SPINE
Prepared by: Ms. Sarah A. Ligaya, PTRP
Scanning examination
Mobility
ANATOMY
2 divisions
Cervicoencephalic/Cervicocranial
upper cervical spine
C0-C2
Cervicobrachial for the lower cervical
spine.
Lower cervical spine
C3-C7
Cervicoencephalic/
Cervicocranial
upper cervical spine
C0-C2
Injuries in this area lead to symptoms of:
Headache
Fatigue
Vertigo
Poor concentration
Hypertonia of sympathetic nervous system, and
Irritability
Cognitive dysfunction, cranial nerve dysfunction and
sympathetic system dysfunction.
LIGAMENTS
ANTERIOR ATLANTO-OCCIPITAL MEMBRANE
is strengthened by the anterior longitudinal ligament.
TECTORIAL MEMBRANE
is a broad band covering the dens and its ligaments
is found within the vertebral canal
is a continuation of the posterior longitudinal ligament.
ALAR LIGAMENTS
two strong rounded cords found on each side of the upper dens passing
upwards and laterally to attach on the medial sides of the occipital condyles
limit flexion and rotation
play a major role in stabilizing C1 and C2, especially in rotation
Lateral Flexion Alar Ligament Stress Test
Rotational Alar Ligament Stress Test
ATLANTO-OCCIPITAL
JOINTS (C0 TO C1)
are the two uppermost joints.
The principal motion of these two joints is:
Flexion-extension (15 to 20) or nodding of the
head.
Side flexion is approximately 10, whereas rotation
is negligible.
ATLANTO-AXIAL
JOINTS (C1 TO C2)
Pivot/trochoid joint
Most mobile articulation of the spine
FL-EX (10 deg.)
Side flexion (5 deg.)
Rotation (50 deg.)
Ligament: transverse ligament of the atlas
which holds the dens of the axis against the anterior
arch of the atlas.
It is this ligament that weakens or ruptures in
rheumatoid arthritis.
Transverse Ligament Stress Test.
cruciform ligament of the atlas
UNCINATE JOINTS OR
JOINTS OF LUSCHKA
C3 TO T1
not seen until age 6 to 9 years and
are not fully developed until 18 years
of age.
The uncus gives a saddle form to the
upper aspect of the cervical vertebra,
which is more pronounced
posterolaterally; it has the effect of
limiting side flexion.
Extending from the uncus is a joint
that appears to form because of a
weakness in the annulus fibrosus.
FACET ORIENTATION
The superior facets
of the cervical
spine face:
upward, backward,
and medially (PSM)
The inferior facets
face:
downward, forward,
and laterally.
Cervical Spine
Resting position: Midway between flexion and extension
Close packed position: Full extension
Capsular pattern: Side flexion and rotation equally
limited extension
IVD
make up approximately 25% of the
height of the cervical spine.
No disc is found between the atlas and
the occiput (C0 to C1) or between the
atlas and the axis (C1 to C2).
give the cervical spine its lordotic
shape.
The nucleus pulposus
functions as a buffer to axial
compression in distributing
compressive forces
annulus fibrosus acts to withstand
tension within the disc.
NERVE
ROOTS
- Eight cervical nerve roots.
- Each nerve root is named
for the vertebra below it.
- As an example, C5 nerve
root exists between the C4
and C5.
- In the rest of the spine,
each nerve root is named
for the vertebra above; the
L4 nerve root,
- for example, exists
between the L4 and L5
vertebrae
VERTEBRAL
ARTERY
passes through the transverse
processes of the cervical
vertebrae
usually starting at C6 but entering
as high as C4supplies 20% of
the blood supply to the brain
ICA (80%)
The vertebral and internal
carotid arteries are
Vertebral arteries and ICA are
stressed primarily by rotation,
extension, and traction
movements.
VERTEBRAL ARTERY
lies close to the facet joints and vertebral body where it
may be compressed by osteophyte formation or injury to
the facet joint.
