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Stiff neck. Outcomes. Be familiar with the clinical presentation of an acute cervical locking and a discogenic locked neck. Be familiar with the most widely used physiotherapy treatment protocol for a patient with a typical acute cervical locking and a discogenic locked neck. Types.

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Presentation Transcript
outcomes
Outcomes
  • Be familiar with the clinical presentation of an acute cervical locking and a discogenic locked neck.
  • Be familiar with the most widely used physiotherapy treatment protocol for a patient with a typical acute cervical locking and a discogenic locked neck.
types
Types
  • Postural
  • Atlanto-axial rotation fixation
  • Spasmodic torticollis
  • Hysterical torticollis
  • Stiff neck as a result of muscles
history
History
  • Painless contracture of one of the sternocleidomastoïd muscles
  • Gives rise to the neck fixating in side flexion towards the affected side and rotation away from it
  • Lack of treatment may lead to permanent deformity
acute cervical locking
Acute cervical locking
  • Sudden onset
  • A snapping sound is heard
  • Sudden uncontrolled movement
  • Most common between C2/C3
  • Synovial pinching
  • Localised to the mid-cervical area
  • Severe, sharp pain with proximal referral the patient should try to move out of the position
acute cervical locking cont
Acute cervical locking (cont)
  • Noticeable lateral flexion, slight flexion/rotation away from the pain
  • During PAIVMS’s any movements which decreases the articular space would evoke the familiar pain
treatment
Treatment
  • Try to unlock the joint as soon as possible
  • Longitudinal in position of deformity
  • Rotation and lateral flexion Grade IV-
  • Joint MUST be unlocked on day 1
  • Further treatment must be directed towards pain relief, muscle spasm and gaining full joint mobility
traumatic onset
Traumatic onset
  • History of trauma eg. bump against head
  • If not unlocked on day 1: Manipulation

Strengthening

Muscle spasm

discogenic locked neck
Discogenic locked neck
  • Gradual onset
  • No specific movement
  • May awake with locked neck
  • Any level between C2-C7
  • Disc
  • Neck pain
  • Worst pain is over medial scapula area (Cloward area’s)
  • Deep pain
dicskogenic locked neck cont
Dicskogenic locked neck (cont)
  • Noticeable flexion, lateral flexion away from the pain
  • Extension, lateral flexion and rotation towards the painful side is stiff but not blocked
treatment1
Treatment
  • Intermittent constant cervical traction
  • Transverse movement
  • Unilateral PA
  • Rotation and lateral flexion
  • Longitudinal cephalad Grade I, II and IV-
treatment cont
Treatment (cont)
  • With distal symptoms the treatment must be of a longer duration
  • Slower recovery if other structure eg. dura and nerve roots also show symptoms
  • Restriction of extension is often one of the remaining signs after treatment
  • Central PA Grade IV often clears this sign