7.3: Cervical Spine - Examination Flashcards
T/F: Tone of the subjective assessment will not rely on how well the patient understands you
False, it does rely
T/F: Always consider pt’s educational background and match what language the pt is used to
True
T/F: You can ask the occupation in the demographic part of the subjective
true
Why is distance from home to work or clinic asked
the distance or the commute to these areas may be a big factor in manifesting neck pain
what is asked in the demographic
name, age, sex, handedness, systemic conditions (sometimes occupation if the need arises but is documented in lifestyle)
T/F: in pt’s c neck conditions, asthma will not cause hypertrophy of the breathing muscles in any way
False
Most common complaint of pts with neck conditions
pain
weakness
heaviness
stiffness or LOM
numbness/paresthesia (sometimes referred in other regions)
headaches/dizziness
funcional limitations
Characteristics of pain
Intensity
Onset
Location
Description of sensation
Frequency and duration
Pattern
Aggravating & relieving factors
why ask type of pain
to know what structure is affected
why is location of pain important
it can also help with differential diagnosis as some conditions present with localized pain while some present with diffused pain, radiating pain, referred pain
quality and quantity of pain
Consistency/duration
Location
Intensity
Type of pain
T/F: PT should establish the 24 hour behavior of pain
true
persistent pain may indicate what?
malignancy or other conditions that may have something that occupies the spaces in the cervical region
Weakness & heaviness may signify what
myotomal problems
heavines may indicate vascular problems
Why can headaches & dizziness be a chief complaint?
d/t the msk dysfunction of the spine especially in the C1-C3 levels
What may headaches indicate
muscle tightness
how does headaches that are musculoskeletal in origin present
unilaterally
What to ask if the pt complains of headaches?
frequency, when does it stop, is it recurring (these are not all)
Next step if the pt’s headache is a major complaint after trauma
bring to ER ASAP and defer treatment and refer to other professionals in that specific field
Reports of dizziness is under what realm?
usually vestibular (ear) function
What to suspect if pt complains of dizziness?
Vestibular problems or Vertebrobasilar insufficiency
what are the 5Ds of VBI
dizziness
diplopia
drop attack
dysarhria
dysphagia
what to ask in pts c dizziness
intensity, duration, and if it associated with certain positions
what does dizziness associated c positions indicate?
may indicate a semicircular canal problem
fainting of the pt c intact consciousness and is usually associated c Hypoxia in the brain
drop attack
what is the usual reason why the pt does not go to school/work/other events in their daily lives and is usually the trigger why they go to PT
functional limitation
the longer the interview, the ____ the considered conditions should be
lesser
by the end of the subjective, the PT has at least ____ conditions that are considered
2-3 (accdg to sir jose)
What do we usually ask in the HPI of pts c neck problems
identify cause of the symptoms (may be bc of trauma)
insidious sx
course of sx from the onset until the moment the pt meets with PT
concurrent Tx such as medications or other Mx done (if applicable)
Ask for ancillary procedures
What is usually asked in PMHx
any history of weight loss or gain
previous meds (including the meds taken for the systemic conditions e.g. meds for DM or Htn if applicable)
previous PT sessions
Systems review
What to ask in the physical environment
pertinent house furnitures or appliances
ask also about sleeping arrangements such as mattresses and pillows
work ergonomics
type of commute
T/F: pillow height does not contribute to neck pain
false
T/F: position of the arms during sleep can strain the neck or overstretch the contralateral brachial plexus
true
Why do we consider the type of chair used by the pt
the chair is one of the causes of spinal alignment alteration
T/F: PT should ask pt to estimate the height of the chairs and tables used
True
subdivisions of the subjective assessment
demographics
chief complaint
hpi
pmhx
physical environment
psychosocial environment
lifestyle and hobbies
pt’s goal
why do we need to ask the psychosocial environment
identify behavioral problems present that may contribute to the condition
what is usually asked in the psychosocial environment
beliefs
influences
family or social support
dependents
level of stress and anxiety
coping strategies
if pt can pay for the Tx
why is it important to know if pt can pay for the treatment
If the pt does not have the means to pay, how will they get better?
