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ORTHO 2 > C-spine exam > Flashcards

C-spine exam Flashcards

1
Q

incidence of neck pain

A

22-70% of the population will have neck pain at some point in their life

10-20% of population of report neck pain at any one point in time

54% have experienced neck pain within the last 6 months

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2
Q

severity of neck pain incidence

A

up to 44% will become chronic (> 6 mo)

5% will become disabled

second only to LBP in workers comp

typically 25% of patients receiving OP PT

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3
Q

common medical diagnoses

A 
arthritis
disc pathology
trauma (fractures, dislocations, etc)
tumors
infection
torticollis
myofascial pain syndrome
whiplash

for most coming to PT:

  • clear diagnostic criteria is not established
  • pathoanatomical cause is not identifiable
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4
Q

risk factors for poor outcome

A
  • age >40
  • co-existing LBP
  • long hx of neck pain
  • bicycling as regular activity
  • loss of strength in hands
  • “worrisome” attitude
  • poor quality of life
  • “less vitality”
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5
Q

tincture of time

A

does the “wait and see,” “time heals all wounds” work with mechanical neck pain??

“the changes in pain scores over the varying trial periods in these untreated subjects with chronic mechanical neck pain were consistently small and not significant”

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6
Q

patient management

A

follows same sequence as learned for the extremities:

  • exam
  • eval
  • diagnosis
  • prognosis
  • intervention
  • re-eval/outcomes
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7
Q

exam

A

follows same process as for extremities:

HISTORY
PHYSICAL EVAL:
-observation- posture, symmetry, edema, color
-palpation-mobility, tenderness, TrP
-clear above and below
-ROM/flexibility
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8
Q

History

A

PMH- (intake form)

HPI- (intake form)

Systems Screen-

Subjective-

  • listen for red/yellow flags
  • VAS or NPRS
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9
Q

VAS

A

visual analog scale

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10
Q

NPRS

A

national pain rating scale

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11
Q

MCID

A

minimal clinical ? difference

=2 point difference in VAS or NPRS to say there is a significant difference

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12
Q

observation

A

POSTURE

MUSCLE SYMMETRY

KINESIOPHOBIA

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13
Q

posture

A

note deviations, correct and note change in symptoms

Frontal Plane:

  • lat flexion
  • rotation
  • scapular position (elevated/rotated/winging)

Sagittal Plane:

  • eyes & mandible normally horizontal
  • forward head posture- common!
  • protracted/retracted shoulder
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14
Q

muscle symmetry

A

hypertrophy, atrophy, spasm

  • upper//mid/lower trap
  • deltoid x3
  • pec major
  • SCM
  • infraspinatus
  • lat dorsi
  • erector spinae
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15
Q

kinesiophobia

A

how comfortable/willing are they to move?

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16
Q

palpation

A 
temperature
skin mobility
fascial tightness
muscle spasm (localized vs. general)
Trigger points
tender points
bony prominences
-mastoid
-nuchal line
-spinal processes
-articular pillar
-facets
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17
Q

motion testing

A

AROM –> PROM (overpressure)

  • 2 methods flexion
  • 2 methods extension
  • protraction/retraction
  • lateral flexion
  • rotation
  • distraction
  • compression
  • spurling’s
  • scapular mobility
  • segmental motion
  • local sign
  • referred sign
  • quadrant
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18
Q

local sign

A

maximally close down 1 side- facet

*if there is degeneration you can expect local sharp pain

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19
Q

referred sign

A

when facet closes, intervertebral foramen closes (stenosis and hypertrophy, disc protrusion)

will pinch the nerve root coming through there

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20
Q

to maximally stress the upper c-spine

A

retract for flexion

protract for extension

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21
Q

to maximally stress the lower c-spine

A

protract for flexion

retract for extension

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22
Q

quadrant

A

(pg 120)
PASSIVE MOTION

extend–> ipsilateral lat flexion –> ipsil. rotation

palpate thumb lateral to spinous process

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23
Q

motion testing amount of stress

A

compression –> spurlings –> quadrant

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24
Q

segmental motion testing

A
  • OA specific
  • sidebend challenge
  • F/E challenge
  • AA specific
  • lateral glide
  • rotation upslope/downslope
  • PA in prone (CPA, UPA)

*Fryette’s law: by max rotating we can be confident that they aren’t contributing to flex/ext

