MSK 2 > UCS Classification/Diagnoses > Flashcards

UCS Classification/Diagnoses Flashcards

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1
Q

Non-Ischemic Vertebral Artery S/Sx

A
  • Ipsilateral posterior neck pain/occipital HA
  • C5/6 cervical root impairment (rare)
  • Non-ischemic Sx can precede ischemic events by a few days to several weeks
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2
Q

Internal carotid Artery

A
  • 80% of blood flow to brain
  • bifurcates from common carotid at C3
  • influenced by cervical motion (mostly extension)
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3
Q

A-O Dislocation

A
  • 100% Fatal
  • Shear force of occiput on atlas
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4
Q

Fracture of posterior arch of atlas

A
  • Result of vertical compression
  • massive suboccipital HA
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5
Q

A-A Dislocation

A

Rupture of transverse ligament

(RA, Downs Syndrome)

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6
Q

Ear

A
  • O-C1 Facet
  • C2-3 Disc
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7
Q

Eye and jaw

A
  • C1-2 Facet
  • C2-3 Facet
  • C2-3 Disc
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8
Q

Cap-Like Headache

A

-C5-6

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9
Q

Vague, encompassing whole head

A

T4 & Lower Lumbar

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10
Q

Examples of Causes of

Referred, Radicular Sx

A

Occipital Neuralgia

Cord Compression

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11
Q

Profile:

Cord Compression

A

Onset after 50 years old

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12
Q

Cord Compression

A
  • Tumor pressing and irritating a neural structure of spinal cord or meninges
  • bone, connective tissue, accumulation of blood, abscess
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13
Q

Body Chart:

Cord Compression

A

Radicular pain with coughing, paralysis

  • non-traumatic strong spasm
  • non-traumatic strong pain in elderly patient
  • may also complain of fever and weight loss
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14
Q

History:

Cord compression

A
  • Persistant or progressive arm pain lasting >6-9months
  • Pain worsening after 1 month
  • previous HA history but this episode new or different
  • OE signs worse than symptoms
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15
Q

ROM:

Cord Compression

A
  • non-traumatic capsular pattern
  • Empty end feel
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16
Q

Neurological Exam:

Cord Compression

A
  • Radial deviator weakness
  • thumb flexor weakness
  • intrinsic hand muscle weakness/atrophy
  • >1 level involved
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17
Q

Vasculogenic Referred Pain

A
  • From venous congestion or arterial deprivation to MS areas
  • Ex. Cervical Artery Dysfunction
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18
Q

Cervical Artery Dysfunction Cause

A
  • Trauma
  • Atherosclerosis

(associated with HTN, hypercholesterolemia, hyperlipidemia, hyperhomocystemia, DM, genetic clotting factors)

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19
Q

5 D’s

3 N’s

1 A

A

Dizziness, Diplopia, Dysphagia, Dysarthria, Drop Attack

Nausea, Numbness, Nystagmus

Ataxia

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20
Q

Dizziness

A

CN VIII

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21
Q

Diplopia

A

Descending Spinal Tract

Descending Sympathetic Tract

CN V (??)

