Cervicothoracic Spine II

Question 1

What condition creates “muddying of sensation”

Answer 1

Nociplastic pain

Question 2

What are some neck pain functional questionaires?

Answer 2

General - Neck Disability Index (NDI)
Whiplash Associated Disorder (WAD)

Question 3

What percentage of people will experience neck pain?

Answer 3

70%

Question 4

What percentage of people will experience PERSISTENT neck pain?

Answer 4

33-44%

Question 5

What is the cost of neck pain second to?

Answer 5

Worker’s comp costs

Question 6

Which population experiences neck pain more?

Answer 6

Women

Question 7

Is neck pain more common in older or younger people?

Answer 7

Older

Question 8

What part of the spine has the smallest amount of spine related pathology?

Answer 8

Thoracic

Question 9

What are the strongest risk factor for Neck pain?

Answer 9

Female
HX of neck pain

Question 10

What are some other risk factors for neck pain?

Answer 10

Over 40 years of age
Coexisting LBP
Regular cycling
Hand weakness
worrier
poor quality of life
low vitality
high job demands
smoking
low social/work support

Question 11

What is the etiology of neck pain?

Answer 11

Most often unidentified
- typically Mechanical Neck Disorder
- Nerve root compromise

Question 12

What is the functional range of motion for extension of the neck?

Answer 12

50-70 degrees to look up

Question 13

What is the functional range of motion for rotation of the neck?

Answer 13

60-70 degrees for driving
full is 70-90

Question 14

What are signs and symptoms of neck pain?

Answer 14

Varied
patterned
impaired scapular mechanics

Question 15

What does imaging fail to do?

Answer 15

identify symptomatic structures

Question 16

What are MRIs good at finding?

Answer 16

asymptomatic MRI findings in the neck
-50-73% with bulging and herniated discs
-94% annular tears
-13% cord compression

Question 17

What is not good about tests and measures for neck pain?

Answer 17

Poor screening tools and lack diagnostic accuracy

Question 18

Why are JMs recommended for neck pain?

Answer 18

JM to modulate neck muscle function, increase deep muscle recruitment, reduce superficial muscle recruitment

Question 19

What are JMs more effective than?

Answer 19

PCP or non-manual Rxs

Question 20

Why are Cervical Manipulation CPRs helpful for neck pain?

Answer 20

predict success

Question 21

Name some CPRs for neck pain?

Answer 21

Bilateral involvement
Sedentary work more than 5 hours a day
feeling better with movement
extension does not increase symptoms
OA without radiculopathy

Question 22

What are the MOST RECENT CPR for cervical pain?

Answer 22

Symptoms over 38 days
less than 10 degrees difference in rotation
pain with PA springs

Question 23

What are some Thoracic manipulation CPRs?

Answer 23

Symptoms over 30 days
No symptoms distal to shoulder
Extension does not increase symptoms
Fear avoidance beliefs questionnaire under 12
Diminished T3-5 kyphosis
Cervical extension less than 30 degrees

Question 24

What kind of neck pain is MET effective on?

Answer 24

Acute and persistent neck pain

Question 25

What kind of METs should we prescribe for nociplastic pain?

Answer 25

Motor control and strengthening exercises for stabilization 30-60 minute sessions 2-3 x a week 7-12 weeks

Question 26

What should our METs for cervicothoracic spine focus on?

Answer 26

Local and global muscle training

Question 27

Is there strong evidence for MET for cervicothoracic spine?

Answer 27

Yes

Question 28

What are the parameters for METs for cervicothoracic spine?

Answer 28

8-12 visits 2x a week for 6 weeks led to benefits that lessened by 6 months 3x a week over 1 year was till good at 3 years

Question 29

Is stretching beneficial in isolation?

Answer 29

NO Needs to be combined with MET

Question 30

Are modalities recommended for cervicothoracic pain?

Answer 30

Current evidence is lacking, not recommended

Question 31

Is pt education/counseling effective for cervicothoracic pain?

Answer 31

YES - strong evidence - early movement without provocation -reassurance of good prognosis and full recovery

Question 32

What is the prognosis for ACUTE neck pain?

Answer 32

mild problems with rapid recovery (~45%) moderate problems with incomplete recovery (~40%) severe problems and no recovery (~15%)

Question 33

What are some indications for a worse prognosis of neck pain?

Answer 33

Pain over a 6/10 NDI less than 30% Pain catastrophizing Post traumatic stress cold hypersensitivity

Question 34

Why are major limitations of pharmaceuticals important?

Answer 34

Lack of replications of findings, creates inconsistent results

Question 35

Are epidural injections effective?

Answer 35

Limited evidence of effectiveness

Question 36

Are NSAIDs effective for neck pain?

Answer 36

NO - limited evidence of effectiveness