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25
Q

in pre position R rotation

A 
protraction= R extension, L flexion
retraction= L extension, R flexion
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26
Q

if trying to stretch the L posterior OA

A

side bend L and retract

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27
Q

OA (O/C1) primary motion

A

=flexion extension

max rotation –> F/E testing

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28
Q

AA (C1/C2) primary motion

A

=rotation (45 deg)

max flexion –>rotation

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29
Q

flexibility tests

A

Levator, splenius cerv., post. scalene

upper trap & SCM

middle & anterior scalene

suboccipitals

30
Q

strength testing

A

ISOMETRIC

DEEP NECK FLEXOR ENDURANCE

CRANIAL CERVICAL FLEXION TEST

31
Q

isometric strength testing

A

provide counter-force stabilization

EASY increase/decrease of force

  • flex/ext
  • lat flexion
  • rotation
32
Q

deep neck flexor endurance

A

pt. supine; actively chin tucks and holds up off hand/table.

+ test= loss of chin tuck or patient’s head touches clinician hand for >1 sec

  • patients with neck pain: mean=24.1 secs
  • patients w/out neck pain: mean= 38.95secs
33
Q

neurological testing

A

(upper motor neuron lesion VS. cervical radiculopathy VS. peripheral nerve lesion??)

MSR (musculoskeletal reflexes)

  • biceps- C6
  • brachioradialis- C6
  • triceps- C7

Hoffmann’s reflex

Babinski

Clonus

Sensation testing

  • circumferential
  • monofilament
34
Q

upper motor neuron lesions

A

=spinal cord and above

  • Hoffman
  • Babinski
  • Clonus
  • myotomes

-DTR (exaggerated reflex)

35
Q

lower motor neuron lesions

A

=nerve

  • ULTT
  • compression/distraction
  • Spurling
  • Quadrant
  • dermatomes
  • sensation (glovelike, peripheral, derm)

-DTRs (diminished reflex)

36
Q

peripheral nerve distribution

A

slide 21

37
Q

dermatomes

A

slide 22

38
Q

Hoffman’s reflex

A

tests for upper motor neuron lesion

flick 3rd DIP

+ test= other fingers contract/twitch

39
Q

Babinski

A

tests for upper motor neuron lesion

stroke on sole of foot from heel to toes

+ test= toes flare/extension
**normal in babies

40
Q

Clonus

A

ankle- DF
wrist- extension

relax first and then quick stretch and hold
-similar to DTR– causes excitation of muscle
-can grade by number of contractions
=sustained clonus if there are numerous contractions

41
Q

tests for cervical radiculopathy

A 
compression test
spurlings test
distraction test
quadrant test
brachial plexus compression test
cervical hyperflexion/extension tests
valsalva maneuver
ULTT
shoulder abduction test
42
Q

C1-2 myotome

A

cervical flexion

43
Q

C3 myotome

A

cervical lateral flexion

44
Q

C4 myotome

A

shoulder elevation

45
Q

C5 myotome

A

shoulder abduction

46
Q

C6 myotome

A

elbow flexion

wrist extension

47
Q

C7 myotome

A

elbow extension

wrist flexion

48
Q

C8 myotome

A

thumb extension

ulnar deviation

49
Q

T1 myotome

A

finger abduction/adduction

50
Q

ULTT

A

upper limb tension test

median
ulnar
radial

51
Q

pathological responses to ULTT

A
  • reproduction of symptoms
  • a sensitizing test alters the symptoms
  • side to side asymmetry of symptoms
52
Q

normal responses to ULTT

A
  • deep ache in cubital fossa
  • deep ache/stretch in radial forearm/hand
  • tingling to fingers supplied by appropriate nerve
  • stretch in anterior shoulder
  • above responses ^ with contralateral c-spine lateral flexion
  • above responses decrease with ipsilateral c-spine lateral flexion
53
Q

upper c-spine instability tests

A

sharp purser

alar ligament stability

upper cervical flexion test

54
Q

diagnosis

A

neck pain w/ mobility impairments

  • cervicalgia
  • pain in the thoracic spine

neck pain with headache

  • headache w/ neck movement/position
  • cervicocranial syndrome

neck pain with movement coordination impairments

  • sprain & strain of c-spine
  • whiplash

neck pain w/ radiating pain

  • spondylosis w/ radiculopathy
  • cervical disc disorder w/ radiculopathy
  • cervical myelopathy
55
Q

clinical reasoning

A
  • identify main patient complaints
  • identify important (relevant) impairments
  • classify patient according to best evidence (CPG)
  • consider at a minimum, treatments according to CPG (is there a need to modify? is there a need to add treatments?)
56
Q

S/S neck pain w/ mobility deficit “mechanical neck pain”

A

PAIN DESCRIPTION:

