Screening the head,neck and back DD.pptx

Thi presentation is about screening for diseases in head, neck and back. This presentation include theory on how will you identify a condition and how to diffrentiate one condition from another.

1. screening the head neck and back prepared by : irsa suleman

2. TOPICS TO BE COVERED : Screening for oncologic causes of back pain Screening for cardiac causes of neck and back pain Screening for peripheral vascular causes of back pain

3. SCREENING FOR ONCOLOGIC CAUSES OF BACK PAIN : Cancer is a possible cause of referred pain . Multiple myeloma is the most common primary malignancy involving the spine often resulting in diffuse osteoporosis and pain with movement that is not relieved while the person is recumbent . chronic presentation of LBP (5 to 20 years ) Radicular symptoms due to cord compression Pain not relieved with recumbency

4. GI cancer, myelomas, and lymphomas can also spread to the spine via the paravertebral venous plexus. This thin-walled and valveless venous system probably accounts for the higher incidence of metastases in the thoracic spine from breast carcinoma and in the lumbar region from prostatic carcinoma. For most oncologic causes of back pain , the thoracic and lumbosacral areas are affected .

5. Past Medical History : Prompt identification of malignancy is important, starting with knowledge of previous cancers. Past history of cancer anywhere in the body is a red flag warning that careful screening is required. Always ask clients who deny a previous personal history of cancer about any previous chemotherapy or radiation therapy .

6. Screening for Cardiac causes of neck and back pain

7. Vascular pain patterns originate from two main sources: cardiac (heart viscera) and peripheral vascular (blood vessels). The most common referred cardiac pain patterns seen in a physical therapy practice are angina, myocardial infarction, and aneurysm. the heart is innervated by the C3 through T4 spinal nerves (jaw, neck, shoulder, arm, upper back, or chest)

8. Angina chest pain radiating to the anterior neck and jaw or mid thoracic back pain . lag of 3 to 5 mins b/w exertional activity and onset of pain Misdiagnosis : TMJ dysfunction, teeth grinding . 2 . MYOCARDIAL ISHEMIA Back pain, anterior neck and/or mid-thoracic spine in both men and women. HX: unexplained perspiration (diaphoresis), nausea, vomiting, pallor, dizziness, or extreme anxiety Age, past medical history and vital signs assessment are important when screening for angina or MI.

9. 3. AORTIC ARTERY ANEURYSM Rapid onset of severe neck or back pain (buttock, hip, and/ or flank pain possible) Pain may radiate to chest, between the scapulae, or to posterior thighs Pain is not relieved by change in position Pain is described as “tearing” or “ripping” Other signs: Cold, pulseless lower extremities, blood pressure differences between arms (more than 10 mm Hg diastolic) and abdominal bruits HX : AGE 60 to 70, male sex, family history, smoking , spinal fusion surgery.

10. Screening for peripheral vascular causes of back pain

11. OBSTRUCTION OF THE AORTIC BIFURCATION Pt report back pain alone, back pain with any of the following features, or any of these signs and symptoms alone Bilateral buttock and leg pain or discomfort Weakness and fatigue of the lower extremities Absent lower extremity pulses Color and/or temperature changes in lower Limb Symptoms are often bilateral because the obstruction occurs before the aorta divides

12. Back pain, vascular or neurogenic Diagnosis is difficult to make between back pain of a vascular versus neurogenic Frequently, vascular and neurogenic claudication occurs in the same age group (over 60) Vascular and neurogenic disease often coexists in the same person with an overlap of symptoms of each several major differences to look for but especially response to rest (i.e., activity pain), position of the spine, the presence of any trophic (skin) changes

13. Vascular Rarely the spine movements produces pain With walking pain starts after 1-2 or 3-5 mins Pedaling on bicycle will cause angina as load on heart increases Neurogenic Spine movements can produce pain Pain produced immediately after adapting a specific position Pedaling will produce pain as spine is in extension and forward flexion will relieve pain SLR reduces pain (further evaluation)

14. What if the client has back pain before even getting on the bicycle that is not relieved when bending forward? What diagnostic information does that provide? The client could be experiencing neurogenic back pain that would normally feel better with flexion, but now while pedaling, vascular compromise occur In some cases, neurogenic pain lasts for hours or days despite change in position because once the neurologic structures are irritated, pain signals can persist

15. T he Bicycle test has its greatest use when only one source of back pain is present: Either vascular or neurogenic and even then, chronic neurogenic pain may not be modulated by change in position. An alternate test to distinguish neurogenic claudication (pseudo claudication) from vascular claudication is the Stoop test . The individual being tested walks quickly until symptoms develop. Relief of symptoms in response to sitting or bending forward is a positive test for a neurogenic source of pain Straightening up and extending Pain the spine reproduces the symptoms