OLDER PEOPLE
may contribute to altered blood flow in the arteries:
atherosclerotic changes and
other vascular risk factors (e.g., hypertension, high
fat or cholesterol levels, diabetes, smoking)
Rotation and extension of as little as 20 have
significantly decrease vertebral artery blood flow.
Dutton reports that the most common mechanism for nonpenetrating injury to the vertebral artery is neck
extension, with or without side flexion or rotation.
VERTEBRAL ARTERY
The greatest stresses are placed on the vertebral arteries in
four places:
where it enters the transverse process of C6
within the bony canals of the vertebral transverse processes
between C1 and C2
and between C1 and the entry of the arteries into the skull
Given the type of injury possible, symptoms may be delayed.
Symptoms related to the vertebral artery include:
Vertigo
Nausea
Tinnitus
drop attacks (falling without fainting)
visual disturbances, or,
in rare cases, stroke or death.
Dizziness
Giddiness
Drop attacks
Syncope (loss of consciousness)
Stroke
Diplopia, blurred vision
Visual hallucination
Tinnitus (ringing in the ears)
Flushing
Sweating
Lacrimation (tearing)
Rhinorrhea (runny nose)
Scotomata (visual defect in
defined area of eye[s])
Hiccups
Myotonic jerks
OBSERVATION
Shoulder Levels.
Normally
With injury?
Poking chin will cause shoulders to be?...
Facial Expression.
Such observation should give the examiner an idea of how much the
patient is subjectively suffering.
Evidence of Ischemia in
Either Upper Limb.
The examiner should note any altered coloration of the skin, ulcers, or
vein distention as evidence of upper limb ischemia.
ACTIVE MOVEMENTS
PASSIVE MOVEMENTS
RESISTED ISOMETRIC MOVEMENTS
SCANNING EXAMINATION
Active Movements of
the Cervical Spine
Flexion
Extension
Side flexion left and right
Rotation left and right
Combined movements (if necessary)
Repetitive movements (if necessary)
Sustained positions (if necessary)
Flexion
palpate
the relative movement between the mastoid and
transverse process of C1
posterior arch of C1 and the lamina of C2
Posterior bulging of SP of C2 Forward
subluxation of atlas
Sharp Purser test
MAX ROM is normally found when the chin is able to
reach the chest with the mouth closed;
however, up to two finger widths between chin and
chest is considered normal.
SCM compensation
IV foramen: 20-30% larger inflexion than in extension
Extension
Side, or lateral,
flexion
20 to 45 deg
palpate adjacent transverse
processes on the convex side
Rotation
70 to 90
Repetitive Movements
Or Sustained Postures
Passive Movements of
the Cervical Spine
A.
B.
C.
D.
FLEXION
EXTENSION
SIDE FLEXION
ROTATION
A. FLEXION
palpates between the mastoid process and the transverse
process for movement between C0 and C1
between the arch of C1 and spinous process of C2
The rest, palpate between SP
B. SIDE FLEXION
C. ROTATION
palpating the adjacent transverse
processes on each side while doing the
movement
the TP on the side to which the head is
rotated will seem to disappear (bottom
one) while the other side (top one)
seems to be accentuated in the normal
case.
If (-) disappearance/accentuation: there is
restriction of movement between C0 and
C1 on that side.
A.
B.
C.
D.
FLEXION
EXTENSION
SIDE FLEXION
ROTATION
Shoulder Girdle.
Abduction
Flexion
Scaption
Apleys scratch test (right and
left)
Rotation in 90 abduction
Elbow joints
Flexion
Extension
Supination
Pronation
Wrist and hand joints
Flexion
Extension
Abduction
Adduction
Opposition of thumb
and little finger
Myotomes
Resisted isometric contractions with joint at or near resting
position (5 sec.)
Dont let me move you,
Cervical Myotomes
Neck flexion: C1 to C2
Neck side flexion: C3 and cranial nerve XI
Shoulder elevation: C4 and cranial nerve XI
Shoulder abduction/shoulder lateral rotation: C5
Elbow flexion and/or wrist extension: C6
Elbow extension and/or wrist flexion: C7
Thumb extension and/or ulnar deviation: C8
Abduction and/or adduction of hand intrinsics: T1
Sensory Scanning
Examination
Accomplished by running relaxed hands over all aspects
of the arm.
