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PCMI > 2.2. Cervical Spine Complaint > Flashcards

2.2. Cervical Spine Complaint Flashcards

1
Q

6 components to observe with a normal cervical spine inspection

A
  1. cervical spinal curvature (lordosis)
  2. carrying angle
  3. trachea midline
  4. no LN swelling
  5. no thyroid enlargement
  6. muscles
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2
Q

Abnormal findings with a cervical spine complaint inspection

A
  1. trauma, scars, masses, goiter
  2. carrying angles
  3. distended EJV (need to elevate head above 30 degrees)
  4. tracheal deviation
  5. masses in neck
  6. mediastinal mass
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3
Q

8 areas to palpate during a cervical spine exam

A
  1. occiput
  2. mandible
  3. clavicle
  4. muscles: SCM and trapezius
  5. thyroid
  6. cricoid cartilage
  7. trachea
  8. cervical spine: spinous process, vertebral prominence (C7), transverse processes, facets
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4
Q

important things to document when someone comes in with neck/cervical complaint?

A

initial presence and level of sensory/motor loss

rectal tone

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5
Q

what clinical significance does recent neck trauma raise concern for?

A

cervical spinal fracture

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6
Q

what clinical significance does neurologic symptoms of signs that suggest SC issue (weakness, gait difficulty, bowel/bladder dysfunction) raise concern for?

A

cervical cord compression

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7
Q

what clinical significance does shock like paraesthesia (Lhermitte’s phenomenon) with neck flexion raise concern for?

A

cervical cord compression or MS

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8
Q

what clinical significance does fever and chills raise concern for?

A

infection

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9
Q

what clinical significance does hx of IV drug use raise concern for?

A

cervical spine or disc infection

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10
Q

what clinical significance does immunosuppression raise concern for?

A

infection

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11
Q

what clinical significance does chronic glucocorticoid use raise concern for?

A

infection cervical spine compression fx

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12
Q

what clinical significance does unexplained weight loss raise concern for?

A

malignancy

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13
Q

what clinical significance does cancer hx raise concern for?

A

metastatic disease to cervical spine

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14
Q

what clinical significance does headache, shoulder/hip girdle pain, or visual symptoms in older pt’s raise concern for?

A

Rheumatic disease (polymyalgia rheumatica- disease causing muscle pain and stiffness that’s usually worse in morning, giant cell arteritis)

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15
Q

what clinical significance does anterior neck pain raise concern for?

A

non-spinal cause (angina pectoris)

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16
Q

what would be pertinent negatives when doing a cervical spine/neck examination?

A

nuchal rigidity
meningismus
NEXUS criteria

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17
Q

what dermatome is at lateral forearm and thumb?

A

c6

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18
Q

what dermatome is at the nipple line

A

T4

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19
Q

what dermatome is at the umbilicus

A

T10

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20
Q

what speciality test would you perform if you had concern for meningeal irritation?

A
  1. Kernig’s sign
  2. Brudzinkski’s sign
  3. nuchal rigidity
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21
Q

what speciality test would you perform if you had concern for cervical radiculopathy?

A
  1. Spurling’s test

2. Manual distraction test

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22
Q

what speciality test would you perform if you had concern for thoracic outlet syndrome?

A
  1. Roo’s
  2. East test
  3. Addisons
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23
Q

common causes of neck stiffness (inability or unwillingness) to move neck is a concern for:

A
  • c spine fx
  • cord injuries
  • ligamentous injury
  • muscle strain
  • muscle spasm
  • SAH
  • meningitis
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24
Q

