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becky: MSK UQ > LECTURE 3: Cervical Spine > Flashcards

LECTURE 3: Cervical Spine Flashcards

1
Q

2 main big picture goals for cervical interventions

A
  1. improve pain/reverse dysfunctions
  2. prevent happening again/chronicity
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2
Q

Acute phase goals:

A

*encourage patient to perform ADLs as tolerated!
*absence from abuse recommended (gentle ROM)

-increase pain free ROM
-regain soft tissue extensibility (decrease guarding)
-regain NM control
-confidence, reassurance that spine is meant to be resilient

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3
Q

Acute phase intervention: what should we do?

A
  1. move ASAP!
  2. manual therapy EARLY to t-spine
  3. walking
  4. global strength, postural re-ed
  5. modalities in the beginning (not a lot of research, but good for patient buy in)
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4
Q

cervical collars research: are they good?

A

may delay recovery
BUT, collar can be necessary if patient has SEVERE CAPSULAR RESTRICTION (severe injury or surgery)

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5
Q

subacute phase goals:

A

*should have big decrease or no pain, full painfree ROM
*posture stabilization, retrain entire spine
*full body integration
*ergonomic work changes
*overall strength/CV

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6
Q

What is the phase that is critical in preventing chronicity and disability?

A

sub-acute phase

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7
Q

what is VITAL for successful outcomes in subacute phase?

A

CATEGORIZE AND RECATEGORIZE
*need to monitor and check/change buckets as needed

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8
Q

In what phase are we paying attention to: what activities does the patient need to return to?

A

sub-acute phase
*work towards specific goals! functional training

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9
Q

chronic phase approach for neck pain

A

*need to use a multi-modal approach for tailoring to patient needs
*CBT, aerobics, meds, etc, YELLOW FLAGS

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10
Q

What are the 4 buckets for neck pain CPG?

A
  1. neck pain w/ mobility deficits
  2. movement coordination impairments
  3. neck pain w/ HAs
  4. neck pain w/ radiating pain
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11
Q

Neck pain w/ Mobility Deficits

A
  1. motion will CONSISTENTLY reproduce pain at end range AROM/PROM
  2. limit in ROM
  3. restricted cervical + thoracic mobility (stiff joint mobs)
  4. referred pain/neck pain w/ joint mob
  5. lack in cervico-scapulo-thoracic strength/NM control (in sub-acute, chronic cases)
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12
Q

CPG for ACUTE neck pain with mobility deficits

A

B: T-spine HVLAT
C: Cervical mobs or HVLAT (C: no diff in strength of evidence)

B: Cervical ROM ex’s, scapulothoracic strength, UE strength

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13
Q

WAD: neck pain with movement coordination impairments common signs and symptoms

A

-trauma or whiplash MOI or
-hypermobility general no clear MOI
may have associated concussive signs and symptoms

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14
Q

expected exam findings for movement coordination impairments

A

+ CCFT
+ neck flexor mm endurance test (30 sec-45sec)
+ pressure aigometry

-strength and endurance deficits
-neck pain w/ mid range motions, worsen at end range (transitioning)
-trigger points/tenderness
-sensorimotor impairments may include altered mm activation patterns, proprioceptive deficits, postural balance/control
-neck pain and referred pain w/ joint mob

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15
Q

what is important/recommended for WAD?

A

MANUAL + EX + ED
patient ed: stay active, recovery expected in 2-3 months
*pain free neck ROM ex (especially flexion, rotation)
*isometrics can be good to start
*strengthening scaps, extensors, general conditioning

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16
Q

Neck pain with headaches (cervicogenic) looks like:

A

FACET DYSFUNCTION
1. noncontinuous, unilateral neck pain + HA
2. comes and goes w/ activity, mid-range pain

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17
Q

neck pain w/ headaches: expected exam findings

A

+ cervical flexion rotation test (AA joint)
-HA w/ provocation of involved upper cervical segments C1-3
-OA, AA joint or C2-C3

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18
Q

CPG recommendation for neck pain w/ HAs

A

Active mobility/ROM ex’s
Self SNAGs to AA joint
Cervical HVLAT/mob
T-spine HVLAT
Manual therapy + scapulo-thoracic strength and endurance training

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19
Q

cervicogenic HAs often occur in patients w/ deficits in:

A

OA
AA
C2-C3

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20
Q

PTs mainly treat which 2 types of headaches?

A
  1. cervicogenic
  2. tension
    (migraines and cluster are mainly pharmacological)
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21
Q

which is the only bilateral headache?

22
Q

CPGs for HEADACHES w/ evidence level

A

acute: B=active mobility ex
acute: C= self SNAG

subacute: B: c-mobs
subacute: C= self SNAG

chronic: B= c-spine mob, shoulder and neck exercises

23
Q

neck pain w/ radiating pain symptoms

A

8-12 pain person
-neck pain w/ radiating pain in UE (narrow band of lancinating)
-UE positive neuro exam
(dermatomes, maybe myotomal, reflex)

