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MSPT II > 2. C/S Examination > Flashcards

2. C/S Examination Flashcards

1
Q

Neck pain may be assoc’d w/….

A

HAs

LBP

Hx of MVA

*2nd most common reason for referral to PT, w/ neck pain making up 25% of pts seen for tx

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2
Q

Symptoms of CS Dysfunction

A
  • Neck pain
  • HAs (cervicogenic)
  • Upper thoracic/scap pain
  • TMJ/craniofacial pain
  • UE pain (separate card)
    • radicular vs referred
  • UE neurologic sx’s
    • parasthesias, numbness, reflex changes, weakness
  • Balance, auditory, visual disturbs
    • Cervical myelopathy
    • Vert aa occlusion
    • Vestib dysf
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3
Q

Sx’ of CS Dysf

UE Pain

Elaborate…

A
  • Radicular→ along dermatome; due to compression/irritation of nerve root
  • Referred→ somatic referral into UE from various cervical tissues
    • joints, ligs, mm’s
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4
Q

Interventions for CS

A
  • Evidence lacking
  • High degree of variation of tx strategies= high degree uncertainty about optimal tx
  • Pts w/ neck pain lag behind LBP and knee pain in response to PT
  • Pathoanatomic source of neck pain cannot be ID’d in the majority of pts
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5
Q

Basic Exam for Pts w/ Neck Pain

Always what?

A

ALWAYS take thorough hx

ALWAYS have pt compete SRO tool

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6
Q

Basic Exam for Pts w/ Neck Pain

Do more, less, enough of what?

A
  • LESS→ in pts w/ high irritability/acute inj
    • avoid irritating pt or worsening patho or injury
  • MORE→ in pts w/ low irritability/subacute/chronic
  • ENOUGH→ to make a sound tx decision and classify into subgroup
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7
Q

More on Exam for pts w/ Neck Pain

A
  • Do high lvl functional testing as pts are improving any and may be ready for return to sport or work
    • sport specific, work-related functional tasks
  • GOAL: By end of exam, be able to classify into subgroup!!
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8
Q

Suggested Order of Examination for Neck Pain

A

see pics

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9
Q

Exam: Hx

Start by asking Gen questions about injury/problem, then proceed down list

A

see pics

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10
Q

More questions to ask!!

A

see pics

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11
Q

Self Reported Outcome tools for CS region

Global Rating of Change Scale

*can be used for any region of body

A

see pics

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12
Q

More SROs for Neck Pain

A

PSFS

NDI (see pics)

  • NDI
    • We want LOW, LOW=LESS disability
      • MDC= 5/50 for uncomplicated neck pain; 10/50 for radiculopathy
        • NOTE: double value if using % score
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13
Q

MacDermid et al 2009

NDI

Takeaways

A
  • NDI is reliable, valid and responsive
  • Scored out of 50
  • 40-50, or 0-10= approaching ceiling/floor effect
  • Score outside 10-to-40 range→ supplement w/ PSFS
  • 0-4=no disability
  • 5-14=mild
  • 15-24=moderate
  • 25-34=severe
  • >35=complete disability
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14
Q

Ex. NDI

Upon initial exam, Sachiko’s NDI score was 20/50 and weeks later is 16/50. Can you confidently say based on this info her disability has lessened?

A

NO!!!

does NOT meet MDC

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15
Q

UQ Neuro Screen

Myotomes

A
  • C1-2→ cervical flexion
  • C3→ cervical LF
  • C2-C3-C4→ shoulder elevation
  • C5→ shoulder ABD
  • C6→ forearm PRO
  • C5-C6→ elbow flex
  • C6→ wrist ext
  • C7→ elbow ext/wrist flex
  • C8→ thumb extension (thumb for thumb)
  • C8→ gen. grip (mult mm’s/lvls but mostly C8)
  • T1→ hand intrinsics→ Abd Digiti Minimi
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16
Q

UQ Neuro Screen

Dermatomes

*pts eyes closed, light brushing over dermatomes B/L

A
  • C2,3→ post neck
  • C4→ AC jt
  • C5→ lat aspect of upper arm
  • C6→ lat aspect forearm, hand; thumb, index finger (D1/D2)
  • C7→ middle finger (D3)
  • C8→ ring/little finger (D4/D5); medial aspect of hand/wrist
  • T1→ medial forearm
  • T2→ medial arm, axilla forearm

