MSK 2 Exam 2

Most common age and sex to have neck pain

females > 50

Facets in C-pine are oriented at what angle

45 degrees

C1

atlas

C2

axis

Radiograph position to see C0-C2

open mouth AP (odontoid)

Abnormal ADI (antlantodens interval) in adult

> 3mm

Abnormal ADI (antlantodens interval) in kids

> 5mm

Best radiograph view to see uncoverterbral joints

lateral

Most mobile joint in C-spine

atlanto-occipital

Couple motion of upper cervical

rotation and sidebending opposite direction

Couple motion of mid-cervical

rotation and sidebending same direction

Couple motion of thoracic

rotation and sidebending opposite direction

L rotation at C1 occurs with _ at C2

R sidebend

Arthokinematics of C1 on occiput

convex on concave

Arthokinematics of C1 on C2

convex on convex

Most sidebending occurs are

OA

Most rotation occurs at

AA

R rotation results in L transverse process of C1 gliding

anterior

R rotation results in R transverse process of C1 gliding

posterior

How is the head able to face forward during lateral flexion

contralateral rotation at C1/C2

5 D’s

dizziness

diplopia

dysarthria

dysphagia

drop attack

3 N’s

nystagmus

nausea

numbness

What to test before AROM after trauma

ligament laxity

Forward head posture result in this lower cervical position

flexion

Forward head posture result in this upper cervical position

extension

What motions would be restricted in left mid-cervical facet capsular restriction

flexion deviated to left

side bending right

right rotation

What motions would be restricted in right upper-cervical facet capsular restriction

forward nodding deviate to L

backward nodding deviate to R

What pattern of restriction would indicate upper cervical involvement

rotation and sidebending loss to opposite sides

What pattern of restriction would indicate mid-cervical involvement

rotation and sidebending loss to same side

Limited side bending right could be caused by

restricted mid-cervical R downglide or L upglide

restricted R sde bend at OA or L rotation at AA

Best test to rule in/out upper C-spine rotation constriction

cervical flexion-rotation test

mobilization and manipulation are _ effective

equally

Is adaptive shortening painful?

No

Facet restriction results in decreased _ at involved facet

upglide

Facet entrapment sign includes pain with _ motions

downglide

Referred pain into UE and DTR changes can indicate this syndrome

lateral foraminal stenosis

Best meds for osteoarthritis

ibuprofen

naproxen

celebrex

Best med for Rheumatoid arthritis

methotrexate

Methotrexate is considered a

DMARD

DMARD stands for

disease modifying anti-rheumatic drug

Adverse effects of methotrexate

GI issues, headache, fatigue, hair loss

JAK inhibitor adverse reaction

immunosuppression

First line med for osteoporosis treatment and prevention

bisphosphonates (alendronate)

Adverse effects of bisphophonates (alendronate)

hypocalcemia (muscle cramping)

First line med for osteoporosis treatment

denusumab

Adverse effects of denusumab

\n hypocalcemia (muscle cramping)

Second line treatment for osteoperosis

teriparatide

Adverse effects of teriparatide

hypercalcemia (muscle weakness)

