Common Cervical Conditions

Question 1

• 47 y.ol male construction worker
• PMH 2 knee surgeries and shoulder surgery
• History of several MVA including 1 roll over accident after drinking
• tingling and numbness in his pinky and ring finger that has worsened since he has been working at the power plant on his latest job assignment

Answer 1

• Cervical Radiculopathy
• Cervical Disc Herniation
• Cervical Disc Bulge

Question 2

Treatment for Radiculopathy, Herniation, or Bulge

Answer 2

• Traction
• Nerve flossing
• Thoracic Spine Mobs
• Core strengthening
• Neuro based exercises

Question 3

Diagnose:

• BP = 160/95
• Resting Pulse >100
• Resting Respiration >25
• Fatigue
• Temp >100 F

Answer 3

Not mechanical

Systemic Inflammation or Systemic Disease Process

Question 4

Diagnose:

• Hand wasting of intrinsics, thenar, or hypothenar eminence
• Unsteady Gait
• Bowel or Bladder disturbances
• Arm Weakness

Answer 4

• Cervical Myelopathy

- Carpal Tunnel

Question 5

Treatment for Myelopathy or Carpal Tunnel

Answer 5

• Functional training
• Nerve glossing/gliding
• Stretching

Question 6

Diagnose:

• pain and muscle stiffness following hit in football game
• difficulty turning head and looking down
• HA

Answer 6

Whiplash
Cervical Hyperextension injury
Sprain Strain

Question 7

Treatment for Whipslash

Answer 7

Neuro based exercises
Thoracic Mobility exercises
Post concussion management
Challenge their balance
Work on core work
Soft tissue techniques

Question 8

Diagnose:

• PMH: osteoporosis
• sharp pain
• AROM is extremely guarded and limited
• fell in bathroom last night and hit tub with crown of her head

Answer 8

R/O fracture (jeffersons fracture)

Question 9

Diagnose:

• job: administrative assistant
• pn is worse at end of week and better after doing yard work over weekend
• walking relieve’s symptoms
• knots in shoulder and back

Answer 9

Fibromyositis
Postural related myalgia syndromes
Cervical Trigger point referred pain
“Tech Neck”

Question 10

Treatment for Tech Neck

Answer 10

Trigger point treatments (dry needling, ART)
Joint Mobs
Postural education
Thoracic spinal exercises (increase ext and mobility)

Question 11

Diagnose:

• bilateral/quadrilateral limb paresthesia affected by neck movements
• Hyperreflexia
• Clonus
• +Babinski or Hoffman’s

Answer 11

Cervical Cord Compression

Question 12

Diagnose:

• 17 YOF
• severe neck pn (12/10)
• cannot move her head in any direction
• denies trauma or fall
• Was fine when she went to bed last night

Answer 12

Cervical Acute Torticollis

Pseudototicollis

Question 13

Treatment for Torticollis

Answer 13

• MFR for muscle spasms
• Joint mobs if tolerated
• Trigger point treatment
• modalities for pn
• Tractions

Question 14

Diagnose:

• chronic neck pn
• denies neuro signs
• No weakness
• Mild trigger point tenderness
• palpation does not replicate
• Burning/deep ache that is not pinpointed
• Compression test worsens pn

Answer 14

Facet Syndrome
Annular tear
Internal Disc Derangement

Question 15

Treatment for Facet Syndrome

Answer 15

• Joint Mobs, HVLA
• Traction
• Core Strengthening
• Neuro based exercises
• Thoracic Mobility exercises

Question 16

Diagnose:

• mod sized lump under his SCM/jaw line
• Chronic neck/back pn
• Difficulty sleeping at night
• Choking

Answer 16

Refer out for CA testing

non-organic, non-mechanical

Get lymph nodes looked at

Question 17

Diagnose:

• HA that radiates to back of head
• Symptoms worse over last 2 mo
• pt getting divorced
• 2 children
• Denies arm sx
• vomited 2 days ago
• Better w/ exercise or massage

Answer 17

Upper trap = HA
Stress HA
Fibromyositis

Question 18

Treatment for stress HA/fibromyositis

Answer 18

• Soft tissue techniques
• Joint mob
• Trigger point therapy
• Postural reeducation
• neuromuscular reed

Question 19

Diagnose:

• 50 y.o. pt
• constant pn over last 4 mo
• pn is worse at night
• most of eval causes discomfort
• lack consistent capsular patterns

Answer 19

r/o CA

Question 20

Diagnose:

• 60 YOF
• Mild moderate ache in biceps and neck/upper trap
• Worse at night
• Difficulty sleeping
• Difficulty reaching behind back and across shoulder
• Worse when looking up or reaching overhead

Answer 20

Shoulder OA

Cervicobrachial syndrome

Question 21

Treatment for OA

Answer 21

treat shoulder
-Isometrics, mobs, scap stabs, RTC reed, inhibit upper traps
Treat C-spine

Treat whole body

Question 22

Diagnose:

• 48 YOF
• c/o HA
• PMH: MVA 15 years ago
• TMJ
• Spousal abuse
• Distraction causes pn & Compression causes pn

Answer 22

Cericogenic HA
Migraine HA
Muscular referred pn

Question 23

Contraindications for Manual Therapy

Answer 23

• Joint hypermobility/instability
• Joint inflammation or effusion
• Hard end-feel
• Medically Unstable
• Acute pn that worsens with repeated attempts
• Acute radiculopathy
• bone disease
• detectable fracture
• Spinal arthropathy
• Deteriorating CNS pathology
• Post-joint fusion
• Blood clotting disorder

Question 24

Precautions to Manual Therapy

Answer 24

• Malignancy
• Total joint replacement
• Bone disease not on radiograph
• Connective Tissue Disorder
• Pregnancy/involving pregnancy
• Recent trauma/cauda equina
• early healing phase
• unable to communicate
• psychogenic pt
• long-term use of corticosteroids
• skin rashes/open wounds
• eleveated pn levels

Question 25

Red Flags

Answer 25

• unexplained weight loss
• Compromise to multiple spinal nerve roots
• Gradual increase in pn over time
• Regional expansion of pn
• Spasms with PROM
• Visual disturbances
• painful and weak resistive testing
• Hoarseness
• Limited scapular elevation
• Horner’s Syndrome
• T1 palsy
• Arm pn

Question 26

Yellow Flags

Answer 26

• Recent trauma
• Acute capsular patterns
• Severe movement loss
• Strong spasms
• Paresthesia
• Segmental paresis
• UMN signs and symptoms
• continuous pn
• Hx of LLOC
• Memory loss/forgetfulness
• Problem solving difficulties
• Reduced motivation
• Irritability
• anxiety/depression
• insomnia