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Ortho > C-spine > Flashcards

C-spine Flashcards

1
Q

How do you motion test for OA joint?

A
  • rotate C2-7 maximally, then nod actively
  • passively for coupling pattern: supine, flex upper cervical, apply traction, rotate 30 degrees, should see L flex occur opposite side
  • Flexion and extension is assessed; flexion restrictions most common
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2
Q

What is the coupling pattern for upper cervical spine?

A

Rotation and lat flex occur in opposite direction

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3
Q

How do you perform MET for OA joint?

A

Flex upper cervical spine, apply traction, rotate 30 to one side

  • look up and toward SS rotation for agonist
  • look down and toward contralateral side of rotation for antagonist
  • hold 5s, then mob into further rot/ lat flex
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4
Q

How do you motion test for the AA joint?

A
  • look at full cervical rotation; Max flex to lock out C2-7, rotate; should see at least 50% rotation ROM
  • Passive segmental mobility: translate C2 anterior
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5
Q

How do you do HEP MET for the AA joint

A
  • Max flex and rotate, with resistance for agonist or antagonist m’s provided by hands
  • opening on contralateral side to rotation
  • Closing on SS to rotation
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6
Q

How do you mob the CO-1 segment?

A

anterior force over CO-1 joint with pt in prone

- push until 1st pt of pain; hold; then push beyond pain

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7
Q

How do you mob the C2-3 segment?

A

find C2 SP, move laterally, push soft tissue medially; apply anterior force to articular pillars
- push until 1st pt of pain; hold; if tolerable, push past pain and mob

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8
Q

How do you mob the C1-2 segment?

A

find C2 SP and move laterally, push soft tissue medially; have pt rotate towards affected facet to lock out C2-3; apply anterolateral force (directed towards mouth) to articular pillars
- push until 1st pt of pain; hold; if tolerable, push past pain and mob

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9
Q

How do you mob for HA into upper cervical flexion or lower cervical extension?

A

pt seated; chin tuck either passively by PT or actively by pt; PT blocks level below targeted segment
- opposite fore upper cervical flexion and lower cereal extension

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10
Q

What are S and S of cervical myelopathy?

A
  1. Headache and head pain
  2. Sensory disturbance of the hands
  3. Muscle wasting of hand intrinsic muscles
  4. Unsteady gait
  5. Positive Babinski’s sign
  6. Hyperreflexia
  7. Multisegmental weakness and/or sensory changes
  8. Muscle spasms
  9. Easy fatigability
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11
Q

What are the special tests for ligamentous instability?

A
  1. Sharp-purser - resistance over forehead and thumb over C2 SP; pt slowly flexes head; + = head slide backward (injury to transverse lig)
  2. Lat Flex alar lig stress test - palp C2 SP; SB head; SP should move contralateral direction of SB; + = delay in SP movement
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12
Q

What are S and S of VA insufficiency?

A
  1. Drop attacks
  2. Dizziness or lightheadedness related to neck movement
  3. Dysphasia
  4. Dysarthria
  5. Diplopia
  6. Malaise and nausea
  7. Vomiting
  8. Severe headaches
  9. Unsteadiness in walking, incoordination
  10. Weakness in extremities
  11. Sensory changes in face or body
  12. Hearing difficulties
  13. Facial paralysis
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13
Q

What is the screening position for testing for VAI?

A

Rotation and extension; hold 10s

- can be done passively by PT or actively by pt in prayer position

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14
Q

What are the TBCs for neck pain?

A
  1. pain control
  2. centralization
  3. mobility
  4. Conditioning and increase exercise tolerance
  5. reduce headache
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15
Q

What are the examination findings for pain control TBC?

A
  1. Very recent onset of symptoms
  2. Symptoms precipitated by trauma
  3. Referred or radiating symptoms extending into the upper quarter
  4. Poor tolerance for examination or most interventions
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16
Q

What are the proposed interventions for pain control TBC?

A
  1. Gentle active ROM within pain tolerance
  2. ROM exercises for adjacent regions
  3. Physical modalities as needed
  4. Activity modification to control pain
17
Q

What are the examination findings for centralization TBC?

A
  1. Radicular/referred symptoms in the upper quarter
  2. Peripheralization and/or centralization of symptoms with ROM
  3. Signs of nerve root compression present
  4. May have diagnosis of cervical radiculopathy
18
Q

What are the proposed interventions for centralization TBC?

A
  1. Mechanical/manual cervical traction

2. Repeated movements to centralize symptoms

19
Q

What are the examination findings for mobility TBC?

A
  1. Recent onset of symptoms
  2. No radicular/referred symptoms in the upper quarter
  3. Restricted ROM with rotation and/or discrepancy in lateral flexion ROM
  4. No signs of nerve root compression or peripheralization in the upper quarter with cervical ROM
    - can have degenerative or traumatic hx
20
Q

What are the proposed interventions for mobility TBC?

A
  1. Cervical and thoracic spine mobilization/manipulation
  2. Active range of motion exercises
    - PA mobs as well as selective ROM for AA and OA
21
Q

What are the examination findings for conditioning and increased exercise tolerance TBC?

A
  1. Lower pain and disability scores
  2. Longer duration of symptoms
  3. No signs of nerve root compression
  4. No peripheralization/ centralization during ROM
22
Q

What are the proposed interventions for conditioning and increased exercise tolerance TBC?

A
  1. Strengthening and endurance exercises for the muscles of the neck and upper quarter
  2. Aerobic conditioning exercises
23
Q

What are the examination findings for reduce headache TBC?

A
  1. Unilateral headache with onset preceded by neck pain
  2. Headache pain triggered by neck movement or positions
  3. Headache pain elicited by pressure on posterior neck
24
Q

What are the proposed interventions for reduce headache TBC?

A
  1. Cervical spine manipulation/ mobilization
  2. Strengthening of neck and upper quarter muscles
  3. Postural education
25
Q

Is there evidence for traction?

A

yes; exercise + mechanical traction for pts with cervical radiculopathy resulted in in lower NDI and pain at 6 mo and 12 mo follow ups

26
Q

What is the coupling pattern for the lower cervical spine

A

same side coupling with rotation and lateral flexion

27
Q

What does dysfunction in 1st rib mobility lead to?

A

sx of TOS, cervical dysfunction, and breathing issues

28
Q

What does dysfunction in mid thoracic lead to?

A
  1. shoulder symptoms
  2. Head aches
  3. Mid back pain
  4. breathing issues
29
Q

When is traction indicated?

A
  1. +distraction test
  2. no directional preference
  3. pain dominant
30
Q

Quadrant’s test is positive. what does this indicate?

A

SB, extension, and rotation (foraminal closure)

  • Radicular pain = nerve root involvement
  • localized pain = facet joint pathology
31
Q

Spurling’s test is positive. what does this indicate?

A

SB (foraminal compression)

- radicular pain = radiculopathy

32
Q

What are some treatments for HA?

A
  1. OA and AA mobs/ MET (seated and prone)
  2. Occipital distraction
  3. manual traction
  4. lower cervical mobs/ MET in restricted motions
33
Q

How do you assess cervical stabilization?

A

chin tuck hold position

- should be able to hold chin tuck for 30s

34
Q

What are interventions for cervical stabilization?

A
  1. Pressure cuff at 20 mmHg, chin tuck without SCM for hold at 30mmHg, progress to graduated marks
  2. educate in sitting, standing, and during fxn’l activities

Ortho (10 decks)

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