*NOTE: in general, derms in UE overlap. This is why radiculopathies typ may cause PARTIAL NUMBNESS or PARASTHESIAS, but are unlikely to result in complete anasthesia

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17
Q

UQ Neuro Screen

DTRs

A
  • C5, 6→ Biceps
  • C6→ Brachioradialis
  • C7→ Triceps

See pics for scoring

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18
Q

Patho Reflexes for Upper Motor Neuron Lesions/Myelopathy

Hoffman’s Sign

A

see pics

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19
Q

Pathological Reflexes for UMN Lesions/Myelopathy

Babinksi’s

A

see pics

20
Q

Peripheral Joint Screening:

Look for symptom repro/aggravation and/or limtd or abnormal motion

A
  • Cursory assess of UE function→ forms, remove shirt/coat, reaching OH
  • Cursory observation and inspection of UE jts
  • Shoulder/Elbow→ Apley Scratch Tests; reach overhead
  • Wrist/Hand→ Grip test; wrist/finger AROM
21
Q

Observation/Inspection

Posture

A
  • FHP? If yes, can they reverse it?
  • Torticollis? Acute wry neck (adult version of torticollis)
  • Scapular pos (protracted? elevated?)
  • Cervicothoracic junction (C7-T1)→ Dowager’s Hump?
    • T-spine
    • Kyphosis normal, flattened, excessive?
      • scoliosis? rib hump?
22
Q

Mvmt Patterns & ROM Testing

A
  • Includes:
    • Cervical AROM testing
  • *Keep order consistent bc any 1 mvmt can influence ROM of mvmt that follows!

see pics for instructions

23
Q

Mvmt Patterns & ROM Testing

Recommended Order of Testing:

A
  1. L. rotation
  2. R. rotation
  3. EXT
  4. FLEX
  5. L L/F
  6. R L/F
24
Q

Passive ROM: 2 options

A
  1. Apply manual overpressure to single AROM mvmts
  2. Perform w/ pt in Supine to eliminate mm tension and assess mobility of spine
25
Q

Differentiation of “Intrinsic” vs. “Extrinsic” Cervical ROM restrictions

Cross-arm Cervical ROM test

A

*If no longer restricted w/ arms up= mm tension

*If still restricted w/ arms up= CS issue

26
Q

Cervical Passive Interverterbral Mvmts (PIVM)

A
  • Record as normal, hypOmobile, hypERmobile
  • Record as painful or not
  • Perform in following order:
    1. O-A jt→ lateral glide
    2. Mid and Lower cervical segment lateral glides
  • NOTE the diff in mobility and pain response bw sides
27
Q

Mid and Lower Cervical Segment Lateral Glides

A
  • PT uses abdomen to exert constant gentle stabilizing pressure against apex of pts head; force applied w/ therapists 2nd MC head to “push” pts articular pillar @ the desired lvl (or you can reach underneath and pull)
  • PT glides ea segment starting @ C2 and ending @ C6 L then R
  • Diff in mobility and pain response bw sides noted @ ea segment
28
Q

P-A glide (Spring Tests) on Cervical Spine

A
  • Pressure applied B/L (P-A) glide
  • Pressure applied U/L (just off side to SP) to assess segmental rotation
    • Push down on Rt Side of SP== L rotation
    • Push down on L Side of SP== R rotation
  • uncomfortable
  • More comfortable if P-A force directed slighly SUP towards pts eyeballs (along plane of facets jts)
  • CS spring tests (P-A) not as commonly used today as in past
29
Q

These tend to shut down w/ chronic neck pain or inflammatory CS neck pain

A

DCFM’s!!!!

30
Q

Testing of the DCFM’s:

Craniocervical Flexion Test

CCFT

A
  • Tests neuromsk control and endurance of the Longus capitis and Longus colli
  • Primary functional action is to sustain low int contraction to support Cervical jts during functional acts
  • Primary anatomical action is to flex the head on a stable C/S
31
Q

Craniocervical Flexion Test

A
  • Test Motion: Pt asked to gently and slowly perform head nodding motion as if saying “yes”. If pt able to demonstrate this w/out compensatory mvmts: proceed to steps below
  • air filled cuff placed bw occiput and C7 w/ pt in hooklying
  • Pts face must be horiz.

