Pathologies Flashcards by Freja Endersby

What is cervical spondylosis?

Degenerative disc disorder affecting the facet joints. 
- Lower spine most affected 
( C5-6,C6-7 and C4-5)
-Age group 45+ 
- Onset - Insidious or traumatic.

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What are the patho-anatomical changes related to cervical spondylosis?

Loss of disc heigh due to disc dehydration/degeneration
Vertebrae approximate
formation of marginal osteophytes
Increased weight bearing on facet joints
Possible nerve root entrapment and spinal cord compression due to degenerative changes

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What are the symptoms of Cervical spondylosis?

Bilateral/unilateral neck pain
referred pain into shoulder, arm or head - this can be somatic or radicular referred pain
Neck stiffness

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What are the signs of cervical spondylosis?

Decreased cervical ROM
pain on PAIVM of involved levels
Altered posture
Dermatomal changes if nerve root involved
Degenerative changes on xray

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What would you observe on an xray of cervical spondylosis?

Disc space narrowing
Anterior osteophyte formation
Lipping and irregularity of vertebral bodies.

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What is the cause of cervical disc herniation?

Caused by degenerative weakness of annulus with the nucleus prolapsing through.
Affects individuals in 30s
male:female 1:1
C6-7 and C5-6 most common levels

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What are the risk factors of disc herniation?

Age
Smoking
Lifting heavy objects
Driving

However uncommon , less common than disc prolapse in the lumbar spine.

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What would you observe in a pro-section of disc herniation?

Source of pain =
Tear of outer annulus and inflammatory process
Disc prolapse =
Centrally, posterolaterally and bulge.

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What are the symptoms of cervical disc herniation?

Acute and rapidly worsening neck pain , central or unilateral
referred pain in scapula
pain worse on coughing and sneezing
antalgic posture - head head in flexion
if posterolateral/ spinal nerve involved = radicular referred pain into the arm and hand
Paraesthesias / anaesthesia into the UL
Myelopathy , central cord stenosis

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What is facet joint osteoarthritis?

Degenerative disorder
more common over 65
Pathology - Synovitis. disintegration of articular cartilage, osteophyte formation, joint space narrowing.

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what are the symptoms of Facet OA ?

Local , often unilateral neck pain
somatic pain referral into shoulder,scapula region depending on levels affected
stiff neck

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What are the signs of facet OA

Decreased ROM into facet closed pack position ( extension, ipsilateral side flexion and ipsilateral rotation)
Pain reproduced on PAIVM of affected levels
degenerative changes on xray

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What would you see on an x-ray for facet OA

cartilage destruction of facet joints
Loss of joint space
Osteophyte formation around joint margins
IVD and vertebral bodies normal.

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What is cervical radiculopathy?

Cervical radiculopathy, commonly called a “pinched nerve,” occurs when a nerve in the neck is compressed or irritated where it branches away from the spinal cord. This may cause pain that radiates into the shoulder and/or arm, as well as muscle weakness and numbness

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What is lateral canal stenosis?

narrowing of I-V foramina
Causes nerve root compression and irritation
Neurological changes

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What are the common causes of irritation of the IV formina usually in the medial half ( narrowest)

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Inflammation
Postero-lateral disc prolapse
degenerative changes of facet joints e.g osteophytes
Most commonly impacting C6,7,5 levels

What are the signs and symptoms of cervical radiculopathy (lateral canal stenosis)?

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Acute severe arm pain in dermatomal distribution
Altered sensation in dermatomal distribution
Referred pain below ( Clowards signs)
Myotomal/reflex changes
Neck pain
Pain worse on compression movements of foramina IV
Night pain
Antalgic posture

What is cervical myelopathy?

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Compression of the spinal cord by

Severe central degenerative changes e.g osteophytes
large disc prolapse

What are the signs and symptoms of cervical myelopathy ( central canal stenosis)

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Chronic neck pain
associated symtoms- mild gait disturbances / numb clumsy hands
other signs - bladder dysfunction, gait disturbance, LL dysfunction.
Symptoms aggravated with movements or postures that decrease size of spinal canal e.g extension.
MEDICAL EMERGENCY

What is the mechanism of whiplash?

