2.2. Cervical Spine Subjective Examination Flashcards
Demographic data include? (5)
Name
Age
Sex
Handedness
Systemic conditions (hypertension, diabetes, asthma)
Spondylosis (also called spondylosis deformans) is often seen in persons ____
years of age or ____
25 years of age or older
It is a generalized disease of aging
initiated by intervertebral disc degeneration.
Spondylosis
Cervical spondylosis is present in ___% of those older than 45 years
60%
Cervical spondylosis is present in ___% of those older than 65 years
85%
Symptoms of osteoarthritis do not usually appear until a person is ___ years of age or older
60 years of age or older
T OR F: Shoulder of the dominant hand sides is always lower than the non-dominant
TRUE; If a patient manifests higher
dominant side shoulders, it could
indicate cervical conditions that
needs to be checked later on
In patients with neck conditions, asthma may cause ____ of the breathing muscles because of their difficulty in breathing
hypertrophy of
the breathing muscles
Chief complaint include? (7)
pain,
weakness,
heaviness,
stiffness or LOM,
numbness/paresthesia,
headache/dizziness,
functional limitations
Behavior of symptoms (4)
SAR 24
Sustained posture or movement
Aggravating & relieving factors
Referred pain
24 hour pattern
quantity & quality of pain (4)
CLIT
consistency/duration
location
intensity
type
T OR F: Pain is considered normal in traumatic cases and is present because of the area’s inflammation
TRUE
T OR F: Pt experiences pain but has no history of trauma & cannot be resolved by rest or positional changes is considered a red flag
TRUE
This might imply other problems such as systemic, carcinogenic/malignancy and now prompt further testing and observation
T OR F: If the pain is mechanical, such as in muscle tightness or nerve root impingement, pain will still not be relieved in certain positions
FALSE
Pain is relieved in certain positions for mechanical problems
Lumbar Spondylosis relieving position
flexed position (nakakuba)
Cervical disc herniation relieving position
Patient usually extend their neck to
avoid the hernia from pressing on
the spinal nerves or spinal cord
location of pain usually associated with musculoskeletal problems
localized
location of pain usually associated with spinal cord problems, nerve roots, or brachial plexus
radiating
Cervical radiculopathy primary symptoms (5)
unilateral motor and sensory symptoms into the upper limb,
with muscle weakness (myotome),
sensory alteration (dermatome),
reflex hypoactivity,
focal activity
T OR F: Radiculopathy usually presents bilaterally
FALSE
Radiculopathy are nerve root problems in the cervical spine that presents unilaterally
Condition brought about by other spinal
conditions (e.g. herniations, spondylosis) with any nerve impingement
Radiculopathy
acute radiculopathies are associated with?
disc herniations
chronic radiculopathies are associated with?
spondylosis
Disc herniations in the cervical spine
commonly cause severe neck pain that may radiate into the _____ (3), limit ____ (1), and an increase in pain on ____ (4)?
severe neck pain that may radiate into the shoulder, scapula and/or arm, limit ROM, and an increase in pain on coughing, sneezing, jarring, or straining
injury to the spinal cord itself
Cervical myelopathy
Cervical myelopathy primary symptoms (4)
Spastic weakness,
Paresthesia,
Incoordination in 1 or both lower limbs,
Proprioceptive and/or sphincter dysfunction
Diffused pain on the upper back may indicate?
Myofascial pain syndrome
How many trigger points in order for the
condition to be considered as Myofascial pain syndrome?
at least 3 trigger points
T OR F: if the problem is postural, pain appears after sustaining a specific posture for a long time
TRUE
T OR F: Persistent pain that does not resolve even in prone may indicate malignancy or other conditions that may have something that occupies the spaces in the cervical region
FALSE
Persistent pain that does not resolve even in SUPINE
chief complaint of weakness is associated with?
myotomal problem
chief complaint of heaviness is associated with?
vascular problems
T OR F: Sensory disturbances may signal nerve
root compression
TRUE
chief complaint of stiffness or LOM is associated with?
