Block 4 Rheumatology - ORTHO C_T-Spine.pdf

Name C-Spine Injury Torticollis Summary Multiple MOAs with varied presentation depending on severity, etiology, location of injury, non-traumatic Posterior Neck Pain: C-spine lateral curvature Etiology General trauma, especially falls and MVAs Can also be nontraumatic You are literally a baby "Wry n...

Name C-Spine Injury Torticollis Summary Multiple MOAs with varied presentation depending on severity, etiology, location of injury, non-traumatic Posterior Neck Pain: C-spine lateral curvature Etiology General trauma, especially falls and MVAs Can also be nontraumatic You are literally a baby "Wry neck" Cervical Strain/Sprain Cervical Spondylosis (Degenerative Disc Disease) Posterior Neck Pain: Soft tissue injuries of the cspine Posterior Shoulder Pain: C5/6 and 6/7 are most common sites Signs General: - ROM pain/limitation in neck/ traps/UEs - Radiation Neurological: - Paresthesias - Loss of sensation - Weakness Special Tests - Trap/SCM spasming - Reproducible pain in trap/SCM - Resting deviation to affected side General: - Limited ROM - Neck/shoulder pain worse with upright activity - Radiating reticular pain Neuro: - Myelopathy Treatment Overall Differentiate trauma or no injury then R/O zebras w/ general ROS Fx of c-spine will be in 911 Med C-Spince Fracture R/O: - No neuro/sensory changes, no AMS, no loss of consciousness, no tenderness, no pain - NSAID - Physical therapy - Massage - Nonradicular pain Whiplash is most common MOA - Worse with motion - No neuro deficits Narrowing of cervical foramen due to cervical abnormality: - bone spurs - disc herniation - ligamentum flavum protrusion Tests Spurling's Maneuver: - For spondylosis and cervical disk herniation - Palpation: - Tenderness - Apply axial pressure to top of pt's head - Crepitus while laterally flexed - Symmetry - (+) = reproduced pain down arm - Position - ROM (active v. passive) Hoffman's Reflex: - Strength (6 directions plus - Flick middle finger nail with pt's hand shoulder strug (C4)) relaxed in yours - (+) Flexion of index/middle finger XRAY: AP, lateral, odontoid Physical Exam Hoffman Reflex (+) Babinski Hyperreflexia Imaging: - Plain XRAY - MRI if no improvement with tx OR myelopathy present - Soft collar for support - Ice/heat to comfort - Soft tissue massage - NSAIDs - NSAIDs - Cervical pillow/roll - Epidural steroid injection (ESI) Decompression - Home traction - PT traction/recovery Can lead to paralysis if untreated! May require fusion if severe Cervical Stenosis Posterior Shoulder Pain: Congenital: Short pedicles, funnel-shaped spinal canal Narrowing of sagittal diameter of cervical canal Developmental: Weight training C5/6 are most common! Acquired: Spondylosis, spurs, disc bulging Often asymptomic until triggered by hyperflexion/extension Upper extremity symptoms: Youngs: Herniated disks Cervical Radiculopathy Referred neurological pain (dermatome) resulting in numbness, weakness, loss of reflexes Cervical Disk Herniation Nucleus pulpsos extrudes through annulus fibrosis (jelly out of the donut) Thoracic Spondylosis Degenerative disk disease of the t-spine Thoracic Disk Herniation Olds: Foramen narrowing due to DDD - Decreased cervical lordosis - Pain relief with hand on top of head - Paresthesias Spurling Maneuver (+) - XRAY - MRI - EMG/NCS to determine neuro-involvement type - NSAIDs - Decompression Do not manipulate spine! Many spontaneously resolve in 2-8 weeks Conservative or surgical depending on severity See DDD - Neck pain - Radicular pain MRI - T-spine pain - Pain worse with sitting/bending forward - Weakness/numbness Imaging - Plain XRAY - MRI - Can trial NSAIDs or oral steroids - Traction may help - ESI trial Conservative or surgical depending on severity - Can trial NSAIDs - ESI trial Nucleus pulpsos extrudes through annulus fibrosis (jelly out of the donut) T11/12 most common! ↑ ↓← → ° ± 1. Review the major anatomy of the cervical and thoracic spine. Review it lol 2. Determine important components of the patient history that are essential in the evaluation of a patient with suspected cervical or thoracic spine pathology. History: Mechanism of injury, "point with one finger where it hurts," any tingling, loss of sensation, limit of ROM, limited daily activities, weight loss? Assessment: Pain = subjective; tenderness = objective. * ROM, tenderness, strength, radiculopathy, special tests * 3. Recognize pertinent clinical landmarks utilized in examination of the cervical and thoracic spine. Learn them I guess, lmao Name Summary Etiology Signs 4. Describe normal range of motion and strength for the cervical and thoracic spine. 6 directions: Lateral x2, Coronal/Inferior, Flexion/Extension 5. Perform special tests to assist in the diagnosis of disorders of the cervical and thoracic spine. Spurling: Press on coronal aspect of head with patient gazing upright and lateral. May reproduce radicular sx Hoffman's: Flick pt's middle finger looking for pointer/thumb flexation 6. Demonstrate an appropriate musculoskeletal and focused neurologic examination of the cervical and thoracic spine. No real notes for this 7. Create a differential diagnosis of cervical and thoracic spine pathologies based on the localization of symptoms (i.e. neck pain, arm pain). Neck Pain: Cervical strain or fx, cervical spondylosis Arm Pain: Cervical radiculopathy, stenosis, herniated disk; thoracic spine, scholiosis/kyphosis 8. Compare and contrast the presentation, diagnosis, and initial treatment of common abnormalities of the cervical and thoracic spine encountered in the primary care setting. SEE ABOVE 9. Recognize the patient presenting with a cervical or thoracic spine disorder that requires hospital admission or referral to orthopedic surgery. Surgical if severe: T-spine fractures, burst fractures Special Tests Tests Treatment Overall