Cervical Unit- Background and condition specific information

what are the different kinds of cervical spine pathologies?

can be myogenic, mechanical, anatomical, neurogenic, psychosomatic (and acute, chronic, acute on chronic)

what are the preferred/biased movements in the cervical spine based on the anatomy of the cervical vertebrae?

flexion/extension, lateral flexion, and rotation

which artery is susceptible to damage or stretching/compressio9n due to osteophyte formation and sclerotic build up in the cervical region?

the vertebral artery (since runs through the transverse foramen

describe the 5 Ds and 3Ns that occur with vertebral artery damage

• dysarthria

• dysphagia

• diplopia

• dizziness

• drop attacks

• nystagmus

• numbness around the nose and mouth

• nausea

how can you tell if there is internal carotid damage and not vertebral artery damage?

internal carotid dysfunction typically occurs in younger patients, and see presentation of horners syndrome (miosis, anhidrosis, ptosis)

what is unique about the ligamentum flavum?

has a high concentration of elastin, is yellowish but is especially susceptible to age related changes (decreased water content, leads to reduced elasticity)

about how much motions is available at the AO joint?

5 degrees of flexion, 10 degrees of extension, negligible rotation, and 5 degrees of lateral flexion

about how much motion is available at the AA joint complex?

5 degrees of flexion, 10 degrees of extension, 35-40 degrees of rotation, and negligible lateral flexion

how much motion is available at the intracervical region?

35-40 degrees of flexion, 55-60 degrees of extension, 30-35 of both lateral flexion and rotation

how do the zygopophyseal joints move during rotation?

to the ipsilateral side (to the side of rotation) the joints approximate and gap on the opposite side

what is the prevalence of neck pain in PT practice?

2nd most common body region treated (after LBP) and is also second to LBP in annual worker’s compensation costs

what are the risk factors for acquiring neck pain?

• age (40 years or older)

• co-existing LBP

• cycling

• loss of hand strength

• worrisome attitude

• poor QOL

• less vitality

what are items that may determine poor prognosis for neck pain?

• 6 or greater on NPRS

• high self reported disability

• high pain catastrophizing

• high acute post-traumatic stress symptoms

• cold hyperalgesia

what are the 4 classifications for neck pain?

• neck pain with mobility deficits

• neck pain with radiating pain

• neck pain with movement coordination deficits

• neck pain with headaches

which disorders fall under neck pain with mobility deficits?

degenerative joint disease, degenerative disc disease, fracture, facet dysfunction, spondylosis/OA, stenosis

describe the typical characteristics of neck pain with mobility deficits

• pain is gen localized to the neck, prox humerus, or scapular region

• limited ROM

• usually no associated radicular symptoms (except in stenosis)

• pain is reproduced with segmental motion or ROM assessment

• may be associated weakness of neck musc or periscapular musc

• onset is gradual

• stiffness with sustained positions and better with motion

what is spondylosis/cervical OA?

spondylosis is a loss of disc height and changes to the vertebral body, OA is a loss of space in the zygopophyseal joint (both may be evident on imaging but asymptomatic) and either can lead to spondylolithesis (usually anterior slippage of 1 vertebrae to another)

what is spondylolisthesis?

a condition where one vertebra slips forward over the one below it, often due to degeneration of the intervertebral disc or a defect in the pars interarticularis. This displacement can cause nerve compression and result in pain or other neurological symptoms.

what are the physical examination findings of spondylosis?

reduced motion, capsular pattern, possible “giving way” or catch in movement

describe facet joint dysfunction/zygopophyseal joint syndrome

• generally acute onset

• usually in younger pop

• “neck stiffness/slept wrong”

• usually directionally specific with closing pattern (when turn left it hurts on the left)

• localized muscle guarding

• imaging tends to be unremarkable

describe the referral patterns of facet/zygopophyseal joint dysfunction/syndrome

C2-C3 refer pain to the back of the lead and laterally, C3-C4 to the lateral neck, C4-C5 into the lateral neck and part of the upper trapezius, C5-C6 into the UT, and C6-C7 into the scapular region (see image)

what is stenosis?

narrowing of the spinal canal or foramen that can lead to compression of neural structures and resultant symptoms.

what are the symptoms of central stenosis (which occurs more often in middle age and older pops)?

hypperreflexia below the level of the injury, + UMN reflexes, possible muscle atrophy, LE weakness, wide based gait, altered/poor balance, UE and LE parasthesia

what are the symptoms of foraminal stenosis?

unilateral (more common) or bilateral symptoms, hyporeflexia, dermatomal sensory changes, myotomal strength deficits, hand weakness (think similar to herniated disc which usually affects 1 segment)

what is the cervical myelopathy cluster?

• gait deviation

• + hoffmans test

• inverted supinator sign

• babinski

• age over 45

post test prob 94% when 3/5 of above are present

what things may cause stenosis?

anything encroaching on the central canal or nerve root (bone spurring/arthritis, retrolisthesis, ligamentum flavum hypertrophy, large disc herniations, tumors)

how does foraminal stenosis typically present?

present similar to discogenic problem (herniation) but is due to arthritis of the neck (think aged population), radiating symptoms may be intermittent and be position dependent, myotomal weakness may be present, hyporeflexia, no UMN signs, parasthesias

what are some reasons for neck pain wirth movement coordination deficits?

• often thought of as whiplash (acute)

• can also be caused by

  • hypermobility/laxity

  • poor posture/motor control

  • poor muscular endurance (scapular and cervical musculature)

  • can be related to concussion and other trauma

describe the staging of movement coordination deficits

• acute is often very guarded

• traction often painful AND compression

• increased muscle tone

• multiple structures irritated

• may present with concussion symptoms

what are risk factors for delayed recovery for whiplash associated disorders?

• decrease in spine mob immediately after acciden t

• pre-existing neck trauma

• older

• female

• psychological factors

• pending litigation

describe neck pain with headaches

• aka “cervicogenic headaches”

• usually unilateral “ram’s horn presentation”

• provocated by sustained neck positions

• sensitive to external pressure or manual palpation over th eupper cervical C0-C2 region

• symptoms usually starts in neck/base of head (subocciptal) and progress superiorly/anteriorly

what “unusual symptoms” might present with cervicogenic headaches?

can have unusual symptoms- photophobia, phonophobia, nausea, autonomic signs and symptoms, and dizziness