arthritic changes
Can be a chief complaint due to musculoskeletal dysfunction of the spine especially in the C1-C3 levels
Headaches & Dizziness
Headaches & Dizziness may indicate muscle tightness usually for what muscle group?
muscle that inserts to occiput
headaches that are musculoskeletal in origin
present ____
unilaterally
headache is a major complaint after trauma may indicate?
traumatic brain injury or concussion
Reports of dizziness can affect what function?
ear/vestibular function
dizziness may indicate what problems and insufficiency?
vestibular/ear problems or vertebrobasilar insufficiency
5 Ds of VBI
dizziness,
diplopoia,
drop attack,
dysarthria,
dysphagia
double vision
diplopia
dancing eyes
nystagmus
depressed visual field
scotomas
dizziness associated with certain head or body positions may indicate?
semicircular canal problem or vertebral artery problem
Falling with no provocation while remaining conscious
drop attack
Drop attack is a symptom of VBI that may indicate ____ oxygen levels in the brain
low oxygen levels/hypoxia in the brain
indicates defects in articulation, enunciation, or rhythm of speech
Dysarthria
characterized by slurring, slowness of speech, indistinct speech, and breaks in normal speech rhythm
Dysarthria
difficulty swallowing
Dysphagia
Pain on swallowing may indicate? (4)
disc protrusion into the esophagus or pharynx,
osteophyte projection,
vertebral subluxation,
soft- tissue swelling in the throat
When a patient has dysphagia, swallowing becomes more difficult and the voice becomes weaker when the neck is flexed or extended?
extended
What joint dysfunction is commonly accompanied by headaches?
Craniovertebral joint dysfunction
C1 headaches occur where?
at the base and top of the head
C2 headaches occur where?
referred to the temporal area
pain and referred symptoms are decreased or relieved by placing the hand or arm of the affected side on top of the head
Bakody’s sign
Bakody’s sign usually indicative of problems in what cervical levels?
C4 or C5
lead to anxiety, pain catastrophizing (negative or heightened orientation toward pain), and other adverse psychosocial factors over time, and it can play a major role in the symptoms felt by the patient
Chronic post whiplash syndrome
a report of an insidious onset in someone
older than 55 years of age may indicate?
cervical spondylosis
typically occur from a blow to part of the brachial plexus or from stretching or compression of the brachial plexus
“Burners” or “stingers”
may result from excessive nodding as the patient tries to focus through the correct part of the glasses
Upper cervical symptoms
often painful when activities that require push-and pull motion (such as, lawn mowing, sawing, and cleaning windows) are performed
Cervicothoracic (lower cervical/upper thoracic spine) joint problems
Extension or Flexion: What can aggravate
symptoms in patients with radicular signs and symptoms?
extension
what pain usually occurs immediately?
Bone pain
what can either come on immediately
(e.g., a tear) or occur several hours or days later (e.g., stretching caused by a motor vehicle accident).
muscle or ligamentous pain
Pain affected by laughing, coughing, sneezing, or straining can mean that an increase in _____ may be contributing to the problem.
increase in intrathoracic or intraabdominal pressure
T OR F: paresthesia (a “pins and needles” feeling) happens occurs if pressure is applied to the nerve root.
TRUE
T OR F: Unilateral symptoms usually indicate either systemic disorders (e.g., diabetes, alcohol abuse) that are causing neuropathies or central space–occupying lesions.
FALSE
BILATERAL symptoms usually indicate either systemic disorders that are causing neuropathies or central space–occupying lesions.
T OR F: If symptoms are not varied by a change in position, the problem is likely to be mechanical in origin.
FALSE
If symptoms are not varied by a change in position, the problem is NOT LIKELY to be mechanical in origin.
Lesions of what cervical level may affect the diaphragm and thereby affect breathing? (3)
C3, 4, 5
encourages forward head posture and increases activity of accessory respiratory muscles
Mouth breathing
Type of pillow that tend to retain their shape and have more “bounce;” they do not offer as much support
Foam pillows
What sleeping positions can increase the stress on the lower cervical nerve roots (2)
patient “hugging” the pillow
OR
abduct the arms when sleeping
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.
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.
normal lordotic curvature of neck
30° to 40°
