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Cervical Illness Scripts Flashcards

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1
Q

Epidemiology for cervical spondylosis

A
  • > 50 years old
  • Men affected more than women
  • Risk factors: sedentary lifestyle, smoking, repetitive motion/trauma to neck
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2
Q

Epidemiology for cervical radiculopathy

A
  • Most common b/w 40-60 years old
  • Men more affected then women
  • Risk factors: smoking and strenuous activities
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3
Q

Timing of symptoms for cervical spondylosis

A
  • Early: mild/intermittent neck pain & stiffness, HA, decreased rotation ROM (dysfunction -> instability -> stabilization)
  • Later: can lead to nerve compression & instability of cervical spine resulting in pain, parasthesia, weakness; common age-related change; often asymptomatic
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4
Q

Timing of symptoms for cervical radiculopathy

A
  • Early: Irradiating arm pain corresponding to a dermatomal pattern, neck pain, parasthesia, muscle weakness in a myotomal pattern
  • Later: Reflex impairment/loss, HA, scapular pain, sensory & motor dysfunction in UEs & neck
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5
Q

Symptoms of cervical spondylosis and painful activities

A
  • Pain: HA, neck, shoulder, may affect dermatome if nerve roots are involved
  • Could be tender in neck/along boney prominences
  • Activities: C spine movement of extension, rotation (movements that decrease foramina space), maintaining head posture for long bouts of time
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6
Q

Keys parts for examination of cervical spondylosis

A
  • MMTs: neck/shoulder may be pain limited & may demo decreased MMT if nerves are compressed
  • Facet changes leading to boney block
  • ROM limited over time
  • Distinguishing features: changes in vertebral body articulations
  • Key rejecting features: presence of neurological Sx/unrelenting pain
  • Special tests: Spurlings, ULTT-A, & cervical rotation
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7
Q

Symptoms of cervical radiculopathy and painful activities

A
  • Pain: along dermatomal pattern affected, neck, & possible HA
  • Could be tender in the neck
  • Activities: Symptoms are generally amplified with movements that may be unidirectional or multidirectional reduce the space available for the nerve root to exit the foramen causing impingement
  • Pain is NOT relieved by rest
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8
Q

Keys parts for examination of cervical radiculopathy

A
  • MMTs: Could be weaker due to nerve compression
  • Could involve bone spurs or degenerative changes in the spine
  • ROM could be limited due to stretching of the nerve
  • Distinguishing features: relief upon distraction
  • Key rejecting features: no relief upon distraction
  • Special tests: (Cervical CPG) Spurlings, ULLT-A, distraction, cervical rotation <60º
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9
Q

PT management for cervical spondylosis

A
  • Postural awareness education
  • Cervical manual therapy
  • Isometric exercises
  • Cervical muscle strength/endurance training
  • Nerve glides if radicular symptoms
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10
Q

PT management for cervical radiculopathy

A
  • PROM
  • Manual therapy
  • Stretching exercises in comfortable range
  • Isometric exercises
  • Nerve glides/tensioners
  • Cervical muscle strength/endurance training with minimal pain
  • Increase ROM in stretching exercises
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11
Q

Epidemiology for cervical muscle strain

A
  • Most common in midlife
  • Females affected more than males
  • Risk factors: over use (work or activity), injury (whiplash), diseases (OA, RA)
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12
Q

Epidemiology for vasculopathy (Carotid Dissection) SERIOUS

A
  • Common cause of stroke I young patients, median age is mid 40s
  • Slightly more common in men
  • Risk factors: seasonal variation in BP, air pollution, migraine
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13
Q

Timing of symptoms for cervical muscle strain

A
  • Early: pain in limited or all ranges of C-spine
  • Later: limited ROM, strength/endurance due to (d/t) limited use of muscles
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14
Q

Timing of symptoms for vasculopathy (carotid dissection) SERIOUS

A
  • Early: acute pain onset described as “unlike any other”, mid-upper cervical pain, p! around ear & jaw temporoparietal HA ptosis cranial nerve VIII-XII dysfunction
  • Later: transient retinal dysfunction, DAN s/s, transient ischemic attack or cerebrovascular accident
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15
Q

Symptoms of cervical muscle strain & painful activities

A
  • Pain: posterior & lateral neck, pain with palpation
  • Pain is relieved by rest
  • Activities: cervical flexion, extension, rotation, sidebending
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16
Q

Symptoms of vasculopathy (carotid dissection ) SERIOUS and painful activities

A
  • Pain: ipsilateral HA, facial or eye pain, & anterior neck pain
  • May be painful to palpate (many don’t present with mechanical triggers)
  • Pain is NOT relieved by rest
  • Activities: not specific, more constant pain
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17
Q

