MMD I: Week 4 (Neck CPGs & CPRs)

Exam 2 Content

20% of the brain’s blood supply is provided by this artery, which travels through the C6-C1 transverse foramina

Vertebral artery

What does the neck disability index (NDI) measure?

Measures how neck pain has impacted everyday life (pain intensity, personal care, lifting, headaches, concentration, work, driving, sleeping, and recreation)

MCID for NDI

5 to 10 points (10% to 20%)

What does the Patient Specific Functional Scale (PSFS) measure?

Patient selects 3 activities they are unable to do/are limited due to their neck pain, and they rank how well they can do said activy on a sclae form 0-10

MCID for the PSFS

2 points average / 3 points per single activity

MCID for the Numeric Pain Rating Scale (like VAS)

2 points

What does the Global Rating of Change (GROC) measure?

A patient's subjective perception of health or functional change over time, typically from their perspective at the start of treatment to their current status.

MCID for GROC

3 points

• Moderate: 4 or 5 points

• Significant: 6 or 7

What are he 2 highest evidence risk factors for poor prognosis according to the CPG?

• Femal sex

• Prior history of neck pain

Recovery is the fastes in the first ____ to _____ months. It slows down after ____ months

6 to 12 months / 12 months

Expected physical examination findings for Mobility Deficits classification:

• Limited Cx ROM

• Passive and active end-range pain

  • Central and unilateral pain

  • May have UE pain referral

• Pain with segmental provocation

• Strength and motor control deficits (subacute - chronic)

Expected physical examination findings for Movement Coordination Impairments classification:

• (+) Cranial Cervical Flexion Test (CCFT)

• (+) DNF Endurance Test

• (+) Pressure algometry

• (+) Strength and endurance deficits

• MID range pain, worsens at end range

  • Hx of trauma/whiplash

  • UE pain referral

• TTP trigger points

• Sensorimotor impairment

  • Concentration, memory issues

  • Hypersensitivity

Expected physical examination findings for Cervicogenic Headaches classification:

• (+) Cervical Flexion-Rotation Test

• HA with segmental provocation

  • non-continuous unilateral neck pain + headache

  • HA triggered by movement or by sustained position

• Limited Cx ROM

• Restricted upper cervical segmental mobility

• Strength, endurance, and coordination deficits

Expected physical examination findings for Radiating Pain classification:

• (+) Test cluster: ULTT, Spurling’s, Cervical distraction, and limited Cx ROM

• UE sensory, strength or neuro deficits 

  • Dermatomal paresthesia

  • Myotomal weakness

Tests and measures for Mobility Deficits classification:

ICD: Cervicalgia or pain in the thoracic spine

• Cervical AROM

• Cervical and thoracic segmental mobility

Tests and measures for Movement Coordination Impairments classification:

ICD: Sprain and strain of cervical spine

• Cranial cervical flexion test

• DNF endurance test

• Deep cervical extensors

Tests and measures for Cervicogenic Headaches classification:

ICD: Headaches or cervicocranial syndrome

• Cervical AROM (upper>lower cx spine ROM)

• Cervical segmental mobility

• Cranial cervical flexion test

Tests and measures for Radiating Pain classification:

ICD: Spondylosis with radiculopathy or cervical disc disorder with radiculopathy

• ULTT

• Spulring’s Test

• Cervical Distraction

Interventions for Mobility Deficits classification (B and C level):

• Thoracic manipulation

  • ++Acute and chronic

• Cervical manipulation

  • ++Chronic

• Cervical mobilization

  • ++Chronic

• Cervical ROM

  • ++Acute

• UQ Strengthening and Stretching

• NM Exercise

  • ++Chronic

• DN, intermittent traction

  • ++Chronic

T/F: Manual therapy combined with exercise was proven more effective at reducing neck pain than manual therapy alone

True

Thoracic spine thrust manipulation can be used for reducing pain and disability in patients with ____________ ____ ______

Neck-related arm pain

What is something you should ALWAYS do after manipulation techniques?

Provide ROM exercises (UT & levator stretch, DNF strenghtening)

What are the suggested muscles targeted for stretching/flexibility interventions?

• Scalenes

  • OA ext, SB and CL ROT

• UT

  • SB away and ROT towards

• Levator Scap

  • SB + ROT towards + depression

• Pecs 

  • Doorway stretch

Interventions for Movement Coordination Impairments classification:

• ROM with strengthening + postural exercises

  • ++ Acute

• MINIMIZE collar use

  • ++ Acute

• Combined Manual Therapy and Exercise

  • ++ Acute, + Chronic

• TNMES

• Education on prognosis

  • ++Acute, + Chronic

Average recovery for WAD is:

2-3 months

Interventions for Cervicogenic Headaches classification:

• Active Mobility

  • ++Acute

• Upper cx self glides

• Cervical manipulations

  • ++ Subacute and chronic

• Thoracic Thrust

  • ++ Chronic

• Manual + ST strength and endurance

  • ++ Chronic

Interventions for Radiating Pain classification:

• Exercise with mobilizing and stabilizing

  • ++Chronic, +Acute

• Low level laser

• Possible short term collar

• Manual therapy + exercise

  • ++ Chronic

• Intermittent traction

  • ++ Chronic

CPR - For identifying individuals with cervical radiculopathy

1. (+) Spurling’s

2. (+) Radiating sx relief with cervical distraction

3. (+) ULTT

4. ROM <60° on involved side

LR: +30.3 (All 4 variables)

CPR - For identifying individuals with neck pain likely to respond to mechanical cervical traction

1. Age > 55

2. (+) shoulder abduction test

3. (+) ULTT

4. Symptom peripheralization with lower cervical (C4-C7) PA motion testing

5. (+) Neck distraction test

> 4 variables present: +LR = 11.7

CPR - For identifying individuals with neck pain likely to respond to thoracic spine manipulation

1. Symptoms < 30 days

2. No symptoms distal to the shoulder

3. Looking up doesn’t worsen symptoms

4. FABQPA < 12

5. Diminished upper thoracic kyphosis T3-T5

6. Cervical Extension ROM < 30

>3 variables present: +LR = 5.5

When does the clinical reasoning pause #1 happen?

After gathering general information → you formulate an initial hypothesis

When does the clinical reasoning pause #2 happen?

After gathering patient goals (end of subjective)→ you modify your hypothesis, establish SINSS, and plan physical exam

Shoulder Abduction Sign (Bakody’s Sign)

Relief of upper extremity radicular sx

• Flexed/abducted position

• Resting arm on head

• Typically C5/6/7 nerve root

What are the regionally specific questions to ask for the SE (Cx Spine)?

• Hx of headaches

• Vision changes

• Referred/radiating sx