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MSK > 2.2. Cervical Spine Objective Examination > Flashcards

2.2. Cervical Spine Objective Examination Flashcards

1
Q

If the patient is supporting the head and neck during the history and observation and is afraid to move the head what sign does this indicate?

A

Rust’s Sign

indication of cervical instability dt fracture or ligamentous injury

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2
Q

T OR F: Abnormalities in one area frequently affect another area. For example, excessive thoracic kyphosis may cause a “poking” chin (cervical spine is in extension) to compensate for the thoracic deformity and to maintain the body’s center of gravity centered beneath the base of support.

A

FALSE:

Abnormalities in one area frequently affect another area. For example, excessive LUMBAR lordosis may cause a “poking” chin (cervical spine is in extension) to compensate for the LUMBAR deformity and to maintain the body’s center of gravity centered beneath the base of support.

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3
Q

Normal value for cervical lordosis

A

30° to 40°

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4
Q

Stiff neck; muscle spasm, tightness, or prominence of the sternocleidomastoid muscle causing lateral flexion to affected side and opposite side rotation; can be congenital or acquired

A

Torticollis

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5
Q

In Klippel-Feil syndrome which cervical vertebra are most commonly affected by congenital fusion?

A

C3-5

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6
Q

Acute torticollis can also be caused by what type of neck problem?

head is laterally flexed away from painful side

A

Disc problems can cause acute torticollis

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7
Q

A habitual poking chin can result in adaptive shortening of what muscles?

A

Occipital muscles

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8
Q

T OR F: A poking chin causes the cervical spine to change alignment resulting in increased comprehensive stress of the facet joints and anterior discs and other anterior elements

A

FALSE

A poking chin causes the cervical spine to change alignment resulting in increased comprehensive stress of the facet joints and POSTERIOR discs and other POSTERIOR elements

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9
Q

A habitual poking chin may also lead to weaknesses in what group of muscles?

A

Deep neck flexors

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10
Q

What muscles are tight in an upper crossed syndrome?

A

PUL
pectoralis major and minor,
upper trapezius,
levator scapulae

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11
Q

What muscles are weak in an upper crossed syndrome?

A

DSLR
deep neck flexors,
serratus anterior,
lower trapezius,
rhomboids,

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12
Q

True or False:

Torticollis may be habitual, in other words, the patient always goes back to this posture.

A

True

Habitual posture may result from postural compensation, weak muscles, hearing loss, temporomandibular joint problems, or wearing of bifocals or trifocals (Magee).

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13
Q

T OR F: Head and neck posture should be checked with the patient standing and then sitting, and any differences should be noted

A

FALSE

Head and neck posture should be checked with the patient SITTING and then STANDING

The first movements that are carried out are the active movements of the cervical spine with the patient in the sitting position.

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14
Q

Which shoulder is lower, dominant side or non-dominant side?

A

Dominant side should be slightly lower

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15
Q

Which shoulder is lower, injured side or non non-injured side?

A

Non-injured side is lower

the injured side may be elevated to provide protection or because of muscle spasm

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16
Q

Rounded shoulders may be the result of or the cause of a poking chin, also causes the:

scapulae to protract or retract?
humerus to laterally or medially rotate?
Anterior/Posterior structures to lengthen?
Anterior/Posterior structures to tighten?

A

Rounded shoulders may be the result of or the cause of a poking chin, also causes the:

scapulae to PROTRACT
humerus to MEDIALLY ROTATE
POSTERIOR structures to lengthen
ANTERIOR structures to tighten

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17
Q

Atrophy of the deltoid is caused by which nerve palsy?

A

Axillary nerve palsy (C5, C6 nerve root)

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18
Q

True or False:

Observing patient facial expression is important to give the examiner an idea on how much the patient is objectively suffering.

A

FALSE:

Observing patient facial expression is important to give the examiner an idea on how much the patient is SUBJECTIVELY suffering.

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19
Q

Patient with cervical spine injury describe findings:

Head tilted towards pain or away from pain?
Head rotated towards pain or away from pain?
Face tilted upward or downward?

A

Patient with cervical spine injury describe findings:

Head tilted away from pain
Head rotated away from pain
Face tilted upward

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20
Q

hysterical patient describe findings:

Head tilted towards pain or away from pain?
Head rotated towards pain or away from pain?
Face tilted upward or downward?

A

hysterical patient describe findings:

Head tilted towards pain
Head rotated towards pain
Face tilted downward

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21
Q

True or False:

Referred pain from conditions, such as spondylosis, tends to occur in the shoulder and arm rather than the neck.

A

True:

Common areas for spondylosis are c4-5, c5-6 and c6-7

nerve roots c5, 6 and 7 have dermatome distributions to the shoulder and arm

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22
Q

True or False:

when examining the cervical spine it must include the neck, upper thoracic spine, upper ribs, and both upper limbs.

A

True:

Many of the symptoms that occur in an upper limb originate from the neck. Unless there is a history of definite trauma to a peripheral joint, an upper limb scanning examination must be performed to rule out problems within the neck.

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23
Q

T OR F

AROM examination should summation of all movements of the entire cervical spine, not just at one level

A

TRUE

This combined movement allows for greater mobility in the cervical spine while still providing a firm support for the trunk and appendages.

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24
Q

If the patients movement is aberrant or uncontrolled during AROM examination, what is this called?

A

Cervical movement control dysfunction

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25
Q

Female patients tend to have a greater cervical AROM than males, except in what movement?

A

flexion

26
Q

ALL cervical motion available range decreases with age, except what movements?

A

rotation at C1-C2 may increase

27
Q

True or False:

The movements should be done in a particular order so that the most painful movements are done first, so the painful portion of the examination finishes faster.

A

False:

The movements should be done in a particular order so that the most painful movements are done last, and no residual pain is carried over from the previous movement.

