C-Spine Exam Flashcards
Incidence of Neck pain
- 22-70% at some point in life
- 10-20% at any one time
- 54% within last 6 months
Risk Factors for Poor Outcome (8)
- age >40
- co-existing LBP
- long hx neck pain
- cycling as regular activity
- loss of strength in hands
- worrisome attitude
- poor quality of life
- less vitality
Physical Eval – steps OPCR
-observation, palpation, clear above/below, ROM/flexibility
Observation of Posture
- Frontal Plane: lat flexion, rotation, scap position
- Sagittal Plane: eyes and mandible normally horizontal, FHP COMMON, protracted/retracted shoulder
Muscles to evaluate (symmetry)
-trap, delt. pec major, SCM, infraspinatus, lat, erectors
Palpation – bony prominences
-mastoid, nuchal line, SPs. APs, facets
AROM –> PROM (overpressure)
- 2 methods flexion/extension
- pro/retraction
- lat flexion
- rotation
- quadrant
Motion Testing
- distraction/compression (incl Spurlings)
- scapular mobility
OA Specific motion test
full rotation to limited side, then nod
AA specific
Flexion rotation test (p67)
-do bilat, place in end-range flexion to lock up lower Cspine & rotate at AA jt
C2-C7 motion tests (3)
- lateral glide in supine
- rotation upslope/downslope in supine
- PA in prone (central & unilat)
Flexibility tests (4)
- Levator, Splenius cervicis, post scalene
- upper trap & SCM
- middle & ant scalene
- suboccipitals
Strength testing
- isometric – easy incr/decr of force, provide counter-force stab – flex/ext, lat flex, rotation
- deep neck flexor endurance (without neck pain mean ~39 sec, with pain ~24)
Neuro testing
- MSR: biceps (C6), brachioradialis (C6), triceps (C7)
- Hoffman’s, Babinski, clonus
- sensation testing
Special tests (6)
- Spurlings
- Valsalva
- Brachial Plexus compression test
- Cervical hyperflexion test
- Cervical Distraction test
- Shoulder Abduction test
Cranial Cervical Flexion Test
- hooklying, neutral spine, BP cuff to 20mmHg, pt flattens Cspine and hold 10 sec 22/24/26/28/30
- positive = unable to incr at least 6mmHg, can’t hold 10 sec, use of superficial muscles (SCM), sudden chin movement or cervical extension
ULTT – pathological responses (3)
- reproduction symptoms
- sensitizing test alters the symptoms
- side to side asymmetry of symptoms
ULTT – normal responses (5)
- deep ache in cubital fossa
- deep ache/stretch in radial forearm/hand
- tingling to fingers supplied by nerve
- stretch in anterior shoulder
- above responses with increased ipsa/contralateral Cspine lateral flexion
ULTT 1 – median
-Shoulder abd 110/ER, elbow flex–>ext, FA supinated, wrist/fingers extended
ULTT – ALL (2)
- shoulder girdle depression
- Cspine lateral flex away
ULTT 2 – median
same as 1 but shoulder abd 10
ULTT 3 – radial
-shoulder IR/abd 10 and incr, elbow extended, FA pronated, wrist flexed/ulnar dev, fingers flexed
ULTT 4 – ulnar
-shoulder ER/abd 90 and incr, elbow flexed, FA pronated, wrist extended/radially deviated, fingers extended
Special tests for C1/C2 instability (do in order, stop if +) (4)
- Sharp Purser
- Alar ligament stability
- Upper cervical flexion test
- VBI
Sharp-Purser - modified
- tests instability of C1 on C2, do this one first (symptom relieving)
- pt sitting, PT stabilize C2 SP and glide head/C1 backwards on C2
Sharp Purser
- look for symptoms with flexion
- mouth/limb numbness, nausea, weakness
Alar ligament stability
- stabilize C2 SP with pincer grasp (head in slight flexion)
- PT laterally flexes neck
- = SP doesn’t rotate with lat flexion
Upper cervical flexion test
- pt supine, PT hands posterior arch C1, lifts pt head with fingertips
- look for separation of occiput and C1 during movement, reproduction of symptoms
Risk factors for C1/2 instability (2)
long term steroid use, CP
Diagnosis (4)
