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OCS prep > C-spine APTA (2) > Flashcards

C-spine APTA (2) Flashcards

1
Q

What are the common clinical findings associated with neck pain with headaches? (5)

A
  • unilateral headache associated with neck/suboccipital area symptoms that are aggravated by neck movements/positions
  • headache that is produced or aggravated with provocation of the ipsilateral posterior cervical myofascia and joints
  • restricted cervical ROM
  • restricted cervical segmental mobility
  • abnormal/substandard performance on the CCFT (craniocervical flexion test)
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2
Q

Describe the craniocervical flexion test.

A
  • Tests the NM control of the longus colli and capitus
  • Pt in supine hooklying. Neck to a neutral position, with inflatable pressure unit to 20 mmHg. Pt nods to an increase of 2 mmHg and holds for 10 seconds. Then rests for 10 seconds. Then repeats, with a subsequent increase in 2 mmHg (to 24 mmHg), with 10 second hold. Repeat to 30 mmHg.
  • normal to get to 26-30 mmHg.
  • substandard with loss of neutral position, or substitution of superficial neck flexors (SCM, scalenes).
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3
Q

What are the 2 standard symptoms of neck pain with headache?

A
  • noncontinuous and/or unilateral neck pain and associated (referred) headache
  • Headache precipitated or aggravated by neck movements or sustained positions
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4
Q

When assessing ROM in a pt w/ neck pain with headaches, what specifically should be looked at more closely?

A
  • rotation at C1-2
  • C1-2 has a high frequency of involvement in pts with neck pain with headaches
  • if less than or greater than 45*, it may be concerning for an issue at this segment
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5
Q

If C1-2 rotation is thought to be abnormal, what test should be performed? How is it conducted?

What is considered abnormal?

A
  • the FRT (Flexion-rotation test)
  • Pt in supine. Pt’s head and neck are maximally flexed, then passively rotate to each side. Normal ROM is ~45* to each side. ROM may be limited by pain/guarding. Abnormal can be considered < 32* of rotation. Clinically, the test is positive if there is a 10* reduction in ROM on either side.
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6
Q

How much rotation ROM is attained at C1-2? How many degrees to we get from the rest of the C-spine?

A
  • 50% rotation at C1-2 (45*)

- 4-8* at each other segment

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7
Q

What is the the difficult dx differential when trying to assess for neck pain with headaches?

A
  • migraines
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8
Q

A pt comes in with a referral for cervicogenic headaches, and presents with decreased ROM into flexion and extension. They also have some painful upper cervical segmental dysfunction. Is this more consistent with migraines or cervicogenic headache?

A
  • decreased flexion/extension ROM and painful upper cervical joint dysfunction is more indicative of cervicogenic headache
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9
Q

What does a muscle length/provocation test for neck pain with headaches look like?

A
  • Pt supine. Stabilize C2, and then bring pt into upper cervical flexion. Can emphasize the R or the L suboccipitals by rotating 20-30* to the R or L respectively.
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10
Q

What test should be used to assess muscle strength/endurance for pts with neck pain with headaches? What are the two “scores” for the test?

A
  • the CCFT
  • activation score: pressure achieved and held for 10 seconds
  • performance score: increase in pressure multiplied by number of repetitions
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11
Q

What is expected for a CCFT score for pts with neck pain with headaches compared to the normal population?

A
  • lower activation and performances score, although same highest pressure
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12
Q

What is test looks as the endurance of neck flexors that is appropriate for pts with neck pain with headaches? How is it performed?

A
  • neck flexor endurance test
  • pt in supine hooklying with head/neck in neutral position. Maximally retracts chin, keeping that alignment, then lifts head ~ 1” off plinth.
  • Therapist places hand under occiput and focuses on skin folds on anterior neck.
  • Pt cued to tuck chin and keep head up if head touches hand, or skin folds begin to separate. Only gets one cue.
  • losing skin fold or touching hand for >1 second afterwards ends the test
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13
Q

What are the average hold times for the neck flexor endurance test for men and women?

What about pts with neck pain?

A
  • men: 39 seconds
  • women: 29 seconds
  • pain: 24 seconds
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14
Q

What are appropriate manual techniques and stretches for neck pain with headaches?

A
  • suboccipital stretching
  • C1-2 mobilizations and contract-relax for rotation
  • C0-1 mobilizations/manipulations and contract-relax for flexion/general mobility
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15
Q

What does a self-stretch of the suboccipitals look like?

