Cervical & Thoracic Pathology 2
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| Inflammatory Disorders | Ankylosing Spondylitis; Juvenile RA; RA; Osteoporosis?; Fibromyalgia?
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| Anklyosing spondylitis occurs where & affects who most? | Affects the spine & SI joints; chronic inflammatory disease; Affects men > women; Age of onset < 40 yrs old
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| Where is there a high risk for fx with ankylosing spondylitis? Why? Problems in patients with this disorder? | Lower c-spine, because of decreased mobility; High risk for instability in upper c-spine; May have iritis or photophobia
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| Juvenile RA causes what? | Painful, swollen, stiff joints; destruction of articular cartilage; more pressure with joint contact; lots of abnormal tissue created
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| Rheumatoid Arthrtis | Destruction of articular cartilage; weakening of ligaments, upper c-spine can be damaged by inflammation
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| RA most commonly affects which joints? | OA, AA, uncovertebral joints; upper c-spine very unstable; can progress from pain & loss of ROM to instability
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| Osteoporosis | Condition in which the skeleton contains a smaller total quantity of bone tissue than normal for the age, sex, and culture of the patient
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| Fibromyalgia | Non-specific characterized by musculoskeletal pn, stiffness & easy fatiguibility, women > men; 20-50 yo; dx of exclusion
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| Traumatic Disorders | Whiplash; Cervicogenic HA; Cervicogenic dizziness; Disc herniations; Fx's & Dislocations; SC Injuries (first 4 could also be mechanical)
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| Whiplash | hyperextension injury to the neck; due to acceleration/deceleration; Children <8-10 yo have increased risk 2ndary to short neck & big head; may have slow onset & involve many structures
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| When do neuro s/sx begin with whiplash disorders? | Stage 3; dysphagia, dysarthria. Also pain, stiffness, mm spasm, HA's, neurological (cranial, cervical, brachial)
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| Cervicogenic HA | "Referred pn perceived in any part of the head caused by primary nociceptive source in the musculoskeletal tissues innervated by cervical nn"
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| Most pronounced hypomobility in c-spine is where? | C0-1 & C0-5
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| Cervicogenic Dizziness | Non-specific sensation of altered orientation in space & dysequilibrium originating from abnormal afferent activity from the neck; most often associated with flex/ext injuries
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| Red Flags & S/sx of Cervicogenic Dizziness | *Ataxis; *Unsteady gait; Postural imbalance associated with neck pain; Limited neck ROM; HA's
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| Dizziness Test | Patient seated & passively roate head; Holy head still while pt turns trunk left & rick;
If dizziness only with passive head rotation, suspect inner ear problem
Dizziness with both cases, suspect VBI
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| Where is the highest incidence of disc herniation in the thoracic spine? | T7-8 > T6-7 > T9-10
*Apex of convexity of t-spine at T7-8
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| Most common symptom of disc herniation in t-spine? | Anterior Chest Pain
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| Common Fx's of Spine | Dens fx; Ring of atlas; Spondylolisthesis of axis; May lead to complete or incomplete SC lesion
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| Axis Fractures | Hyperflexion injury can lead to dens fx
Type 1: avulsion of odontoid tip; difficult to detect
Type 2: fx thru base of dens; non-union complication
Type 3: sub-dental injury; good prognosis
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| Hangman's Fx | Hyperextension injury; Bilateral fx of pedicles of axis or pars
Associated anterior subluxation/dislocation of C2 vertebral body
Results from severe extension injury
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| Teardrop Fx | Avulsion of anteroinferior corner of cervical vertebral body by ALL; often from diving into shallow water
May be 2ndary to hyperflexion or hyperextension
Typically at C2
Usually a traction injury from ALL/ant. A-A ligament
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| Clay-Shoveler's Fx | Avulsion fx of SP of C7 or T1
Sudden load on flexed spine
May be 2ndary to rotational injury
Stable
Flex/ext very painful
Lig. nuchae probably pulls on SP of C7/T1 to cause avulsion fx
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| Neuropraxia? Axonotmesis? Neurotmesis? | Conduction delay w/o disruption of nerve
Damage to axon but not myelin sheath
Damage to axon AND myelin sheath
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| Axial loading | compression of all structures (C1 fx: Jefferson's)
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| Sidebending/Rotation | C2-3 fx (Hangman's); Traction or compression of spinal nerve
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| Flexion/Extension | Mid-cervical fx's/dislocations
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| Spinal Cord Injuries | Birth: Erbs-Duchenne palsy, upper trunk lesion; Klumpke's palsy; C7-8 & T1 & stellate ganglion causing ptosis of eye
Viral infections
Sports Injuries
GSW & Knife injuries, MVA
Positional
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| Brachial Plexus injuries | Upper trunk injuries are most common; Isolated middle trunk injuries very rare Kids mostly injury lower trunk
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| Vertebral osteomyelitis | Elderly males; Associated with UTI, soft tissue infections, URI, immunocompromised pts;
S/sx: high WBC, fever, high sed rate, localized spinal pain, mm spasm, loss of ROM
Rx: antibiotics, surgery, rehab
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| Epidural abscess | Males = females
2ndary to infection, epidural injection, catheterization
S/sx: fever, spinal pn, local tenderness
True medical emergency
Prognosis: fair with early treatment
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| Congenital/Peds Pathology | Klippel-Feil Syndrome; Down's Syndrome; Achondroplasia; Cervical rb; Infantile Torticollis
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| Klippel-Feil Syndrome | No neck appearance; head appears to rest on thorax
Fusion of C-spine, partial or total, unilateral or bilateral
Abnormally lower hair line with short neck
May be asymptomatic until adulthood until they develop instability or spondylosis
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| Down's Syndrome | OA & AA defects; Silent killer- doesn't take much for dens to move & compress on SC
Flex/ext films suggested
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| Achondroplasia | Most common form of dwarfism
Foramen magnum stenosis & sleep apnea in infant
Spinal stenosis as adult
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| Cervical Rib | Originates from costal process; Fuses with transverse process by age 10
Only 10% of people with cervical rib become symptomatic
Most commonly occurs at C7
Can compress neuro & vascular structures
Brachial plexus should run over the 1st rib
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| Infantile Torticollis | Usually shortened SCM
Plagiocephaly (skull & facial asymmetry) may be present
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| Acute Torticollis | Disc derangement: wakes up in AM with deformity, mobs worsen pn, traction with extension helps, analogous to lateral shift in LB
Facet joint dislocation
Spasm of SCM
Acute C2-C7 facet joint impingement
C2-3 most likely affected; mobs highly effective
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