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OCS Cervical and thoracic OCS
Terms in this set (130)
Tear drop fx
Bursting type of fracture of cervical region; produces a characteristic anterior-inferior bone chip; fragment resembles a "teardrop" on x-ray film; associated with flexion and compression forces.
orientation of cervical facets
45 deg to vertical in sagittal plane (C2-7), facets of AA are horizontal.
orientation of thoracic facets
60 deg to vertical in sagittal plane, leads to inc rigidity w/ dec axial rot in lower TS compared to upper as the lower transition to being more vertical like in LS
necessary cervical ROM for ADL's
65 to 70 deg of rotation and of flex/ext. Shoe-tying requires more flx/ext, driving car in reverse and crossing street require the most rot
3 negative predictors of clinical success post cervical ant discectomy and fusion
workers comp (50% less chance of success), preoperative use of "weak" narcotics, dermatomal sensory loss of phys. exam (50% less chance of successes)
order for ULTT A
1. scap depression 2.sho ABD 3. forearm sup
4. wrist and finger ext 5. sho ER 6.elbow ext
7. contra then ipsi SB
cluster for differentiating CGH vs. tension-type or migraine (signs present in CGH) (3) and the best predictors (2)
Sn 100%, Sp 94%. 1. Decr. AROM cervical ext, 2. palpably painful OA-C3/4 jt dysfunction, 3.deep cervical flx strength impairments w/ cranio-cervical flx test (CCFT). Another study determined the best predictors were palpably painful C1/2 jt dysfxn, pec minor length Sn 80%
Cervical flexion and rotation test
for dx CGH. + is reproduction of pain or 10 deg loss of motion. Sn .86, Sp. 100
Deep cervical neck flexors
rectus capitis anterior, rectus capitis lateralis, longus colli, longus capitis
rectus capitus posterior major
from the SP of C2 inserting on the lateral part of the inferior nuchal line of the occiput. Primarily extends and also ipsi rot
rectus capitus posterior minor
from the tubercle on the posterior arch of the atlas to medial part of the inferior nuchal line of the occiput, extends head
obliquus capitis inferior
from the apex of C2 SP laterally and superiorly to the inferior part of the C1 TP. Ipsi rotation
Obliquus capitis superior
from the superior surface of C1 TP cranially and medially to insert of the base of the occiput b/w inf/sup nuchal lines. Extends and ipsi SB (contra rotation)
rectus capitis anterior
from lateral mass of the atlas and root of PT of C1 to base of occiput just anterior to foramen magnum. flexes head at C0-C1
rectus capitis lateralis
extends from TP of atlas and inserts on to occipital bone just lateral to the occipital condyle. contributes to ipsi SB of head
quick flick to 3rd or 4th finger. + is flexing of thumb IP w/ or w/o flx of index finger prox or distal IP's; positive may denote SC compression or intracranial pathology; positive test has been found in asymptomatic pts (w/ cord compression & spondylosis) so + w/ other neuro signs/sx would warrant referral. Sn 100%
Normal responses for median n. ULTT
deep stretch or ache in cubital fossa extending down anterior and radial forearm and into radial hand, tingling in thumb and first 3 fingers, some may feel ache in anterior sho; all responses should be equal on both sides
course and fxn of transverse ligt
strongest part of the cruciform ligt. runs across the arch of the atlas (spanning b/w lateral masses of the atlas) behind the dens and inserts onto the occipital bone b/w the apical ligt and tectorial membrane. connects the atlas with the dens of the axis. Counteracts anterior translation of the atlas relative to the axis, thus maintaining the correct position of the dens on the anterior arch of the atlas.