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22
Q

Dysphagia

A

CN IX

CN X

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23
Q

Dysarthria

A

CN XII

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24
Q

Drop Attack

A

Reticular Formation

Rostral Pons

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25
Nausea
CN VIII Vestibular Nucleus
26
Numbness
CN V Ascending Spinothalamic (body)
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Nystagmus
Lower Vestibular nuclei + others
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Ataxia
Inferior Cerebellar Peduncle
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Internal Carotid Artery Non-Ischemic (local) S/Sx
- head/neck pain with temporal HA - Horner's Syndrome, - pulsatile tinnitus - CN palsies (common: IX thru XII)
30
Internal Carotid Artery Less Common Local S/Sx
- ipsilateral carotid bruit - scalp tenderness - neck swelling - CN VI palsy - Orbital pain - anhidrosis (facial dryness)
31
Internal Carotid Artery Ischemic (cerebral/retinal) S/Sx
SEVERE - TIA - Ischemic stroke (usually MCA territory) - Retinal Infarction - Amaurosis Fugax (loss of vision in one eye due to temporary lack of blood flow to retina; sign of impending stroke)
32
4 Headaches
- Migraine (vascular) - Cluster (Vascular) - Tension-Type (muscular) - Cervicogenic
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Body Chart: Migraine
Unilateral May change sides between attacks
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Pain: Migraine
Throbbing Nausea phono/photophobia
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Intensity: Migraine
Severe
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Body Chart: Cluster HA
Unilateral may change sides between attacks
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Intensity: Cluster HA
Excruciating begins suddenly and builds up in short time
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Body Chart: Tension HA
Bilateral band-like pain forehead to occiput
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Pain: Tension HA
- Tightness, pressure, dull ache - no nausea - mild photo/phonophobia
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Intensity: Tension HA
mild to moderate
41
Body Chart: Cervicogenic HA
- unilateral, unilateral with spread, or bilateral - Unilat\>bilat - No side shift - frontal, retro-orbital, temporal, occipital - associated with suboccipital neck pain
42
Pain: Cervicogenic HA
- Referred from source in neck - pain starts in neck and spreads to face/head - described as aching, deep boring pain - less often throbbing/pulsing - crepitus is common complaint
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Intensity: Cervicogenic HA
- Mild to moderate - can be severe
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Agg Factors: Migraine
- Not affected by neck movements - worse with exercise - 24 hour pattern: rarely awakens pt, occurs upon arising
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Agg factors: Cluster
- Not affected by neck movements - worse with exercise
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Agg Factors: Tension HA
- Not affected by neck movements - worse with exercise - 24 hour pattern: cyclic groupings 30-60 min, 3-4x/day
47
Agg factors: Cervicogenic HA
Neck movement or sustained postures and stress - 24 hour: may wake with Sx due to sleeping posture or busy previous day. - often present when wakes +morning CS stiffness
48
Ease Factors: Migraine
- Reclining dark room - cold compress to temples - immediate injection of analgesic at first sign of attack
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Ease Factors: Cervicogenic HA
- Change of posture - Lie down - ice, heat - massage - simple analgesics in early stages
50
History: Migraine
- HTN, Anxiety, Menstruation, Food types - onset of HA in adolescence/young adult life - HA lasts several hours to full day - Diagnosis only made if pt has history of 5-6 attacks that last \>/=4 hours - 75% of migraine pts have 1st degree relative with migraines - extensive physical and neurological examinations clear
51
Duration of Attack: Migraine
4-72 hours
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Duration of Attack: Cluster
Varies -periords free of HA then HA in clusters
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Duration of Attack: Tension HA
30min-7days
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Duration of Attack: Cervicogenic
Gradual onset with movement
55
Headaches with Aura
Migraine (visual, sensory, motor or speech Sx)
56
Physical Exam: Migraine Cluster HA Tension HA
may have an element of cranial vertebral dysfunction
57
Location Sx: Cervicogenic HA 0-1 Facet
- Occipital (can be bilat/one side worse) - supraorbital - ear pain
58
Location of Sx: Cervicogenic HA C1-C2 Facet
- Sub-occipital (starts in back, progresses to front--forehead, into/behind eye) - temporal pain/band of pain around head
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Location Sx: Cervicogenic HA C2-3 Facet
- Pain like C1/2 - Anterior neck pain
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Location Sx: Cervicogenic HA C2-3 Disc
- Pain like C1/2 - Anterior Neck pain (into throat) - into ears - may have cloward sign
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Location Sx: Instability
catching, unilateral pain, head feels heavy, feel need to hold up head
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Location Sx: Hypermobility
+/- pain (central/unilateral)