Keys parts for examination of cervical muscle strain

A
  • MMT: trapezius, levator scapula, SCM, semispinalis, splenius
  • ROM: limited
  • Key distinguishing features: pain & stiffness in neck, decreased ROM, weakness/numbness/tingling, HA, spasms
  • Key rejecting features: pain does NOT worsen with movement, imaging
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18
Q

Keys parts for examination of vasculopathy (carotid dissection ) SERIOUS

A
  • MMT: facial muscles, scalp, suboccipitals, anterior neck (SCM, scalenes, hyoids)
  • Internal carotid artery is involved
  • ROM: possibly limited d/t whiplash MOI or pain in certain motion
  • Key distinguishing features: pain in jaw/neck, HA, dizziness, Horner’s Syndrome, DAN s/s
  • Key rejecting features: no Horner’s s/s or abnormal function of eye(s), underproduced by Hautaunt’s/deKlyn’s/AROM testing, but can be positive later***
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19
Q

Special tests for cervical muscle strain

A
  • Spasm palpation
  • ROM: flexion, extension, & rotation
  • MRI/US
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20
Q

Special tests for vasculopathy (carotid dissection) SERIOUS

A
  • AROM: ipsilateral rotation, extension, & ipsilateral sidebend
  • deKlyn’s test (supine)
  • Hautaunt’s test (sitting & arms out)
  • Premanipulation holds tests (if positive refer to Doppler US or imaging)
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21
Q

PT management for cervical muscle strain

A
  • Patient education & counseling
  • Activity avoidance
  • Therapeutic modalities
  • Stretching
  • Working from limited pain-free ROM towards PLOF AROM
  • Posture education
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22
Q

PT management for vasculopathy (carotid dissection) SERIOUS

A
  • Refer to ED for medication/imaging & possible surgical intervention
  • Motor control training & education to prevent extreme end ROM
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23
Q

Epidemiology for cervical tension HA

A
  • Mostly 30-45 years old
  • Females and males are almost equally affected
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24
Q