(+) difference = use pinwheel, pin, cotton batting, or brush
(or a combination of these) to map out the exact area of
sensory difference
May include:
deep tendon reflexes
Pathological reflexes
Neurodynamic tests
Reflexes
Common Reflexes Checked in Cervical
Spine Assessment
Biceps (C5, C6)
Brachioradialis (C5-C6)
Triceps (C7, C8)
Hoffmann sign (if upper motor neuron lesion
suspected)
Jaw Jerk (CNV)
Pathologic Reflexes
Hoffman (Digital) Reflex
ELICITATION:
Flicking of terminal phalanx of index, middle, or ring
finger
POSITIVE RESPONSES:
Reflex flexion of distal phalanx of thumb and of distal
phalanx of index or middle finger (whichever one was not
flicked), interphalangeal joint of the thumb of the same
hand flexes/adducts.
PATHOLOGY:
Increased irritability of sensory nerves in tetany
Pyramidal tract lesion
Sensory Distribution
Of The Peripheral Nerves
Dermatome Pattern Of
The Various Nerve Roots
C5 lateral arm
C6 lateral forearm, thumb, index finger
C7 posterior forearm, middle finger
C8 medial forearm, ring and little fingers
T1 medial arm
Muscles
and their
referred
pain
patterns
Muscles
and their
referred
pain
patterns
Referred pain
patterns suggested
with pathology of
the apophyseal
joints.
Bakodys sign
The patient may state that the pain and referred symptoms are
decreased or relieved by placing the hand or arm of the
affected side on top of the head
it is usually indicative of problems in the C4 or C5 area.
DIZZINESS?
Semicircular canal problems
vertebral artery problems.
Falling with no provocation while remaining conscious is
sometimes called a drop attack.
Has
the patient experienced any Disturbances
such
VISUAL
DISTURBANCES?
Pain on swallowing
Breathing
Swallowing
Looking up at the Ceiling
40 to 50 of neck extension is usually
necessary for everyday activities
Looking down at Belt Buckle or Shoe Laces
At least 60 to 70 of neck flexion is
necessary.
Shoulder Check
Tuck Chin IN
Poke Chin OUT
Neck Strength
Paresthesia
FUNCTIONAL ASSESSMENT
FUNCTIONAL ASSESSMENT
Special Tests
For cervical muscle (deep neck flexors) strength:
Craniocervical flexion test (CCF)
Deep neck flexor endurance test
For neurological symptoms:
Brachial plexus lesions
Brachial plexus tension test
Shoulder depression test
Tinel Sign for Brachial Plexus lesions
Distraction test (if symptoms are severe)
Foraminal compression/Spurlings test (three stages) (if symptoms are absent or mild)
Maximum cervical compression test
Upper limb neurodynamic (tension) tests
Shoulder Abduction or Relief Test
Radicular symptoms at C4 C5 nerve roots
For myelopathy:
Romberg test
Lhermittes
10 Second Step Test
Special Tests
Outcome Measures
Whiplash Disability Questionnaire (WDQ) (Figure 3-30)
to assess the impact of whiplash associated disorders
including social and emotional problems.
