Neck and Cervical Spine

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*A dysfunction of the nerve root of the cervical spine. Risk factors include manual lifting requiring lifting (25 lbs +), smoking, overhead work, driving or operating vibrating equipment, trauma; causes referred neurogenic pain/loss of reflexes

S/Sx:
-Insidious or acute onset of neck and arm discomfort
-Muscle spasms or fasciculations
-Discomfort can range from dull ache to severe burning pain
-Pain can radiate to the scapula initially then along the upper or lower arm and into the hand, depending on the nerve root involved.
-Pt may c/o sensory changes along a nerve root dermatome
Some patients c/o motor weakness
-Many patients report reduction in symptoms by abducting their shoulder and placing their hand behind their head or lying down
-Pain increased by coughing, straining, standing or sitting, head tilting

PE:
*+/- head tilt away
from affected side
*Active ROM decreased in extension, flexion and lateral bending
*TTP over paraspinals, especially on ipsilateral side as the affected nerve root
*Muscle tenderness may be present along dermatone where sx are referred
*+/- weakness in myotomal distribution:
*C5 WEAKNESS OF SHOULDER ABDUCTION*
*C6 WEAK ELBOW FLEXION & WRIST EXTENSION*
*C7 WEAK ELBOW EXTENSION & WRIST FLEXION*
*C8 WEAK THUMB EXTENSION & ULNAR DEVIATION*
*Asymmetry of DTR's (as above)
*+/- dermatonal decrease or loss of sensation
*? Hyperesthesias

*Special tests:
-Spurling test (cervical compression test)
-Valsalva test
-Manual cervical distraction

*Confirmatory Tests:
1. X-ray (first)
2. MRI tells you everything! (BEST TEST!)
3. CT scan- for 3d image of bone
4. EMG- tells you where the nerve problem is coming from (ex: carpel tunnel to locate the spot where nerve isn't working b4 surgery)

*C7 (60%) and C6 (25%) nerve roots are most commonly affected

C/B: disc herniation (young); foraminal narrowing from osteophyte formation due to arthritis (old)

Tx:
-PT
-NSAIDs/Cox2 Inhibitors (ex: Naproxen)
-Naproxen (can be addictive)
-TCAs (help w/ nerve pain)
-Cervical traction
-Surgery (LAST LINE!)

Cervical radiculopathy

*An osteoarthritic condition affecting the upper spine- also called cervical spondylosis or DDD of the C-spine

S/Sx:
-Limited mobility of c-spine
-Pain with upright activity
-HA
-Chronic neck pain
-Irritability, fatigue, sleep disturbances
-Loss of balance
-Weakness and or loss of sensation in upper ext.
-TTP over paraspinals
Decreased active and passive ROM
-+/- upper extremity radicular findings
*Decreased sensation
*Asymmetric DTRs
*Myotomal weakness
*Don't forget to evaluate gait and ask about BB bladder dysfunction

Dx: -Hx- car accident, football
-X-ray
-MRI
-CT scan

Tx:
*PT (first line)
*Massage therapy
*NSAIDs/Cox2 Inhibitors
*Narcotic pain relievers
*Muscle relaxants
*Traction
*Surgery

Degenerative joint and disc disease- Cervical Arthritis

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Fracture/dislocation

Injury to the neck &/or upper back which results from trauma or blow to face, jaw, frontal head

*May involve:
-Soft tissue injury to muscles and ligaments surrounding spine
-Fracture, dislocation of vertebrae
-Spinal cord injury (CCS)

S/Sx:
-Neck pain, stiffness, tenderness
-HA
-Parasthesias
-Numbness
-Shoulder pain and spasm
-Radicular signs

C/B:
-Trauma
-Motor vehicle accident
-Sports injuries
-Falls
-Assaults

Dx:
-C-spine films
-MRI
-CT scan
-History

Tx:
-Once serious pathology has been r/o...
*Steroids
*Pain management
*Cervical collar
*Muscle relaxants
*Physical therapy
*Heat/ice
*Follow closely

Hyperextension/hyperflexion

Focal cervical dystonia
-May be painless
-May be spastic or sustained
-Due to muscle spasm, head tilted and/or turned

Tx: botulin injection

Torticollis

*Irritation and spasm of the muscles of the neck, upper back, or both
-Pain could be related to muscle injury, ligamentous strain, facet joint irritation, and/or disc injury- no way to tell with PE
-C/B: whiplash, arthritis, sublclinical radiculopathy, emotional and physical stress, poor posture, poor sleeping habits

S/Sx: neck pain, tenderness, HA, shoulder pain, arm pain
-Palpable spasm
-TTP neck musculature
-Decreased ROM
-weakness

Dx: based on H & P; r/o more serious, underlying pathology

Tx: TREAT UNDERLYING PATHOLOGY FIRST!
-PT
-Stress reduction
-Cervical collar
-Muscle relaxants
-Ice/Heat
-NSAIDs
-Trigger point injection

Cervical Strain

-Biceps: C5
-Brachioradialis: C6
-Triceps: C7

Neck is first place you see arthritis!

Cervical Spinal Reflexes
-Biceps:
-Brachioradialis:
-Triceps:

Manuel cervical distraction

Cervical radiculopathy special tests:

Spurling test- positive finding is pain

Cervical radiculopathy special test:

Valsalva Maneuver- "hold your nose and blow"

Cervical radiculopathy special test:

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