Head and Neck common conditions Flashcards
(22 cards)
What are some pathoanatomical cervical conditions?
Headache:
- cervicogenic
- muscle tension
Spondylosis:
- cervical facet syndrome
- facet joint OA
- degenerative disc disease (DDD)
- Disc herniation
Radiculopathy & myelopathy
Cervical instability
Whiplash disorder (WAD)
What is the clinical presentation of cervicogenic headaches?
- unilateral pain (usually)
- pain in neck triggered by movement/sustained postures
- lying down alleviates symptoms
- reduced ROM
- possible reduced DCF strength
- probable poor posture
How does a migraine usually present?
- unilateral by may shift sides during attack
- begins in fronto-temporal region
- NOT triggered by movement palpation/position
- nausea frequently occurs
- usually no deficits in DCF endurance or cervical ROM
What is the clinical presentation of spondylosis?
used to describe varying levels of degenerative changes in spine
- most commonly found in C5-6, C6-7
- found more than 90% at 60+ years old
Presentation:
- gradual onset or neck/arm symptoms
- increased frequency or severity
- morning stiffness of neck, improving throughout day
- may present w/ acute stiff neck, cervical myelopathy, and VBI
What are some physical examination findings of spondylosis?
- reduced motion in sagittal plane
- decreased side bending
- capsular patern
- possible “giving way” or catch in movement
- radicular symptoms
What is zygapophysial joint dysfunction/cervical facet syndrome?
- acute cervical joint lock OR “wry neck”
- axial, unilateral pain
- can refer but NOT past shoulder
- MOI: sudden closing motion or sustained position
- palpation will be TTP just lateral to midline
- PA’s will be painful at level of dysfunction
confirmed by diagnostic intra-articular zygapophyseal joint injections
What is facet joint OA?
- facet joints showing signs of OA
- degenerative changes are present in asymptomatic patients -> these changes don’t always cause pain
What is DDD?
Degenerative Disc Disease:
- reduction of mucopolysaccharides in NP -> increase of collagen in NP -> loss of disc bulk
- leads to less shock absorption, more segmental mobility, facet compression, subluxation
What age and where are cervical disc herniations most common?
- Males in their 30’s
- most common at C5-6, C6-7
- less common than lumbar spine
What herniation causes the most symptoms?
- posterior and posterior-lateral herniations
- posterior-lateral will cause unilateral radiculopathy
- central may cause bilateral symptoms (myelopathy)
What is cervical radiculopathy?
- MOI: associated usually w/ degenerative changes or disc herniations
- usually unilateral pain/radiation
- pain radiates from the neck to the extremity
- pain, numbness, &/or weakness
What is cervical myelopathy?
- spinal cord compression due to compressive or tensile forces (UMN)
- normally insidious onset & s/s are variable
- referral back to MD is appropriate
What are signs of Myelopathy?
Early signs:
- gait disturbance
- clumsy hand syndrome -> bilateral hand atrophy
- Lhermitte’s sign
- spastic paresis (lower > upper)
- pluri-segmental sensory involvement
Drop attacks
Autonomic disturbances
Vertigo
What is the difference between Radiculopathy vs. Myelopathy?
Radiculopathy:
- unilateral weakness (NOT multilevel)
- unilateral sensation disturbance (dermatomal)
- +ULTT
- depressed DTR’s (single level)
Myelopathy:
- bilateral, multilevel weakness in legs &/or arms
- usually no sensory component in early stage
- hyper DTR’s
- UMN reflexes
What are the main signs of cervical instability?
- history of major trauma
- catching/locking/giving way
- poor muscular control
- excessively free/loose end feel (hypermobile)
- unpredictability of symptoms
- spondylolisthesis via MRI
What are whiplash associated disorders? (WAD)
- effects of sudden acceleration-deceleration forces on neck
- may result in bony or soft tissue injury
collision details show NO predictive ability in identifying poor outcome
What are the clinical findings of WAD’s?
- central nervous system signs
- periodic loss of consciousness
- pt does not move neck, even slightly
- painful weakness of neck muscles
- gentle traction and compression are painful
- severe muscle spasm
- complaints of dizziness
What are some sources of symptoms for WAD?
- soft tissue structures
- joint capsule & ligaments
- zygapophyseal joints
- central or peripheral neurologic systems
- intervertebral disc
- dorsal root ganglia
- vascular structures
- visceral structures
What are some prognostic factors for a poor outcome in those with WAD?
- risk factors for persistent problems
- high neck pain intensity
- high self-report disability (NDI)
- high post-traumatic stress symptoms
- strong catastrophic beliefs
- cold hyperalgesia
What is fatty infiltration in WAD?
- increase fatty infiltrates in cervical flexors and extensors found via MRI
What are some non-surgical medical interventions?
Injections:
- nerve blocks
- facet blocks
Radiofrequency ablation
Rehab implications
What are some surgical interventions?
- discectomy
- fusion (anterior cervical discectomy and fusion ACDF)
