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MSK1 > 7.3: Cervical Spine - Examination > Flashcards

7.3: Cervical Spine - Examination Flashcards

1
Q

T/F: Tone of the subjective assessment will not rely on how well the patient understands you

A

False, it does rely

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2
Q

T/F: Always consider pt’s educational background and match what language the pt is used to

A

True

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3
Q

T/F: You can ask the occupation in the demographic part of the subjective

A

true

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4
Q

Why is distance from home to work or clinic asked

A

the distance or the commute to these areas may be a big factor in manifesting neck pain

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5
Q

what is asked in the demographic

A

name, age, sex, handedness, systemic conditions (sometimes occupation if the need arises but is documented in lifestyle)

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6
Q

T/F: in pt’s c neck conditions, asthma will not cause hypertrophy of the breathing muscles in any way

A

False

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7
Q

Most common complaint of pts with neck conditions

A

pain

weakness

heaviness

stiffness or LOM

numbness/paresthesia (sometimes referred in other regions)

headaches/dizziness

funcional limitations

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8
Q

Characteristics of pain

A

Intensity

Onset

Location

Description of sensation

Frequency and duration

Pattern

Aggravating & relieving factors

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9
Q

why ask type of pain

A

to know what structure is affected

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10
Q

why is location of pain important

A

it can also help with differential diagnosis as some conditions present with localized pain while some present with diffused pain, radiating pain, referred pain

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11
Q

quality and quantity of pain

A

Consistency/duration
Location
Intensity
Type of pain

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12
Q

T/F: PT should establish the 24 hour behavior of pain

A

true

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13
Q

persistent pain may indicate what?

A

malignancy or other conditions that may have something that occupies the spaces in the cervical region

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14
Q

Weakness & heaviness may signify what

A

myotomal problems

heavines may indicate vascular problems

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15
Q

Why can headaches & dizziness be a chief complaint?

A

d/t the msk dysfunction of the spine especially in the C1-C3 levels

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16
Q

What may headaches indicate

A

muscle tightness

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17
Q

how does headaches that are musculoskeletal in origin present

A

unilaterally

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18
Q

What to ask if the pt complains of headaches?

A

frequency, when does it stop, is it recurring (these are not all)

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19
Q

Next step if the pt’s headache is a major complaint after trauma

A

bring to ER ASAP and defer treatment and refer to other professionals in that specific field

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20
Q

Reports of dizziness is under what realm?

A

usually vestibular (ear) function

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21
Q

What to suspect if pt complains of dizziness?

A

Vestibular problems or Vertebrobasilar insufficiency

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22
Q

what are the 5Ds of VBI

A

dizziness

diplopia

drop attack

dysarhria

dysphagia

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23
Q

what to ask in pts c dizziness

A

intensity, duration, and if it associated with certain positions

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24
Q

what does dizziness associated c positions indicate?

A

may indicate a semicircular canal problem

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25
Q

fainting of the pt c intact consciousness and is usually associated c Hypoxia in the brain

A

drop attack

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26
Q

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

A

functional limitation

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27
Q

the longer the interview, the ____ the considered conditions should be

A

lesser

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28
Q

by the end of the subjective, the PT has at least ____ conditions that are considered

A

2-3 (accdg to sir jose)

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29
Q

What do we usually ask in the HPI of pts c neck problems

A

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

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30
Q

What is usually asked in PMHx

A

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

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31
Q

What to ask in the physical environment

A

pertinent house furnitures or appliances

ask also about sleeping arrangements such as mattresses and pillows

work ergonomics

type of commute

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32
Q

T/F: pillow height does not contribute to neck pain

A

false

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33
Q

T/F: position of the arms during sleep can strain the neck or overstretch the contralateral brachial plexus

A

true

34
Q

Why do we consider the type of chair used by the pt

A

the chair is one of the causes of spinal alignment alteration

35
Q

T/F: PT should ask pt to estimate the height of the chairs and tables used

A

True

36
Q

subdivisions of the subjective assessment

A

demographics

chief complaint

hpi

pmhx

physical environment

psychosocial environment

lifestyle and hobbies

pt’s goal

37
Q

why do we need to ask the psychosocial environment

A

identify behavioral problems present that may contribute to the condition

38
Q

what is usually asked in the psychosocial environment

A

beliefs

influences

family or social support

dependents

level of stress and anxiety

coping strategies

if pt can pay for the Tx

39
Q

why is it important to know if pt can pay for the treatment

A

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

40
Q

Usual questions asked in lifestyle and hobbies

A

Type of work, usual position, workload

risk factor profile (alcohol, tobacco use, dietary habits)

past & present levels of activity

41
Q

why is substance use important to note?