most common population of pts with neck pain
TBC ( treatment based classification) system of the neck (5)
Mobility (manip, mobil, and exercise to increase mobilty), centralization(exs/traction/manip to centralize), pain control, headache control, conditioning/ex tolerance
Cervical myelopathy: pathology, sx, clinical sx
narrowed diameter of spinal cord causing compression of cord. sx's: sensory changes in hand start distally and progress proximally (stocking glove in feet and hands), instrinsic muscle wasting, and unsteady walking. occ non dermatomal le sensation, hyperreflexia, + hoffman, and clonus and babinski, +B and B. progressive disorder needing surgery
most common cancers that met to spine
breast, lung and prostate
dxs that present with incompentent or unstable upper cspine
downs and RA (50%), falls in elderly, and mva in young
sxs of upper cervical ligamentous instability:
occipital HA's and numbness sometimes w/ severe restriction of cspine AROM. must test ligt stability PRIOR to neck ROM testing in any pt w/ these signs and in ALL pts whose p is d/t trauma
clinical prediction rule for xrays when to:
1. if pt can't actively rotate neck in 45 degrees either direction. 2. more than 65 yrs old.3 paresthesias in UE/LE 4. dangerous mechanism of injury. 5. If can't sit, walk, bad mva, has midline tenderness at cspine then you can't assess ROM and send to xray.
What visceral causes may refer to neck and mimic mechanical pain?
apical tumor of lung ( due to compression of Brachial plex) CAD (C3 distribution)
increased risk of prolonged pain and disabilty due to pyschosocial factors. FEAR AVOIDANCE BELIEFS MOST IMPORTANT!
deltoid (sho in 90 deg ABD, resist against lat upper arm into ADD), lat forearm and bicep reflex C5 (C6)
Biceps (elbow 90deg flx w/ supination, resist lower forearm into ext), distal thumb, and brachioradialis (C5),C6
C7: myotome & dermatome
tricep (arm overhead, elb flightly flx'd, resist against dorsum of hand into flx & ulnar dev), flexor carpi radialis (wrist flxed and rad dev.'d w/ forearm supinated, resist against thenar eminence into ext & ulnar dev), Dermatome: distal middle finger, key DTR tricep C7
c8: myotome & dermatome
abd pollicus brevis (thumb in ABD, resist against prox. phalanx into ABD), Dermatome: distal 5th finger, no DTR
1st dorsal interossi (index & middle finger separated, resist against med. aspect of prox phalanx of index finger into ABD), Dermatome: medial forearm, no DTR
Most powerful predictor of disability and chronic pain:
leg pain and inability to centralize pain
conditioning classification is composed of which pts?
lower pain/disability scores, longer duration of sx, no signs of nerve rt compression or peripipheralizaton of sx in UQ w/ ROM Tx: strengthening and endurance ex for muscles of neck & UE, aeorobic conditioning
recent onset of sx, no radicular/referred sx in UQ, restricted ROM rot and/or discrepancy in SB ROM, no signs of nerev root compression or pheripheralization of UQ sx
Tx: cervical and thoracic manip/mobs, AROM exs
Reduce HA classification
Chief HA c/o of cervicogenic origin which you can tell by: unilateral HA, sxs start in neck and progress to frontal occular area. pn triggered by neck movement or postion or by pressure on ipsilateral post neck. usually related to stiff and painful C1 C2 with muscle tightness.
radicular/referred symptoms in UQ, peripheralization and/or centralization of sx w/ ROM, signs of nerve root compression, may have dx of cervical radiculopathy
tx centralization: traction and repeated mvts
NDI sig. score?
neck disability index. 60% score is indication that yellow or red flags may be present or that possible serious neck condition present. all functional questions.
+ hoffman and babinski, hyperreflexia of UE/LE, sensory chagnes in a nondermatomal (multisegmental) pattern, clonus at ankle, weakness below level of compression, gait clumsiness. neuron goes from brain to spinal cord.
diminished or absent DTR's, decreased sensation to light touch in a dermatomal pattern and muscle weakness along a specific dermatome. goes from spinal cord to muscle.
