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30 Cards in this Set
- Front
- Back
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Neck pain affects what percentage of the general population each year?
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??
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Neck pain accounts for what percentage of PT visits each year?
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??
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What is the difference between examination and evaluation?
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Examination consists of history, systems review, tests and measures
Evaluation is evaluating the data from MS exam to make clinical judgements regarding MS conditions |
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What is the purpose of screening for referral? (4 reasons)
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1) Differentiate NMS (neuromusculoskeletal) impairments from medical conditions
2) Identify patterns that suggest origin of pain/symptoms 3) Identify signs and symptoms 4) First step in making a diagnosis |
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What is the difference between yellow flags and red flags?
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A) Yellow flags = cautionary/warning
ex: CDV, fear avoidance behavior, osteoporosis B) Red flags = immediate attn in screening or referral |
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What are some examples of category I red flags during screening?
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Factors that require immediate medical attn
Blood in sputum Numbness/parenthesis perianal region Bowel changes Loss of consciousness, altered mental status Neuro deficit not explained by monoradiculopathy Pattern of pain not consistent with mechanical pain (phys exam) Progressive neuro deficit Pulsatile abdominal mass |
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What are some examples of category II red flags during screening?
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Factors that require subjective questioning and precautionary examination and treatment technique
Most useful for clinical decision making when clustered Age > 50 Fever Clonus (may CNS) History of cancer History of disorder predilection of infection or hemorrhage Hx of Metabolic bone disorder Chronic non healing wounds Gait deficit Elevated sedimentation rate Long term corticosteroid use Long term workers comp Impairment precipitated by recent trauma Recent hx of unexplained weight loss Writhing pain |
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What are some examples of category III red flags during screening?
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Factors that require further physical testing and differential analysis
Abnormal reflexes Bilateral or unilateral radiculopathy or parenthesis Unexplained referred pain Unexplained significant upper or lower limb weakness |
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What are the elements of patient/client management?
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Examination (screen), evaluation, either refer or diagnosis, prognosis, intervention
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What are some screening strategies?
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Medical (5 screening steps)
Systems review Upper quadrants scanning (neuro, regional) Serious cervical patho (myelophathy, ligaments instability, vertebrobasilar artery insufficiency) |
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What are the 5 steps of the medical screening process?
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1) Past medical history
2) Risk factor assessment 3) Clinical presentation 4) Associated signs and symptoms 5) Systems review: clusters of signs/sx to pattern underlying system |
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Cervicogenic Signs and Symptoms: A risk factor assessment of Red Flags by each medical screening step - 1) Medical history
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1) Family/personal hx of cancer
2) URI 3) Recent hx trauma ex: MVA 4) Osteoporosis/penia |
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Cervicogenic Signs and Symptoms: A risk factor assessment of Red Flags by each medical screening step 2) Risk factors
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1) BMI
2) Smoking 3) Alcohol 4) Age (play college football) 5) Gender 6) Sedentary lifestyle 7) Diet 8) Occupation |
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Cervicogenic Signs and Symptoms: A risk factor assessment of Red Flags by each medical screening step 3) Clinical presentation
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1) Unknown cause, unkown etiology, insidious onset
2) Symptoms seem out of proportion with injury 3) Symptoms not relieved by PT 4) Pain not relieved by change in position or rest, unrelenting 5) Gradual, cyclical or progressive presentation of symptoms (worse, better, worse) |
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Cervicogenic Signs and Symptoms: A risk factor assessment of Red Flags by each medical screening step 3) Clinical presentation (pain presentation)
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Upper back, shoulder pain (high prevalence areas)
Pain accompanied by full and painless ROM Pain not consistent with psych/emotional overlay - emotional overlay screenings negative Worsening or unrelenting night pain Cardiac: upper quadrant pain, LE movement without UE movement Poorly localized pain Pain accompanied by signs/symptoms associated with specific system (pulm, cardiac, GI) |
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Cervicogenic Signs and Symptoms: A risk factor assessment of Red Flags by each medical screening step.
4) Associated signs and symptoms |
1) Constitutional symptoms present in more serious illness (sweating, fever, diaphoresis, pallor, diarrhea, night sweats, vomiting, dizziness, fatigue, weight loss)
2) Proximal muscle weakness especially if associated with altered DTRs 3) Systemic joint pain |
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What does the physical therapist need to consider in differentiating cervicogenic musculoskeletal pain and symptoms from medical ones?