Page 181
CERVICAL SPINE
CONDITIONS
Tzietzes Syndrome
Aka Costal chondritis
Painful inflammation of the costochondral junction
TORTICOLLIS
Is the head tilted or
rotated to
one side or the other
d/t
muscle spasm,
tightness, or
prominence of the
sternocleidomastoid
muscle)
TORTICOLLIS
MECHANISM OF INJURY:
CONGENITAL/ MUSCULAR:
- ABN position of head in utero
- prenatal injury
- fibroma in the muscle
- rupture of SCM fibers during birth with hematoma and scar formation
ACUIRED:
Acute Traumatic or Inflammatory
Chronic Infectious or Neoplastic
Arthritic
Circatricial
Paralytic
Hysterical Spasmodic
Cervical Injures
Atlanto-axial rotatory subluxation
Mm inflammations
Cervical lymph nodes inflammation
Osteomyelitis
TB
Tumors of spine or SC
Arthritic
RA
Ankylosing spondylitis
OA
Circatricial
Paralytic
Hysterical
Spasmodic
TORTICOLLIS
DISTINGUISHING SIGNS AND SYMPTOMS
TORTICOLLIS
ASSESSMENT
History: Painless deformity since birth
(-) X-RAY findings of C-spine
MANAGEMENT
Passive stretching of the shortened muscle into overcorrected position
Direct gaze: I/L superior direction
Use of skull shaping orthotics
Positioning: head during sleep
Active exercises
Modalities:
Hot applications
Gentle massage
Horizontal and vertical traction
Cervical Orthosis
Functional strengthening of C/L neck muscles
Lateral AND Ant head righting reactions
Surgery: Successful resectioning of fibrotic SCM
Klippel-Feil syndrome
- congenital fusion of some
cervical vertebra, from C2C7; usually C3 to C5 (MC
radiographic findings)
MOST COMMON CLINICAL
FINDINGS:
- Short neck
- Low posterior headline
- LOM on neck motions
ASSOCIATED FINDINGS
- Deafness
- Scoliosis (Alone or with
kyphosis
POKING CHIN
result in adaptive
shortening of the
occipital muscles.
It also causes the
cervical spine to
change alignment
resulting in
increased stress
of the facet joints
and posterior
discs and other
posterior elements
FLAT NECK
FORWARD HEAD
Increased extension of AO joint and upper cervical vertebrae
Increased flexion of lower cervical and upper thoracic
Retrusion of mandible
UPPER CROSSED
SYNDROME
MYOFASCIAL PAIN
SYNDROMES
Cervical Spondylosis
Pain:
Unilateral
Distribution of pain:
Pain on extension
Increases
Pain on flexion
Decreases
No
Instability
Possible
C5C6, C6C7
Onset
Slow
Diagnostic imaging
Diagnostic
Distribution of pain:
Pain on extension
Pain on flexion
No
17 to 60 years
Instability
No
C5C6
Onset
Sudden
Diagnostic imaging
Cervical radiculopathy
injury to the nerve roots in the cervical spine
presents primarily with:
Cervical radiculopathy
WHIPLASH-TYPE (ACCELERATION)
INJURY OR WHIPLASH ASSOCIATED
DISORDER (WAD)
WHIPLASH INURY
MC cause of cervical
ligament sprain and mm
strain
WHIPLASH-TYPE (ACCELERATION)
INJURY OR WHIPLASH ASSOCIATED
DISORDER (WAD)
lead to hypertonia of the sympathetic nervous system.
Some of the sympathetic signs and symptoms the examiner may
elicit are:
CHRONIC POST
WHIPLASH SYNDROME
Can lead to anxiety, pain catastrophizing (negative or
heightened orientation toward pain), and other adverse
psychosocial factors over time, and it can play a major role in
the symptoms felt by the patient.
PATHOLOGY
(a) neuropraxia (Sunderland I), or a stretch injury that results in
a temporary nerve conduction block;
(b) axonotmesis (Sunderland I I-IV), or varying degrees of
rupture of the neural axon in which tile neural sheath remains
intact but internal elements are disrupted;
(c) neurotmesis (Sunderland V), or complete rupture of the axon
and the encapsulating connective tissue;
(d) avulsion, in which tile nerve roots tear away from the spinal
cord.
DX:
Currently, neurophysiological studies appear to underestimate
the severity of the injury and falsely provide optimism about
recovery.
PROGNOSIS
Preganglionic or Postganglionic lesions?
Preganglionic lesions are avulsions from tile cord tl1at
do not spontaneously recover
- Better prognosis if Axonotmesis: axon regrowth (1
mm/day)
- Poor prognosis C5-C7
Recovery : 4-6 months upper arm; 6-9 months lower
arm
Recovery continue until 2 years upper arm; until 4
years lower arm
PROGNOSIS
Infants who recover partial antigravity upper trunk muscle
strength during the first 2 months of life should show full
recovery over the first 1 to 2 years of life.
