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1022 THEORY > Week 2 Cervicothoracic spine > Flashcards

Week 2 Cervicothoracic spine Flashcards

1
Q

function of spine - regional (cervical, thoracic, lumbar spine)

A

cervical - conduit of vertebral artery
thoracic - supports thoracic cage, resolves forces from the humerus/ clavicle/ scapular
lumbar - supports muscles from hip and pelvis

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2
Q

‘stiffness’ lay term vs physio term

A

lay term: lack of comfort during movement
physio term: loss of end range movement in joints

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3
Q

Erect standing: sagittal plane - cervical and thoracic spine

LoG

A

cervical spine:
LoG passes posteriorly creating an extension moment

thoracic spine:
LoG passes anteriorly, creating a flexion moment

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4
Q

Forward deviations of the head and neck result in

A

increased demand on the levator scapula and upper trapezius

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5
Q

Ruptured transverse ligament
橫韌帶斷裂

A
  • C1 can slide forward on C2, risking compression of the brainstem
  • Common causes of rupture: Trauma, Rheumatoid arthritis, Down syndrome
  • Halo-Thoracic brace

transverse ligament maintains the relationship between C1 and C2

RA: immune system attack joint
symptoms: flu-like symtoms (fatigue, fever), often bilateral, morning stiffness more than 30 mins

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6
Q

Costovertebral movements

A
  • The ribs move in a ‘bucket handle’ motion during respiration
  • Flexion, extension and coupled rotation/ lateral flexion
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7
Q

Neutral zone

A
  • translational (accessory) movement is greatest
  • relatively less tension in spinal ligaments
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8
Q

flexion - limit to movement (O/C1, C1/C2, C2-C7)

A

O/C1:
ligamentum nuchae
posterior atlantoaxial ligament

C1/C2:
ligamentum nuchae
ligamentum flavum
facet joint capsules

C2-C7:
ligamentum nuchae
ligamentum flavum
PLL

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9
Q

flexion - limit to movement (thoracic and lumbar spine)

A

thoracic spine:
ligamentum flavum
PLL
facet joint capsules
rib cage

lumbar spine:
ligamentum flavum
facet joint capsules
posterior annulus

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10
Q

extension - limit to movement (O/C1, C1/C2, C2-C7)

A

O/C1, C1/C2:
passive tension in the anterior atlantoaxial ligament

C2-C7:
contact of spinous process
ALL
anterior neck muscles

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11
Q

extension - limit to movement (thoracic and lumbar spine)

A

thoracic spine:
contact of spinous process
ALL
anterior trunk muscles

lumbar spine:
contact of spinous process
ALL
anterior trunk muscles
anterior annulus

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12
Q

rotation & lateral flexion - limit to movement (O/C1, C1/2, C2-C7)

A

O/C1:
alar ligaments

C1/C2:
alar ligaments

C2-C7:
annulus fibrosis

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13
Q

rotation & lateral flexion - limit to movement (thoracic and lumbar spine)

A

thoracic spine:
annulus fibrosis
facet joint capsules
intertransverse ligaments

lumbar spine:
annulus fibrosis
facet joint capsules
intertransverse ligaments
iliolumbar ligaments

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14
Q

coupled movements

A

the facet joints and biomechanics of the soft tissues result in a coupled movement of rotation and lateral flexion occurring simultaneously

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15
Q

muscle action

info

A

Using the cervicothoracic spine as a stable base, the musculature of this region supports and moves the upper quadrant and thoracic cage

Muscle attachments from the upper limb extend the length of the cervical and thoracic spines to allow a broad dispersal of forces, e.g. trapezius, latissimus dorsi

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16
Q

what is vertebral arteries

A
  • branches of the subclavian arteries
  • enter deep to the transverse process of C6
  • pass upwards through the transverse process of each cervical vertebra until C1 and enter the skull via the foramen magnum
  • the vertebral artery is vulnerable to stretch and trauma
  • as it passes through the transverse foramen and passes posteriorly around the lateral mass of C1
  • result in damage to the lining of the artery 動脈內壁損傷 = brainstem stroke
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17
Q

risk factors for neck pain (high evidence)

A

female
previous episode of neck pain

risk factors for prognosis:
- pain intensity
- level of self rated disability
- pain catastrophizing –> wont feel better anymore
- post traumatic stress symptoms
- cold hyperalgesia (increase pain associated with cold)