Alar ligament test
PT stabilizes sp of axis and sb's head away from stabilizing hand. PT should feel sp move imm into her hand..if there is a lag it is suggestive of injury to alar ligament. no studies on validity.
sharp purser test
tests criform ligament or transverse ligament of the dens. ID's subluxation of atlas on axis (used orig for RA and AS pts. One hand stab sp of axis and other hand pushs head (in 20-30 degrees flex) posterior . + test if head felt to slide post WITHOUT the axis moving, other (+)'s are reproduction of myelopathic sx during flx, decr. sx w/ post mvt of atlas. .96 specificity and 0.69 Sn. more sensitive as more pronounced. (-) is C2 moving post as translation force applied.
cold hypersensitivity is a sign of
underlyilng more serious condition
stretch levator scap
ipsileral arm abd and SB away from arm
most common site of cervical radiculopathy?
CT , MRI and plain xrays show pathoanatomic incidence of cervical radiculopathy in ?% of asymptomatic subjects?
19-75% of asymptomatic pts!
CPR to dx cervical radiculopathy?
+ ULTT A (median biais)
+ spurling's test
+ distraction test ( up to 30#'s relieves sx's)
cervical rotation limited >60 degrees.
3 or more rules met: moderate LR 6.1 or 94%
4 rules met 99% specific or 30.3 LR
best tests or ?'s to 1. r/o and 2. r/in CS radiculpathy?
1. (-) ULTT A .97 sensitive
if involved side rotation is > 60 degrees sensitivity is 89%
2. "where are your symptoms most bothersome? neck/scap Sp .84
Neural tension tests false positives?
sig amount are false positives 86.9%?
Treatment of CR
no conclusive non conflicting results that any ONE nonoperative intervention or operative intervention effective.
sx of TOS syndrome
C8/T1 or ulnar nerve distrib of sx's like parathesisas, pain, and weakness worse with postures that stress the NV bundle like elevation, protraction shlds
Exam a TOS pt for:
short hypertonic scalene muscles
short weak scap depressors
breathing ratio: diaphragm should intiate breathing and be a 2:1
+ULT ulnar nerve bias.
CFLR test performed how?
in sittinging passively rotate pt's head away from side being tested and then laterall flex ear to chest. + blocked movement due to hypomobility rib
How to tx TOS:
Lenghten tight muscles: scalense, levator, pec minor
teach diaghramatic breathing
mob 1st rib and tspine
neural gliding techniques
chance of disability in pt with s/p MVA? but if NDI >? points then,
33%, NDI >15 points then 54%
chance of disability in s/p MVA w/ Tampa scale of kinesiophobia score >? increases risk to ?%
score > 41 risk increases to 83%
If TSK<41 the risk decreases from 54% to 36%
"A" tx's for neck pain are: (preponderance of level I/II studies to support)STRONG
mobilization/manip cervical spine
coordination, strengtheing and endurance exercises
"C" treatmetns are (single level II or bunch of LEvel III/IV with expert statements) WEAK
centralization, stretching, thoracic mobs/manips
pathoanatomical dx is _____ in majority of pt's with neck pain
what are poor indicators of success after neck surgery?
dermatomal sesnory loss on exam
preop use of weak narcotics
(lig pending .37 chance of success vsl. pt without ligation
good indicator of neck surgery success
working prior to surgery
prognosis of neck pain
50-85% of pt with neck pain will not fully recover
pt will continue to experience sx's 1-5 years after initial episode
rel minor trauma, negative imaging findings, neckpn/HA's, up to 48 hrs delayed onset, 57% recover in 3 monts, 8% never returnt o work
chronic whiplash>3 mo
multidisciplnary pain clinic appropriach usefule
CPR for thoracic HVLA for neck pain
generalized neck /shld pain<1 mo, significant improvement! but small sample size and 1 PT with limited generalizability
thrust vs non thrust in cpsine?
no sig diff between thrust and non thrust in neck so:
try thrust tspine and cspine non thrust before cspine thrust to tx (b/c VBI)
What does research say about short term outcome (28days) of pts with CR who receive tx?