A

alcohol and smoking can contribute to vascular conditions and these conditions may present Sx in the neck area

42
Q

what should PT get in pt’s goal

A

always be elimination of Sx, should follow up by asking why pt wants to eliminate the Sx

43
Q

What to check in Ocular inspection

A

manner of arrival

mental status

facial expression/wincing

protective posturing

attachments and assistive devices

signs of inflammation

trophic skin changes

deformities, asymmetries, deviations

44
Q

what to look for in palpation

A

skin temp

muscle tone

muscle spasm

muscle guarding

tenderness

mobility of spinous process

tightness or contractures

taut bands, nodules, trigger points

45
Q

T/F: the postural assessment can be done without a plumb line

A

True but it is risky as the plumb line is important to really differentiate

46
Q

Why is Postural assessment usually done first

A

it helps PT know if they have plenty to check later on

47
Q

T/F: the dominant side is usually higher

A

False, it is ALWAYS lower

48
Q

Injured side is usually _____

A

higher

49
Q

in checking ROM, the most painful movement should be done _____

A

last

50
Q

Capsular pattern for the cervical spine

A

side flexion & rotation > rotation

51
Q

what does it imply if painful movement is relieved?

A

condition is not irritable

52
Q

if the pain is not resolved condition is ____ and pain may ____

A

irritable; worsen

53
Q

Normal endfeel for all 4 cervical movements

A

Tissue stretch (firm)

54
Q

PPIVM meaning

A

passive physiological intervertebral movements

55
Q

what should the PT do if the pt can’t hold the position actively

A

DO NOT perform PROM and DO NOT add overpressure

56
Q

If AROM is limited but not painful, _____ can be done

A

overpressure

57
Q

possible causes of restricted extension & R lateral flexion

A

R extension hypomobility

L flexor muscle tightness

Anterior capsular adhesions

R sublaxation

R small disc protrusion

58
Q

possible caused of restricted flexion and R side bending

A

L flexion hypomobility
L extensor muscle tightness

59
Q

Possible causes if restriction in extension & R side bending is GREATER than ext & L side bending

A

L posterior capsular adhesions
L sublaxation
L capsular pattern (arthritis, arthrosis)

60
Q

Possible causes if restriction of flexion & R side bending = extension & L side bending

A

L arthrofibrosis (very hard capsular endfeel)

61
Q

Possible cause of restriction of side bending in neutral, flexion, and extension

A

Uncovertebral hypomobility or anomaly

62
Q

Nerve root responsible for neck flexion

A

C1-C2

63
Q

Nerve root responsible for neck side flexion

A

C3 & CN XI (accessory)

64
Q

Nerve root responsible for shoulder elevation

A

C4 and CN XI (accessory)

65
Q

Nerve root responsible for shoulder abduction/ER

A

C5

66
Q

Nerve root responsible for elbow flexion and/or wrist extension

A

C6

67
Q

Nerve root responsible for elbow extension and/or wrist flexion

A

C7

68
Q

Nerve root responsible for thumb extension and/or ulnar deviation

A

C8

69
Q

Nerve root responsible for abduction and/or adduction of hand intrinsics

A

T1

70
Q

C1 Dermatome

A

vertex of skull

71
Q

C2 dermatome

A

temple, forehead, occiput

72
Q

C3 dermatome

A

entire neck, posterior cheek, temporal area, prolongation forward under mandible

73
Q

C4 dermatome

A

shoulder, clavicular area, upper scapular area

74
Q

C5 dermatome

A

deltoid, anterior aspect of entire arm to base of thumb

75
Q

C6 dermatome

A

anterior arm, radial side of hand to thumb and index finger

76
Q

C7 dermatome

A

lateral arm and forearm to index, long, and ring fingers

77
Q

C8 dermatome

A

medial arm and forearm to long, ring, and little finger

78
Q

T1 dermatome

A

medial side of forearm to base of little finger

79
Q

Usual nerve roots and muscles that are usually tested for reflex

A

Biceps (C6)

Triceps (C7)

Brachioradialis (C5-C6)

80
Q

What to assess during FA?

A

Multiplanar activities of the neck (e.g. breathing, looking up at the ceiling, looking down at belt buckle or shoe, shoulder check)

81
Q

Recommended OMT to use

A

Neck disability index

82
Q

How to interpret Neck Disability Index

A

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

MSK1 (8 decks)

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