A
  • supine hooklying.

- Pt gently nods until stretch felt, then hold

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16
Q

Are there cervical strength deficits in pts with neck pain?

Does intensity of contraction make a difference?

A
  • yes
  • in both strength as well as endurance, most specifically with craniocervical flexion
  • in endurance not only at moderate intensities, but low intensities as well
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17
Q

Is exercise, manual, or a combination more effective with neck pain with headaches?

A
  • the combination is most effective (~10%) per the one study that looked at it.
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18
Q

Is exercise alone or manual alone more effective for neck pain with headaches?

A
  • nope; about the same in effectiveness
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19
Q

What exercises have support for efficacy for neck pain with headaches?

A
  • supine DNF therex

- isometrics with low level rotation with flexor/extensor co-contraction

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20
Q

T or F;

Stretching, postural education, and strengthening exercises do not have an effect on neck pain with headaches.

A
  • F

- shown to reduce frequency of headaches and disability, even at 1 year follow-up.

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21
Q

What two interventions are appropriate for a workplace population?

A
  • workplace education
  • physical exercise programs
  • reduced frequency of neck pain, headaches, and shoulder pain at 2, 8, and 12 months
  • short term and long term effects
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22
Q

What are the common clinical findings associated with neck pain with movement coordination impairments? (6)

A
  • chronic neck pain (>12 weeks)
  • abnormal/substandard CCFT performance
  • abnormal/substandard deep flexor endurance test
  • coordination, strength, endurance deficits of neck and upper quarter muscles (longus colli, middle/lower traps, serratus anterior)
  • flexibility deficits of upper quarter muscles (scalenes, UT, levator scap, pec major/minor)
  • ergonomic inefficiencies with performing repetitive actions
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23
Q

What are the common symptoms of neck pain with movement coordination impairments?

A
  • neck pain with associated (referred) UE pain

- symptoms are often linked to a preceding trauma/whiplash

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24
Q

What would be expected with an AROM assessment in a pt w/ neck pain with movement coordination impairments?

A
  • limited range

- pts w/ chronic neck pain (a common clinical finding) typically have 25-35% less ROM than normal

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25
Q

What tests should be conducted to assess strength in pts with neck pain with movement coordination impairments?

A
  • the CCFT and neck flexor endurance test

- expecting substandard performance

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26
Q

What is a general summary for whether/what types of exercise are helpful for neck pain?

A
  • It should be done. It’s more effective than modalities. It has longer term effects.
  • There doesn’t seem to be a difference between low or high intensity therex
  • Proprioceptive focused exercises also have value
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27
Q

What are the 2 primary exercise focuses examined in the literature for neck pain?

A
  • craniocervical flexion

- lower cervical extension

28
Q

What is the standard execution of craniocervical flexion exercise?

A
  • Pt in supine hooklying with head/neck in mid-range/neutral (supported w/ towels as necessary).
  • in the clinic, pneumatic pressure feedback device can be used
  • at home, not necessary
  • palpate superficial musculature to ensure lack of substitution
  • tongue to roof of mouth, lips together, teeth slightly separated
29
Q

What cue can be used to minimize activation of platysma or hyoid during craniocervical flexion therex?

A
  • tongue to roof of mouth, lips together, teeth slightly separated
30
Q

Describe execution of lower cervical extensor training.

A
  • Pt can be prone on elbows, hands and knees, or sitting.
  • Then allow the neck to slowly flex down with return to starting position, while keeping neutral craniocervical alignment.
  • Pt should try to generate the movement from the lower cervical spine instead of the upper cervical spine
31
Q

What are the common clinical findings associated with neck pain with radiating pain? (4)

A
  • UE symptoms, usually radicular or referred pain, that are produced or aggravated with Spurling maneuver and ULTTs, and reduced with the neck distraction test
  • decreased cervical rotation (<60*) toward the involved side
  • signs of nerve root compression
  • success with reducing UE symptoms with initial exam and intervention procedures
32
Q

What are common symptoms associated with neck pain with radiating pain?

A
  • neck pain with associated radiating pain (narrow band of lancinating) in the involved UE
  • UE paresthesias
  • UE numbness
  • UE weakness
33
Q

What are some common signs of an upper motor neuron pathology? (5)

A
  • hyperreflexia (upper or lower extremities, clonus)
  • positive Hoffman or Babinski
  • clumsiness of gait
  • generalized weakness below level of compression
  • diffuse sensory changes that don’t follow a dermatomal pattern
34
Q

What conditions may be associated with an upper motor neuron pathology that could be more mechanical in nature?

