C-Spine Examination Lab Refined Flashcards
PART 1: INTRO
PART 1: INTRO
Factors Associated with Development of Chronic Neck Pain:
- Less baseline pain and disability intensity
- Hx ________ and ________ symptoms (pain)
- Age (>___ years)
- Longer symptom duration
- Decreased _______ strength (disability)
- Headache
- Concomitant LBP
- Previous _________
- Bicycling as regular activity
- Worse health perceptions
- Worse ____
- More worrying
- neck and shoulder
- 40 years
- hand
- trauma
- QoL
The lifetime risk of developing neck pain is __-__%.
Approximately __-__% of individuals develop persistent pain and disability.
- 22-70%
- 20-44%
It is important in the patient interview to ask ______________ when patients present with neck pain for things such as:
- Cervical Arterial Dysfunction
- Structural Instability (upper cervical ligament, Frx)
- Pain referral from cardiopulmonary systems
- TMD
- UE Radiculitis/ Radiculopathy
- Central neurologic system
- Screening for other non-musculoskeletal health condition or musculoskeletal condition where referral is indicated
screening questions
It is important in the patient interview to ask their _________ limitations such as:
- Checking blind spot
- Prolonged static positioning (computer work, driving, etc.)
- Scanning ground for safety (older adults)
- Looking over head
- Lifting/ pushing/ pulling with UEs (heavy doors, etc.)
functional
- What is the most common outcome measure used?
- What are some others?
- PSFS (Patient-Specific Functional Scale)
- Neck Disability Index (NDI), Whiplash Disability Questionnaire, QuickDASH, Dizziness Handicap Inventory (DHI)
PART 2: VISUAL INSPECTION AND SYSTEMS REVIEW
PART 2: VISUAL INSPECTION AND SYSTEMS REVIEW
What are we looking for in our visual inspection?
- Gross abnormalities
- Alertness
- Integumentary
- Posture Assessment (resting vs ability to correct)
What is our goal with the systems review?
Identify impairments for continued tests and measures.
What are the 5 parts of the systems review?
- Cardiopulmonary
- Integumentary
- MSK
- Neuromuscular
- Cognition/Affect
PART 3: ELIMINATION TESTS
PART 3: ELIMINATION TESTS
What parts are included in elimination testing?
- UQ Screen
- Neuro Screening Tests
- Other Screening Tests
- Special Tests
Describe the UQ Screen.
- ) C-Spine AROM is done (flexion/extension, lateral flexion, rotation)
- ) C-Spine Resistance is done
- ) UE AROM is done (shoulder flexion and abduction, reach behind head, reach behind back, elbow flexion/extension, wrist flexion/extension, fist/open hand)
- ) UE Resistance is done (shoulder flex/abd/ER/IR, elbow flex/ext, wrist flex/ext, grip)
What is applied at the end of each AROM during the UQ Screen?
Overpressure is applied to stress joint structures
Describe the myotome screening for each nerve root.
C1= capital flexion C2= capital extension C3= lateral flexion C4= shoulder elevation C5= shoulder abduction C6= elbow flexion/wrist extension C7= elbow extension/wrist flexion C8= thumb abduction T1= finger adduction
What elimination tests are used for CAD?
- End Range Rotation Test
- VBI Test
- Modified VBI Test
What elimination tests are used for Upper Cervical Stability?
- Modified Sharp Purser Test
- Upper Cervical Flexion Test
- A-O Membrane Test
- Tectoral Membrane Test
- Alar Ligament Stability Test
What elimination test is used for Cervicogenic Headaches?
Cervical Flexion-Rotation Test
What elimination test is used for Radicular Pain/ Radiculopathy?
ULTT
PART 4: STRUCTURAL STRESS TESTING
PART 4: STRUCTURAL STRESS TESTING
With structural stress testing we are trying to better understand what?
The patients MSK pattern via active, passive, resistive testing
With stress testing what 4 things are we looking for?
- Quality
- Quantity
- Willingness
- Provocation
With structural stress testing, we might also want to look at contractile unit ________.
length
Why is resistive testing done in mid range?
Helps to decide whether it is a contratile or inert tissue issue.
PART 5: PALPATION AND JOINT MOB
PART 5: PALPATION AND JOINT MOB
Palpation involves both ______ and _________ structures.
bony and soft tissue
What is PAIVM Testing?
Passive Accessory Intervertebral Movement Testing (PAIVM)
-CPAs and UPAs
What is PPIVM Testing?
Passive Physiological Intervertebral Movement Testing (PPIVM)
- CO/C1 Mob testing (flex/ext, lateral flex)
- C1/C2 Mob testing (rotation)
- Mid and Lower C-Spine (up/down glides)w
PART 6: CONFIRMATION TESTS
PART 6: CONFIRMATION TESTS
What are the confirmation tests for Radicular Pain/ Radiculopathy?
- Spurling’s Compression Test
- Cervical Distraction Test
- Valsava Maneuver
- Brachial Plexus Compression Test
- Cervical Compression Test
What 4 things are in Wainner’s Test Item Cluster?
- Spurling’s Test +
- Cervical Distraction Test +
- ULTT +
- C-Spine Rotation AROM <60 degrees
What is Wainner’s Test Item Cluster useful for?
Ruling In cervical radiculopathy, radicular pain if 4/4 are +
Describe the Neck Flexor Muscle Endurance Test.
- Pt Position: Supine/ hook lying
- Position pt into maximal retraction
- Pt maintains retraction while lifting head ~ 1 inch off of table
- Line drawn on skin folds (anteriolateral neck)
- If position begins to be compromised, verbal cues to hold the head up or tuck the chin
- Time pt’s ability to hold until (1) loss of capital flexion position or (2) head touches examiners hands > 1 sec
- What are the mean hold times for the Neck Flexor Muscle Endurance Test?
- What is a MDC for the test?
- Male: 38.9s +/- 20.1s
- Female: 29.4 +/- 13.7s
-17.8s for change in muscle endurance
Describe the Craniocervical Flexion Test (CCF Test)
- The pressure biofeedback unit placed behind the subjects’ upper neck
- Baseline pressure of 20 mm Hg
- Patient instructed on CCF & practice the head-nodding action
- Progressively target and hold the 5 pressure levels (2 mm Hg each) x 10 seconds (between 22 mm Hg and 30 mm Hg)
- 10 sec rest breaks between each level
- Terminated when:
- Pressure decrease > 20mmHg
- Pt cannot perform motion without substitutions
What is the activation score normal?
10s hold without substitution at 26-30mmHg
