Cervicogenic Headaches and Cervical Instability Quiz

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Questions and Answers

Which muscle groups are commonly associated with increased tightness in cervicogenic headache patients?

Pectoralis major and gluteus maximus

Biceps brachii and triceps brachii

Rectus abdominis and external obliques

Upper trapezius and levator scapulae (correct)

What distinguishes cervicogenic headaches from migraine headaches?

Increased frequency of unilateral symptoms

The absence of headache pain

Higher incidence of upper cervical joint dysfunctions (correct)

Greater cervical range of motion

Which technique is effective for reducing cervicogenic headache symptoms?

Strengthening exercises for the hamstrings

Static stretching of lower back muscles

C1-C2 SNAG technique (correct)

Aerobic exercise focusing on endurance

What is a common weakness observed in patients with cervicogenic headaches?

Deep neck flexors Signup and view all the answers

Which treatment modality is not typically used for cervicogenic headaches?

Chemotherapy Signup and view all the answers

What does the performance index evaluate in muscle endurance?

The ability to maintain maximum pressure for a specific duration Signup and view all the answers

Which of the following is NOT considered a subjective feature of clinical cervical instability?

Poor neuromuscular control Signup and view all the answers

How do proprioception exercises benefit patients with cervical spine instability?

They enhance the quality of controlled motion Signup and view all the answers

What is the purpose of spinal manipulation in physical therapy for cervical instability?

To target hypomobile segments below the level of instability Signup and view all the answers

What does the activation score measure?

The highest pressure level achieved for 10 seconds Signup and view all the answers

Which symptom is commonly associated with cervical spine instability?

Sharp pain with sudden movements Signup and view all the answers

What is a common surgical intervention for severe cervical spine instability?

Anterior cervical fusion Signup and view all the answers

Why is improving posture important for those with cervical instability?

It reduces loads placed on spinal segments Signup and view all the answers

What characterizes movements occurring in the neutral zone of the spine?

They occur against minimal passive resistance. Signup and view all the answers

Which condition indicates a clinical spinal instability?

Increased neutral zone relative to total range of motion. Signup and view all the answers

Which factor is NOT associated with degeneration or mechanical injury of the spinal stabilization components?

Sedentary lifestyle. Signup and view all the answers

What are aberrant motions in the context of clinical instability?

Sudden accelerations or decelerations outside the intended plane of movement. Signup and view all the answers

Which of the following symptoms is associated with cervical instability?

Head feels heavy and neck locks with movement. Signup and view all the answers

What does the Sharp-Purser test specifically assess?

Integrity of the Atlanto-Axial joint and transverse ligament. Signup and view all the answers

What should be expected during the Transverse Ligament Stress Test?

Evaluation of hypermobility of the atlantoaxial joint. Signup and view all the answers

Which of the following symptoms is commonly reported with cervical degeneration?

Paraspinal muscle spasm. Signup and view all the answers

What is the primary dysfunction observed in patients with cervical hypomobility?

Stiffness of the cervical spine Signup and view all the answers

Which of the following is NOT a proposed intervention for managing cervical hypomobility?

Ultrasound therapy Signup and view all the answers

What percentage of cervical radiculopathy cases are typically caused by foraminal encroachment?

70% to 75% Signup and view all the answers

Which clinical examination test is used to identify cervical nerve root compression?

Spurling's test Signup and view all the answers

Which symptom is typically NOT associated with cervical radiculopathy?

Loss of coordination in the legs Signup and view all the answers

What range of motion indicates limited ipsilateral neck rotation for identifying cervical radiculopathy?

Less than 60 degrees Signup and view all the answers

What is the common cause of cervical radiculopathy, accounting for less than 25% of cases?

Herniated intervertebral disc Signup and view all the answers

What is the primary focus of the pathoanatomical model in diagnosing conditions?

Determining the specific dysfunctional structure Signup and view all the answers

What is a common characteristic of patients with cervical hypomobility during motion testing?

Restricted active and passive motion Signup and view all the answers

Which classification category does NOT fall under neck pain classifications?

Cervical hypermobility Signup and view all the answers

What does centralisation in the response to movement indicate?

A shift in pain location towards the center of the body Signup and view all the answers

How did the treatment-based classification of neck pain evolve after the 2008 update?

It introduced treatment-oriented subgroups for effective intervention Signup and view all the answers

Which aspect is commonly assessed in the response to movement model?

Immediate changes in symptom severity Signup and view all the answers

What is NOT a characteristic of the treatment-based classification system?

It focuses on structural dysfunctions Signup and view all the answers

Which of the following is a treatment-oriented subgroup for acute spinal pain syndromes?

Cervical hypomobility Signup and view all the answers

What is the intended purpose of the categorization system proposed by Werneke et al.?

Identify patients likely to benefit from conservative treatment Signup and view all the answers

What is the primary focus of a cervical collar in managing cervical pain?

To provide relative rest throughout the day Signup and view all the answers

What is a recommended approach to help manage pain through exercise?

Choose enjoyable activities like walking or biking within pain tolerance Signup and view all the answers

Which test is specifically used to assess the neuromotor control of deep flexors in the cervical spine?

Cranio Cervical Flexion Test (CCFT) Signup and view all the answers

How can cervicogenic headaches be differentiated from migraines based on physical examination?

Headaches are aggravated by specific neck movements or sustained postures Signup and view all the answers

What implication does a reduced range of motion more than 10° during the CFRT suggest?

Potential cervicogenic headache due to upper cervical dysfunction Signup and view all the answers

What is a key feature of the pain experienced by patients with cervicogenic headaches?

Pain is localized in the neck and can spread to various areas of the head Signup and view all the answers

What is the estimated incidence of cervicogenic headaches among chronic headache sufferers?

