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PT OCS Exam > C/S and T/S > Flashcards

C/S and T/S Flashcards

1
Q

Neck Outcome Predictors

A

Pre-op use of weak narcotics, dermatomal sensory loss and worker’s compensation cases decrease likelihood of improvement 50%

NDI improves by 2.3x if patient is working vs. litigation pending (33%)

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2
Q

Neck Outcome Predictors

A

Pre-op use of weak narcotics, dermatomal sensory loss and worker’s compensation cases decrease likelihood of improvement 50%

NDI improves by 2.3x if patient is working vs. litigation pending (33%)

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3
Q

Ottawa C/S rules to R/O fracture

A

No XR if there is >45 degrees Bilat. ROM and no risk factors present (if unable to rotate to 45 recommend XR)

High Risk (yes = XR if: Age >65, Dangerous MOI (fall from 1 m (5 stairs), diving injury, high speed MVC or rollover/ejection, Bike collision), Paraesthesia in UE/LE

Low Risk, (no = XR) if: Simple RE MVC, sitting position in ED, Able to ambulate, delayed pain onset, no mid C/S tenderness

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4
Q

Nexus II CT scan S/P head injury

A 
Evidence of skull Fx
Scalp hematoma
Neuro deficit
Altered alertness (GCS 15)
Age > 65
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5
Q

Neck pain classification

A 
Pain Control
Centralization
CGH
Exercise and conditioning
Mobility
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6
Q

Mobility

A

Recent onset of symptoms
No radiculopathy
Tx: MTT and exercise

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7
Q

Pain Control

A

Temporary classification until they can be classified. Acute injury.

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8
Q

Centralization

A

Radiculopathy
Sx below the elbow
Tx: Promote centralization

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9
Q

Headache

A

Primary C/O CGH

Tx:MTT, DNF training, Scapular PREs

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10
Q

Exercise/Conditioning

A

No Radiculopathy
Age>60
Chronic
Strength and conditioning exercises

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11
Q

Chronic neck pain factors

A 
Age > 40
H/O C/S pain and coexsting LBP
Cycling
Dec. strength in hands
Worrisome attitude
Poor quality of life
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12
Q

ICF classification

A

Neck pain with: Mobility Impairments, Headaches, radiating/radiculopathy, movement/coordination impairments

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13
Q

Neck pain with mobility impairment

A

C/S AROM

C/S and T/S segmental mobility

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14
Q

Neck pain with Radiculopathy

A

ULTT(A)
Spurling’s
Distraction
Involved side rotation

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15
Q

Neck pain with Radiculopathy

A

ULTT(A)
Spurling’s
Distraction

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16
Q

Use of Thoracic HVLA for neck pain (CPR) (4/6 or more is ideal)

A

Sx

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17
Q

Use of HVLA for neck pain (CPR) (3/4)

A

Sx

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18
Q

Ottawa C/S rules to R/O fracture

A

No XR if there is >45 degrees Bilat. ROM and no risk factors present (if unable to rotate to 45 recommend XR)

High Risk (yes = XR if: Age >65, Dangerous MOI (fall from 1 m (5 stairs), diving injury, high speed MVC or rollover/ejection, Bike collision), Paraesthesia in UE/LE

Low Risk, (no = XR) if: Simple RE MVC, sitting position in ED, Able to ambulate, delayed pain onset, no mid C/S tenderness

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19
Q

Nexus II CT scan S/P head injury

A

Evidence of skull Fx
Scalp hematoma
Neuro deficit
Altered alertness (GCS 65

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20
Q

Neck pain classification

A 
Pain Control
Centralization
CGH
Exercise and conditioning
Mobility
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21
Q

Mobility

A

Recent onset of symptoms
No radiculopathy
Tx: MTT and exercise

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22
Q

Centralization

A

Radiculopathy
Sx below the elbow
Tx: Promote centralization

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23
Q

Headache

A

Primary C/O CGH

Tx:MTT, DNF training, Scapular PREs

24
Q

Exercise/Conditioning

A

No Radiculopathy
Age>60
Chronic
Strength and conditioning exercises

25
Q

Chronic neck pain factors

A 
Age > 40
H/O C/S pain and coexsting LBP
Cycling
Dec. strength in hands
Worrisome attitude
Poor quality of life
26
Q

ICF classification

A

Neck pain with: Mobility Impairments, Headaches, radiating/radiculopathy, movement/coordination impairments

27
Q

Dermatomes

A

C4 - Over the acromioclavicular joint.

C5 - On the lateral (radial) side of the antecubital fossa, just proximally to the elbow.

C6 - On the dorsal surface of the proximal phalanx of the thumb.

C7 - On the dorsal surface of the proximal phalanx of the middle finger.

C8 - On the dorsal surface of the proximal phalanx of the little finger.

T1 - On the medial (ulnar) side of the antecubital fossa, just proximally to the medial epicondyle of the humerus.

T2 - At the apex of the axilla.