Microsurgical reconstruction of the brachial plexus is
indicated for infants who do not recover antigravity
strength by 5 to 6 months of age, because successful
surgery results in a better outcome than natural history
alone.
Infants who have partial recovery of CS-C6-C7
antigravity strength at 3 to 6 months of age have
permanent, progressive limitations of motion and strength.
Erb-Duchenne Paralysis.
UPPER NERVE ROOT INJURY
(C5,C6)
Cause:
Compression
Stretching
Most common impairments:
paralysis of the rhomboid,
levator scapulae,
serratus anterior,
subscapularis,
deltoid,
supraspinatus,
infraspinatus,
teres minor,
biceps brachialis,
brachioradialis, and
supinator muscles.
Erb-Duchenne Paralysis.
Therefore the shoulder usually is
held in extension,
medial rotation, and adduction with
elbow extension and forearm
pronation.
Although grasp function is intact,
sensory loss usually is present
sensation over the radial surfaces
of the forearm and hand and the
deltoid area are affected.
Dejerine-Klumpke
Paralysis.
Lower BPI (C8-T1)
Atrophy and weakness are evident in the muscles of the
forearm and hand as well as in the triceps. The obvious
changes are in the distal aspects of the upper limb.
The resultant injury is a functionless hand. Sensory loss
occurs primarily on the ulnar side of the forearm and
hand.
paralysis of tile wrist flexors and extensors and the
intrinsic muscles of the wrist and hand.
Clinically, hand grasp is poor, although more proximal
muscles are intact.
Burners or stingers
These are transient injuries to the brachial plexus typically occur from a blow
to part of the brachial plexus or from stretching or compression of the
brachial plexus.
combined with factors, such as stenosis or a degenerative disc spondylosis).
Erbs Point
st
1
MOI
nd
2
MOI
rd
3
MOI
IMPAIRMENTS
Weak AB-ER
Common contractures of the upper extremity include:
scapular protraction
Shoulder extension, and
wrist and finger flexion.
Medial rotation and Add contracture
absent or abnormal sensation may lead to neglect, and injuries to the skin often
go unnoticed
The primary functional limitations involve:
reaching and grasping,
manipulation of objects, and
bilateral hand use;
Resultant delayed motor activities may include:
getting into and out of positions over the involved side,
protective extension using the involved side, and
delayed balance reactions.
Creeping may be delayed or replaced by scooting,
Significant functional limitations in hand to head, hand to mouth, and
overhead activities
Rehabilitation Management:
Evaluation, Intervention, and
Clinical Implications
Reflexes
Developmental milestones
MMT
Sensory Test
Motor function of UE
AROM/PROM
PT: Acute -> preventive (first few months)
Goals over first few years:
Achieving and maintaining full range of motion,
muscle extensibility,
normal motor control,
strength,
functional bilateral activities, and
developmental skills
Rehabilitation Management:
Evaluation, Intervention, and
Clinical Implications
2 years of age, goals should include:
achievement of age-appropriate self-care skills (e.g., dressing and grooming using
either extremity) and
active participation in age-appropriate movement activities and preschool
program.
Family education:
passive ROM exercises,
goals of the home program,
risk of contractures,
importance of joint integrity,
precautions to prevent overstretching and joint dislocation,
precautions with regard to sensory loss, and
how to position the infant in all activities to maintain range of motion and regain
muscle strength
Rehabilitation Management:
Evaluation, Intervention, and
Clinical Implications
Facilitation of fill1ctional development through therapeutic play activities,
such as:
hand to mouth;
reaching,
grasping, and
manipulating objects;
propping on the elbows;
hands to midline;
rolling to each side; and
Bilateral hand activities.
Facilitation of a normal scapulothoracic and glenohumeral relationship should
be emphasized.
A variety of play activities should be used to promote strengthening of
weakened muscles.
To develop motor control throughout the range of motion, the clinician should
control time to fatigue, allowing the child to be successful by initially
challenging the involved extremity in a gravity neutral position.
