Cervical Disorders Lecture PDF

CERVICAL DISORDERS Dr. Aftab Ahmed Mirza Baig, PhD MS(Advanced Physiotherapy), PhD (Health, Physical Education and Sports Sciences) Associate Professor, Department of Physical Therapy, Faculty of Health Sciences, Iqra University, Nort...

CERVICAL DISORDERS Dr. Aftab Ahmed Mirza Baig, PhD MS(Advanced Physiotherapy), PhD (Health, Physical Education and Sports Sciences) Associate Professor, Department of Physical Therapy, Faculty of Health Sciences, Iqra University, North Campus  LEARNING OBJECTIVES Participants will be able to explain, General Cervical Anatomy Overview Facet & Disk Dysfunction & Cervical Spondylosis. Acute Locking Of C-spine. Whiplash Injury There clinical features, evaluation and management CERVICAL GENERAL ANATOMY FACET JOINT AND DISC DYSFUNTION NERVE ROOT COMPRESSION/ IMPINGMENT (Radiculopathy) SENSORY – MOTOR SYMPTOMS in corresponding dermatome & myotome  Herniated Nucleus Pulposus Varying degrees Disc bulge – Mild symptoms Usually go away with nonoperative treatment – Rarely an indication for surgery Extrusion (herniation) – Moderate/severe symptoms Nonoperative treatment  Herniated Nucleus Pulposus Symptoms – Neck pain – Shoulder pain – Arm, forearm, and hand pain May resemble carpel tunnel syndrome, rotator cuff problems.  DEGENERATIVE JOINT DISEASE(facet/disc) / CERVICAL SPONDYLOSIS CERVICAL SPONDYLOSIS lateral canal stenosis Cause : ????  Precipitating factors: – trauma, – overuse, – genetic predisposition Associated Risk factors: – smoking, – driving, – heavy lifting, – using vibratory devices, – activities involve prolong posturing in flexion or extension of neck – Degeneration involves : Facet joint Intervertebral disc Ligamentous hypertrophy PRICIPITATING ACTIVITIES – Asymptomatic Symptomatic Sudden onset  LATERAL CANANL STENOSIS RADICULOPATHY CENTRAL CANAL STENOSIS MYELOPATHY (THICKING OF LIGAMENTS & SPURS CAUSES IMPINGMENT )  DEGENERATIVE JOINT CHANGE (ASYMPTOMATIC) PRICIPITATING ACTIVITY SUDDEN ONSET OF SYMPTOMS TREATMENT SYMPTOMS DISAPPEARS STRUCTURAL CHANGES REMAIN UNCHANGED  EVALUATION Age = > 50 Pain - stiffness – numbness & parasthesis Pain –mechanical in nature. Tenderness – facet joint ( mid- cervical )  CAPSULAR PATTERN OF RESTRICTION (activities involve neck rotation , lateral flexion and extension) Accessory movement – Hypomobility lower cervical upper thoracic spine ( cervico-thoracic junction) – Hypermobility mid-cervical spine  Cervical compression and distraction test positive Diminished reflex, sensory changes and motor weakness Labs: – XRAY – MRI – CT SCAN  TREATMENT NSAIDS Electrophysical Agents ROM Xs Cervical pillow Joint Mobilization Stabilization Exercises Postural Correction - PATIENT EDUCATION Avoid prolong extension activities Avoid working above head ACUTE LOCKING OF CERVICAL SPINE ACUTE LOCKING OF CERVICAL SPINE Unguarded movement of cervical spine Common in children and young adult Pathomechanical disorder of intervertebral disc or apophyseal joint Neck lateral flexion ,flexion & rotation to opposite side  Mechanical block to neck movement towards side of lession mechanincal derangment causes locking of movement Disc buldge – anteriorly presses anterior longitudinal ligament and cause spasm – Posteriorly presses : posterior longitudinal ligament, spinal cord or nerve root.  SUBECTIVE FINDINGS SITE Articular pillar cervical spine ONSET Sudden AM/PM/ early morning or sudden NIGHT unguarded movement of neck Nature of sharp neck pain pain  OBJECTIVE FINDINGS OBSERVATION : – Antalgic neck posture : lateral flexion to opposite side , slight flexion & rotation to opposite side. PHYSIOLOGICAL MOVEMENT : – Pattern of restriction lateral flexion , rotation & extension towards painful side. – Active & passive movement both limited and painful. – ACCESSORY MOVEMENT : Limited & painful  MANAGMENT Self resolving if left untreated Electrophyscial agents Soft tissue techniques – Relexation technique – MET (muscle energy technique) ROM under traction – Traction increase ROM and improves pain Cervical stabilization exercises  Patient advices: – Avoiding neck flexion – Soft collar ( acute phase) – Encourage patient to use neck as activly as possible.  Whiplash Injuries Injury due to trauma to the cervical spine Mechanism of injury – Hyper Flexion (head-on-collision) – Hyper Extension (rear-end-collison) – Vertical compression – Direct trauma – Mixed mechanisms Motor vehicle accidents & impact sports 85% whiplash responsible for Rare end collision - Hyper-extension injury  Hyper Flexion Injuries Head-on collision Falling face forward Forcible forward flexion Structures primarily injured – Post. L. lig – Ligamentum nuchae – Alar lig – Post. i.v Disc – Nerve root – Vertebral body Compression Subluxation  Hyper Extension injury Rear ended collision Head Falling backwards Forcible extension of the neck. Structures injured – Anterior l.lig – Disc – Ant. Muscles – Sympathetic chain  Mixed Injuries Flexion-rotation Extension-rotation Vertical compression Structures injured – Multiple structures – Muscles and ligaments  Clinical Presentation Neck pain Upper back pain Headaches Radiating pain to the occiput, shoulders, arms Neurological symptoms – Numbness, weakness Remote signs and symptoms – Leg weakness and numbness – Bowel or bladder symptoms  Evaluation History – Mechanism of injury (Flexion, extension or mixed) – Aggravating and relieving factors – Additional symptoms and complains – Bowel or bladder symptoms  Evaluation Physical examination – Muscolo-skeletal exam Range of motion (cervical spine and shoulders + arms) Palpation – Neurological exam Sensory and motor examination Reflexes Gait – Always assume spinal cord trauma unless proven otherwise –  Management  Based on injured structures  Immobilization  Investigations  Plain x-ray  MRI  Multi-modal approach  Interventions  Physical therapy  Pharmaceuticals Questions?