MSK I Cervical Powerpoint 2-MD Spring 2012

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Cervical Spine II:

Cervical Spine II

Subcranial Instability:

Subcranial Instability Causes: RA, ankylosing spondylitis , down’s syndrome, corticosteroids, post trauma Post Trauma Always get A/P radiograph with open mouth – odontoid view

Subcranial Instability:

Subcranial Instability Transverse lig . of atlas prevents excessive anterior translation Normal 3mm adults, 4mm children Compress medulla, spinal cord, vertebral arteries, superior sympathetic ganglion

Subcranial Instability :

Subcranial Instability Patient Symptoms Pain in upper neck radiating to occiput , temporal or frontal aggravated by jarring movements Difficulty returning head to neutral after looking down or forward Feeling that their head is “falling off”

Subcranial Instability:

Subcranial Instability Lower brain stem symptoms Vertebral artery signs Spinal cord symptoms Sympathetics Nasopharyngeal symptoms Refer DIRECTLY to Physician

Flattening of occipito-cervical curve:

Flattening of occipito-cervical curve

Acceleration/Deceleration Whiplash:

Acceleration/Deceleration Whiplash History of trauma – usually MVA Symptoms minor to severe, may be bilateral – but worse on one side Various anatomical structures involved May have autonomic symptoms Must have odontoid view radiograph before treatment

Acceleration/Deceleration Whiplash:

Acceleration/Deceleration Whiplash Pt. presentation Guarded posture Limited AROM with muscle guarding No neurological signs – check Babinski Abnormal Muscle tone Joint overstretch/ hypermobility Weak anterior neck musculature Tenderness and increased tone to palpation

Cervical Spine Stenosis & Myelopathy:

Cervical Spine Stenosis & Myelopathy Degenerative Disc Disease (DDD) – lose disc height Vertebra slide posteriorly – narrow central canal Degenerative Joint Disease (DJD) – osteophytes form at posterior aspect of vertebral bodies Compress anterior aspect of cord Mimic ALS, MS, Parkinson’s

Cervical Spine Stenosis & Myelopathy:

Cervical Spine Stenosis & Myelopathy Aching in neck and shoulders – occasional radiation into B UE B Parasthesias UE and LE B Weakness in UE and LE, problems with balance/coordination

Cervical Spine Stenosis & Myelopathy:

Cervical Spine Stenosis & Myelopathy Forward head with thoracic kyphosis Limited AROM Permanent or transient neurological signs + Babinski , clonus and general weakness of LE Muscle tightness

Headaches :

Headaches Musculoskeletal Origin: Pain begins in cervical, suboccipital or thoracic region and radiates to head Affected by change in position, movement or cervical provocation May have history of trauma

Headaches:

Headaches Forward head posture Poor postural awareness/ergonomics Upper trap/levator tightness Increased tone and tenderness No neurological signs

Medical/Congenital Conditions of Cervical and Thoracic Spine:

Medical/Congenital Conditions of Cervical and Thoracic Spine

Muscular Torticollis:

Muscular Torticollis Etiology unknown Minimal deformity at birth, firm swelling develops in SCOM Swelling resolves leaving contracture and deformity – SB to same side and rotate away Radiographs differentiate from boney torticollis Stretching performed daily for first year

Scheurmann’s Disease:

Scheurmann’s Disease Osteochondrosis of the spine Begins at puberty and progresses until growth complete, males > females Form of AVN affecting anterior epiphyseal plate Disc projections into vertebra – Schmorle’s Nodes Affects 3-4 levels – marked kyphosis

Fracture & Fracture/Dislocation:

Fracture & Fracture/Dislocation Due to fall on head/neck, diving, MVA Fracture treated with traction for reduction and immobilization Spare the spinal cord Fracture/dislocation involve spinal cord resulting in quadrapalegia Surgical fixation

Halo:

Halo

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