If pt is <54 years old, dominant arm not affected, able to look down without pain, and tx consists >50% of time of traction, manual tx, and deep cspine flex strengthening pt will have 90% improvement with 4/4 and 85% with 3/4.
Which neck pain patients will improve with traction and exercise treatments? (CPR-5)
age >55 yo
peripheralize sx's with c4-c7 mobility testing.
+ ULT A
+Shld abd test
4/5 95% improvement 3/5 79% improvement
neck distraction test
PT applies manual axial force of up to 30#s and pts sx's must decrease for +
shld abd test
In sitting pt places their hand on their head to support UE. + is allievation of pt's sx's
is there a stat sig between force of pull for success and non success for cspine traction?
NO! unable to establish parameters with RBE.
exerises for neck
1) posture: retract add scap and elongation cspine
2) DNF exercise: slow controlled craniocervical flex w/o SCM co contraction in supine
What are research driven criteria to r/i or r/out CG HA's? (and are not present in tension ha or migraine) sn100% specific 94%
-weakness in CCFT, deep cervical flexor strength impairments
-lack of cspine ext
-painful palp of oa-C3/C4
other diagnostic findings for cervicogenic HA?
palpably painful C1/C2 joint dysfucntion
pect minor muscle length
Only 80% sensitive
What interventions are best to decrease HA duration?
combo of MT + EX
HA frequency and intensity and neck pain all respond well to ?
Ex, MT and combo of EX and MT.
If a pt at risk for VBI, will ex alone help?
yes, ex has excellent results if can't do MT.
effiacy of self snag tx with belt for HA's?
Excellent increases in ROM and decreased HAk
treat pt with referred pain below elbow x 6 weeks , 38 yo and no nerve root compression with:
mechanical traction: sx's distal to elbow and >30 days (two key elements)
mechanical neck pain: definition and requirements
pain that may or may not have an identifiable or specific etiology, but that can be provoked by neck mvts or provocative tests. Requires 1 or more of the following signs /sx: (1) pain in cervical or upper TS (2) pain, para's or other changes in cutaneous sensation of spinal origin located in the upper thoracic, shoulder, or arm
area; or (3) alterations in reflexes or loss of motor fxn in UE's, again from spinal origin
Prevalence of upper cervical instability in ppl w/ RA and w/ downs syndrome
RA 40-50%, downs 10-30%
yellow flag attitudes and beliefs
pain is harmful or disabiling resulting in guarding and fear of mvt; 2. all p must be abolished before returning to activity; 3. expectation of incr p w/ activity or work, lack of ability to predict capabilities; 4. catastrophizing, expecting the worst; 5. belief that p is uncontrollable; 6. passive attitude towards rehab
yellow flag behaviors
indicate heightened fear-avoidance: 1. use of extended rest; 2. reduced activity level w/ sig. withdrawl form daily activities; 3. avoidance of normal activity & progressive substitution of liefstyle away from productive activity; 4. reports of extremely high pain intensity; 5. excessive reliance on aids (e.g. braces, crutches); 6.sleep quality reduced following onset of back p; 7. high intake of alcohol or other substances w/ inc since onset of back p; 8. smoking
if yellow flags ID'd, then tx may need to be modified to do the following:
emphasize active rehab and positive reinforement of fxnl accomplishments, graded exs program that directs attn toward attaining certain fxnl goas and AWAY from sx of pain, graded exposure to specific activities that a pt fears as potentially painful or difficulty to perform
risk factors for cervical manips and prevalence for complications
HTN, migraines, oral contraceptive use, smoking; risk for serious complication post manip= ~6/10 million (0.00006%); 3/10mil for death (0.000003%); rates adjusted to assume that only 1/10 complications actually reported. More recent estimate for serious complication post manip ranged from 1 in 20,000 (0.01%) to 5 in 10 mil (0.0005%). risk for non-serious side effects ranges 1-2%, most common being local discomfort (53%), local HA (12%), fatigue (11%) or radiating discomfort (10%). 85% of the complications reported as mild-mod, 64% appear w/in 4hrs post manip and w/in 24hr 74% resolve. Less than 5% side effects characterized as dizziness, nausea, hot skin, or other c/o's
do patients w/ neck pain related to whiplash- assoc disorder benefit from thoracic manip?
