4- Cervical Spine Flashcards
Red or Yellow Flag?: Hoarseness
Red
Reflex testing
C5-6: Brachioradialis C6: Biceps C7: Triceps
Explain the osteokinematics associated with cervical spine rotation
rotation about a vertical axis coupled with ipsilateral sidebending
If 3 of which 4 tests are positive… it is 65% CPR of cervical radiculopathy
- Spurlings
- Rotation< 60 degrees
- Distraction Test
- ULNT
Whats general ROM for cervical flexion?
40 degrees
Whats general ROM for cervical sidebending?
45 degrees
Red or Yellow Flag?: Segmental or multisegmental hyporeflexia or areflexia
Yellow
What is superoanterior glide of superior facets and facet joints during flexion restricted by?
Joint capsule
Red or Yellow Flag?: Tinnitus
Yellow
Red or Yellow Flag?: History of LOC
Yellow
Explain the biomechanics of cervical spine flexion
-Anterior osteokinematic roll of superior vertebra -Superoanterior glide of superior facets and facet joints -Anterior translation slide of superior vertebra on the ICD
Red or Yellow Flag?: Severe movement loss
Yellow
How do you test cardinal plane movements?
AROM then PROM
Red or Yellow Flag?: Visual disturbances
Red
What should you watch for when testing cardinal plane movements?
- Quality of motion - Symptom provacation - Willingness to move - Presence of specific patterns of restriction
Red or Yellow Flag?: Spasm with PROM
Red
Red or Yellow Flag?: Arm pain (Pt <35 or greater than 6 months duration)
Red
What does the alar ligament test test for?
Frontal plane stability
What does it mean when spurlings, rotation <60 deg, distraction test, and ULNT are all positive?
90% predictive of cervical radiculopathy
What is anterior roll of superior vertebra during flexion restricted by?
Extensor muscles and posterior ligaments
Red or Yellow Flag?: Painful and weak resistive testing
Red
Red or Yellow Flag?: Difficulties problem solving
Yellow
What is the safest order of objective examination?
- Structural examination 2. Craniovertebral (UCS) Scan 3. Stabilitiy Testing, NBI Testing 4. Neurological examination 5. Cardinal plane movements 6. Special Testing 7. Segmental mobility testing
Red or Yellow Flag?: Irritability
Yellow
Red or Yellow Flag?: Anxiety or depression
Yellow
What does flexion do to the IVD?
anterior compression and posterior distraction
Red or Yellow Flag?: Horner’s Syndrome (SNS deficiency, ptosis, miosis)
Red
Red or Yellow Flag?: Compromise to multiple spinal nerve roots
Red
Red or Yellow Flag?: Insomnia
Yellow
Red or Yellow Flag?: Constant or continuous pain
Yellow
What is uncovertebral and facet arthrokinematic motion limited by during sidebending?
joint capsule
Whats general ROM for cervical rotation?
80-90 degrees
Red or Yellow Flag?: Acute capsular pattern
Yellow
Red or Yellow Flag?: Unexplained weight loss
Red
Whats general ROM for cervical extension?
70-80 degrees
Explain the osteokinematics associated with cervical spine sidebending
-Ipsilateral osteokinematic roll -Superoanterior glide of the contralateral superior facet -Posteroinferior glide of the ipsilateral facet -Inferomedial glide of the ipsilateral uncovertebral joint -Superolateral glide of the contralateral uncovertebral joint -conttalateral translation of the vertebra on the disk
Red or Yellow Flag?: Moderate to severe radiating pain
Yellow
Red or Yellow Flag?: Paresthesia
Yellow
What is the posterior roll during extension restricted by?
anterior prevertebral muscles and the ALL
Red or Yellow Flag?: Recent trauma
Yellow
Red or Yellow Flag?: UMN signs and symptoms
Yellow
What is anterior translation slide of the superior vertebra on the IVD during flexion restrained by?
IVD and nuchal ligament
Red or Yellow Flag?: Limited scapular elevation
Red
Red or Yellow Flag?: Regional expansion of pain
Red
Red or Yellow Flag?: T1 palsy (weakness of hand intrinsics)
Red
Explain the biomechanics of cervical spine extension
-Posterior roll -Inferoposterior glide -Posterior translation of the vertebra on the disk
Red or Yellow Flag?: Moderate to severe headaches
Yellow
Red or Yellow Flag?: Gradual increase in pain over time
Red
Red or Yellow Flag?: Strong spasms
Yellow
What is translation of the disk during sidebending limited by?
IVD
What is the transverse ligament test test for?
Sagittal plane stability
What does the Jefferson fracture test test for?
Transverse plane stability
Myotome Testing
c1- cervical flexion c2-cervical extension c3-cervical sidebending c4-scapular elevation c5-shoulder abduction and external rotation c6- elbow flexion and wrist extensions and shoulder IR c7- elbow extension and wrist flexion c8-thumb extension t1-hand intrinsics and interossei
Red or Yellow Flag?: Segmental paresis
Yellow
What is the inferoposterior glide during extenion restrained by?
facet joint capsule
What is ipsilateral roll during sidebending limited by?
contralateral scalenes and intertransverse ligaments
What does the Sharp-Purser Test test for?
Translational stability
Red or Yellow Flag?: Memory loss or forgetfulness
Yellow
Red or Yellow Flag?: Reduced motivation
Yellow
What does the Vertebral artery test test for?
Vascular stability
What is the posterior translation of the vertebra on the disk during extension restrained by?
IVD
What does the distraction test test for?
Longitudinal plane stability
What are the components of a cervical scan?
- Neck rotation - UC sidebending - UC flexion - UC extension - Compression - Distraction
What is Lhermitte’s Phenomenon?
a shock-like sensation that radiates down the spinal column to the UEs or LEs with neck flexion (myelopathy, neck trauma, radiculopathy)