HVLA contraindications for neck symptoms

A
  • RA (weak odontoid l. susceptible to rupture)
  • Down syndrome: weak odontoid l., may have incomplete or missing odontoid
  • carotid disease, PVD, or risks thereof
  • osteoporosis or risks of mets, anticoags, osseous or ligamentous disrupture
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25
primary muscles affecting neck flexion
SCM scalene prevertebral ms tell pt "bring chin to head"
26
primary muscles affecting neck extension
splenius capitis splenius crevicis small intrinsic ms of neck "look up at ceiling"
27
primary muscles affecting neck rotation
SCM | small intrinsic ms of neck
28
primary muscles affecting neck lateral bending
scalene | small intrinsic neck ms
29
central neuropathy
nerve entrapment by msk or myofascial tissue that produces paresthesias that creates pain and decreased muscle strength
30
common sites for central neuropathy
intervertebral foramen and thoracic outlet
31
what tests would you do to test for central neuropathy? which one is highly specific?
1. compression test 2. spurlings test - highly specific 3. neck distraction test
32
Pt presents with decreased distal pulses, digital cyanosis and ischemia in the UEs, what issue with you include in your diagnosis?
thoracic outlet
33
When you perform the Adson's test for suspicion of thoracic outlet syndrome, where specifically would the occlusion be if the test was positive?
subclavian a between scalene (when looking away from affected side) or 1st rib/cervical rib (looking toward affected side)
34
What do you have to make sure before you attempt to perform specialty tests that are sensitive to subarachnoid irritation? Specifically nuchal rigidity, brudzinski's sign, and kerning sign?
no injury to c-spine or cervical cord
35
which test is most sensitive to inflammation in subarachnoid space (e.g meningitis or subarachnoid hemorrhage)
nuchal rigidity (found in 84% of acute bacterial meningitis and 21-86% of subarachnoid hemorrhage cases)
36
etiology of cervical spinal cord injuries
- ANY sport, but specifically football, hockey, lacrosse (contact) - axial load accounts for over half c-spine injuries: force transmitted to bone and disc - neck flexion to 30 degrees: lordosis lost and protective soft tissue is no longer protective
37
what injury can result in a wedge fracture?
flexion and compression injury
38
NEXUS Criteria
National Emergency X-Ray Utilization Study (NEXUS) Criteria, No/normal: 1. posterior midline cervical spine tenderness 2. intoxication 3. alertness 4. Focal neuro deficits 5. painful distracting injuries
39
What is the broad based differential for traumatic neck pain?
- myofascial injury - cervical fracture - ligamentous injury - disc injury - cord or nerve root injury - SCIWORA (Spinal Cord Injury Without Radiographic Abnormality)
40
What are the symptoms of myofascial neck pain?
pain spasm loss of ROM in neck occipital headache *Usually not identifiable on MRI, CT, radiograph, or bone scan
41
If a SCIWORA is suspected, what MUST happen?
keep spine immobilized until MRI and evaluation/consultation with a neurosurgeon
42
What are the causes of atraumatic neck pain?
``` cervical spondylosis discogenic pain myofascial pain whiplash torticollis facet OA radiculopathy myelopathy referred pain ```
43
What population of people is a SCIWORA more common in?
kids and elderly
44
What is the most common cause of acute and chronic neck pain in adults?
cervical spondylosis
45
What is the difference between cervical myelopathy and radiculopathy?
Myelopathy: any neurologic deficit related to the spinal cord is myelopathy Radiculopathy: any neurologic deficit occurring at or near the nerve root
46
What are the signs and symptoms of cervical myelopathy?
``` bilateral or distal sx's clumsy hands gait disturbances sexual dysfunction bowel or bladder dysfunction ```
47
What are the signs and symptoms of cervical radiculopathy?
- sharp, burning, pain radiating to the trapezius, periscapular area, or down the arm. - Weakness or paresthesias may develop weeks after pain onset
48
What is the most common location or cervical radiculopathies?
C5-C6 followed by C6-C7
49
What are the signs and symptoms of meningitis?
- fever - malaise - HA - photophobia - neck pain, stiffness - AMS (atypical measles syndrome), rash - nuchal rigidity, Kernig's and Brudzinksi's signs of meningeal inflammation
50
What are the causes of meningitis?
``` hemophilus Strep. Pneumonia Neisseria meningitidis gram negative diplococci viral, or aseptic ```
51
When should imaging be completed on patients with atraumatic cervical pain?
patients with: - progressive neurologic findings - moderate to severe neck pain who do not respond to conservative management over six weeks
52
What is the primary function of the OA joint?
flex and extend
53
What is the primary function of the AA joint?
rotation
54
What is the primary function of C2-C7?
rotation and side bending on the same side
55
What is a positive compression test and what is it indicative of?
upper extremity pain, parasthesias, or numbness upon compression of the head in a neutral position *Indicates a central neuropathy
56
How is Adson's test performed?
Physician stands behind the patient, abducts, extends, and externally rotates the patients arm while palpating the radial pulse. Patient first extends and turns their head toward the affected side. Inhale and hold. Head is then turned to opposite side as they hold inhalation
57
What is a positive adson's test?
loss or change in pulse; reproduction of pain/paresthesia.
58
What is the Roos or EAST test?
Patient abducts shoulder to 90 degrees and ER with elbow flexed to 90 degrees. Open and close fists for up to 3 minutes.
59
What is a positive Roos or EAST test and what does it indicate?
reproduction of pain/paresthesia Indicates thoracic outlet syndrome, specifically compression of the subclavian artery
60
What is the nuchal rigidity test?
Physician flexes patients head to chest. Marked stiffness/resistance to flexion indicates inflammation in the subarachnoid space (meningitis or SAH)
61
What is Brudzinski's sign?
Flex patient's head forward. Positive sign would be flexion in both hips and knees. Indicates inflammation in subarachnoid space
62
What is Kernig sign?
patient lies supine, thigh is flexed to 90 degrees, attempt to passively extend the leg at the knee. Increased resistance to extension and pain behind knee indicates meningeal/dural irritation

PCMI (15 decks)

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