pts receiving TSM experienced sig. greater reduction in pain (measured on VAS) compared to those who didn't
define whiplash and overall prognosis
relatively mild trauma (rear end MVA not necessarily at high speed), negative imaging findings (repeat in 7-10 days if swelling), neck pain/occipital HA's, can have up to 48hr delay of sx onset; 57% recover in 3mo, 8% remain so effected they can't return to work
normal activities ASAP, NSAIDs recommended but muscle relaxants/narcotics NOT recommended, collar only for few days, active mobs (short arc), progress to isometric and deep flexor retraining as needed; if chronic (>3mo)= multidisciplinary pain clinic approach
in pts w/ neck p who meet the thoracic manip CPR, do they do better w/ cervical HVLA or thoracic HVLA?
cervical HVLA had better outcomes; with that said other studies that look at pts w/ neck pain who receive TSM (not compared to neck HVLA) have found clinically meaningful decr. in numeric pain rating and sig. inc in cervical AROM in all directions except extension; some evidence shows TSM may decr pain/improve fxn in pts w/ gr I compressive myleopathy
performing specific craniocervical flx exs vs. flexion endurance: which one demonstrates greater immediate improvements in pressure pain thresholds, mechanical hyperalgesia & perceived pain relief during active mvt?
specific craniocervical flexion ex (biofeedback device, find highest pressure b/w 22-30mmHg pt can hold comfortably and do 10x10" w/ 10" rest b/w reps)
using biofeedback for craniocervical flexion test, what is the median pressure achieved for those w/ chronic neck pain vs asymptomatic group
starting at 20mmHg, median w/ chronic np was 24 mmHg vs 28 mmHg in asymptomatic
dynamic muscle training and relaxation vs. ordinary activity in female office workers w/ chronic neck p
dynamic muscle training and relaxation did NOT lead to better improvements in neck p compared w/ ordinary activity
neural mobilization vs. cervical/upper quadrant mobs for decr. pain and incr. function in pts w/ cervico-brachial syndrome
both demonstrate improvements in p/fxn, they produce equal improvements in function but pain reduction is greater w/ nerve mobs
during sensory testing, 2 findings may occur: 1. deficits w/in 1 specific dermatome, indicating ?(a) or
2. more generalized sensory disturbance found, indicating ? (b)
(a.) injury to corresponding nerve root
(b.) may be a red flag indicating presence of myelopathic condition or yellow flag indicating some level of psychosocial distress. Same thing for mytomes.