These meds are no longer recommended for osteoporosis

calcitonin, raloxifene

Adverse effects of NSAIDs

bleeding, toxicity

Duloxetine considered an

NSAID

2nd line meds for osteoarthritis

tramadol, capsaicin, glucosamine

Categories of neck pain with

mobility deficit

headache

poor coordination

radiating pain

Outcome measure for pts with mechnanical neck pain and radiculopathy

NDI

No disability on NDI

0-4

Mild disability on NDI

5-14

Mod disability on NDI

15-24

Severe disability on NDI

25-34

Completely disabled on NDI

>34

acute is considered

< 6 weeks

subacute considered

6-12 weeks

chronic considered

> 12 weeks

Best intervention for neck pain with mobility deficits

manual therapy and exercise

Normal mmHg for cranial cervical flexion test

26-30

Mid range pain that worsens at end range indicates this category of neck pain

movement coordination

Common MOI for neck pain with movement coordination

whiplash

no physical signs of dysfunction, no pain

WAD 0

no physical signs of dysfunction, complaints of pain

WAD I

msk symptoms, complaints of pain

WAD II

neuro symptoms, msk symptoms, complaints of pain into UE

WAD III

fracture/dislocation, complaints of pain

WAD IV

Good tests for WAD prognosis

deep neck flexor endurance

cranial cervical flexion

\+ deep neck flexor endurance test

loss of chin tuck or occiput in hand for > 1 second

deep neck flexor endurance tests these muscles

longus capitis and longus colli

Most important intervention for WAD

education to remain active

Limit use of these interventions for WAD

modalities, manual therapy (passive)

Symptoms of neck pain with radiating pain

< 60 rotations towards pain DTR, sensation, myotome changes

Tests to rule in neck pain with radiating pain

Spurlings, Cervical distraction

If this test is negative, good to rule out neck pain with radiating pain

ULTT median nerve

All tests for neck pain with radiating pain

Sparlings

Cervical distraction

ULTT

Valsalva

Shoulder Abduction

Interventions for neck pain with radiating pain

nerve mobs, traction, mobs and manips

Nerve root impingement most common at which levels affects which nerves roots

C5/C6, C6/C7

C6, C7

Everyone that can centralize symptoms has a _ *but not all people with DP get* _

DP, centralization

Postural syndrome symptom presentation

pain remains local

pain is time dependent

cervical ROM full and pain free

no parestheia

Dysfunction syndrome symptom presentation

pain stays local

no parestheia

no pain at rest, only at end range

ROM loss in 1 direction

pain present > 6-8 weeks

Dereangement syndrome symptom presentation

rapid change in symptom location/severity

pain at any time

* Pt is 74 years old with 8/10 RUE pain and cervical pain. His symptoms began 2 months ago with insidious onset. He experiences some tingling that can travel as low as his thumb. Symptoms are relieved while lying down with head elevated. Symptoms are worsened with walking, standing, and riding his bike. Upper limb tension tests were (-) and Cervical distraction test was (+). He has been in outpatient therapy for a week now and his pain has not improved with repeated movements. Based on this case, what MDT classification would you give this patient?
* Derangement
* Dysfunction
* Postural
* Other

Other

* Based on the case above, what diagnosis would you give this patient? 
* Radiculopathy
* Lateral stenosis
* Cervical HNP
* Upper cross syndrome

Lateral stenosis

Pt reports 7/10 neck pain that radiates into b/l UE. Pt reports 5/10 pain with repeated extension movements. However, pain still remains in b/l UE. What MDT classification would you give this pt?

* Derangement
* Dysfunction
* Other
* Cervicogenic headache

Other

1. A 45 y.o. the patient complains of neck pain with an insidious onset that radiates into the thumb while watching the Jets. Patient reports relief of symptoms when looking up towards the ceiling. Which intervention would be most appropriate for this patient?


1. C1/C2 Contract Relax, Cervical Rotation SNAG
2. Chin Tucks, Isometric Cervical Extension against ball
3. Prone I’s Y’s T’s, Cervical Traction
4. Postural Education, Wall Scaps

Chin Tucks, Isometric Cervical Extension against ball

Decreased sensation to 3rd and 4th digits, wrist flexion weakness, 1+ tricep DTR, which nerve root do you suspect to be involved?

C7

C5 myotome

shoulder abduction

C6 myotome

elbow flexion, wrist extension

C7 myotome

elbow extension

Pt reports symptoms changes with sustained postures but repeated motion fails to provoke symptoms, whats next?

static testing

Force should only be progressed when symptoms are

unchanged

Progression of force

repeated motion

repeated motion pt overpressure

repeated motion PT overpressure

mobs

manips

Interventions for postural syndrome

posture correction

avoid prolonged postures

Interventions for dysfunction syndrome

repeated end range loading in direction of movement loss

Interventions for derangement syndrome

end range movement or sustained posture in direction of centralization