EXAM 2 - Cervical Disorders Verified A+
common disorders ✔️- cervical stenosis: foraminal, central canal
- zygapophyseal joints (facets)
- cervical disc lesions
- cervical instability
- cervicogenic headache (CH)
- myofascial pain disorder/postural syndrome
- whiplash-associated disorders
cervical stenosis ✔️- narrowing of the intervertebral foramen (foraminal stenosis) OR narrowing of the
vertebral canal (central stenosis)
• in our 20s we begin to get fissures on disc, the disc dehydrates
• 4-5th decade nucleus dries out
• leads to increase load on the vertebral endplates
• bone spurs occur at the vertebral endplates
• narrowing of the IVD space
• buckling of ligaments can cause even more narrowing
- foraminal stenosis: canal changes could lead to spinal nerve impingement
- central canal stenosis: cervical cord compression due to obliteration of the subarachnoid space
What can cause central stenosis? ✔️• uncovertebral joints
• facet hypertrophy
• bone spurs
• ligamentum flavum and PLL
• cervical instability
• disc
,foraminal stenosis ✔️- narrowing of the intervertebral canal
- most common
- 72% of all stenosis
- degeneration of cervical spine
foraminal stenosis - history ✔️- gradual onset (spondylosis)
- flexion of cervical spine usually will decrease symptoms
- extension increases symptoms
- pain usually unilaterally
- distribution in the affected level dermatome
- pain progressively gets worse during the day
- no gait, balance, or bowel and bladder problems
- more of a LMN lesion rather than UMN
foraminal stenosis - physical exam
• postural assessment
• AROM
• repetitive motion
• MMT
• neurological test ✔️- postural assessment: forward head posture, cervical spine might be laterally
flexed away from pain
- AROM: lack of cervical extension and ipsilateral rotation and side flexion towards side of pain
• ipsilateral cervical spine rotation < 60°
- repetitive motion: preference for flexion
- MMT: possible weakness on the myotome involved
- neurological test: DTRs hypo and negative pathological reflexes
Note:
• extension narrows, flexion opens canal
, • C5, C6, C7 most likely involved
foraminal stenosis - special tests ✔️- spurling's test
- distraction test
- upper limb tension test (ULTT) - median nerve (C5-C7)
foraminal stenosis - medical tests ✔️- radiography
- CT
- MRI
- myelogram
- nerve conduction velocity
- EMG
Cervical radiculopathy: CPR ✔️- positive spurling's test
- positive distraction test
- positive ULTT1
- presence of < 60 degrees of cervical rotation to the involved side
2/4 = 21%
3/4 = 65%
4/4 = 90%
spurling's test ✔️- sitting
- patient side flexes the neck (30-45°) to the uninvolved side first followed by the affected side
- the examiner carefully presses straight down on the head, hold for 5-10 seconds
- 15 lbs of force
- neck pain with no radiation into the shoulder or arm does not constitute a positive test
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