According to APTA, capsular pattern of cervical spine is
full flx, limited ext, symmetrical limits of SB and rotation (so chin should still be able to come to chest even w/ severe OA)
thoracic outlet syndrome may be suspected in pts w:
sings of nerve root compression whose sx peripheralize w/ SB opposite the side of sx
thoracic outlet test (elevate arm stress test)
standing. ABD arms to 90deg, ER sho, flx elbow to 90deg so elbows slightly behind frontal plane. Open/close hands slowly for 3min. + is sx (ischemic p, heaviness or profound weakness in arm, n/t in hand) reproduction. lacks specificity, but high Sn so r/o if negative
VBI screening recommended for:
all pts receiving mobs/manips that require them to move toward terminal ranges of neck motion and all pts whose neck p resulted from trauma (recent or previous hx). test via pre-manip hold at end range and having pt count backwards from 15 (maintain eye contact & monitor for CN sx) or minimized deKleyn test/ modified VBI
minimized deKleyn/ modified VBI test
pt supine, moved passively and sequentially into right and left rot, followed by ext, then ext w/ rot in each direction. During each mvt, have pt count backwards from 15. All done w/ head supported on table (which is why it's minimized/modified). downside is if techniques don't require all of these motions, then there's no reason to take pt into them
single best neuro screen test to dx cervical radiculopathy
diminished or absent biceps DTR
single best screening test for cervical radiculopathy
ULTT A, negative test rules it out, SN 97%, -LR= 0.12. Best method to rule in is the cluster
imaging choices: for acute non-trauma (a) and for acute trauma (b)
(a). radiograph A-P, lat and oblique views
(b.) A-P, lat, odonoid (i.e. mouth open); flx/ext views may be helpful when primary views don't demonstrate instability but ligt injury suspected
CT indicated for:
eval of abnormal areas seen by plain film or high clinical suspicion of fracture
MRI indicated for
high contrast b/w soft tissues. for demonstration of specific anatomic lesions of disk, spinal cord, and nerve roots, esp in pts w/ neuro conditions being considered for surgery, also used to detect neoplasm, infection, and fracture
needle electromyography used to (a). Nerve conduction studies may be combined w/ EMG to (b)
(a)sample selected limb muscles to detect neural pathophysiology and localize it to root level(s). (b.)rule out other causes of sx, such as diffuse peripheral neuropathy or more distal mononueropathy. Needle EMG is gold standard for establishing dx of both lumbar and cervical radiculopathy
attachments from ant surface of manubrium and upper surface of mastoid process, and lat hlaf of sup nuchal line of occipital bone. unilaterally draws head toward sho and contra rot (pointing chin cranially). bilaterally extends head in FHP. Can also assist in respiration by raising thorax when head fixed
attachments on ant tuberlces of TP's of C3-6 and inf surface off basilar part of occipital bone. flexes and slightly assists in ipsi rot of vertebrae and head.
mult. attachments on bodies & TP's from T3-C3. can be divided into inf. oblique, vertical intermediate, and sup. oblique parts. flexes and assists in rot of vert. & head
from ant tubercles of TP's C3-C6 to scalene tubercle & ridge on upper surface of 1st rib. Dual action: neck fixed= elevates 1st rib, rib fixed=ipsi SB and contra rot.
posterior tubercles of TP's C2-C7 to upper surface of 1st rib behind subclavian groove. Dual action: neck fixed= elevates 1st rib, rib fixed=ipsi SB and contra rot.
post tubercles of TP's C4-C6 to outer surface of 2nd rib behind attachment of serratus ant. Dule action: neck fixed=elevates 2nd rib; rib fixed: ipsi cervical SB
from lower half of ligt nuchae, SP's C7-T3 to lat. su. nuchal line & mastoid process. bilaterally extends CS, unilaterally causes ipsi SB and rot
from SP's T3-T6 to post. tubercles of TP's C1-C3 immediately ant. to attachment of levator. bilaterally extends CS, unilaterally causes ipsi SB and rot
semispinalis capitis and cervicis
deep to splenius capitis and cervicis, superficial to deep suboccipitals. act w/ splenius muscles to extend head and CS. greater occipital nerve (C2) pierces this muscle and can become entrapped here (in cervicis)= greater occipital neuralgia
originates form all thoracic SP's and C7 SP, ext. occip. protub., ligt. nuchae. important role in assisting w/ force coupling to allow normal scap up. rot. & post. tipping during elevation
originates at rib angles 7-12 and ascends to rib angles 1-6 and C7 TP. tissue texture changes of this muscle at rib angle thought to indicate rib cage dysfunction
O: outer surface and sup. border of ribs 1-8 (possibly down to 10) and fascia of assoc. ext. intercostal muscles. Attaches to ant surface of the vertebral border of scap.
