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MS II -- C-Spine > C-Spine Exam > Flashcards

C-Spine Exam Flashcards

1
Q

Incidence of Neck pain

A
  • 22-70% at some point in life
  • 10-20% at any one time
  • 54% within last 6 months
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2
Q

Risk Factors for Poor Outcome (8)

A
  • 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
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3
Q

Physical Eval – steps OPCR

A

-observation, palpation, clear above/below, ROM/flexibility

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4
Q

Observation of Posture

A
  • Frontal Plane: lat flexion, rotation, scap position

- Sagittal Plane: eyes and mandible normally horizontal, FHP COMMON, protracted/retracted shoulder

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5
Q

Muscles to evaluate (symmetry)

A

-trap, delt. pec major, SCM, infraspinatus, lat, erectors

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6
Q

Palpation – bony prominences

A

-mastoid, nuchal line, SPs. APs, facets

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7
Q

AROM –> PROM (overpressure)

A
  • 2 methods flexion/extension
  • pro/retraction
  • lat flexion
  • rotation
  • quadrant
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8
Q

Motion Testing

A
  • distraction/compression (incl Spurlings)

- scapular mobility

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9
Q

OA Specific motion test

A

full rotation to limited side, then nod

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10
Q

AA specific

A

Flexion rotation test (p67)

-do bilat, place in end-range flexion to lock up lower Cspine & rotate at AA jt

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11
Q

C2-C7 motion tests (3)

A
  • lateral glide in supine
  • rotation upslope/downslope in supine
  • PA in prone (central & unilat)
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12
Q

Flexibility tests (4)

A
  • Levator, Splenius cervicis, post scalene
  • upper trap & SCM
  • middle & ant scalene
  • suboccipitals
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13
Q

Strength testing

A
  • 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)
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14
Q

Neuro testing

A
  • MSR: biceps (C6), brachioradialis (C6), triceps (C7)
  • Hoffman’s, Babinski, clonus
  • sensation testing
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15
Q

Special tests (6)

A
  • Spurlings
  • Valsalva
  • Brachial Plexus compression test
  • Cervical hyperflexion test
  • Cervical Distraction test
  • Shoulder Abduction test
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16
Q

Cranial Cervical Flexion Test

A
  • 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
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17
Q

ULTT – pathological responses (3)

A
  • reproduction symptoms
  • sensitizing test alters the symptoms
  • side to side asymmetry of symptoms
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18
Q

ULTT – normal responses (5)

A
  • 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
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19
Q

ULTT 1 – median

A

-Shoulder abd 110/ER, elbow flex–>ext, FA supinated, wrist/fingers extended

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20
Q

ULTT – ALL (2)

A
  • shoulder girdle depression

- Cspine lateral flex away

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21
Q

ULTT 2 – median

A

same as 1 but shoulder abd 10

22
Q

ULTT 3 – radial

A

-shoulder IR/abd 10 and incr, elbow extended, FA pronated, wrist flexed/ulnar dev, fingers flexed

23
Q

ULTT 4 – ulnar

A

-shoulder ER/abd 90 and incr, elbow flexed, FA pronated, wrist extended/radially deviated, fingers extended

24
Q

Special tests for C1/C2 instability (do in order, stop if +) (4)

A
  • Sharp Purser
  • Alar ligament stability
  • Upper cervical flexion test
  • VBI
25
Q

Sharp-Purser - modified

A
  • 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
26
Q

Sharp Purser

A
  • look for symptoms with flexion

- mouth/limb numbness, nausea, weakness

27
Q

Alar ligament stability

A
  • stabilize C2 SP with pincer grasp (head in slight flexion)
  • PT laterally flexes neck
    • = SP doesn’t rotate with lat flexion
28
Q

Upper cervical flexion test

A
  • pt supine, PT hands posterior arch C1, lifts pt head with fingertips
  • look for separation of occiput and C1 during movement, reproduction of symptoms
29
Q

Risk factors for C1/2 instability (2)

A

long term steroid use, CP

30
Q

Diagnosis (4)

A
  • 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)
31
Q

Neck Pain with mobility deficit (mechanical neck pain) – S/S

A
  • 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
32
Q

Neck pain w mobility deficit – special tests

A
  • distraction/compression/Spurlings/Quadrant

- cranial cervical flexion test

33
Q

6 variables for cervical manipulation for neck pain

A
  • NDI <11.5
  • bilateral pattern of involvement
  • not performing sedentary work
  • neck movement relieves
  • cervical extension does not aggravate
  • dx of spondylosis without radiculopathy
34
Q

6 variables for thoracic manipulation of neck pain

A

-symptoms <30

35
Q

Thoracic manipulation – interventions

A
  • seated distraction manip twice
  • supine upper thoracic (trigger) twice
  • supine middle thoracic manip twice
  • upright AROM rotation in cervical flexion
  • AROM, HEP, therex
36
Q

types of headache (5)

A
  • migraine
  • sinus
  • cluster
  • tension*
  • cervicogenic*
37
Q

S/S tension headache CPR

A
  • 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
38
Q

CPR for TrP in tension headaches

A
  • predictor variables
  • intervention = pressure release, MET, STM
  • temporalis, suboccipitals, upper trap, SCM, splenius/semispinalis capitis
39
Q

Cervicogenic headache S/S

A
  • 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
40
Q

cervicogenic test

A

PT holds head while pt rotates torso L and R (takes out vestibular components)

41
Q

Cervicogenic headache rx

A
  • cervical mob/manip
  • stretching
  • coordination, strengthening, endurance
42
Q

Neck pain with movement coordination impairments “whiplash” S/S

A
  • 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
43
Q

whiplash rx

A
  • 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)
44
Q

4 variables for whiplash prognosis

A
  • 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
45
Q

cervical radiculopathy s/s test item clusten

A
  • cervical rotation toward involved side s A test

- 3 or more items present = +LR 6.1

46
Q

cervical radiculopathy – 4 variables for outcomes

A

-age 50% visits (manual, traction, DNF training)

47
Q

CPR for use of traction w cervical radic – 5 variables

A
  • age >=54
    • shoulder abduction test
  • +ULTT A
  • sx peripheralize with central PA motion testing @ C4-7
    • distraction test
48
Q

cervical radic intervention – traction

A
  • 15 min
  • supine 24 degrees flexion
  • 60 sec on/20 sec off (50% force when off)
  • initially 10-12 lbs
49
Q

cervical radic intervention – exercise

A
  • scap training
  • correct FHP
  • DNF training
50
Q

neck pain with radiating pain – interventions from CPG (4)

A
  • upper quarter and nerve mob procedures
  • traction
  • thoracic mob/manip
  • put in neutral, lateral glide to opp side

MS II -- C-Spine (7 decks)

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