14% to 18% Signup and view all the answers

Which muscle group is primarily strengthened in the craniocervical flexion training?

Deep cervical flexors Signup and view all the answers

Study Notes

Cervical Spine Disorders

These disorders involve the cervical vertebrae, encompassing anatomy, biomechanics, red flags, and treatment classifications.

Objectives

Students should master the clinical anatomy related to the cervical spine.
Students should understand the clinical biomechanics of the cervical spine.
Students need to identify red flags associated with cervical spine issues.
Students should understand the classification and treatment of cervical disorders.

Cervical Vertebrae Characteristics

The transverse processes in the upper six cervical vertebrae contain a foramen (transversarium).
Typical cervical transverse processes have anterior and posterior tubercles for muscle attachment.
The body's superior surface projects upward, while the inferior surface is angled.
The spinous processes are short and bifid (except the seventh).

Joints of Cervical Spine

Craniovertebral (atlanto-occipital, atlanto-axial) joints connect the skull to the cervical spine.
Zygapophyseal (facet) joints connect adjacent vertebrae, restricting excessive movement.
Uncovertebral joints uniquely found in the cervical spine connect adjacent vertebrae.

Uncovertebral Joints

These joints are located between the C3 and C7 vertebrae.
They consist of unique processes (uncinate processes) that articulate with the level vertebra above.
The facet joints comprise the superior and inferior articular processes of the adjacent vertebra.

Facet Joints

In the middle and lower cervical spine (C2-C7), facet joints are in the sagittal plane, inclined upward and forward at approximately 45 degrees.
The facet joints of C1-C2 are more horizontally aligned to facilitate greater neck mobility (roughly 50% of rotation occurs at this level).

Motions Available

Spinal motions occur simultaneously and are coupled.
In the cervical and upper thoracic regions, side bending is coupled with axial rotation moving in the same direction.
In the upper cervical spine, relative rotation happens during cervical lateral flexion at the C1-C2 and occiput-C1 levels.

Ligaments of Cervical Spine

Ligaments for the cervical and upper regions of the neck include the anterior longitudinal ligament, posterior longitudinal ligament, ligamentum flavum, interspinal ligament, and nuchal ligament.
The transverse ligament of the atlas encloses and lubricates the dens as the atlas pivots.
The alar ligament runs from the dens' lateral borders to the occiput—part of the upper cervical spine stabilization.
The apical ligament runs from the dens' tip to the occiput, taut in head traction.

Vertebral Artery

The vertebral artery provides crucial blood supply to the brain stem and cerebellum.
Occlusion of the vertebral artery, particularly with neck extension and rotation, can cause dizziness, nystagmus, slurring of speech, and loss of consciousness.
Testing the arteries is essential before neck traction or manipulation.

Red Flags

This is a list of features that could indicate a serious underlying condition needing further investigation.
Conditions listed includes cervical myelopathy, neoplastic conditions, upper cervical instability, inflammatory/systemic diseases, and vertebral artery insufficiency.
Specific symptoms such as sensory disturbances in the hands, muscle wasting, unsteady gait, hyperreflexia, bowel and bladder disturbances, specific ages, histories of cancer, unexplained weight loss, constant pain, and night pain are among the features.

Classification Types

Neurological or non-specific pain: categorized as having neurological involvement or mechanical pain.
Clinical condition: based on signs and symptoms (e.g., cervicogenic headache).
Pathoanatomical: based on the structure dysfunction (e.g., facet joint issues).
Based on response to movement: centralisation and changes in pain location with movement.

Treatment-Based Cervical Spine Classification

1-Cervical hypomobility: neck pain with restricted mobility.
2-Cervical radiculopathy: neck pain radiating into the arm.
3-Clinical instability: neck pain with movement coordination issues.
4-Acute pain (whiplash): pain related to movement coordination impairments.
5-Cervicogenic headache: neck pain with headache symptoms.

Examination Findings and Interventions for Cervical Hypomobility

Examination frequently finds restricted AROM (active range of motion) and PROM (passive range of motion), PIVM (passive intervertebral motion) testing in the cervical and upper thoracic regions.
Interventions often include AROM exercises, muscle energy techniques, mobilization/manipulation techniques, and in subacute and chronic patients.

Cervical Radiculopathy

A common cause is foraminal encroachment due to factors like decreased disc height and degenerative changes in the uncovertebral or zygapophysial joints.
Herniation of the intervertebral disc contributes about 25%.
Symptoms usually involve pain in the neck and one arm, motor/reflex changes, and may be unilaterally or bilaterally present if severe "bony spurs" are present, impinging on nerve root(s)
If peripheral pain, weakness, or "pins and needles" symptoms exist, they tend to match dermatomal (nerve root) patterns.

Clinical Instability

This refers to the spine's inability to maintain proper placement during physiological activities.
This can lead to spinal cord/nerve root damage, pain, and deformity.
The larger the neutral zone and lessened passive resistance to movement, the greater the chance of clinical instability.
Poor posture, repetitive trauma, acute trauma, and/or cervical musculature weakness can contribute.

Acute Pain and Whiplash-Associated Disorders

Whiplash involves sudden acceleration-deceleration forces resulting in a complex array of issues affecting muscles, joints, ligaments, discs, and nerves.
The Quebec task force categorizes whiplash-associated disorders by clinical presentations.

Positive Spurling test (cervical compression test), neck distraction test, Upper limb neurodynamic test 1 (ULNT 1), and limited ipsilateral neck rotation.
Other assessments to measure cervical instability includes Sharp-Purser test, Transverse Ligament Stress Test, Neck Flexor Muscle Endurance, and Craniocervical flexion test.