1
Q
What are three Outcome Assessments Tools
A
- Neck Disability Index
- VAS
- Numeric Pain Scale
2
Q
Cervical Disc Derangement
A
- Disruption in Disc Integrity
- Due to traumatic or gradual microtrauma
- MC in 18-50 yo
3
Q
MC location of Cervical Disc Derangement
A
- C5/6
- C6/7
4
Q
Steps in Cervical Disc Derangement
A
- Annular (radial) fissure damage
- Nucleus herniates OUT DISC = Disc herniation
5
Q
IVD Dz breakdown
A
- MC in Lumbar
- 2nd MC in Cervical
- Least Common in Thoracic
6
Q
What is the description of a Disc Protrusion
A
- Base WIDER THAN Herniation
- Confined to disc lvl
- Outer annual fibers intact
7
Q
What is the description of a Disc Extrusion?
A
- Base NARROWER THAN Herniation
- Extends above or below endplate
- Complete annular tear
*** uncontained **
8
Q
What is the definition of a Disc Sequestration?
A
- Disc herniation breaks off -> Spinal Canal
- Symp. span across many N. Roots
- Requires surgery
9
Q
What is the definition of the Cervical Disc Derangement symptoms [4]
A
- Neck pain / Arm pain
- Worse w. cough/sneeze/bearing [Triad of Dejerine]
- Worse w. Ext/Rot/LF
- Pain referred to Occiput
10
Q
What are some palliative factors to cervical disc?
A
derangement
chin retraction
good posture
cervical traction
11
Q
You want to order an MRI in Cervical Disc Derangement if the following occur:
A
- PT fails to improve w. conservative care
- Worsens / Neuro Deficit
- Red flags present
12
Q
What are the 4 Medical Management of Cervical Disc Derangement [4]?
A
- NSAIDS
- Corticosteroids
- N. Block
- Surgery
13
Q
What are the 5 Chiro Management of Cervical Disc Derangement [5]
A
- Stim
- Soft tissue / Traction
- Mckenzie
- F &D / Adjust
- Taping / Rehab (Chin tucks, Wall angels)
14
Q
What are three Causes of Cervical Radiculopathy?
A
- Disc herniation
- IVF encroachment
- Chemical irritation
15
Q
What are three Symptoms of Cervical Radiculopathy?
A
- Pain / Numb / Tingling
- Weakness in UE
- Stiff neck -> Decreased ROM
16
Q
What are three Imaging for Cervical Radiculopathies?
A
- Radiograph
- MRI
- EMG (Studies N. Root)
17
Q
What are 6 Chiro Management of Cervical Radiculopathy [6]?
A
- Stim
- Soft tissue / Traction
- Mckenzie
- F &D / Adjust
- Tape / Rehab (Chin tucks, Wall angels)
- N. Flossing
18
Q
What is Cervical Myelopathy?
A
- Compression of Cervical Spinal Cord
19
Q
What are some Causes of Cervical Myelopathy [4]?
A
- Post. Protruding Disc
- OPLL
- Degen change
- Spinal stenosis
20
Q
What are some Symptoms of Cervical Myelopathy?
A
- Weak muscle (SPASTIC)
- Gait Disturbance
- Bowel/bladder Disturbance
- Neck pain/stiffness
Hyperreflexia in LE
21
Q
What are some Signs of Cervical Myelopathy [5]?
A
- Hand muscle Atrophy
- HYPERreflexia below compression lvl
- Neck flexion causes shock pain down back [L’Hermitte’s]
- Finger escape sign
- Inverted Radial Reflex
22
Q
What is the Finger escape sign?
A
- PT hold hand with extends fingers
- Medial (4th/5th) will deviate with flexion
23
Q
What is the Inverted radial reflex?
A
- C6 root compression with cord compression
- Weak brachioradialis reflex w. SPASTIC finger flexors
they have C6 reflex diminished with spasticity at C8
24
Q
What is the Best IMAGING for assessing changes to Spinal Cord?
A
- MRI
25
What are some Chiro management of Cervical Myelopathy?
- Contraindication to HVLA (DON'T ADJUST)
- Managed by MD
- Mobilize
- Extension exercises
- Rehab for limbs
26
What are 4 mechanisms that cause Facet Syndrome?
- Degeneration
- Trauma
- Inflammation
- Cartilage erosion
27
What are some Symptoms of Facet syndrome in C-Spine?