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Whiplash is an acceleration-deceleration mechanism , may result from rear end of side impact , may result in bony or soft tissue injuries.
Rear end collision mechanism- Hyperextension followed by hyperflexion, with the hyperextension phase being the most damaging( anterior cervical features) and the hyperflexion phase being limited by chin:chest or forehead:steering wheel

List the possible lesions in whiplash

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Muscle strain:SCM, scalenes/precervical muscles
Capsule sprain or fracture
Ligament sprains/tears ALL,PLL,IVL
IVD Prolapse , annular tears , clefts in endplates
Vertebral arteral ischaemia
Concussion
Thoracic outlet syndrome
PTSD management vital for recovery

What is the typical duration of symptoms for whiplash?

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Duration of Symptoms

On average 6weeks- 1 year
10% of patients will go on to develop chronic pain.

What are the biological symptoms of whiplash?

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pain
stiffness
headaches
nausea
dizziness
referred pain
paraesthesia
blurred vision
difficulties swallowing

what are the psychological symtoms of whiplash?

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Depression
Anxiety
anger
loss of job and income
marital and family
PTSD
fear of driving.

what is whiplash association disorder (WAD) classification?

- WAD1- neck pain - WAD2A- neck pain , altered movements , local mechanical hyperalgesia - WAD2B- above plus psychological impairment - WAD2C- above plus generalized hyperalgesia. - WAD3- above plus neuro signs - WAD4- fracture/dislocation

What are postural dysfunction signs?

- Poor upper quadrant posture - FHP - forward head posture - Trigger points - May have full AROM and absence of joint signs

What are the symptoms of postural dysfunction?

- Widespread neck pain radiating into shoulders and neck - Worsened by prolonged postures , e.g sitting at a computer or driving - Often easier in morning and worse at the end of the day.

What is a Cervicogenic headache?

- Irritation of trigeminal nuclei (TGN) or within cranial nerve. - A dysfunction in an upper cervical spine structure which refers pain into the head.

What are the S&S form upper cervical - cervicogenic headache

- Does the pain occur in relation to neck symptoms - leading the neck assessment for limitations in AROM and PROM - headaches - Face,eye,TMJ,ear pain - Nausea - dizziness - FHP - postive joint findings - weakness in deep neck flexors - trigger points.

What are the special questions for the neck ( 5Ds) and 2Ns)?

- Dysphasia - Dysphagia - Drop attacks - Dizziness - Diplopia - Nystagmus - shacking of the eyes - Nausea -links to circulatory examination.

What are factors should we investigate with a cervicogenic headache - history

- onset - trauma, postural strain , degenerative disease? - precipitating factors- sustained neck postures of movements - Pathomechanics- referred pain from upper spine structures ( convergence theory)

Describe the underlying pathology of CAD( Cervical Arterial Dysfunction

- Arteries narrowed due to plaque formation - Trauma- whiplash , intubation - Connective tissue abnormalities- Spontaneous arterial dissection - Upper cervical instability- RA or acute whiplash

Risk factors for CAD

- Hypertension - Hypercholesterolemia - Diabetes - High BMI - Family history - Upper cervical instability - Infections - Smoking

Give the signs and symptoms of CAD - 2ns and 5ds

- Nystagmus - Nausea - Dizziness - Drop attacks - Diplopia - Dysarthria - Dysphagia - Cerebral or cerebellar signs e.g. ataxic gait

Give the subjective signs and symptoms of cervical instability

- Feeling of instability - head may fall off - Neck/shoulder pain - Symptoms of VBI/CAD - Chronic headaches - Episodes of locking - Lump in throat - Metallic taste - Paraesthesia of lips,tongue,bilateral hands and feet

How was you objectively assess a patient with signs and symptoms of cervical instability

- AROM&PROM limited - Hypertrophy of anterior neck musculature - Overactive SCM

Pathologies Flashcards

(36 cards)