Rehabilitation Management:
Evaluation, Intervention, and
Clinical Implications
Activities should involve toys of different sizes, shapes, and textures and should
incorporate:
hand to mouth,
transferring items from one hand to the other,
weight shifting in prone position,
quadruped or sitting,
creeping, and
reaching for toys at various angles and distances.
Constraining the opposite extremity for brief periods or occupying the opposite
hand with another object can be extremely helpful in focusing and encouraging the
child to use the involved extremity.
Transitional movements over the involved extremity,
Pulling to stand using bilateral hands,
Challenging balance reactions while sitting on a lap or therapy ball, and
Performing bilateral upper extremity activities (e.g., catching a large ball, clapping
to music, or opening a jar)
Weight-bearing activities such a s wheelbarrow walking, bear crawling, crab
walking and wall push-ups are important for the development of shoulder girdle
strength and stability as well as to improve proprioception and body awareness.
Potential Cause:
Neurologic injury
Clinical Characteristics
Progressive neurologic deficit
Upper and lower extremity symptoms
Bowel or bladder dysfunction
Cervical Myelopathy
Motor Changes
Initial Symptoms (Predominantly Lower Limbs)
Spastic paraparesis
Stiffness and heaviness, scuffing of the toe, difficulty climbing stairs
Weakness, spasms, cramps, easy fatigability
Decreased power, especially of flexors (dorsiflexors of ankles and toes;
flexors of hips)
Hyperreflexia of knee and ankle jerks, with clonus
Positive Babinski sign, extensor hypertonia
Decreased or absent superficial abdominal and cremasteric reflexes
Drop foot, crural monoplegia
Later Symptoms (In Order of Occurrence)
Various combinations of upper and lower limb involvement
Mixed picture of upper and lower motoneuron dysfunction
Atrophy, weakness, hypotonia, hyper-reflexia to hyporeflexia, and absent
deep tendon reflexes
Cervical Myelopathy
Sensory Changes
Headache and head pain
Neck, eye, ear, throat, or sinus pain
Sensory symptoms in the pharynx and larynx
Paroxysmal hoarseness and aphonia
Rotary vertigo
Tinnitus synchronous with pulse or continuous whistling noises
Deafness
Oculovisual changes (e.g., blurring, photophobia, scintillating scotomata,
diplopia, homonymous hemianopsia, and nystagmus)
Autonomic disturbance (e.g., sweating, flushing, rhinorrhea, salivation,
lacrimation, nausea, and vomiting)
Weakness in one or both legs, drop attacks with or without loss of consciousness
Numbness on one or both sides of the body
Dysphagia or dysarthria
Myoclonic jerks
Hiccups
Respiratory changes (e.g., Cheyne-Stokes respiration, Biot respiration, or ataxic
respiration)
Cervical Myelopathy
(+) pathological reflexes (e.g.
Babinski, Hoffman)
Hyperreflexia of DTRs
Clonus
(+) lhermittes sign
sharp, electric shock-like pain down
the spine and into the upper or
lower limbs
INDICATION: dural or meningeal
irritation in the spine or possible
cervical myelopathy.
