MUSK 2 - Weeks 1-5 Content (Exam Revision)

Ligaments of the cervical spine

• Superior and Inferior Crus

• Transverse ligament of atlas

• Alar ligament

• Posterior and anterior longitudinal ligaments

• Ligament Nuchae

Trigeminal Autonomic Cephalagias - location and classification

• intense one sided pain centred by eye or temple

• Considered neurological disorder

• Also known as cluster headaches

Symptoms of cluster headaches

• Ipsilateral, severe pain

Craniovertebral Instability (Definition and symptoms)

Excessive movement at C1-C2 vertebrae (bony or ligamentous abnormality). Leads to neurological symptoms when spinal cord and nerve roots are involved

Causes of Craniovertebral instability

Acute trauma, degeneration or congenital conditions

What is a Hangman’s fracture and what are the 3 types

Hangman’s fracture - Head forced back by impact, results in fracture of both pedicles of C2.

• Type A - Compression

• Type B - Distraction

• Type C - Rotation

Presentation of Craniovertebral Instability

Neck Pain, Wry Neck posture, headache, myelopathy, vascular symptoms, feeling unstable

Diagnosis of Craniovertebral Instability

Severe symptoms + acute trauma = urgent referral for imaging

• Alar ligament test

• Sharp Purser test

• Neurological exam

• Imaging

Cervical Arterial Dissection (CAD) - Definition and Risk factors

A tear in the wall of the vertebral artery and can result in stroke

• Minor trauma

• Infection

• Genetic factors

• Younger than 55

CAD symptoms and treatment

Immediate referral to ER

• Mod-severe pain - often progressing

• Spontaneous onset after minor trauma

• Unfamiliar neurological symptoms (balance, speech etc.)

Vertebro-basilar Insufficiency (VBI) - definition and signs

Decreased blood flow to posterior portion of the brain

• >65 yrs

• Spondylosis

• Atherosclerosis

• Trauma

• Stiffness

• 5 D’s & 3 N’s

What are the 5 D’s and 3 N’s

D - Dizziness, Diplopia (double vision), Dysarthria (Talking), Dysphagia (Swallowing), Drop attacks

N - Nausea, Numbness, Nystagmus

How to diagnose VBI

Sustained EOR L & R rotation - 10 secs unless symptoms provoked

Immediate referral to ER

Cervical Myelopathy - Causes and Symptoms

Causes - Trauma, stenosis

Symptoms

• Bilateral Neuro Symptoms

• Bilateral weakness

• Bladder bowel dysfunction

• Saddle anesthesia

May have to refer to ER

Whiplash Syndrome - Symptoms

• Neck pain

• Arm pain

• Headaches

• 5 D’s 3 N’s

• Decreased mobility

• Delay in onset after trauma

• Psychosocial onset

• Clear MOI

Grades of WAD

0 - NIL

I - Complaint of pain, stiffness, tenderness

II - Neck pain + musk signs

III - Neck pain + Neuro signs

IV - Neck pain + fracture or dislocation

Disc Prolapse - cause and symptoms

Acute = trauma, Insidious = degeneration

• Neck pain

• Impaired AROM + PROM

Cervical Radiculopathy - Symptoms

• Neuro loss

• Disc injury

• Trauma

• Neck and arm pain ±

• Positive Cluster or Wainner

What is the Cluster or Wainner

ULTT1, Cervical Rotation, Axial Distraction, Spurling’s A test

Cervical Radiculopathy - Diagnosis and Treatment

• Imaging, Spurling’s, Neuro exam

• Immobilization, manual therapy

Stinger and Burner Syndrome

Traction Injury, common in contact sports

• Radicular burning, shooting, stinging

• Numb and weak

• Possible ACL injury or Clavical

Stinger and Burner Syndrome - Diagnosis and treatment

• Neuro Exam, AROM/PROM, MMT

• Posture retraining, AROM/PROM, stretching, sport specific strengthening

Migraine phases and management

• 1) Prodrome, 2) Aura, 3) Migraine, 4) Postdrome

• Management - Pharmacology, lifestyle balance, Psychology, education

Tension-type headaches - causes and symptoms

• Stress, poor posture, muscular, nutritional

• Bilateral pressing or tightening, not aggravated by physical activity

• Episodic or chronic