A
  • cord compression

- cervical myelopathy (essentially cord compression resulting in motor changes)

35
Q

What are some common signs of lower motor neuron pathology? (3)

A
  • hyporeflexia
  • decreased sensation to light touch in dermatomal pattern
  • muscle weakness in myotomal pattern
36
Q

What nerve roots should be tested with concern for radicular pathology?

A
  • C5-T1
37
Q

What are the myotomal/dermatomal/DTR patterns to be tested with C5?

A
  • deltoids
  • lateral forearm
  • Biceps brachii (C5,6)
38
Q

What are the myotomal/dermatomal/DTR patterns to be tested with C6?

A
  • Biceps brachii and extensor carpi radialis longus/brevis (wrist extension and radial deviation in pronation)
  • distal thumb
  • brachioradialis (C5,6; elbow flx in neutral forearm rotation)
39
Q

What are the myotomal/dermatomal/DTR patterns to be tested with C7?

A
  • Triceps and flexor carpi radialis (wrist flexion and radial deviation)
  • distal middle finger
  • Triceps
40
Q

What are the myotomal/dermatomal/DTR patterns to be tested with C8?

A
  • abductor pollicis brevis (thumb in abduction, resistance against proximal phalanx towards adduction)
  • distal 5th digit
  • no DTR
41
Q

What are the myotomal/dermatomal/DTR patterns to be tested with T1?

A
  • First dorsal interossei (index and middle finger separated; resistance at proximal phalanx trying to bring them together)
  • medial forearm
  • no DTR
42
Q

What are the two scales to grade reflexivity?

A
  • 0-4+:
    • 4+: hyperreflexivity indicative of upper motor neuron lesion
    • 3+: hyperreflexive w/in normal range
    • 2+: normal
    • 1+: hyporeflexive w/in normal range
    • 0: absent
  • or:
    • increased
    • normal
    • reduced/absent
43
Q

T or F;

  • neurological testing can be diagnostic of cervical radiculopathy.
A
  • F; nope…with the arguable exception of the C5 DTR

- Basically, it’s not enough to cleanly dx; which makes sense. There are a lot of potential causes for neuro changes.

44
Q

What neurological screening test is the most helpful to rule in a cervical radiculopathy?

A
  • biceps reflex; if positive (reduced/absent), the likelihood for cervical radiculopathy increases from 23-59%
45
Q

Describe Hoffman’s test.

What’s the sensitivity for UMN lesion?

A
  • pt sitting or standing
  • hold the pt’s hand in pronation, while stabilizing proximal to the distal interphalangeal joint of the middle finger. Then flick the distal middle finger downward.
  • positive sign would be thumb adduction w/ or w/o index finger flexion
  • sensitivity is 94%
46
Q

What musculature may mimic radicular pain with a muscle length deficit?

A
  • scalenes
  • pec minor
  • probably more than this…
47
Q

What variation of the ULTT is most closely associated with cervical radiculopathy?

A
  • median nerve variant
48
Q

Describe the sequence for median n. ULTT.

A
  • pt supine
  • scapular depression
  • shoulder abduction to 90-110* w/ elbow flexed
  • forearm supination, wrist and finger extension
  • shoulder external rotation
  • elbow extension
  • contralateral and/or ipsilateral cervical sidebend
  • positive with:
  • partial or full symptom reproduction
  • side-to-side differences of >10* for ROM at same sensitizing joint, or
  • determine location on the symptomatic side
49
Q

What is the sensitivity/specificity for median n. ULTT?

A
  • sensitivity is 97%
  • specificity is 22%
  • excellent screen for radiculopathy, however not specifically diagnostic.
50
Q

Describe execution of Spurling’s test.

What is it designed to detect?

What is it’s sensitivity/specificity?

A
  • pt seated. Sidebends/slightly rotates to the involved side. Therapist adds compressive force at head of ~7kg (15.4 lbs).
  • designed to provoke symptoms by reducing neural foramen size.
  • sensitivity is 50%, specificity is 90%.
  • so if it’s positive, it’s pretty likely that there is a mechanical impingement in the c-spine
51
Q

Describe execution of the distraction test.

What is it designed to detect?

What is it’s sensitivity/specificity?