28
Q

Myotomes

A 
C1/C2: neck flexion/extension
C3: neck lateral flexion
C4: shoulder elevation
C5: shoulder abduction
C6: elbow flexion/wrist extension
C7: elbow extension/wrist flexion
C8: finger flexion
T1: finger abduction
29
Q

Neck pain with Radiculopathy

A

ULTT(A)
Spurling’s
Distraction

30
Q

Neck pain with movement/coordination impairment

A

CCFT (biofeedback at 22-30 in 2 mm/Hg intervals x10 sec each

DNF endurance test (40 sec average norm in patients with no neck pain)

31
Q

Use of C/S HVLA for neck pain (CPR) (3/4 predictors ideal)

A

Sx 10 degrees
Pain with PA to mid-C/S
Positive patient expectations

32
Q

C/S screening exam

A 
Blood Pressure
Cardiovascular status
Craniovertebral ligament testing (Alar ligament)
Neuro Exam
Positional testing
Carotid palpation
CVA risk? (stroke card)
33
Q

Cervical Artery risk factors

A 
Trauma to upper C/S
H/O migraine
HTN
High cholesterol
Cardiac disease
DM
Coagulopathy or on thinners
long-term steroids
Recent infection
Post-partum
no mechanical cause of symptoms or trivial head/neck trauma
34
Q

CONTRAINDICATIONS for C/S OMT

A 
Multi-level nerve pathology
Worsening neuro function
Severe, non-mechanical pain
Unremitting night pain
Recent trauma
UMN lesion
SCI
35
Q

Instability (Risk factors)

A 
Congenital Syndrome (Down's)
Throat infection
H/O trauma to C/S
RA or Ankylosing spondylitis
Recent head, neck or dental surgery
36
Q

CONTRAINDICATIONS for C/S manipulation

A 
Dislocation
**Acute Fx or soft tissue injury**
Instability
Tumor
Infection
Myelopathy
Recent Sx
Osteoporosis
Anky. Spondylitis
RA
Vascular disease
VAI
Connective tissue disease
Coagulopathy or thinners
37
Q

Red Flags

A 
**H/O VBI**
dizziness
blurred vision
diplopia
nausea
tinnitus
drop attacks
dysarthria
dysphagia
38
Q

Cervical Myelopathy

A 
Stocking glove sensory changes
Intrinsic muscle wasting
Hyperreflexia (3+)
Multi-segmental neuro changes
Bowel-Bladder changes
Unsteady gait

(+) Clonus, Hoffman, Babinski (UMN lesion)

39
Q

C/S Myelopathy Dx cluster (3+/5)

A 
Gait abnormality
Age > 45
Babinski +
inverted supinator
Hoffman's +
40
Q

Radiculopathy

A

Usually affects C5-C6

Dermatome - Radial 1/3 of the arm
Myotome - Biceps, wrist extension
DTR - Biceps

41
Q

Neural tension test false positives

A

ULTT occurs at 49.4 degrees of elbow extension

Slump occurs at 15 degrees of knee extension

42
Q

Cervical Radi. predictors of short-term improvement (3/4)

A

Age

43
Q

Patients to benefit from traction and exercise (CPR, 4+/5)

A 
Age > 55
Peripheralization with C4-C7 mobility
\+ ULTT
\+ Bakody
\+ Distraction
44
Q

Traction paramaters

A

No difference between 10-40 lbs. of force

45
Q

Neuro glides tecniques

A

Sliding (distal end lengthens while proximal end shortens)

Tensioning (distal and proximal end both lengthen)

*sliding doubles excursion with less strain of the nerve

46
Q

Thoracic Outlet Syndrome

A

Neurogenic (75%) followed by venous or arterial
Pain/numbness/tingling on affected side

Venous - discoloration with swollen UE, aching and heaviness

Arterial - Chronic claudication with use

47
Q

TOS exam

A

1st rib elevated
(+)CRLF test with opposite rotation and same side bending
Limited C-T junction mobility
+ULTT (ulnar N)
Pulse usually intact
Muscle imbalance with shortened scalenes,pec. minor and LS, weak SA, Lats, LT
Poor Posture

48
Q

Whiplash (WAD)

A

usually grouped in the pain control group (symptoms might delay 48 hours and last for 3 months)

Tx: Education on normal activity ASAP, NSAIDs, pain-free ROM

*collar only if absolutely necessary for a few days but narcotics and relaxants not recommended

49
Q

Cervicogenic headaches

A

Unilateral without side shift and ipsilateral UE pain
Aggravated by neck movement

Tx:DNF and posture training, self-snag technique for HEP

50
Q

Trigeminocervical neucleus

A

TMJ, headache and neck pain all related because of this structure

51
Q

Migraines

A

can be treated by greater occipital nerve block (30 day relief)

52
Q

CGH (Dx CLuster 3/3)

A

Dec. AROM extension
Pain with OA-C3/C4 joint palpation
CFFT impaired

53
Q

C1-C2 Ligament stability test

A

Sharp’s Pursor (tests the cruciform ligament)

Alar ligament

54
Q

C/S ROM

A

CO-C1 responsible for nodding while C1-C2 is responsible for 50% of rotation ROM

55
Q

Red Flags

A

Pancoast Tumor: H/O smoking in men over 50 y/o, nagging shoulder and scapular pain into ulnar distribution with possibility of Horner’s syndrome

Central Cord lesion: Older age, H/O trauma, RA or Down’s. Presents with gait disturbance with hyper reflexia.

Septic Arthritis: Insidious chest pain in the SC joint, H/O drug use, DM or trauma. Fever and swelling likely present.

Cholecystitis: R side medial scapular pain

PT OCS Exam (8 decks)

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