) turn into chronic

Answer 21

50%

Question 22

A level evidence:

To improve recovery in pts with WAD, clinicians should

Answer 22

1. educate pt that early return to normal, non-provocative, pre-accident activities is important AND
2. provide reassurance that good prognosis and full recovery commonly occurs

Question 23

WAD: treatment

AROM in this position

Answer 23

anti-gravity

Question 24

WAD: graded exercise progress to

Answer 24

more direct treatment

Question 25

**WAD:** Will require this type of approach overall

Answer 25

Multimodal PT alone often insufficient

Question 26

**WAD:** 9 predictors of chronicity

Answer 26

1. no post-secondary education 2. female 3. hx of neck pain 4. baseline neck pain intensity \> 55/100 5. neck pain at baseline 6. HA at baseline 7. catastrophizing 8. WAD grade 2 or 3 9. no seat belt use in collision

Question 27

**A level recommendation** **WAD:** Clinicians (should/should not) consider using cervical manipulation and mobilization procedures to reduce neck pain and headache.

Answer 27

should

Question 28

**A level recommendation** **WAD:** Clinicians should consider the use of these types of exercises to reduce neck pain and HA

Answer 28

* coordination * strengthening * endurance

Question 29

**Level of evidence:** * should consider use of UQ and nerve mobilization in pts with neck and arm pain * should consider cervical IMT combined with other interventions in pts with neck and neck-related arm pain

Answer 29

**B**

Question 30

**Level of evidence:** Centralization procedures (repeated motions) to promote centralization are not more beneficial in reducing disability when compared to other forms of interventions

Answer 30

**C**

Question 31

**Level of evidence:** Thoracic manipulation can be used for pts with primary complaints of neck pain and neck-related arm pain

Answer 31

**C**