N: long thoracic
A: protracts scap, assists w/ force coupling for normal scap up. rot & post tip, when scap fixed, it pulls ribs post.
O: clavicle and sternum
I/A: distal attachment- lateral lip of bicipital groove, flx's and IR's arm. if distal fixed w/ UE flx'd, it will pull rib cage ant/sup/lat
N: medial and lat. pectoral
this muscle can rupture during weight lifting
O:ant/sup surfaces for ribs 3-5
I: coracoid process
N: medial pectoral n
A: stabiizes scap, if short protracts scap
Divides axillary artery into 3 parts
3 parts: sternal, costal, lumbar
sternal- arises from back of xiphoid
costal- from internal surfaces of costal cartilages and adj. ports of ribs 7-12 (lower 6 ribs)
lumbar-from first 2 or 3 lumbar vert.
pain from dissecting thoracic aneurysm
usually in chest, can radiate to back if asecending aorta involved. usually sudden onset, often unrelenting, not relieved by position change
pain from peptic ulcer of post wall of stomach or duodenum
boring p from epigastric area to mid-TS. can be triggered or relieved by eating. Can result from prolonged NSAID use.
pain from inflamed gall bladder (cholecystitis)
usually right upper quadrant and right infrascapular region. often accompanied by mod. fever, nausea, vomiting. sx 1-2 hr after eating heavy mea. right upper quadrant often tender w/ incr tenderness during inspiration (Murphy sign)
pain from acute pancreatitis
p around T/L junction
pain from kidney infection or renal stones
usually at costovertebral angle or flank area. kidney issues usually assoc. w/ fever, nausea, vomiting and renal colic (flank p accompanied by lower abdominal pain that spreads into labia or testicles). ASK ABOUT HX OF UTI!!
most common form of CA in TS
spinal metastases secondary to primary breast, lung, or colon CA
common findings w/ primary thoracic tumors
painful scoliosis, long-tract signs and leg pain
normal chest expansion of rib cage
5cm measured at nipple line (<2.5cn is considered pathologic)
thoracic facet referred pain locations
most commonly 1 segment inf. & slightly lateral to the affected joint. no more superior than 1/2 of vertical hight of that vertebral segment, but can refer distally up to 2.5 segments below the level. T3-4 and 4-5 have potential to refer to ant chest wall & sternum. C7-T3 overlap extensively, cause paravertebral pain, inf toward super angle of scap and interscap region toward inf angle. T11-12 localized paravert., ipsi iliac crest
cervicogenic vs. tension type HA
CGH: usually unilaterally or uni that spreads to other side, occasionally bilat. A strong indicator is side consistency or side locking of HA (i.e. it does NOT change sides w/in or b/w attacks- side locking was found in only 20% of migrainers, 12% w/ TT), described as ache (rather than pulsating); typically assoc w/ p in neck, sho, suboccipital region (but presence of this is NOT dxtic); onset of p often in neck, then spreads (migraines typically start in the head then go to neck). pain usually in ophthalmic division of trigeminocervial nucleus (if more face p-in mand. or max divisions then could indicate TMJ as cause), has variable intensity (migraines ususally stay same or gradually build); other sx may incl nausea, lightheadedness, dizziness, or visual disturbances (not key or dominant fts); usually lack a temporal pattern/distinctive pattern (clusters & migraines usually >4hrs & can last days). usually has mechanical causes but pt can't always determine them. like other HA's it can be provoked by stress. relieved by rest and meds (unlike most other HA's) unless chronic. jt dysfxn in C0-3
Tension: usually band-like, bilateral or whole-head HA. Doesn't worsen with activity. Can last 30min to 7 days. Pain is pressing/tightening, non-pulsating.
THIS SET IS OFTEN IN FOLDERS WITH...
OCS- CPRs and tx classifications
OCS Lumbar OCS
OCS surgical facts
OCS Innervations, anatomy, peripheral nerves
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