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Agg Factors Cervicogenic HA 0-1 Facet C1-2 Facet C1-2 Disc
- Neck movements or sustained head positions - May not know pattern - stress/tension - 24 hour: wake with Sx due to sleeping posture or busy previous day - often present upon waking + morning c/s stiffness
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Agg Factors: Cervicogenic HA C2-3 Disc
Flexion/extension
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Agg Factors: Instability/Hypermobiity
Depends on severity of injury/Sx
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Ease Factors: Cervicogenic HA 0-1 Facet C1-2 Facet C2-3 Facet C2-3 Disc
- Change posture - Lie down - ice/heat - massage - simple analgesics
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History: 0-1 Facet C1-2 Facet C2-3 Facet C2-3 Disc
- Sudden Onset: consider acute subarachnoid hemorrhage, spontaneous dissections, vertebral/carotid Aa - Gradual Onset: microtrauma (posture/work/previous injury), 50% will relate onset to head/neck trauma - History can be weeks-years - Begins in neck and spreads to head - HA's may be semi-continuous or follow pattern - Don't respond to migraine drugs
68
History: Instability/Hypermobility
Ask about Hx of RA
69
Posture: Cervicogenic HA
Forward head
70
ROM: Cervicogenic HA 0-1 Facet C1-2 Facet
Protraction retraction
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ROM: Cervicogenic HA C2-3 Facet
Cervical rotation vs cervical SB
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ROM: Cervicogenic HA C2-3 Disc
Cervical flexion/SB
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ROM: Instability/Hypermobility
- depends on stage of disorder - may have extreme limitations or excessive movement - non-traumatic capsular pattern with RA, ankylosing spondylitis and neoplasm
74
Provocation Tests 0-1 Facet
Protraction/retraction + SB
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Provocation tests: C1-2 Facet
Protraction/Retraction + Rotation
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Provocation tests: C2-3 Facet vs UVJ
Facet: Rotation + SB UVJ: SB + Rotation
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Special/Provocation tests: Instability
+ Alar and/or transverse ligament
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Palpation: Cervicogenic HA 0-1 Facet C1-2 Facet C2-3 Facet C2-3 Disc
0-1 Facet: C1 unilat PA in neutral C1-2 Facet: C1 & C2 Unilat PA in rotaion C2-3 Facet: C2 unilat PA in neutral C2-3 Disc: C3 Central PA stiff/pn (careful palp of C2 PA)
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Palpation: Instability/Hypermobility
- Pain/spasm with central PA - stiffness to adjacent segments
80
Muscle Length/Strength UCS Disorders
Length: - Suboccipital - Upper trap - levator scapulae - scalenes Strength: -deep cervical flexors
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Neurological Testing UCS Disorders
May have +ULNT Cord Compression: paresis, paresthesia, hyperreflexia, babinski, clonus
82
Location of Sx: Whiplash
- Pain (suboccipital, neck, shoulder, scapula, back, unilat/bilat, frontal HA, retro-orbital pn, face, throat - Patches of numbness/paresthesia - laryngeal disturbances Patchy/dermatomal
83
Factors influencing recovery of Whiplash Associated Disorders
- Direction of force (extension worst) - Velocity of Impact (8mph=concussion; 30mph=intra-cranial bleeding) - Curvature of CS (straight/kyphotic=worse injury) - Position of head/neck - Symptoms immediate=worse - Impact expected/not
84
Structures Impacted in Whiplash
Facets, disc, Mm, Lig, C vertebrae, brain, meninges, Aa, nervous system
85
Special Questions: Whiplash
- hearing/vision disturbances - dizziness - feelings of instability - depression/fatigue - irritability - Insomnia - light-headedness
86
Diagnostic Tests: Whiplash
- CT, myelography, EMG (only if neuro signs present) - X-ray to r/o fracture (transoral x-ray)
87
OE Findings Acute Whiplash
- Pain dominant complaint - cautions/apprehensive movements of neck, shoulders, arms - c/o dizziness with active movements - palpation deferred - difficult to perform neuro or neurodynamic tests - VA usually deferred
88
OE Findings Sub-Acute Whiplash
- Active movement to end range (limited/stiff/spasm) - Complete neuro - increased c/o thoracic/lumbar pain (inflam of NS) - Hyper/hypomobility with PAIVMs or cervical stability testing
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OE Findings: Chronic Whiplash
- Sx may be intermittent - Limited active movements - weak Mm - Palpation findings - Neurodynamic tests performed
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Treatment of Whiplash
Phase 1: pain, immobility, protection, mobility Phase 1-3: Exercise
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Fractures
- A-O Dislocation: Fatal - A-A Dislocation - Fx of posterior arch of atlas - Jefferson Fx - Dens Fx - Hangman's Fx Rotary A-A Subluxation
92
Jefferson Fx
- Fx of ant and post arches of C1 - break in 4 places - usually blow to back of head
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Dens Fx
- Common in MVA - Picked up with open mouth x-ray
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Hangman's Fx
- Fx of C2 pedicles with dislocation of the body of C2 on C3 - results in dens into brainstem - not always fatal
95
Rotary A-A Subluation
Face mask injury
96
Different stabilizing braces
- Aspen - Philadelphia - Soft Collars (reversed) - Minerva
97
MSK 2
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