Clinical Examination. of the. Cervicothoracic Region. Neck Disability Index. Serious Pathological Conditions. Medical Screening Questionnaire

Transcription

1 Clinical Examination Clinical Examination of the Cervicothoracic Region Screening for associated serious pathological conditions Neck disability index Physical Exam Serious Pathological Conditions Cervical Myelopathy Neoplastic Conditions Upper Cervical Ligamentous instability Vertebral artery insufficiency Inflammatory or systemic disease Medical Screening Questionnaire Screen for potential serious medical disease Neck Disability Index Vernon, et al. (1991) Modification of Oswestry low back index Gives an index of the patient s perceived disability 10 sections/6 possible responses (0 6) Responses are added Verify on history Neck Disability Index 0 4 no disability 5 14 mild disability moderate disability severe disability > 35 complete disability

2 Neck Disability Index May be used as a tool for tracking functional progress Current location of symptoms Neck Scapula Extremity Segmental (dermatomal) Nonsegmental (nondermatomal) Verify on pain diagram What do we know about pain location Localized neck pain may arise from any cervical spine structure Very localized pain will likely be from a structure under the painful area What do we know about pain location Pain originating from a facet joint or disc may give rise to proximal pain in the neck and shoulder girdle Upper cervical segment dysfunction may give rise to headache Lower cervical segment dysfunction may produce pain in the chest wall, shoulder girdle or neck Dwyer, et al. (1990) Pattern of referred pain with cervical facet joint stimulation in patients with neck pain Schellhas, et al (1996) and Grubb, et al. (2000) Pattern of referred pain with IVD stimulation *Useful in identifying the segment involved not the structure involved What do we know about pain location? Pain in the arm or extending into the distal part of the extremity (forearm and hand) more likely to be nerve root in origin UE pain worse than neck pain or felt in the absence of neck pain most likely nerve root in origin

3 C 4 What do we know about pain location? C 4 root Lateral aspect of neck/top of shoulder girdle C 5 root Lateral aspect of neck/top of shoulder girdle extending into the proximal arm C 6 root Lateral aspect of the arm, forearm into the thumb and index finger C 7 Posterior aspect of the arm Dorsal aspect of the forearm and into the thumb, middle, and index finger C 5 C 6 C 7 Cervical Roots As Origin of pain in the Neck or Scapular Region (Tanaka, et al. 2006) Scapular region pain is generally the initial symptom in radiculopathy and can persist alone before UE symptoms Compression confined to the dural sheath of the nerve root

4 Suprascapular pain C 5 root C 6 root Interscapular pain C 7 root C 8 root Scapular pain C 8 root Tanaka, et al Type of pain Ache somatic structure Sharp/lancinating DRg/inflammed nerve root Constant vs. Intermittent Pain scale Be aware of unchanging pain Symptom magnification Underlying medical disease Associated parasthesias Unilateral Bilateral Quadrilateral Sign of ischemia Aggravating Factors Question patient about movements, positions, or postures that intensify the symptoms Easing Factors Question patient about movements, positions, or postures that improve symptoms Verify on NDI Aggravating/Easing Factors Disc peripheralization of symptoms with flexion or persistent pain with sagittal plane motions Foraminal stenosis peripheralization of symptom with extension, ipsilateral sidebend/rotation Joint dysfunction localized neck pain with neck ROM Nerve root irritation Decrease pain with arm elevation or on top of head Decrease arm pain with support (Temporal Relationships) More aggravating as day progresses (mechanical) More aggravating in the AM (inflammatory) Night pain Does the pain wake you? Is it related to a change in position? Consider a red flag if not related to a change in position Mechanism of injury Previous episodes Length of previous episodes Previous prescription Special tests

5 (Special Questions) Cardinal symptoms VBI/Cervical Instability Headaches Dizziness Symptoms caused by compromise of the spinal cord, brainstem or brain via direct trauma or indirectly 2 to altered blood flow Nystagmus nonvolitional rhythmic motions of the eyes Lip parasthesias Drop attacks sudden collapse without loss of consciousness Bilateral/quadrilateral parasthesias Diplopia, Dysphagia, Dysarthria Fainting Must screen for in all post traumatic patients (MVA) Immediate medical referral