Clinical Presentation of Cervical Spine Flashcards
(111 cards)
1
Q
Name the 4 categories of neck pain
A
- neck pain w/ mobility deficit
- w/ headache
- w/ movement coordination impairment
- w/ radiating pain
2
Q
If an individual has neck pain with mvmt coordination impairment, in which aspect of the ROM will they have pain?
A
they will have pain throughout the entire ROM
3
Q
When moving the neck, motion occurs all the way to which thoracic vertebrae?
A
T4 - therefore upper thoracic mobility is important for patients with neck pain
4
Q
Questions to ask if patient had a trauma
A
loss of consciousness, seatbelt, speed and direction
5
Q
Special questions
A
functional/comparable postures (have pt demonstrate)
sleep position
headaches
strength changes
6
Q
What are the 3 components of irritability?
A
- vigor
- severity
- duration
7
Q
Name the red flags
A
constant pain night pain/sweats increase in symptoms w/ cough/sneeze extremity weakness bilateral UE sx LE sx signs/sx of VBI
8
Q
4 categories of red flags
A
- non-musculoskeletal
- vertebrobasilar injury
- cranio-vertebral ligament injury
- Cervical myelopathy (cord damage)
9
Q
Vertebrobasilar Artery Insufficiency (VBI) causes
A
compromised blood flow to the brainstem caused by atherosclerosis, stenosis, or trauma
may result in brain stem ischemia
10
Q
VBI problem area
A
Acute angle C1 to foramen magnum (between C1 and C2)
rotation to the contralateral side will lengthen the artery and occlude it
11
Q
VBI most common in:
A
patients with neck pain and history of trauma
12
Q
Vertebrobasilar artery insufficiency can be diagnosed via:
A
5 D’s and 3 N’s (gold standard = ultrasound doppler)
13
Q
5 D’s of VBI
A
dizziness drop attack diplopia dysarthria dysphagia
14
Q
3 N’s of VBI
A
numbness
nausea
nystagmus
15
Q
drop attack
A
patient loses muscular control of legs due to artery occlusion and they fall down but do not lose consciousness
16
Q
diplopia
A
double vision
17
Q
dysarthria
A
slurred speech
18
Q
dysphagia
A
difficulty swallowing
19
Q
nystagmus
A
eyes drift back and forth
20
Q
“and” of 5D’s and 3N’s of VBI
A
ataxia (abnormal gait)
21
Q
Cranio-vertebral ligament injuries are due to what and involve which 3 ligaments?
A
due to trauma or disease process
- alar ligament
- transverse ligament
- tectorial membrane
22
Q
Alar ligament
A
runs from dens to occiput
23
Q
transverse ligament
A
holds dens (c2) against C1
24
Q
Tectorial membrane
A
attaches head to neck, continuation of anterior longitudinal ligament, prevents head from rolling forward
25
cranio-vertebral ligament injuries
risk to brain stem and upper cord, may be associated with dens fracture, may require surgical fixation
require radiographs with mouth open to see dens
26
signs/symptoms of cranio-vertebral ligament injuries
5D's and 3N's as well as mouth/lip numbness and feeling of lump in throat
27
atlanto-axial interval
space between dens and atlas
28
Cervical myelopathy
upper motor neuron lesion (injury to spinal cord)
29
signs/symptoms of Cervical myelopathy
UMN signs
spasticity, hyperreflexia, visual/balance disturbances, ataxia, bowel/bladder changes
multi-segmental paresthesia
tests = babinksi, clonus, hoffman's
30
4 common clinical presentations (categories from the guide to be used in documentation)
1. impaired posture
2. connective tissue dysfunction
3. localized inflammation
4. referred pain syndromes; peripheral nerve entrapment
31
Impaired posture
muscle imbalances
- can be neck pain with headache or neck pain with movement coordination impairment
- check head on neck posture, thoracic posture, shoulder posture, etc
32
Muscle imbalances
muscle pain, tightness, trigger points (treat with SCS!)
