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Year 1: OS Exam 1 > 2.4 Cervical Dx and Tx > Flashcards

2.4 Cervical Dx and Tx Flashcards

1
Q

Hangman’s fracture

A

Hyperextension of cervical spine resulting in traumatic spondylolisthesis of C2 with fracture of the vertebral arch of C2, as well as tearing of ligaments between C2 and C3

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2
Q

While viewing AP radiograph of C spine, spinous processes should lie in a straight line, except if they are bifid. If there is malalignment, what may be present?

A

Unilateral facet joint dislocation

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3
Q

While viewing AP radiograph of C spine, the distance between the spinous processes should be equal. no space should be 50% wider than the one immediately above or below. If it is, it is characteristic of what?

A

Anterior cervical dislocation

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4
Q

What radiographical view enables assessment of C1 and C2, although associated fractures may be better viewed on lateral projection?

A

Open mouth radiograph

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5
Q

T/F: lateral masses of C1 should overhang the lateral masses of C2

A

False; if this is present, it is likely a burst fracture

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6
Q

45 degree oblique view of C spine will demonstrate what structures?

A

Intervertebral foramina

Possible presence of osteophyte encroachment of spondylosis (right posterior oblique demonstrates left foramina and vice versa; narrowing is indication for MRI)

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7
Q

Contraindications to HVLA in cervical area

A

Advanced RA and Down syndrome may be associated with alar ligament instability

Vertebral artery disease may be associated with thrombosis

Advanced carotid disease

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8
Q

37 y/o female presents with complaints of diarrhea that started 2 weeks prior with a MVC. SD at which of the following levels is most likely parasympathetic facilitation contributing to her symptoms?

A. OA
B. C4
C. C7
D. T4
E. T7
A

A. OA

[bc that’s where vagus n. comes out]

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9
Q

19 y/o female presents complaining of headaches. States she has been having headaches since age 17 after MVA whiplash injury and finds they are worsened by stress .OSE findings include OA preference to right rotation and restriction from R to L translation. These findings worsen in extension. What is the diagnosis?

A

OA F RR SL

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10
Q

OSE reveals restriction of rotation to the right at the AA. Which of the following is the correct direction for the patient’s activating force during MET?

A. Rotating right
B. Rotating left
C. Sidebending right
D. Sidebending left

A

B. Rotating left

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11
Q

16 y/o male presents complaining of headaches, numbness, and tingling in first 3 digits on his palmar side. On exam you dinf that his C6 dermatome seems to be affected. Which of the following spinal segments is likely affected?

C5-C6

Or

C6-C7

A

C5-C6

Because nerves in c-spine exit above spinal segment

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12
Q

Patient presents with right neck pain. OSE reveals restricion to cervical extension and rotation to the right. After doing ST/MFR, you find C4 is rotated L, restricted to extension, and prefers L->R translation. Which of the following is correctly named SD?

A. C4 E RL SL
B. C4 F RL SL
C. C4 E RR SL
D. C4 F RL SR

A

B. C4 F RL SL

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13
Q

Compression test

A

Physician applies an axial compresssion of head in neutral

Positive test = pain down arm in nerve root distribution

Indicates = nerve root compression (cervical radiculopathy)

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14
Q

Spurling’s maneuver

A
  1. Compression of head in neutral
  2. Compression of head in extension
  3. Sidebend away from affected side then toward the affect side and add compression

Positive test = pain down arm in nerve root distribution

Indicates = nerve root compression (cervical radiculopathy)

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15
Q

what binds the atlas posteriorly?

A

transverse Atlantan l. (part of cruciform l.)

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16
Q

what is the myodural bridge?

A

true connections b/t rectus capitis posterior major and dura mater
-contains neural component which monitors burial tension, anchors muscle, and role in cervicogenic pathologies

17
Q

what anatomical structures are located between the anterior vertebral line and the posterior vertebral line?

A

dens
intervertebral disc space
vertebral body

18
Q

what anatomical structures are located between the posterior vertebral line and spinal laminar line?

A
  • lateral mass
  • facet joint
  • lamina
  • pedicle
  • zygaphphyseal articulation
19
Q

what anatomical structures are located between the spinal laminar line and the posterior spinous process line?

A

spinous process

20
Q

For C2-7- in what direction should we find rotation and sidebending? Why?

A 
Same direction (type 2)
-theoretically due to uncinate process
21
Q

How would the typical patient present with a Type 1- Neutral SD in the C2-7? What population is this common in?

A
  • traumatically and present with simultaneous anterior and posterior muscle spasms
  • severely arthritic pts
22
Q

How would the typical patient present with a Type 2- F/E SD in the C2-7?

A

painful

23
Q

In what direction do SB and rotation occur in the OA joint?

A

Opposite

  • major motion is flexion/extension
  • minor SB and Rotation movement
24
Q

What is the primary movement of the AA joint? What muscle is responsible for this?

A

rotation -almost NO SB/rotation

obliques capitis inferior m. (origin: axis SP to insertion: atlas lateral mass)

25
Q 
What are ROM degree's for cervical:
flexion
extension
SB
Rotation
A

flexion: 45-90
extension: 45-90
SB: 45
Rotation: 70-90

26
Q

What part of the SOAP note would you document SD found?

A

objective portion

27
Q

contraindications for soft tissue OMT: (6)

A
  1. fx
  2. open wound/surgical site
  3. infection (bone or ST)
  4. DVT
  5. coag
  6. neoplasm
28
Q

contraindications for muscle energy OMT: (8)

A
  1. undiagnosed joint swelling
  2. severe osteoperopsis
  3. neoplasm
  4. infection
  5. hematoma
  6. rheumatoid arthritis
  7. fracture
  8. dislocation
29
Q

What is the therapeutic timing/reps for soft tissue?

A

30 sec to 10-15 reps or until tissue response reflects optimal response or no changed in cont treatment

30
Q

What is the therapeutic timing/reps for HVLA?

A

usually 1 rep

31
Q

What is the therapeutic timing/reps for MET?

A

3-5 reps

32
Q

What is the therapeutic timing/reps for ART?

A

10-30 reps

33
Q

What is the therapeutic timing/reps for Stills?

A

usually 1 rep

34
Q

What are contraindications for HVLA of the cervical area? (4)

A
  1. advanced RA - alar l instability since dislocation of dens can cause death or quadriplegia
  2. Down syndrome - same as above
  3. vertebral artery disease- could be associated with thrombosis
  4. advanced carotid disease
35
Q

What are general contraindications for HVLA? (7)

A
  1. inflammatory arthritis
  2. malignancy
  3. acute radiculopathy
  4. klippel-Feil syndrome
  5. chiari malformation
  6. Achondroplastic dwarfism
  7. osteogenesis imperfecta
36
Q

indications for ST OMT?

A

cervical SD with significant ST component

37
Q

indications for HVLA or ART OMT?

A

cervical SD w/ ROM restriction that most likely attributed to SD in cervical facet joint, AA joint, or OA joint
-hard, firm end feel

38
Q

indications for MET or Still’s OMT?

A

Cervical SD

Year 1: OS Exam 1 (39 decks)

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