Timing of symptoms of cervical tension HA

A
  • Early: combination of unilateral pain, ipsilateral diffuse shoulder & arm pain
  • Later: pain lasts longer & becomes more chronic
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25
Symptoms of cervical tension HA and painful activities
- Pain: unilateral "ram's horn" or unilateral dominant HA usually originating from C1-C3 - Pain with palpation - Pain is NOT relieved by rest - Activities: neck movement & posture (driving, typing at a computer)
26
Key parts for examination of cervical tension HA
- MMT: neck muscles - ROM: limited - Key distinguishing features: pain localized in the neck & occiput which can spread to other areas in the head (forehead, orbital region, temples, vertex, or ears), usually unilateral
27
Epidemiology for closed head injury/bleed
- Mostly 30-50 years old - Males are more affected than females
28
Timing of symptoms for closed head injury/bleed
- Early: Focal neurological signs depending on what area of the brain is affected including hemiparesis, speech impairment, sensory impairment, cranial nerve palsy, vomiting, ataxia, headache, and seizures - Later: More likely to present with nonfocal sx such as headache, lightheadedness, cognitive impairment, apathy or depression, parkinsonism, somnolence, and seizures
29
Symptoms of closed head injury/bleed and painful activities
- Pain: HA - Not painful to palpate - Pain is NOT relieved by rest - Activities: none
30
Key parts for examination of closed head injury/bleed
- MMT: as part of a near screen - Brain, dura, & bones of the skull may be affected - ROM: limited possibly due to pain or paresis - Key distinguishing features: neurological symptoms
31
Special tests for cervical tension HA
- Flexion rotation test - Motion screen
32
Special tests for closed head injury/bleed
- Head CT - Brain MRI
33
PT management of cervical tension HA
- C-spine manipulation/mobilization - T-spine manipulation - Trigger point therapy - Deep neck flexor exercises - Upper quarter muscle strengthening
34
PT management of closed head injury/bleed
- Referral
35
Epidemiology of whiplash injury
- Commonly you're age: 18-23 years old - Females affected more than males - Risk factors; sporting injuries, falls, passengers, riding bus or truck, MVC/MVA, decreased neck mobility, preexisting head trauma
36
Epidemiology of C-spine acute bacterial meningitis (SERIOUS)
- Commonly in newborns, babies, & young children, teens, & young adults (babies are at increased risk) - About equal b/w males and females - Risk factors: people living in close quarters, those with compromised immune systems or have been recently sick, with certain medical conditions, those with a head injury
37
Timing of symptoms for whiplash
- Early: Neck p!, stiffness, shoulder p!, dizziness, pain or numbness in arm or hand, irritability, blurred vision, concentration problems, ringing in ears, sleeplessness, depression, anxiety, PTSD, restricted ROM of cervical spine, mechanical cervial spine instability, headache - Later: Persistant pain and neuro sx, limited ROM, altered muscle recuritment patterns, depression, anxiety, persistent headache/migraine
38
Timing of symptoms for C-spine acute bacterial meningitis (SERIOUS)
- Early: Painful, stiff neck, HA, high fever, sensitive to light, rash, feeling confused or sleepy, easy bruising all over body, tachycardia, nucal rigidity, back pain, seizures, paradoxical irritability in neonates (cuddling and consoling by a parent irritates rather than comforts the neonate), papilledema with increased ICP - Later: Seizures, brain damage, hearing loss, disability, death
39
Symptoms of whiplash and painful activities
- Pain: posterior neck - Painful to palpate - Pain relieved by rest - Activities: cervical AROM
40
Symptoms of C-spine acute bacterial meningitis (SERIOUS) and painful activities
- Pain: C-spine, bottom of skull, upper back - Painful to palpate - Activities: cervical rotation & flexion - Pain is NOT relieved by rest
41
Key parts for examination of whiplash
- MMT: cervical flexors & extensors - Tendons, ligaments, & nerves may be affected - Limited ROM - Key distinguishing features: posts-incidence of hyperextension followed by (f/b) hyperflexion - Key rejecting features: any constitutional signs/symptoms
42
Keys parts for examination of C-spine acute bacterial meningitis (SERIOUS)
- Limited ROM - Key distinguishing features: constitutional signs/symptoms w/ neck pain, not relieved by rest, AMS, photophobia - Key rejecting features: negative lumbar puncture
43
Special tests for whiplash injury
- Cervical MMT - Cervical mobilizations - X-ray
44
Special tests for C-spine acute bacterial meningitis (SERIOUS)
- Spinal tap - CT scan - Kernig's sign/Brudzinski's sign
45
PT management of whiplash injury
- Mobilizations, rest - Directional preference exercises (McKenzie exercises) - Patient edu for normal acitivity - NSAIDs - Spinal manual therapy when hypersensitivity decreases - Strengthening exercises, postural exercises, motor control ex, endurance ex for muscles of the neck & UQ
46
PT management of C-spine acute bacterial meningitis (SERIOUS)
- Refer for antibiotics & fluids - May see after treated for neck flexibility & strengthening ex - Cervical AROM & mobs/manips to address mobility deficits as well as reduce HA - Strengthening neck & UQ muscles in addition to postural education to further improve mobility & decrease frequency of HAs
47
Epidemiology of C-Myofascial pain syndrome
- Commonly middle aged: 27-50 years old - Females affect more than males - Risk factors: injury (trauma or overuse), stress/anxiety, inactive (poor posture/desk job)
48
Epidemiology of syringomyelia (SERIOUS)
- Commonly 20-50 years old - Males affected more than females - Risk factors: congenital abnormality of Chiari malformation, trauma, SCI, spinal cord tumor, hemorrhage, inflammation