33
examination for muscle imbalances
posture
muscle strength
muscle length
palpation
34
most common impairments (muscle) in the neck are located in which muscle group?
deep neck flexors
35
local vs global muscles
local muscles act on segments (segmental control) while global muscles do not have segmental control
36
Trap and SCM working together =
head on neck stability
37
if the trap dominates, what force occurs on the neck?
anterior shear
38
SCM and trap
global muscles; neither has segmental control on neck
39
longus capitis and longus colli
local muscles, provide stability for neck at the segmental level
40
suboccipital muscles
tight = neck will be extended
| compensation for this is lower cervical spine will flex
41
Upper crossed syndrome
line of weakness and tightness
tight pecs, traps, levator scap
weak neck flexors, rhomboids, serratus anterior
42
upper crossed syndrome
tightness causes shoulder elevation and scapula protraction
| inhibited deep neck flexors and lower scap stabilizers
43
Connective tissue dysfunction includes which 4 things?
1. zygapophysial/facet joint dysfunction
2. cervical spondylosis
3. IV disc
4. acute torticollis
44
Zygapophysial facet joints: typical cervical vertebral joints
close packed position = extension
facet glide during cervical ROM
disc compression/distraction
if facet issue, will have pain with extension
45
Motion of typical cervical vertebral joints: flexion
superior segment moves anteriorly and superiorly
46
Motion of typical cervical vertebral joints: extension
superior segment moves posteriorly and inferiorly
47
Motion of typical cervical vertebral joints: side bending (lateral flexion)
ipsilateral side closes and contralateral side opens
48
Motion of typical cervical vertebral joints: rotation
depends
49
retraction/protraction
don't use as strengthening exercise!
50
coupled motion of typical cervical vertebrae
side bending (LF) and rotation occur in the SAME direction, regardless of the position
51
Atypical cervical vertebrae
OA joint
52
what motion occurs at OA joint?
flexion/extension
53
flexion at the OA joint is limited by what structre?
dens at foramen magnum
54
extension at the OA joint is limited by what structure?
bony approximation
55
what is the coupled motion at the OA joint? (atypical vertebrae)
side bending (LF) and rotation occur in OPPOSITE directions
56
OA =
occiput and C1
57
motion at AA joint (c1/c2)
rotation!
58
what is the reason for the rotation at the AA joint?
convex on convex movemnt (bi-convex)
| roll without glide!
59
Uncinate Processes
posterolateral
from uncovertebral joints or joints of Luschka
develop between age 6-9
degenerate early due to shear forces from rotation
60
neck pain with mobility deficit =
joint hypomobility
61
Facet joint dysfunction can be due to what 3 things?
trauma, degeneration, or insidious onset
62
Facet joint dysfunction
can refer pain - diagnostic blocks
pain is sharp and localized but can also be diffuse
pain between shoulder blades could be C4,5,6,7
63
Cervical Spondylosis
degenerative changes of disc, vertebrae, facets, or uncinate processes
nerve root compression, edema, cord compromise
64
cord compromise in cervical spondylosis occurs because of what?
facet hypertrophy which causes stenosis and therefore cord compression
65
Presentation of cervical spondylosis
stiffness, diffuse pain, dull ache, pain with movement, accessory motion limitations
66
Capsular Pattern : Bilateral at OA joint
equal limitation in extension and LF
67
capsular pattern: bilateral at typical vertebrae:
extension is most limited, follwed by equal limitations in rotation and LF
68
capsular pattern: unilateral at OA joint
contralateral LF is limited
69
capsular pattern: unilateral at typical vertebrae
contralateral LF and rotation are limited
70
capsular pattern
a pattern of limitation in those with degenerative changes
71
Central stenosis
cord compromise
| degenerative!
72
lateral stenosis
nerve compromise
73
Stenosis
narrowing laterally in IV foramen where nerve exits
| centrally in spinal canal
74
presentation of stenosis
sx of nerve/cord compression depending on degree of narrowing
75
stenosis can be caused by:
tumor, degeneration, or disc herniation (herniation is usually lateral)
76
68 yr old with neck stiffness and ache. gradual onset over past 3 months, AROM limited and painful into extension and rotation bilaterally
spondylosis! due to age, stiffness and ache
77
IV Discs
gelatinous nucleus pulposus becomes fibrous early
| peripheral annulus fibrosus; concentric rings alternate direction
78
IV discs make up what % of the height in the c spine?
