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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
-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
*+/- 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
-Spurling test (cervical compression test)
-Manual cervical distraction
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)
-NSAIDs/Cox2 Inhibitors (ex: Naproxen)
-Naproxen (can be addictive)
-TCAs (help w/ nerve pain)
-Surgery (LAST LINE!)
*An osteoarthritic condition affecting the upper spine- also called cervical spondylosis or DDD of the C-spine
-Limited mobility of c-spine
-Pain with upright activity
-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
*Don't forget to evaluate gait and ask about BB bladder dysfunction
Dx: -Hx- car accident, football
*PT (first line)
*Narcotic pain relievers
Degenerative joint and disc disease- Cervical Arthritis
Injury to the neck &/or upper back which results from trauma or blow to face, jaw, frontal head
-Soft tissue injury to muscles and ligaments surrounding spine
-Fracture, dislocation of vertebrae
-Spinal cord injury (CCS)
-Neck pain, stiffness, tenderness
-Shoulder pain and spasm
-Motor vehicle accident
-Once serious pathology has been r/o...
Focal cervical dystonia
-May be painless
-May be spastic or sustained
-Due to muscle spasm, head tilted and/or turned
Tx: botulin injection
*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
-TTP neck musculature
Dx: based on H & P; r/o more serious, underlying pathology
Tx: TREAT UNDERLYING PATHOLOGY FIRST!
-Trigger point injection
Neck is first place you see arthritis!
Cervical Spinal Reflexes
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