49
Timing of symptoms for C-Myofascial pain syndrome (MPS)
- Early: pain in 1-2 local regions, deep/achy muscle pain, tender knot in muscle, difficulty sleeping due to pain, can resolve spontaneously or after simple Tx (stretching, heat modalities) in a few wks - Later: widespread pain (generalized), fluctuating pain intensity, when MPS persists >6 mo = chronic MPS
50
Timing of symptoms for syringomyelia (SERIOUS)
- Early: pain, progressive weakness in extremities, stiffness in back, neck, shoulder, arms, legs, HAs, loss of sensation in hands, n/t (numbness/tingling), loss of bladder & bowel control - Can also have no Sx & then you are just monitored by neurologist/could take months-years after initial injury to see Sx - Later: chronic & severe pain, delay in Tx = irreversible spinal cord injury
51
Symptoms of C-Myofascial pain syndrome and painful activities
- Pain: SCM, traps, levitator scap, infraspinatus, rhomboids - Pain with muscle palpation - Pain is NOT relieved by rest - Pain is relieved by relaxation techniques & de-stressing - Activities: muscle overuse, repetitive work, poor posture, pain worse with movement
52
Symptoms of syringomyelia (SERIOUS) and painful activities
- Pain: HAs & pain down arms, neck, mid back, legs - No pain with palpation - Pain is NOT relieved by rest - Activities: lifting heavy objects, anything that causes strain/force on the spine
53
Key parts for examination of C-Myofascial pain syndrome
- MMT: cervical muscles (could be limited to pain, tightness, or lead to a twitch response) - Fascia could be taut band like - ROM could be limited due to pain - Key distinguishing features: finding trigger points, palpable or visible twitching, normal near exam - Key rejecting features: muscle atrophy, abnormal neuro exam
54
Key parts for examination of syringomyelia (SERIOUS)
- Spinal cord is affected - ROM possibly limited due to pain - Key distinguishing features: pain, muscle weakness & atrophy (arms/hands), temperature insensitivity in UE, spasticity/stiffness in LE - Key rejecting features: normal neuro exam
55
Special tests for C-Myofascial pain syndrome
- Trigger point palpation (positive) - Spurling's (negative) - Imaging (all negative)
56
Special tests for syringomyelia (SERIOUS)
- NRI - Dynamic MRI - Myelogram with CT scan
57
PT management of C-Myofascial pain syndrome
- Dry needling - Heat - US massage - Manual therapy - Posture training - Stretching - SNAGS
58
PT management of syringomyelia (SERIOUS)
- Surgery to fix underlying cause/help with symptoms - Muscle strengthening/endurance - Maintaining ROM - Neck stability - Sitting/standing balance
59
Epidemiology for cervical spondylotic myelopathy (central spinal stenosis)
- Commonly >45 years old - Males affected more than females - Risk factors: asians more due to ossification of PLL
60
Epidemiology for Pancoast tumor
- Commonly 40-60 years old - Males affected more than females - Risk factors: Hx of smoking, asbestos exposure, exposure to industrial elements (gold or nickel), diesel exhaust
61
Timing of symptoms for cervical spondylotic myelopathy (central spinal stenosis)
- Early: numbness B hands, loss of UE Fien motor, numbness B feet - Later: Bowel & bladder (B&B) changes, difficulty walking (LE proprioception, vibration)
62
Timing of symptoms for Pancoast tumor
- Early: difficult to Dx early due to many differential Dx - Later: severe pain in shoulder radiating to axilla & scapula along ulnar aspect of hand, atrophy of hand & arm, Horner syndrome, compression of blood vessels with edema
63
Symptoms of cervical spondylotic myelopathy (central spinal stenosis) and painful activities
- Pain: neck, sub scapular region, or shoulder, often radiating into arms - Loss of sensation in LE & may contribute to gait impairment - Pain is relieved by rest - Activities: forward flexion of neck causes electric shock like sensation radiation down spine & into arms
64
Symptoms of Pancoast tumor and painful activities
- Pain: arms, chest, peri-scapular, & upper back pain - TTP (tender to palpate) in shoulder, chest, etc. - Pain is NOT relieved by rest - Activities: constant, sharp pain during UE movement & at rest
65
Key parts for examination of cervical spondylotic myelopathy (central spinal stenosis)
- MMT: C5-C7 regions most commonly affected - Limited ROM - Key distinguishing features: bilateral neurological signs/symptoms - Key rejecting features: imaging
66
Key parts for examination of Pancoast tumor
- MMT: shoulder joint, C8-T2 affected - Potentially limited ROM - Key distinguishing features: severe constant shoulder pain with neurological dysfunction to the hand & Horners syndrome, as well as constitutional S/S - Key rejecting features: no tumor
67
Special tests for cervical spondylotic myelopathy (central spinal stenosis)
- Cluster: gait deviation, Hoffman's test, inverted supinator sign (pos. = rapid finger flexion), Babinski test, age 45 (if 3+ pos SP is 99%) - Sensory loss - MRI
68
Special tests for Pancoast tumor
- CT scan - MRI
69
PT management of cervical spondylotic myelopathy (central spinal stenosis)
- Surgical referral (typically necessary) - Cervical collar brace - NSAIDS, corticosteroid injections - Motor control (NMR), endurance, strength & balance cardio for legs & arms to improve circulation - Endurance aquatic therapy to decrease pressure on spine
70
PT management of Pancoast tumor
- REFERRAL: possible surgery to remove tumor - If surgery is performed: soft tissue mobilization around scar, early mob of GH capsule, PROM & AAROM ex, isometrics - Chest secretion clearance by mobilizing, coughing techniques, suctioning, or temporary tracheostomy - Incentive spirometry to increase trans pulmonary pressure - Strengthening of shoulder girdle starting with isometrics
Advanced Orthopedics
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