Patient complaints
What are some common patient complaints of Facet syndrome/Neck stiffness/Spondylosis?
Acute neck pain (<12 weeks)
Symptoms are isolated to the neck
Unilateral neck pain with referred pain to scapula and shoulder
What tests could you do for Facet Syndrome? What would you find from these tests (what would a + test look like)?
VBI test before you do Spurling's!!!
Spurling's-> likely to be (+)
Unilateral PA: Hypomobility/ +RS of symptoms with UPA
Cervical Rotation ROM: Decreased ROM or movement in CLOSING motions (extension, rotation, lateral flexion)
Unilateral stiffness
What kind of treatments could you provide someone with Facet Syndrome? What is the ICF category?
ICF: Neck pain with mobility deficits
Treatment: Cervical mobilization/manipulation, patient education, exercises to stretch and increase ROM
Treatment examples: upglides/lateral glides/UPA/CPA, STM of paraspinals, SNAGS
What are some common MOIs for Cervical Disc Pathology?
Usually due to degenerative process
Often these people have a history fo trauma, or whiplash with forced extension, compression or rotation
What are some common patient complaints who have a cervical strain/sprain/whiplash?
"tightness" or "spasms"
Intolerance to prolonged positioning (hard to hold head up)
Frequent need for self manipulation
Possible ergonomic insufficiency with repetitive activities
What tests would you do if you are considering cervical strain/sprain/whiplash? What will you likely find with these tests?
MUST SCREEN for ligamentous instability with sharp purser and Alar ligament tests, if (-) move on.
Deep neck flexor endurance: abnormal performance
Cervical proprioception/Lower cervical ROM: Deficits in coordination, strength and endurance in neck and UQ muscles
Palpate superficial neck flexors and joint mobility: +RS with palpation and joint assessment
What is the ICF category? What are some possible treatments?
ICF: Neck pain with coordination deficits
Treatment: coordination, movement practice, strengthening, manual therapy for pain, patient education
Treatment examples: deep neck flexor training, deep neck extensor training, cervical proprioception
What are the common MOIs for cervical sprain/strain?
Injury to soft tissue of C-spine
Can be sudden or progressive
Can be related to trauma or prolonged positioning (sleeping awkwardly)
What are some common patient complaints for Cervicogenic Headache?
UNILATERAL headache in suboccipital/neck area- gets worse with neck movement
Non-continuous HA with unilateral neck pain and referral to the cranium
What kind of tests could you do for Cervicogenic HA? What would they likely tell us (what would a + test look like)?
Upper Cervical ROM: decreased ROM and mobility
UPAs: hypomobility in upper cervical region
Cervical Flexion Rotation Test: (+) test
Suboccipital palpation: reproduction of HA
Deep neck flexor endurance: decreased endurance and incoordination of deep neck flexors
What is the ICF category? What kind of treatments can we provide the patient with?
ICF: Neck pain with Headaches
Treatment: patient education, upper cervical mobilization/manipulation for pain, strengthening neck muscles, improve coordination of deep neck flexors
Examples: Suboccipital STM, AP upper cervical mobilization, suboccipital stretch,
What is the major difference between a tension HA and cervicogenic HA?
Tension HA: diffuse HA (band around the head), feels better in the morning, symptoms increase over time
Cervicogenic HA: Unilateral symptoms, neck pain with referred pain to cranium
What are some common patient complaints for Cervical Radiculopathy
Shooting, narrowing band of pain, going down the arm
UE/hand weakness, numbness and tingling
What tests could we perform for Cervical Radiculopathy? What will the tests likely show us (what would a + test look like for each)?
DO VBI BEFORE SPURLING's!
ROM: Closing neck patterns +RS, UE paresthesias/numbness/weakness, decreased ipsilateral cervical rotation
Spurling's: (+)
Cervical Distraction Test: decreases the patients symptoms
Cervicoscapular unloading: decreases the patients symptoms
ULNTT: symptoms reproduced (median, radial, ulnar)
What is the ICF category? What are some treatments you could provide the patient with?
ICF: Neck pain with radiating pain
Treatments: patient education- positioning, unload tissue with traction, mobilization/manipulation, UQ neural mobilizations/desensitization (sliders-->tensioners)
Examples: Cervical distraction, Cervicoscapular unloading, median/ulnar/radial nerve sliders, cervical slider mobs.
What is Torticollis? How is it treated?
Turning of head or neck to one side- usually caused by contraction of SCM muscle
Resolves well with conservative treatment: PROM and positioning
What are some common patient complaints for Cervical Disc Pathology?
Vague/Diffuse pain
Pain down the midline of the neck/upper back, also into the shoulder blades
WORSE with flexion motion or Valsalva
Improves with traction/unloading
Stiff/Painful in AM, difficulty sleeping
What kind of tests would you do for Cervical Disc Pathology? What would the tests tell you?
Palpation to muscles in cervical region: tenderness to palpation
CPA in cervical spine: pain and +RS
Passive neck flexion test: (+)
What kind of treatment would you give to the patient?
Patient education
Cervical traction/unloading
Mobilization/manipulation for pain
Neural mobilization
Strengthening exercises
What is Wainner's Cluster testing for? What are the different tests associated with it?
Cervical Radiculopathy
Cervical ROM, Spurling's, Cervical Distraction, ULNTT