- Axial neck pain [Unilat]
- Pain w EXT. + ROT.
- Tender palpation
- Refer to Shoulder / Mid Back
28
What are some Clinical Evaluation of Facet Syndrome?
- Compression & Distraction tests helps INDICATE
29
What is the GOLD STANDARD for Facet Syndrome Dx?
- Medial branch block (anesthetic injection)
** (+) = Response to 2 diagnostic blocks @ 2+ lvls **
30
What are 5 Chiro management of Facet Syndrome [5]?
- TENs
- Shockwave (Performs better than other stim)
- Pulse electromagnetic
therapy
- Myofacial soft tissue massage
- Tape / Rehab
*** Manipulation w. exercise encouraged by literature **
31
What is Whiplash?
- Trauma resulting in Musculolig. sprain/strain
32
What are some Causes of Whiplash?
- Sudden accel. / decel. of Head relative to Trunk
- In ANY PLANE
33
Whiplash can even occur at ______ mph
- 5 mph
34
MVA what can cause Whiplash [4]
- Roller Coaster
- Sports
- Punched
- Shaken baby
35
Amount of car damage is..
- Inversely proportional to Whiplash incidence
36
Grades of Whiplash
0: No complaints
1: Neck pain, no physical signs
2: Decrease ROM, point tenderness
3: Neuro signs
4: Neck pain w Fx
37
Median time to RECOVER from WAD (Whiplash)
~ 101 days
** Still not recovered after 1 yr **
38
Paresthesias assoc w. WAD can attribute to... [4]
- TOS
- Myofascial injury
- Stretch injury of Brachial Plexus
- Central cord injuries
39
WAD injuries include these 5 components:
- C-Spine muscle tear
- C-Spine Lig tear
- Disc Herniation
- Instability / Sprain
- Esophageal Hematomas
40
4 causes of Retropharyngeal Hematoma
- Hyperextension to airbag
- Cough / Sneeze / Vomiting
- WAD
- Trauma
41
What is Myelomalacia?
- Softening of spinal cord
- Can bring Hemorrhagic Infarction to spinal cord
42
UNILATERAL facet dislocation causes ________
BILATERAL facet dislocation causes ____
Radiculopathy
Cord injury (compression)
43
What are 3 Affects of muscle spasm?
- Wide open sensory gate and blocked mechanoreception
- Metabolic waste accumulation
- Prolonged spasm leads to myofascial pain syndrome
44
Explain the Tonicity scale [1-4]
+1 : Sustained contraction, mild resistance in passive ROM
+2 : Sustained contraction, moderate resistance in passive ROM
3+ : Muscle rigidity, complete resistance to passive ROM
4+ : Spasm, triggered by movement to EX. irritation (poking muscle causes spasm)
45
What is the WAD PT intake protocol:
- Cervical radiographs w. Flex/Extension
- Normal / Mild loss of lordosis
46
Traditional management of WAD [4]
- Rest
- Analgesic (Anti-Inflam)
- Oral meds / Injections
- Collar
47
What are 4 chiro management results of treating WAD?
- Heal soft tissue 1st
- Aim to reduce pain / inflammation
- Expedite healing
- Encourage mobility
48
When to REFER in WAD Patient?
- Fx
- Instability
- Soft tissue damage
- Neuro deficit
49
What is the Purpose of C1/C2?
- Support occiput
- Provides greatest ROM in C-Spine while maintaining support
50
What are two Conditions that lead to Upper cervical instability?
- Down Syndrome (30%)
- RA (25%-80%)
51
What are the 4 Types of Upper Cervical Instability?
I: simple rotary displacement with intact transverse
2: anterior displacement, 3-5mm, deficiency of transverse
3: anterior displacement beyond 5mm
4: posterior displacement of C1 on C2
52
Explain Type 3 & 4 Upper Cervical instability:
- Highly unstable and require ER immediately
53
3 main Radiograph requirements for C-Spine instability:
- 3mm or 25% ANT. body movement
- 25% vertebral body compression
- 11 degree of angular instability
54
Asymptomatic Cervical unstable patients can be minored with what?
- Be monitored with MRI
** if worsens, neuro consult is required **
55
Cervical Instability & Chiro management can be used for:
- Type 1 & 2 are co manageable
- Type 3/4 are surgery
** NO HVLA at all ***
Evidence Based Managment
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