  • unilateral localizable neck pain (rarely bilateral)
  • referral into T-spine
  • referral into scapular, upper brachial (rarely below elbow)
  • local and/or referred pain reproduced on specific motions

MOTION:

  • restriction in AROM, PROM (abnormal end feel)
  • assess upper vs. lower c spine
  • joint play (PIVM)
  • strength/endurance (esp. DNF)
  • flexibility may be difficult to assess bc of lack of vertebral motion

RELEVANT SPECIAL TESTS:

  • distraction/compression/spurling’s/quadrant
  • cranial cervical flexion test

**LISTEN/ASK FOR CLUES OF IRRITABILITY

57
Q

neck pain w/ mobility deficit CPR intervention

A

cervical manipulation for neck pain

thoracic manipulation for neck pain

58
Q

6 variables for cervical manipulation for neck pain w/ mobility deficit

A

NDI <11.6

bilateral pattern of involvement

not performing sedentary work

neck movement relieves

cervical extension does not aggravate

dx of spondylosis w/out radiculopathy

(+LR of 5.3 if 4 or more of 6 is present)

59
Q

interventions: cervical manipulation for neck pain w/ mobility deficit

A

up-slope glide once per hypomobile segment

not validated yet

60
Q

6 variables for thoracic manipulation for neck pain w/ mobility deficit

A

symptoms <30

+LR of 5.5 if 3 of 6 present
(chance of successful outcome 54-86%)

61
Q

interventions: thoracic manipulation for neck pain w/ mobility deficit

A
  • seated distraction manipulation twice
  • supine upper thoracic manip (trigger) twice
  • supine middle thoracic manipulation (trigger) twice)
  • upright AROM rotation in cervical flexion

(not validated yet)

62
Q

types of headache

A

migraine: 1 sided, 4-72 hours, “throbbing”
sinus: widespread, until treated, “dull”
cluster: 1 sided, 15 min-3 hours, “sharp”
tension: widespread, hours, “dull”

cervicogenic

63
Q

neck pain w/ tension headache –S/S

A
  • bilateral
  • 15 days/month for last 3 months
  • pressing or tightening pain (NPRS <6/10)
  • no increase in pain w/ physical activity
  • no photophobia, phonophobia, vomiting, nausea
  • no evidence of secondary headache
  • no whiplash, surgery, CNS involvement, or red flags
64
Q

CPR for TrP in tension headaches

A

predictor variables: (>=2 is +LR 5.9)

  • headache duration 8.5 hours/day
  • headache frequency <47.5

Intervention:

  • pressure release, MET, soft tissue
  • temporalis, suboccipital, upper trap, SCM, splenius and semispinalis capitis
65
Q

S/S– neck pain w/ cervicogenic headache

A
  • may or may not have associated neck pain
  • persistent, sharp to dull pain
  • symptoms change w/ change in neck position (head on body, body on head)
  • dizziness may be present– differentiate from vestibular or orthostatic hypotension

*w/out vestibular system- hold head still and pt move body bak and forth (if still dizzy= cervicogenic and not vestib.)

66
Q

Rx– neck pain w/ cervicogenic headache

A
  • cervical mob/manip
  • stretching
  • coordination, strengthening, endurance
67
Q

S/S– neck pain w/ movement coordination impairments “whiplash”

A

-often traumatic (MVA)
-neck pain, headaches, referral into shoulder girdle and/or upper arm
-mid range neck pain increase at end range
DNF loss of strength, endurance, control

***PAIN IN MIDRANGE

68
Q

Rx– neck pain w/ movement coordination impairments “whiplash”

A

prevent progression to chronic

  • be gentle
  • watch psychological effects
  • pay attention to PT-pt interaction

coordination, strengthening, endurance
-DNF and posterior neck muscles

stretching

69
Q

cervical whiplash prognosis–4 variables (questions) to not having a persistent disability

A

1: did collision occur at location other than city intersection?
2: upper back pain since collision?
3: still have neck pain at 2 wks post accident?
4: still experience shoulder pain 2 wks post accident?

HIGH RISK=

  • yes to 1 and 2
  • no to 1 and 2; yet to 3, 4

LOW RISK=
-No to 3 and 4

70
Q

cervical radiculopathy S/S

A

test item cluster (TIC)

-cervical rotation toward involved side s A test

71
Q

cervical radiculopathy prognosis

A

short term outcomes
4 variables:
-age 50% visits (manual therapy, traction, DNF training)

72
Q

interventions for neck pain w/ radiating pain

A

from CPG

  • upper quarter and nerve mobilization procedures
  • traction
  • thoracic mob/manip

ORTHO 2 (18 decks)

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