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1) Location of pain and symptoms
2) Sources of pain and symptoms 3) System origin of pain 4) Oncologic origin of pain |
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Where are the Locations of cervicogenic pain and symptoms?
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Anatomic locations
Cervical Thoracic Head Upper extremity Intrathoracic disease most commonly refers pain to the neck, midthoracic spine, shoulder, upper trap |
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What are the Musculoskeletal Conditions as Origins of Neck Pain?
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Torticollis
HNP WAD Central canal stenosis Lateral foraminal stenosis Impaired posture (upper crossed syndrome) Fracture Radiculopathy Spondylosis/DJD Myelopathy Headache Muscle strain (chronic) RA Fibromyalgia Infection (Lyme's, meningitis, retropharyngeal abscess) |
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What are Cervicothoracic Oncologic?
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Metastatic leasion, leukemia, bone tumor, Hodgkin's disease, Pancoast's tumor, cord tumors, lung cancer, esophageal, thyroid cancers
Thoracic spine has the has the highest incidence in the spine of primary cancer and metastatic diseases |
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What are the systems origins for 1) cardio, 2) pulm, 3) GI?
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Cardio: Angina, MI, aortic aneurysm
Pulm: Pancoast's tumor, pneumothorax, bronchitis, lung cancer GI: Esophagitis, esophageal cancer, ulcer |
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What are red flags for systemic disease?
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1) Fever > 37
2) BP > 160/95 3) HR > 100 4) Respiration > 25 5) Fatigue 6) Multi region pain 7) Morning stiffness > 1 hour |
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What are red flags for neoplasm? (6)
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1) Age > 50
2) Personal hx of cancer 3) Night pain 4) Failure to improve with conservative care 5) Pain unchanged by rest 6) Unexplained weight loss |
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What are signs and symptoms of radiographic cervical instability?
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1) Headache in occipital region/numbness
Difficulty in prolonged positions Difficulty/reluctance rotate head Bilateral paresthesias Difficulty holding head up Better with external support Positive alar ligament test Positive sharp-purser test Aberrant movements Myelopathy signs What questions to ask? History of trauma, upper resp infection, RA, Down’s Syndrome- 25% of pts with RA have A/A instability; children with URI may have subluxation Why is this important prior to performing a physical exam? WAD, cervicogenic headache DJD, RA |
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What are risk factors for fracture?
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Age > 65
Osteoporosis Trauma (high velocity, axial load fall greater than 5 m) |
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What are the clinical indicators for fracture?
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Unable to rotate 45 degrees
Midline tenderness Paresthesias Proximal weakness of arms Immediate onset, unrelenting pain |
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Why is important to screen for fracture?
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Fifty percent of cervical spine fractures occur at either the C2 level or at the level of C6 or C7.46
Most fatal cervical instability injuries occur in upper cervical levels, either at craniocervical junction or at C1–C2.47,48 |
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What are the Canadian Cervical Spine Rules?
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Do any of the high risk factors mandate radiography?
Age > 65 Dangerous injury Fall > 1 m or 5 stairs Paresthesias of the extremities Axial load to the head High velocity MVA, ejection, rollover, ATV accident, bike collision [ If yes --> radiographs ] Do any low risk factors allow safe assessment of ROM? [ If no --> radiographs ] Is pt able to actively rotate neck 45 degrees in any direction? [ If no --> radiographs ] PATIENT HAS TO BE CONSCIOUS AND ALERT WITH NO MAJOR DISTRACTING INJURY Sensitivity = 100 Specificity = 43 MEANS this is useful for RULING OUT neck fracture. |
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Is shoulder/arm pain really neck pain?
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Neck: general scan
Active rotation in all 6 directions - (start active because self limiting) Does active neck movement reproduce UE pain? Is rotation < 60? Passive rotation in all 6 directions with overpressure. Do passive movements reproduce UE pain? Special test: Spurling's, Distraction, ULTT Are special test positive? 3/4 - 65% post test prob of radiculopathy 4/4 - 90% prob NOTE: if recent trauma (fall), may perform upper cervical ligamentous stability tests prior to other cervical exam- although starting with AROM generally self-limiting |
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What are myelopathy?
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+UMN
Babinski Hoffman Inverted supinator reflex Hyperreflexia (UE and LE) Clonus Coordination loss Clumsy hands Ataxic gait Neck or head pain Paresthesias (UE or LE) |