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18
Q

characteristics of inflammatory BP vs mechanical BP - age at symptom onset, onset, activity, morning stiffness, inflammatory markers

info

A

inflammatory:
age at symptom onset - <40 yo
onset - persists for >3 months, insidious
activity - improves with exercise
morning stiffness - moderate, persists for >45 minutes
inflammatory markers - elevated in 50-70%

mechanical:
age at symptom onset - any age
onset - variable
activity - improves with rest
morning stiffness - mild, short-lived
inflammatory markers - normal

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19
Q

red flags questions need to ask in an interview

A
  • UWL
  • medications are using
  • any x-rays
  • any difficulty using bladder
  • any pins and needles/ numbness in both legs and arms
  • any fever or night sweats
20
Q

red flag pathologies of the cervical and thoracic spine (8)

A
  • inflammatory/ systemic conditions
  • cervical myleopathy/ cauda equina
  • vertebral artery
  • spinal infection
  • spinal malignancy 脊椎惡性腫瘤
  • spinal fractures/ upper ligamentous instability
  • cervical fractures
  • thoracic compression fracture
21
Q

symptoms/ signs of inflammatory/ systemic conditions

A
  • temp > 37 degrees
  • BP > 160/95mmHg
  • resting pulse > 100bpm
  • resting resp rate > 25pm
  • fatigue
  • morning stiffness - persists > 45 mins, better with movement
  • insidious onset 起病隱匿, persists > 3 months
22
Q

symptoms/ signs of cervical myelopathy/ cauda equina

central myelopathy (central stenosis)

A
  • sensory disturbance of hands
  • wasting of hands intrinsic muscles
  • Hoffman’s sign
  • unsteady gait/ heaviness in legs/ loss of balance
  • bladder disturbances
  • neurological signs: decreased sensation/ motor weakness
  • radicular pain

if pt say yes, maybe there is some specific neuropathology

Hoffman’s sign - involuntary flexion movement of the thumb and or 2nd finger when the examiner flicks 3rd finger

頸椎頸脊髓病變(Cervical Myelopathy) 脊髓病變是臨床上常見疾病，極容易被病人所忽視疾病。 頸椎神經根病變會帶給病人疼痛感覺，脊髓病變症狀進展情況緩慢，不會有很特殊的症狀。 初期雙手麻而已，慢慢地出現上身有緊縛感、下肢無力等。 當意識到情況不對時，往往 在臨床上已經相當嚴重了。

23
Q

common cause of cervical myleopathy/ cauda equina

A
  • central disc herniation
  • spinal canal stenosis
  • post spinal surgery
  • high risk: < 50 yo and obese –> requires a surgical opinion
24
Q

