The Screening Model for the Head and Neck
Questions to Ask
Cancer history?
Trauma?
Cardiac History?
Recent surgery?
Types
Primary and Secondary
Primary cause
traumatic
degenerative
Canadian C- Spine Rules
1. high risk factors
2. low risk factors
3.actively rotate
what is a jeffersons fracture
• Burst fracture of the C1 vertebrae
Red Flags
night pain
5D And 3Ns
Tension Description
described as pressure, mild to moderate tightness, dull ache, sensation of band or vise around head
Cardiovascular causes of neck pain
acute coronary insufficiency, MI, thoracic aortic aneurysm
MRI
advanced imaging for C-Spine
Odontoid Fracture
Type I: Avulsion of tip
• Caused by alar or apical ligament stress
• Type II: Fracture of junction of dens and body
• Most common and most difficult to heal, unstable
• Type III: Fracture deep below junction
• Heals readily
Causes of pain
inflammation
metabolic
vascular
degenerative
tumor
Migraines Description
unilateral, around or behind one eye, associated with N/V
Diaphragm and Lung conditions that lead to neck pain
breathing changes affect symptoms
sharp pleuric pain in axilla, s/s worse with coughing, deep breathing
1. Acute cervical pain with neuro involvement OR instability
2. Chronic pain with neurological symptoms
3. Pattern of infection or malignancy
hangmans fracture
Bilateral fractures of C2 pars interarticularis
• “traumatic spondylolysis”
• Causes dislocation of C2 on C3
• Usually associated with hyperextension injury
(common in hanging)
Assessment of Pain and Patterns
location
onset
description
intensity
duration
Cluster HA Description
boring, stabbing, comes in intervals
S/S of Cervical Myelopathy
loss of hand dexterity
visible changes in handwriting
positive babinskis and hoffmans
Open mouth views
Fractures
• Lateral masses of C1
• Odontoid process
• Vertebral body of C2
• Jefferson Fracture
clay shoveler's fracture
Fracture of posterior spinous process
• Stable fx as posterior ligaments remain intact
• Occurs at C6, C7,T1 or T2
Associated Signs and Symptoms
GI symptoms
Constitutional Ss/Sx
starts in occipital regions and spreads anteriorly towards frontal area
Cervical Spine Views
Specialized- Swimmers view, Flexion and Extension stress view, oblique view
Oblique Views
• Foraminal encroachment
• DDD / disc space narrowing
• Facet joint abnormalities
C-Spine Degenerative Changes
Decreased disc height leads to:
• Vertebral endplate approximation
• Friction at uncovertebral joints
• Osteophyte formation
• Schmorl’s nodes
• Vacuum phenomenon