Stage 1 vs Stage 2 see pics

32
Q

Assess of Atlanto-Axial Jt Rotation

A

w/ pts neck in full passive flexion→ PT rotates pts head L THEN R

*diff in mobility and pain response bw sides noted

33
Q

Special Tests

Atlanto-Occipital Joint

Alar Lig Stress Test

A

see pics for description

  • Normal Findings→ Normally, there should be minimal mvmt of the head and C1 into LF
    • When head LF to Right→ C2 rotates to the Right.
      • PT will feel SP of C2 move toward Left (R rotation of C2 causes its SP to move to L)
    • When head LF to Left→ C2 rotates to the Left
      • PT will feel SP of C2 move to R (L rotation of C2 causes its SP to move to R)
    • If you DO NOT feel mvmt of C2 SP→ this suggests instability of the alar lig, very serious (Red Flag) problem
  • ** You are feeling for ipsilateral rotation of C2— that is what you are palpating w/ this test!!!
34
Q

Transverse Lig Tests OR Anterior Sheer Test

A

* RED FLAG if POSITIVE!!!

  • INCd parasthesias of B/L upper or lower extrems==> cervical myelopathy and instability of Transverse Lig
35
Q

Sharp-Purser Test

The “clunk” one

A
  • NOTE: if this test is Positive→ pt likely had an upper CS subluxation of C1 (Atlas) on C2 (Axis) @ rest, i.e. before doing test. Test maneuver actually reduces the subluxation, and thus a “clunk” and/or reduction in sxs is noted. If this test is (+), there is clearly instability/hypERmobility at C1/C2. Referral to spine surgeon or neurosurgeon is indicated, as this is a very serious problem!!!
36
Q

Vertebral Artery Test → purported to test for vertebrobasilar artery insufficiency (VBI)

*ALWAYS DO THIS TEST JUST TO BE SAFE!!!

Supine or Seated

A
  • VBI: occlusion of blood flow during cervical rotation or extension in the area of junction for vertebral and basilar arteries
  • controversy as to if this test is effective in determining VBI
  • Although true cases of VBI are rare, ignoring suspicion that a pt has VBI risks causing a catastrophic injury****
37
Q

Best special tests to detect Cervical Radiculopathy

ALL of them:

A
  1. Shoulder ABD test
  2. Spurling’s Test
  3. Traction/neck distraction
  4. ULTT
38
Q

Best Special Tests to detect Cervical Radiculopathy

HIGH SPECIFICITY/Low to Mod sensitivity: 3

*good for Ruling IN

A
  1. Shoulder ABD test
  2. Spurling’s Test
  3. Traction/Neck distraction
39
Q

Best special tests to detect cervical radiculopathy

MOD-HIGH Sensitivity

*good for Ruling OUT

A

Upper limb tension test (ULTT)

40
Q

When pts hx and other phys findings indicate possible cervical radiculopathy

These tests Rule IN cervical radiculopathy

*think SpPIN

A

POSITIVE:

Spurlings

Neck distraction

Shoulder ABD test

41
Q

When pts hx and other phys findings indicate possible cervical radiculopathy:

This test Rules OUT cervical radiculopathy: 1

*think SnNOUT

A

NEGATIVE

ULTT

42
Q

Shoulder ABD test

*cervical radiculopathy test

A

NOTE: If this test INCs sx’s→ could be brachial plexopathy

  • We are looking for RELIEF OF SX’S W/ THIS TEST!!! → puts nerves slack
43
Q

Spurling’s Test

*cervical radiculopathy

A

Provocation test ***

can add EXT and Rot towards symptomatic side***

44
Q

Neck Distraction Test

*cervical radiculopathy

A

NOTE: if this test INCs sx’s→ could be brachial plexopathy

*We are looking for RELIEF OF Sx’s w/ this test

45
Q

Upper Limb Neural Tension Test

ULTT

*cervical radiculopathy

Rules OUT (SnNOUT)

A

Provocation test

We are looking for repro or inc in neck/arm sx’s for this test***

46
Q

Valsalva’s Maneuver

A

pt instructed to take a deep breath and hold it while attempting to exhale for 2-3s

*Reproduction or an INC in sx’s==> POSITIVE TEST

47
Q

Palpation

*soft tissues are palpated for tenderness, repro of sx’s, and/or fibrosis or tightness

A
  • SCM (avoid direct downward pressure)
  • Scalenes
  • Semispinalis cervicis/capitis
  • Splenius capitis (splays)
  • Upper traps
  • Mid traps
  • Lower traps
  • Lev scap
  • Suboccipitals w/ pt in supine

MSPT II (20 decks)

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