24
Q

exam findings: neck pain w/ radiating pain

A

+ CPR: ULTT, reproduced w/ ROM, Spurling, Compression/distraction (usually 2 or 3)

positive neuro exam
deficits associated w/ nerve root

25
neck pain w/ radiating pain recommendations:
-side glides MT -cervical strengthening and CT mobility/strengthening -Laser therapy -Cervical collar for short term -Intermittent cervical traction, Manual or mechanical -Pt education for occupational and exercise activities
26
CPR for use of T spine thrust manip
1. Symptoms <30 days 2. No symptoms distal to shoulder 3. Looking up 🚫 aggravate symptoms 4. FABQ physical activity score <12 5. Diminished upper thoracic spine kyphosis 6. Cervical extension ROM <30º 3 or more: increase chance of positive outcome by 86%
27
Sequencing of manual therapy interventions for neck pain:
1. Rx out t-spine hypomobility/ dysfunction 2. Start lower cervical/C-T junction and work superiorly
28
Is there a superior type of exercise for patients with chronic neck pain? NO
Strengthening Stretching NM control Proprioception Balanced Physical activity Yoga/Pilates/Tai Chi/Qigong Strength + NM control Strength + stretching Physical activity + strengthening Multi-modal
29
cervicogenic headache recommendations:
1. manual therapy short term 2. neck exercise long term Cervicogenic HA = ram’s horn presentation of symptoms Jull examined 4 groups (MT, exercise, MT + exercise, control) and found that all intervention groups improved, however the MT group did 10% better in ↓ing HA frequency.
30
what is the effectiveness of using traction?
some support for pain reduction less support for impacting function/disability when cervical traction is combined w/ nerve glides: decreased neck and arm pain, increase function
31
when do patients need surgical interventions?
1. fx/instability 2. SIGNIFICANT weakness (myotomal) 3. progressing neuro deficits 4. SEVERE, unremitting pain, 5. persistent radicular pain
32
what are the 4 common surgeries in cervical spine?
1. ACDF 2. ACCF 3. laminectomy 4. laminoplasty
33
what surgery will you see most of
ACDF: anterior cervical discectomy and fusion cut front, remove disc, bone graft insert, then fusion usually MOI like car accident, so fusion needed
34
what is the ACCF?
Anterior cervical corpectomy & fusion (ACCF) less often then ACDF now Diseased/damaged bone removed Bone graft placed Fusion using metal plate and screws
35
what is surgery most often used for?
nerve decompression due to altered function and severe pain
36
what is laminectomy?
saw off piece of bone to relieve pressure on nerve roots *indicated for: Spinal stenosis Multi level DDD w/ ant spinal cord compression *careful of how many levels due to instability
37
what are mostly done in cervical spine due to lumbar having more weight bearing responsibilities?
laminoplasty and laminectomy *if we take pieces of bone off lumbar spine, this would be big issue down road due to WB needs
38
what is laminoplasty indicated for?
Multi level spondylotic myelopathy goal: eliminate nerve compression, preserves segmental spine motion *instead of removing entire lamina altogether, they make kind of a hinge door and put a plate to hold it.
39
POST OP: usually what is initial treatment looking like
gentle painfree cervical ROM DNF endurance test thoracic movement spinal extensor strength thoracic usually 5-6 weeks after surgery
40
Is there any data on PT interventions post back surgery?
not really...but get operative report! CALL PHYSICIAN post op protocols***** *know what levels *fusions usually come in 5-6 weeks later, strict BLT protocols for 10-12 weeks (10 lb limit)
41
CPG for ACUTE neck pain with mobility deficits
B: clinicians should provide T-spine manips, neck ROM exercises, scap-thoracic and UE strengthening to enhance program adherence C: clinicians may provide cervical manip and/or mobilization (no diff in strength of evidence)
42
CPG for SUBACUTE neck pain w/ mobility deficits
B: clinicians should provide neck/shoulder girdle exercises C: t-spine manip and or mobilization
43
CPG for CHRONIC neck pain w/ mobility deficits
B: multimodal approach of: - T-spine manip and c-spine manip/mob - mixed exercises: NM ex, stretch, strength, endurance, aerobic, cognitive affective elements - dry needling, laser, traction C: neck, shoulder, trunk endurance exercises, patient education, counseling to promote active lifestyle and address cognitive factors
44
CPG for ACUTE neck pain w/ mvmt coordination impairments (WAD)
B: education of returning to ADLs, minimize collar use, posture/mobility ex to decrease pain and increase ROM, reassure patient that recovery is expected to occur within first 2-3 months C: if patient is at low risk of progresing toward chronicity, -1 session of early advice, exercise instruction, education -comprehensive exercise program -TENS F: monitor recovery status to identify patients who may need more intense rehab and early pain education program
45
CPG for CHRONIC neck pain w/ mvmt coordination impairments WAD
C: -patient education, advice focused on assurance, encouragement, prognosis, pain management -mobilization + individualized, progressive submax ex program of cervicothoracic strength, endurance, flex, coordination, using CBT principles -TENS
46
CPG for ACUTE neck pain with headache
B: supervised instruction in active mobility ex C: C1-2 self SNAG exercise
47
CPG for subacute neck pain w/ headache
B: cervical manip and mob C: C1-2 self SNAG ex
48
CPG for chronic neck pain w/ headache
B: cervical or cervicothoracic manip or mob combined w/ shoulder girdle and neck stretching, strengthening, endurance exercises
49
what is treatment for tension headaches?
stress management, exercise, posture, MT, dry needling
50
what is treatment for cervicogenic headaches?
posture, MT, ex, analgesics, NSAIDs
51
CPG for ACUTE neck pain w/ radiating pain
C: mobilizing and stabilizing exercises, laser, short term use of cervical collar
52
CPG for CHRONIC neck pain w/ radiating pain
B: mechanical intermittent traction + stretching/strengthening and cervical and thoracic manip/mobs B: education to encourage participation in work and exercises

becky: MSK UQ (18 decks)

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