symptoms/ signs of vertebral artery

A
  • dizziness
  • difficulty talking (dysarthria)
  • difficulty swallowing (dysohagia)
  • double vision
  • drop attacks (fainting 昏厥)
  • nausea 噁心
  • vomiting, sweating
  • also be wary of presence of gait disturbances, balance problems
25
risk factors of spinal infection
- recent pre-existing infection - imminosupression 免疫抑制 - IV drug use - surgery - social/ environmental factors (homelessness, prisoner)
26
symptoms and signs of cervical infection
symptoms: - local progressive pain - neuro symptoms - fatigue - fever - UWL signs: - **TOP (tenderness of palpation)** - **radiculopathy** - neuro signs - blood tests - MRI
27
symptoms and signs spinal malignancy 脊椎惡性腫瘤
- constant pain/ severe progressive - night pain - UWL - PHx of cancer - neuro signs (bilateral, gait disturbance, bowel/ baldder dysfunction) - fatigue, nausea, fever
28
risk factors, symptoms and signs of spinal fractures/ upper ligamentous instability
risk factors: - **history of osteoporosis** 骨質疏鬆 - **corticosteroid use history** - **PHx of cancer** - **Hx of falls** - **female** - **older age** (>65 yo female, >75 yo male) - **severe taruma** - previous spinal fracture symptoms: - **pain** - **severe pain** - **neurological symptoms** - **instability** signs: - **TOP** - **neuro signs** - spinal deformity - contusion or abrasion 挫傷或擦傷
29
cervical fractures
- **history of trauma** - **high risk activities** (diving, horse riding, football, skiing, gymnastics and hand gliding)
30
thoracic compression fracture
- **occur people with reduce bone density or trauma** (such as falls) - effect on cervical posture
31
whiplash injury
- acceleration-deceleration injury - may result from motor vehicle accidents, but can also occur during falls, diving
32
**symptoms of whiplash injury**
- **activity limitation** - cervicothoracic pain - **dizziness** - **muscle spasm** 肌肉痙攣 - **tenderness** - **pain or numbness in the arm and/or hand** - poor concentration - stiffness reduced ROM - +/- arm pain
33
**`WAD need imaging? (high risk factors)`**
any high risk factors? age > 65 dangerous mechanism numbness in extremities 四肢麻木 --> if yes, radiography
34
**`WAD need imaging? (low risk factors)`**
low risk factors: - **not immediate onset of neck pain** - ambulatory at any time (can walk **anytime**) - sitting position in ED (able to sit in ED) - absence of midline C-spine tenderness ----> if the patient do not have any low risk factors, must go to radiography if there is one of the above: then, is the patient able to rotate neck (45 degrees left and right) actively? ----> No, go to radiography if yes, no radiography
35
**`WAD grading systems`**
grade 0 - no complaints or physical signs (no pain) grade 1 - neck complaints but **no physical signs** (pain/ stiffness/ instability; normal AROM, strength, length testing) grade 2 - neck complaints and **musculoskeletal** signs (decrease ROM/ coordination strength/ endurance) grade 3 - neck complaints and **neurological** signs (decrease/ absent tendon reflexes in UL and LL) grade 4 - **fracture**/ dislocation
36
**`psychosocial and pain factors associated with chronicity/ disability (yellow flags) for WAD`**
- anxiety - high pain intensity - high NDI (neck disability index) score - post traumatic stress symptoms - poor expectations of recovery
37
**`not a predictor for WAD`**
- accident features - imaging findings - motor dysfunction 運動功能障礙
38
**`prognosis of WAD`**
- **high levels of reported pain: Visual analogue scale (VAS) > 5.5/10** - **higher levels of disability: Neck disability index (NDI) >29** - 50% will continue to report pain and disability 1 year after injury - take place within the first 2-3 months after recovery occurs 發生在恢復後的前 2-3 個月內
39
**`management of WAD`**
- education: **return to normal activity ASAP** **avoid use of cervical collar** - exercises: ROM, strengthening, postural, functional retraining - pain education and management
40
cervicogenic headache
- **pain in head but referred from a primary source in the cervical spine** - **pain may arise from any structure** (eg: `muscles, joints, ligaments disc` of the cervical spine) - innervated by **C1-C3 nerves**
41
presentations of cervicogenic headache
- **slow onset**, intermittent - **unilateral headache**, generally starting in the neck and 'spreading' forwards - **muscle tightness** - **decreased strength endurance** - **reduced neck flexion/ extension ROM**
42
management of cervicogenic headache
- exercise (stretching, shoulder girdle) - cervical mobilisation - exercise + manual therapy - dry needling + exercise
43
cervical spondylosis
affects the lower cervical spine, C5/6 is the most mobile region of the neck
44
symptoms/ signs of neck pain with radiating arm pain - radiculopathy
- can occur **due to spondylosis** resulting in a **narrowing of the intervertebral foreman** (lateral stenosis) - **result from a disc protrusion** 椎間盤突出 symptoms/ signs: **- neck pain with radiating UL pain - increased pain with Cx ROM - neuro signs** (nerve root distribution)
45
management of neck pain with radiating arm pain
- strengthening/ posture exercise - pain management education
46
what is wry neck (torticollis)? presentation of wry neck? prognosis of wry neck?
idiopathic/ nerve or muscle damage presentation: - reduce neck ROM, difficulty to look to one side - pain - palpable facet joint tenderness/ stiffness prognosis: resolve within 3-10 days but may be recurrent ## Footnote 在自然情況下，當一個人的臉部總是轉向固定的一側，而頭頸部傾向另一側，這種情形即稱為斜頸症
47
management of non specific neck pain
* Acute/ Sub acute: – Exercise: Cx/ Thoracic ROM, scapulothoracic strengthening, endurance – Cervical mobilisation * Chronic: – As above – Pain education – Postural, coordination, proprioception, kinaesthetic and cognitive awareness retraining, aerobic exercise – Dry needling, traction (grade B)

1022 THEORY (11 decks)

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