28
Q

If the symptoms are relieved in neutral position, is the condition irritable or nonirritable?

A

nonirritable

29
Q

If the symptoms are not relieved in neutral position, is the condition irritable or nonirritable?

A

Irritable

movements may be restricted depending on the intensity of the symptoms.

30
Q

True or False:

In AROM and PROM, if the patient is able to hold the end-range position, the symptoms would not be considered severe

A

True

31
Q

True or False:

If patient cannot hold end range position, we can apply overpressure to determine what causes this.

A

False:

If the patient cannot hold the end range position, any symptoms would be considered more severe and overpressure should not be applied

32
Q

Which combination of movements can cause the vertebral artery to be compressed?

A

rotation, side flexion, and extension

Rotation alone can also cause compression

33
Q

During flexion, _______ occurs in the upper cervical spine, whereas _______ occurs in the lower cervical spine.

A

During flexion, NODDING occurs in the upper cervical spine, whereas FLEXION occurs in the lower cervical spine

34
Q

True or False:

Movement can occur between C2 and C7 without affecting the other vertebrae

A

False:

Movement can occur between C1 and C2 without affecting the other vertebrae

for C2 to C7, if one vertebra moves, the ones adjacent to it will also move.

35
Q

You ask a patient to nod to test the upper cervical spine (C0-C2), they feel tingling in feet, electric shock sensation down the neck, what sign is this called?

A

Lhermitte sign

indicates severe pathology

36
Q

True or False:

For flexion the extreme of ROM is normally found when the chin is able to reach the chest with the mouth closed; up to two finger-widths between chin and chest is considered abnormal.

A

False

For flexion the extreme of ROM is normally found when the chin is able to reach the chest with the mouth closed; up to two finger-widths between chin and chest is considered NORMAL.

37
Q

If the deep neck flexors are weak what muscle initiates flexion?

A

Sternocleidomastoid

causing the jaw to lead the movement, not the nose, because the SCM causes the chin to initially elevate before flexion occurs

38
Q

In flexion, the intervertebral disc _______ posteriorly and _______ anteriorly

A

In flexion, the intervertebral disc widens posteriorly and narrows anteriorly

39
Q

The intervertebral foramen is how many percent larger on flexion than on extension?

A

20% to 30% larger

40
Q

If there is a prominent spinous process of the axis on flexion, what does this indicate?

A

Forward subluxation of the atlas

Sharp-Purser test to test for that

41
Q

If serious symptoms arise (e.g., tingling in the feet, loss of balance, drop attack) during upper cervical extension, this indicates what?

A

Spinal cord compression or Vertebrobasilar dysfunction

42
Q

True or False:

Rotation and side flexion always occur together (coupled movement) but not necessarily in the same direction.

A

True

refresher: C0-2 & C7-T1 opposite directions; C2-7 same directions

43
Q

Most of the rotation occurs at?

A

between C1 and C2

44
Q

True or False

If, in the history, the patient has complained that repetitive movements or sustained postures have caused problems, not only should the specific movements be performed, but they should be either repeated several times or sustained to see if the symptoms are exacerbated.

A

TRUE

45
Q

True or False:

If patient cannot complete AROM, and no overpressure can be tested, PROM can be done in supine

A

TRUE

46
Q

True or False:

The passive ROM with the patient supine is normally greater than the active and passive ROM with the patient sitting

A

TRUE

increased range in the supine position results from relaxation of the muscles that, in sitting, are trying to hold the head up against gravity

47
Q

capsular pattern for cervical spine

A

side flexion & rotation > rotation

48
Q

endfeel for all cervical spine movements

A

tissue stretch

49
Q

Physiological movements between each
pair of vertebrae

A

Passive Physiological Intervertebral
Movements (PPIVMs)

50
Q

If the patient has flexion problems, it might indicate?

A

Might indicate pathologies such as
tumors, dens fractures, etc.

51
Q

If the patient has extension problems, it might indicate?

A

Might indicate vertebrobasilar
dysfunction

52
Q

movement restriction on extension and right side bending possible causes (5)

A

Right extension hypomobility
Left flexor muscle tightness
Anterior capsular adhesions
Right subluxation
Right small disc protrusion

53
Q

movement restriction on Flexion and right side bending possible causes (2)

A

Left flexion hypomobility
Left extensor muscle tightness

54
Q

movement restriction on extension and right side bending restriction greater than extension and left side bending possible causes (3)

A

Left posterior capsular adhesions
Left subluxation
Left capsular pattern (arthritis, arthrosis)

55
Q

movement restriction on flexion and right side bending restriction equal to extension and left side flexion possible causes (1)

A

Left arthrofibrosis (very hard capsular end feel)

56
Q

movement restriction on side bending in neutral, flexion, and extension possible causes (1)

A

Uncovertebral hypomobility or anomaly

56
Q

Upper brachial plexus injury (C5-C6); Muscles of the shoulder region and elbow are affected; sensation of the radial surface of forearm, arm, and deltoid are affected

What palsy?

A

Erb-Duchenne Paralysis / Palsy

56
Q

Atrophy and weakness of muscles of forearm, hand, and triceps (distal extremity changes)

Functionless hand

sensory loss on ulnar side of forearm and hand

What palsy?

A

Klumpke (Dejerine- Klumpke) Paralysis / Palsy

56
Q

Brachial Plexus Birth Palsy is present in how many percent of births?

A

0.1 to 0.4%

56
Q

Brachial Plexus Birth Palsy usually fully recovers by how many months?

A

2 months

Uncured until 3 months = Decreased strength and ROM in UE

57
Q

transient injuries to the brachial plexus, which may be the result of trauma (traction & compression/pinching)

A

Burners and Stingers

MSK (7 decks)

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