A
  • pt supine. Therapist grasps under chin and occiput. Neck flexed to a position of comfort, and then gradually distracted to ~14kg (30.8 lbs). Positive if reduction or elimination of symptoms.
  • designed to detect mechanical compression of nerve root, by reduction of symptoms with increasing foramen size
  • sensitivity is 44%, specificity is 90%
52
Q

What cluster of tests/signs is fairly diagnostic for cervical radiculopathy? How many are needed? What are the general stats?

A
  • ULTT A (median n.)
  • Spurling’s
  • Distraction
  • <60* rotation to the involved side
  • 3 of 4: sensitivity (39%), specificity (94%)
  • 4 of 4: sensitivity (24%), specificity (99%)
53
Q

Is a valsalva useful for diagnosing cervical radiculopathy?

What is the described execution?

A
  • kind of.
  • sensitivity 22%
  • specificity 94%
  • Pt seated. Instructed to take a deep breath, hold it, and then exhale for 2-3 seconds. Positive test is symptom reproduction.
54
Q

What is a cluster of 4 predictors for who is likely to achieve success from a PT intervention in the short term for cervical radiculopathy?

What is the likelihood of success in general? How much does it increase with 3 of 4, or 4 of 4?

A
  • age <54
  • dominant arm not affected
  • symptoms not worsened when looking down
  • multimodal treatment including manual therapy, cervical traction, and deep neck flexor strengthening for at least 50% of the visits
  • In general, 53% will likely see favorable results at 4 weeks.
  • 3 of 4: increases to 85%
  • 4 of 4: increases to 90%
55
Q

What two interventions are typically most effective when treating cervical radiculopathy?

A
  • cervical traction and manual therapy

- significant impact on disability

56
Q

In general, is treatment for cervical radiculopathy better than “wait and see”? Is it better than surgical management?

A
  • Yes. Significant improvements with primarily strengthening therex and HEP.
  • Not necessarily better than surgical management, but as good.
57
Q

What is standard practice for therex for cervical radiculopathy?

A
  • graded exercises for deep/superficial neck muscles and scapulae
58
Q

Is intermittent cervical traction and thoracic thrust manipulation helpful for cervical radiculopathy management?

A
  • in general, yes. Some mixed evidence for how much cervical traction adds, but overall it has good support it seems. Cervical traction should not be considered the primary intervention.
59
Q

Is a semi-rigid collar appropriate for cervical radiculopathy management?

A
  • one study showed good effects when it was part of a multimodal approach. It was compared to “wait and see” though, so how important the brace was is debateable.
60
Q

Describe the findings of the study that broke up treatment targets between mobilizing neural tissue structures and the C-spine, vs articular components of the GH joint and T-spine.

A
  • Went for 8 weeks. Both groups improved in pain and function.
  • The neuromobilization group had significantly better improvements in pain, however
61
Q

How did neuromobilization compare to therapeutic ultrasound in one study?

A
  • it was better; improved elbow ROM and more improved pain
62
Q

What is a primary consideration when trying to intervene with a radiculopathy with neuromobilization techniques?

A
  • it’s important to localize the source of entrapment peripherally.
  • should start with soft tissue mobilization near the entrapment, and then follow that with nerve mobilization exercises
63
Q

What is more likely to be helpful; intermittent or continuous cervical traction?

A
  • intermittent has more support as producing an effect
64
Q

What is the CPR to predict those who may benefit from intermittent cervical traction?

How many variables are needed? How much does the probability of success increase by?

A
  • pt reported peripheralization with lower cervical spine (C4-7) mobility testing
  • positive shoulder abduction sign
  • age >/= 55
  • positive ULTT A
  • relief of symptoms with distraction test
  • generally, will have 44% chance of success with intermittent cervical traction
  • 2 of 6: increases to 79%
  • 3 of 6: increases to 53% **this is weird
  • 4 of 6: increases to 95%
  • basically, I’d want at least 4
65
Q

Is mechanical intermittent or continuous over-the-door traction likely more helpful?

A
  • mechanical per one study.

- Traction seems to be a helpful adjunct treatment overall

66
Q

Is B neck pain more consistent with neck pain with mobility deficits, or movement coordination deficits?

A
  • movement coordination deficits

- mobility deficits is usually unilateral

67
Q

What questionnaire is preferred to provide insight into long-term disability in pts w/ neck pain?

A
  • FABQ

- NDI doesn’t predict future disability

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