MSK: CPG

Question 1

what are some s/s to look for when placing pt in the mobility deficits bucket?

Answer 1

Pt with central or unilateral neck pain

May refer to UE or shoulder girdle (shoulder blade, not below elbow)

Limitation in neck ROM that CONSISTENTLY reproduces symptoms

restricted segmental mobility on cspine and tspine exam,

neck and referred pain reproduced w. provocation of involved segments

neck pain reproduced at end ranges (active and passive)

deficits in cervico-scapular-thoraicic strength and motor control

Question 2

What should PTs do for Neck pain w/ Mobility deficit patients in the Acute Phase

Answer 2

Thoracic Manip + neck ROM + shoulder strengthening- B level evidence

Cervical mob/manip - C level evidence

Question 3

What should PTs do for mobility deficit patients in the subacute phase?

Answer 3

B level evidence- Neck and shoulder girdle ENDURANCE training

C level evidence- Cervical and thoracic manip/mob

Question 4

What does PTs do for mobility deficit patients in the chronic phase?

Answer 4

B level evidence
MULTIMODAL APPROACH
- Cervical/thoracic mob/manip
- mixed exercises
- may do modalities like dry needling and laser/ traction

C level evidence- endurance exercise

Question 5

neck pain w/ movement coordination impairments s/s to look for

Answer 5

Pt with MOI linked to trauma OR general hypermobility

Referred pain to shoulder girdle and UE (not below elbow)

Dizziness/nausea

Headache/concentration problems

Hypersensitivity (to light, sounds)

heightened affective distress (WAD)

Question 6

heightened affective distress that occurs after WAD requires what important intervention

Answer 6

lots of early education to prevent chronicity!

Question 7

Pt w/

Positive cranial cervical flexion text

Positive Neck Flexor Muscle Endurance test

Positive pressure algometry (motor control test w/ BP cuff)

Point tenderness

Strength and endurance deficits

Neck pain with mid-motion that worsens w/ end range positions

reproducible neck pain by provocation of involved

Answer 7

Neck pain w/ movement coordination impairment

Question 8

What is the prognosis for a pt with movement coordination impairment

Answer 8

Recovery expected in 2-3 months

WITH manual therapy + exercise + Pt education

Question 9

What education needs to be given to pts with a movement coordination deficit

Answer 9

Stay active

Early pain science education

Question 10

when treating pts with WAD / hypermobile, what should you do if they experiencing delayed/prolonged recovery?

Answer 10

switch to a multimodal approach including early pain science education

Question 11

Acute recommendations for Movement coordination deficits

Answer 11

B level evidence:

Return to normal activities as soon as possible

minimize use of collar

perform ROM and posture exercises

reassure pt of prognosis (2-3 months)

Question 12

Subacute recommendations for Movement coordination impairments

Answer 12

B level evidence: Multi-modal intervention (manual mobilizations, exercises)

C level evidence: if PT perceives pt as low risk of chronicity, they can do a single session with just education and HEP, TENS

Question 13

Chronic recommendations for movement coordination impairments

Answer 13

C level evidence: Patient education and advice focusing on assurance, encouragement, prognosis, and pain management

Mobilization + submax exercise

TENS

Question 14

neck pain w/ headaches s/s

Answer 14

Pt w/ noncontinuous unilateral neck pain with headache

Headache precipitated or aggravated by neck movements or sustained postures (may not be reproducible on exam just by doing a motion)

Question 15

Neck pain w/ headache patients will typically have what positive test

Answer 15

Cervical flexion and rotation test, isolates the upper cspine

Question 16

Expected exam findings of Neck pain w/ headaches

HA reproduced w/ provocation of ______________

limited _______________

Answer 16

Upper cervical segments

(typically facets or AA joint)

strength, motor control, joint mobility, ROM

Question 17

What segments most commonly cause cervicogenic headaches

Answer 17

OA, AA, and facets of C2 C3
(because afferent info gets lost with sensory info for trigeminal cervical nucleus)

Question 18

What should PTs do for Neck/Headache patients in the acute phase?

Answer 18

B level evidence: supervised instruction in active mobility exercise

C: self-sustained natural apophyseal glide exercise to AA joint

Question 19

What should PTs do for Neck/headache pts in the subacute phase

Answer 19

B level evidence: Cervical manip and mob

C level evidence: self-sustained natural apophyseal glide exercise to AA joint

Question 20

What should PTs do for Neck/headache pts in the chronic phase

Answer 20

B: cerivical/cervicothoracic manipulation/mobilizations + shoulder girdle/neck stretching/strengthening

Question 21

What is recommended for Radiating neck pain patients in the acute phase

Answer 21

Grade C evidence:
Mobility/stability exercises, laser, and potential short term use of cervical collar

Question 22

What is recommended for Radiating neck pain patients in the chronic phase

Answer 22

Grade B evidence

• Traction, stretching, strengthening, mobs/manips
• education and counseling

Question 23

CPR for if T-spine thrust will help a patient w/ neck pain

1. Duration: ___________
2. No symptoms _________________
3. Looking ______________
4. FABQ score of ____________
5. diminished ___________________
6. __________________ ROM __________

Answer 23

Duration: less than 30

No symptoms distal to shoulder

looking up does NOT aggravate

FABQ less than 12 (not catastrophizing)

Diminished upper thoracic kyphosis

Cervical extension ROM less than 30

If 3/6 theres an 86% chance of helping

Question 24

What should we assess for hypomobiltiy/dysfunction in all cervical spine patients

Answer 24

T-spine hypomobility/dysfunction

Question 25

When working with patients who have a cervical dysfunction where should we start

Answer 25

Start at CT junction and work up

Question 26

T or F: there is no superior type of exercise for pts with chronic neck pain

Answer 26

T ask patient their preference of mode of exercise

Question 27

Cervicogenic headache RX: ________ in the short term ___________ in the long term

Answer 27

Manual Therapy Neck exercise