DSA 20- Neck Pain Online Module
with a diminished biceps reflex, what disc is most likely herniated?
C4-5
best imaging modality for herniated nucleus pulposus?
MRI
how to diagnose cervical canal stenosis?
MRI
Somatic dysfunction of what structure can contribute to dizziness in patients with whiplash?
SCM
What test is being performed according to the following: "Cervical extension and left side bending reproduce the pain in the left arm."?
Spurling's test
what does the motor and reflex examination reveal in a cervical spinal stenosis pt @ levels below the lesions?
UMN signs- hyperreflexia and spasticity in lower extremities
myofascial trigger point
a small hyperirritable spot in the muscle that produces a predictable radiating pain pattern
spinothalamic tract compression
affects CL pain and temp sensation w/ light touch often preserved
posterior columns compression
affects IPSI position and vibration sense, possibly leading to gait disturbacnes
Irritation of which muscle most directly explains his rib 1 inhalation dysfunction?
anterior scalene
What corresponding muscle weakness might you find in this patient with a disc herniation at C4-5 level?
arm abduction
cervical facet syndrome
arthritis w/ pain associated w/ zygaphophyseal joints
Spurling's test
assesses for radicular pain- signs and symptoms
what occurs as myelopathy progresses over time?
weakness in the triceps, hand intrinsics, and hip flexors most commonly. Late manifestations include spasticity, as well as bowel and bladder dysfunction.
what does this describe: Injury to Anterior longitudinal ligament, SCM, Scalenes, Longus Colli; these structures are strained w/ extension?
whiplash
how does myelopathy initially present?
with subtle complaints of hand clumsiness or difficulty with balance
muscle innervations- C6
wrist extensors, elbow flexion
why is RA and down syndrome considered relative contraindications to cervical OMT?
d/t laxity of ligaments around the dens
muscle innervations- C8
deep finger flexors, finger interossei
what are other UMN signs associated w/ cervical canal stenosis?
gait disturbance, stiffness and weakness of legs, possible bowel/bladder incontinence
what does this describe: sharp and electric pain, diminished sensation, diminished reflexes, no muscle weakness?
high suspicion for herniated nucleus pulposus w/ radiculopathy
dorsal root compression
leads to dec dermatomal sensation
Cardiac ischemia can radiate to?
left arm and neck due to vagal innervation connecting with cervical plexus; dull and pressure like pain
Disc herniation are influenced by...?
mechanical pressure on the vertebrae and discs- posture, tension, compensations, activity
what does this describe: sensations conform to the areas of muscles present that are innervated by the compressed nerve root, autonomically mediated symptoms result in dizziness, blurring of vision, tinnitus, retro-ocular pain, and facial and jaw pain?
myalgic pain
what does this describe: Paresthesias and dysesthesias may be present, often involving bilateral upper extremities and not following a dermatomal distribution?
myelopathy
what kind of patients may have nausea and emesis d/t equilibrium dysfunction?
myelopathy
what does this describe: pain tends to present more proximally and paresthesia more distally?
neuralgic pain
What does the sinuvertebral nerve supply?
portions of the annulus, PLL, periosteum of vertebral body and pedicle, adjacent epidural veins, dura mater
what attaches to rib 2?
posterior scalene
how are myofascial pain patterns diagnose?
presence of taut muscular band with twitch reflex and predictable referred pain
most pain that radiates is NOT...? (not most common)
radicular
What nerve is responsible for the sensory innervation of the cervical discs?
sinuvertebral nerve
what attaches to the 1st rib?
the anterior and middle scalenes
where does the sinuvertebral nerve come from?
the ventral nerve root, has associations w/ sympathetic plexus
What does inc radicular pain or numbness indicate during spurling's test?
disc disease or foraminal stenosis
muscle innervations- C7
elbow extension, wrist flexion, finger extension
muscle innervations- C5
elbow flexion, arm abduction
muscle innervations- T1
finger abduction
whiplash
injury to soft tissues of the neck, usually anterior structures, lack of bony tenderness; may be associated w/ tinnitus, dizziness
Myalgic pain
irritation of the ventral motor root, deep, boring, unpleasant sensation that tends to be poorly localized because of its referral to sclerotomal areas
Neuralgic pain
originates from irritation of the dorsal sensory root and has a "lightning" or "electric" sensation, tends to be dermatomal and associated with numbness and paresthesia
How to perform spurling's test?
1. extend the neck 2. SB to the affected side 3. add slight axial compression
You found a tenderpoint located on the right inferiolateral aspect of the spinous process of C6. How would you position the neck to treat with counterstrain?
Extension, rotation left, side bending left
what does the motor and reflex examination reveal in a cervical spinal stenosis pt @ the levels of the cervical lesions?
LMN signs- hyporeflexia and weakness in the upper extremities
treatment possibilities for whiplash?
OMT, anti-inflammatories
cervical canal stenosis
usually gradual, insidious onset; w/ UMN signs- weakness, spasticity, clumsiness, altered tonus