Romberg test = (+) UMNL
Ten Second Step Test: Ave:19-20 steps
Cervical Sprains
Cervical Strains
Cervical Spinal Stenosis
Cervical Fractures and Dislocations
Unilateral or bilateral
Distribution of pain:
Pain on extension
Increases
Pain on flexion
Decreases
Yes
11 to 70 years
Most common: 30 to 60 years
Instability
No
Varies
Onset
Diagnostic imaging
Diagnostic
SPINAL STENOSIS
Narrowing of spinal canal
N diameter: 17 mm Spinal canal
10 mm Spinal cord
RELATIVE STENOSIS: 12 mm
ABSOLUTE STENOSIS: 10 mm
ETIOLOGY:
Facet joint hypertrophy
Ligamentum flavum hypertrophy
Disc protrusion4Spur formation
Position:
Avoid: Extension
Ideal: Flexion
CERVICAL RADICULOPATHY
AND RADICULAR PAIN
CERVICAL RADICULOPATHY
- Pathologic process involving neurophysiologic dysfunction of the
nerve root
- Reflex and strength deficits marking a hypofunctional nerve root as
a result of pathologic changes
EPIDEMIOLOGY:
Decreasing frequency of involvement:
C7 C6 C8 C5
CERVICAL RADICULOPATHY
AND RADICULAR PAIN
PATHOPHYSIOLOGY
- Cervical nerve root injury most commonly caused by cervical IVD
herniation
- Next MC cause: Cervical spondylosis
- CERVICAL SPONDYLOSIS
- Degenerative OA changes
- Manifested by:
- ligamentous hypertrophy
- Hyperostosis
- Disk generation
- Z joint arthopathy
- Hypertrophy of Zygapophyseal joints and uncovertebral joints IV
foramina stenosis and nerve root impingement
- Vertebral body osteophytes and dsik material can form a disk that can
also compress adjacent nerve root
CERVICAL RADICULOPATHY
AND RADICULAR PAIN
DIAGNOSIS
- History and PE
- Hx of cervical pain that is followed by an expulsive onset of
upper limb pain
- Spondylitic radicular pain presents more gradually
- Cervical radicular pain can masquerade as deep dull ache or
lancinating pain
- Exacerbating factors:
- Coughing, sneezing, valsalva
- Cervical extension: significant stenosis is present
- (+) Bakody sign
CERVICAL RADICULOPATHY
AND RADICULAR PAIN
DIAGNOSIS
- Atrophy severe or longstanding lesions
- Mm testing has greater specificity
- Altered sensation to pinprick, light touch and vibration
- Long tract signs Hoffmans and Babinski signs : SC involvement
- Spurlings maneuver highly specific but not sensitive
- Root tension more sensitive, less specific
- Lhermittes sign SC involvement, tumor, spondylosis or MS
- Imaging studies
- Plain cervical radiography
- CT Myelography
- MRI Cervical radicuolpathy
- Contrast enhanced CT Scan disk pathology
CERVICAL RADICULOPATHY
AND RADICULAR PAIN
TREATMENT
Primary Objectives:
- Pain resolution
- Improve myotome weakness
- Avoid SC complications
- Prevent recurrence
SURGICAL APPROACH Progressive neuro fdeficit
Pt educ, activity modiification, pain relief
Avoid repetitive heavy lifting
Modalities
TENS
COLD,
Superficial heat but Avoid deep heat!
CERVICAL RADICULOPATHY
AND RADICULAR PAIN
TREATMENT
Cervical Orthosis (1-2 weeks)
Cervical Traction
distract midcervical segment 25 lb weight applied for 25
minutes at 24 degree angle of pull
Cerviothoracic stabilization
- restore biomechanics, limit pain, max function, prevent
recurrence and progression
Cervical strengthening
Medications
NSAIDs
Mm relaxants
Low dose tricyclic antidepressants
Opiate
CERVICAL INTERNAL
DISK DISRUPTION
CERVICAL INTERNAL
DISK DISRUPTION
DIAGNOSIS
- Hx of trauma with acute onset
- With absence of precipitating event, symptoms of CIDD can start spontaneously or
gradually, or explosively
- If (+) referred pain: axial pain associated with nondescript upper limb symptoms
- Exacerbating factors: prolonged sitting, coughing, sneezing or lifting
- Alleviating factors: lying supine with head support
- Subtle ROM restrictions
- If (+) cervical spondylosis cervical extension and side bending more restricted than
flexion and axial rotation
- (+) pain on palpation over cervical SP of involved level.
IMAGING
- MRI
- Plain films hyperostosis and disk space collapse but frequently do not correlate with
pain symptoms
- MARKERS OF DISK DEGENERATION:
- Disk dessication
- Loss of disk height
- Annular fissure
- Osteophytosis
- Reactive end plate changes
CERVICAL INTERNAL
DISK DISRUPTION
TREATMENT
- SIMILAR WITH CERVICAL RADICULOPATHY
- NSAIDS
- Modalities
- Traction should be used cautiously
- Cervical collars help comfortable positioning