some centers do not allow Tx without pay and it can cause a big impact on patient both physically, mentally, and emotionally
Usual questions asked in lifestyle and hobbies
Type of work, usual position, workload
risk factor profile (alcohol, tobacco use, dietary habits)
past & present levels of activity
why is substance use important to note?
alcohol and smoking can contribute to vascular conditions and these conditions may present Sx in the neck area
what should PT get in pt’s goal
always be elimination of Sx, should follow up by asking why pt wants to eliminate the Sx
What to check in Ocular inspection
manner of arrival
mental status
facial expression/wincing
protective posturing
attachments and assistive devices
signs of inflammation
trophic skin changes
deformities, asymmetries, deviations
what to look for in palpation
skin temp
muscle tone
muscle spasm
muscle guarding
tenderness
mobility of spinous process
tightness or contractures
taut bands, nodules, trigger points
T/F: the postural assessment can be done without a plumb line
True but it is risky as the plumb line is important to really differentiate
Why is Postural assessment usually done first
it helps PT know if they have plenty to check later on
T/F: the dominant side is usually higher
False, it is ALWAYS lower
Injured side is usually _____
higher
in checking ROM, the most painful movement should be done _____
last
Capsular pattern for the cervical spine
side flexion & rotation > rotation
what does it imply if painful movement is relieved?
condition is not irritable
if the pain is not resolved condition is ____ and pain may ____
irritable; worsen
Normal endfeel for all 4 cervical movements
Tissue stretch (firm)
PPIVM meaning
passive physiological intervertebral movements
what should the PT do if the pt can’t hold the position actively
DO NOT perform PROM and DO NOT add overpressure
If AROM is limited but not painful, _____ can be done
overpressure
possible causes of restricted extension & R lateral flexion
R extension hypomobility
L flexor muscle tightness
Anterior capsular adhesions
R sublaxation
R small disc protrusion
possible caused of restricted flexion and R side bending
L flexion hypomobility
L extensor muscle tightness
Possible causes if restriction in extension & R side bending is GREATER than ext & L side bending
L posterior capsular adhesions
L sublaxation
L capsular pattern (arthritis, arthrosis)
Possible causes if restriction of flexion & R side bending = extension & L side bending
L arthrofibrosis (very hard capsular endfeel)
Possible cause of restriction of side bending in neutral, flexion, and extension
Uncovertebral hypomobility or anomaly
Nerve root responsible for neck flexion
C1-C2
Nerve root responsible for neck side flexion
C3 & CN XI (accessory)
Nerve root responsible for shoulder elevation
C4 and CN XI (accessory)
Nerve root responsible for shoulder abduction/ER
C5
Nerve root responsible for elbow flexion and/or wrist extension
C6
Nerve root responsible for elbow extension and/or wrist flexion
C7
Nerve root responsible for thumb extension and/or ulnar deviation
C8
Nerve root responsible for abduction and/or adduction of hand intrinsics
T1
C1 Dermatome
vertex of skull
C2 dermatome
temple, forehead, occiput
C3 dermatome
entire neck, posterior cheek, temporal area, prolongation forward under mandible
C4 dermatome
shoulder, clavicular area, upper scapular area
C5 dermatome
deltoid, anterior aspect of entire arm to base of thumb
C6 dermatome
anterior arm, radial side of hand to thumb and index finger
C7 dermatome
lateral arm and forearm to index, long, and ring fingers
C8 dermatome
medial arm and forearm to long, ring, and little finger
T1 dermatome
medial side of forearm to base of little finger
Usual nerve roots and muscles that are usually tested for reflex
Biceps (C6)
Triceps (C7)
Brachioradialis (C5-C6)
What to assess during FA?
Multiplanar activities of the neck (e.g. breathing, looking up at the ceiling, looking down at belt buckle or shoe, shoulder check)
Recommended OMT to use
Neck disability index
How to interpret Neck Disability Index
Raw score or percentage:
0-4 points (0-8%) - No disability
5-14 points (10-28%) Mild disability
15-24 points (30-48%) moderate disability
25-34 points (50-64%) severe disability
35-50 points (70-100%) complete disability