- Neck pain with mobility impairments (cervicalgia, pain in Tspine)
- Neck pain w headache (headache w neck movement/position, cervicocranial syndrome)
- Neck pain w movement coordination impairments (sprain and strain of Cspine without mobility impairments, whiplash)
- Neck pain w Radiating pain (spondylosis w radiculopathy, cervical disc disorder with radiculopathy, cervical myelopathy)
Neck Pain with mobility deficit (mechanical neck pain) – S/S
- unilateral localizable neck pain (rarely bilat)
- referral into Tspine
- referral into scap, upper brachial (rarely elbow)
- local and/or referred pain reproduced on specific motions
- restriction in AROM/PROM w abnormal endfeel
Neck pain w mobility deficit – special tests
- distraction/compression/Spurlings/Quadrant
- cranial cervical flexion test
6 variables for cervical manipulation for neck pain
- NDI <11.5
- bilateral pattern of involvement
- not performing sedentary work
- neck movement relieves
- cervical extension does not aggravate
- dx of spondylosis without radiculopathy
6 variables for thoracic manipulation of neck pain
-symptoms <30
Thoracic manipulation – interventions
- seated distraction manip twice
- supine upper thoracic (trigger) twice
- supine middle thoracic manip twice
- upright AROM rotation in cervical flexion
- AROM, HEP, therex
types of headache (5)
- migraine
- sinus
- cluster
- tension*
- cervicogenic*
S/S tension headache CPR
- bilateral, 15 days/month for last 3 months
- pressing or tightening pain (NPRS<=6/10)
- no incrrease in pain w activity
- no photo/phonophobia, vomiting, nausea
- no evidence of secondary headache
- no whiplash, surgery, CNS involvement, red flags
CPR for TrP in tension headaches
- predictor variables
- intervention = pressure release, MET, STM
- temporalis, suboccipitals, upper trap, SCM, splenius/semispinalis capitis
Cervicogenic headache S/S
- may or may not have associated neck pain
- persistent, sharp to dull pain
- dizziness may be present (differentiate from vestibular or orthostatic hypotension)
- symptom change with change in neck position
cervicogenic test
PT holds head while pt rotates torso L and R (takes out vestibular components)
Cervicogenic headache rx
- cervical mob/manip
- stretching
- coordination, strengthening, endurance
Neck pain with movement coordination impairments “whiplash” S/S
- often traumatic event to neck (MVA)
- neck pain, headaches, referral into shoulder girdle and/or upper arm
- mid range neck pain, increases at end range
- DNF loss of strength, endurance, control
whiplash rx
- prevent progression to chronic – be gentle, watch psych, pay attention to PT-pt interaction
- coordination, strength, endurance – DNF, posterior neck muscles
- stretching (mostly deep neck, some long arm)
4 variables for whiplash prognosis
- did collision occur and location other than city intersection
- upper back pain since collision
- still have pain s/p 2 weeks
- still have shoulder pain s/p 2 weeks
cervical radiculopathy s/s test item clusten
- cervical rotation toward involved side s A test
- 3 or more items present = +LR 6.1
cervical radiculopathy – 4 variables for outcomes
-age 50% visits (manual, traction, DNF training)
CPR for use of traction w cervical radic – 5 variables
- age >=54
- shoulder abduction test
- +ULTT A
- sx peripheralize with central PA motion testing @ C4-7
- distraction test
cervical radic intervention – traction
- 15 min
- supine 24 degrees flexion
- 60 sec on/20 sec off (50% force when off)
- initially 10-12 lbs
cervical radic intervention – exercise
- scap training
- correct FHP
- DNF training
neck pain with radiating pain – interventions from CPG (4)
- upper quarter and nerve mob procedures
- traction
- thoracic mob/manip
- put in neutral, lateral glide to opp side