25 %
79
IV discs
no disc at OA joint
smaller than discs in vertebral bodies
thicker anteriorly than posteriorly!
contact uncinate processes laterally
80
IV discs are stressed via
rotation
81
IV disc dysfunction is caused by which 3 things/causes which 3 things?
1. disc herniation
2. disc degeneration
3. rim lesions
82
the cervical spine is built for:
mobility (this is why IVD are not as large as in lumbar spine)
degenerate sooner than in lumbar spine
83
Disc herniation subjective findings
scapular, paraspinal sx with or w/o neck pain
| pain increases w/ sustained postures and is better with activity
84
disc herniation examination findigns
relief with traction
pain with compression
pain with repeated flexion
possible neuro signs
85
most common location of disc herniation in cervical spine
C5/C6 because it is a common spot for hypermobility, causing shear forces in this area
86
Disc herniation pain
discs can refer pain - if disc herniates and compresses nerve, referral pattern will follow nerve not disc
87
DDD (disc degeneration)
spondylosis
in youth, proteoglycans and H2O are abundant
nucleus begins to resemble annulus and loses height
88
Disc herniation treatment
traction, posture, muscle imbalance
| eval = neuro, flexibility, strength
89
goal of treatment for DDD
unload disc and increase mobility
| same interventions as disc herniation
90
Rim Lesion
horizontal annular tear at anterior vertebral rim, w/o tearing the anterior longitudinal ligament
often a multisegmental injury
poor prognosis
91
rim lesions most often occur due to
hyperextension trauma - whiplash = most common
92
Predisposing factors to rim lesions
extension trauma
MVA hit from behind/poor headrest position
forward head posture
93
S/S of rim lesion
fear of movement
immediate pain after impact
highly irritable neck
same sx with compression and distraction!
difficulty lifting head off pillow (flexion)
94
Rim lesion xray
xray will appear normal, MRI must be done
95
rim lesion: avoid __?
extension
96
treatment for rim lesion
start with eye mvmts, isometrics, neurodynamics, leg/arm movemnts
97
Acute torticollis
contracture of SCM
98
Localized inflammation
whiplash-associated disorders (WAD) = an acceleration-deceleration mechanism of energy transfer to the neck
99
Prognosis in WAD
higher initial NDI score = higher likelihood of developing chronic neck pain
100
higher NDI score at 2-3 yrs post- injury is associated with what 4 things in those with WAD?
1. higher initial NDI score
2. older age
3. cold hyperalgesia
4. higher post-traumatic stress symptoms
101
what to exam for acute vs chronic
```
cranio-vertebral ligaments
vascular structures
soft tissue
joints
IVD
nerves
```
102
Referred pain syndroms: peripheral nerve entrapment includes what 2 things?
1. radiculopathy
| 2. thoracic outlet syndrome
103
Referred pain syndroms: peripheral nerve entrapment
pain relieved with distraction
examine ROM, sidebending, extension
treatment = traction and nerve mobs
classification = neck pain with radiating pain
104
Cervical nerve roots
exit laterally from spinal canal
| IV foramen widens w/ flexion and narrows with extension!
105
Cervical radiculopathy
irritation of sensory nerve root causing pain and or paresthesia in the distal part of the dermatome
106
cervical radiculopathy clinical presentation
unilateral symptoms
neck/shoulder/arm/hand symptoms
worse with movements that narrow foramen (compress nerve)
examine sensory, motor, reflex changes
107
intervention for cervical radiculopathy
unload nerve, ROM to open forament
108
cervical radiculopathy sx are worse with
ipsilateral side bending and extension
109
Radiculopathy is present if these 4 s/s are present (tests are positive)
1. nerodynamics
| 2. cervical rotation towards painful side is limited to
110
Spurling test
compression test -- positive = pain increases with compression (closing lateral foramen)
111
Distraction test
positive = nerve pain in arm decreases with distraction
