cervical - 1 at risk neck Flashcards
T3
at the root od the scapula
T7
at the inf angle of the scapula
L3
umbilicus
L4-L5
the ASIS
S2
PSIS
what do we see with fracture/dislocation red flag
Trauma - motor vehicle accident , Falls, Direct blow or impact
Severe limitations of motion all planes
Deformity may be present
diagnostic imaging needed
what is the point of the Canadian spine rules
does the pt require a diagnostic work up
what is the first question of the canadian spine rules
are there any high risk factors that mandate radiography
are there any high risk factors that mandate radiography - what are the three factors
age >65
dangerous mechanism of injury
parathesis in the extremities
(of any of these are present then the person needs a
what are the dangerous mech of injury dicussed in canadian spine rule
fall onto head
highspeed MVA
axial load to the head
motorized recreational vehicle
bicycle collision
what is the 2nd question in the canadian spine rules
are there low risk factors that allows for safe ROM assesment?
are there low risk factors that allows for safe ROM assesment? - what are teh low risk factors
simple rear-end
normal sitting posture in the ER
amb since the time of injury
delyaed onset of of neck pain and absence of midline tenderness
(if these are true then we can perform a ROM assessment for the pt)
Cancer – neoplasm redflag
Medical history is (+) for cancer
Night pain and other atypical pain manifestations
Unexplained weight loss
Fatigue
Visceral referred pain - Gallbladder/liver
R thoracic/lower rib, R scapula region
Visceral referred pain - Lungs
Thoracic, chest, possibly the shoulder and cervical pain
Visceral referred pain - Cardiac
- Chest, neck, arm pain
C8 distribution
Inflammatory/Systemic red flag - vitals
- Body Temperature > 100 F
- Blood pressure > 160/95 mmHg
- Resting pulse > 100 bpm
- Resting respiration > 25
Inflammatory/Systemic red flag - presentation
- Redness, warmth, swelling
- Discoloration (eg. Jaundice)
- Fatigue, malaise, unwellness
Myelopathic Involvement
Gait and balance disturbances, generalized weakness
May not be associated with any radiating pain
- (+) Signs of UMN involvement
what are the DTR that we use with the cervical region
jaw jerk
pectoral
ankle clonus
babinski
babinski and ankle clonus are testing what
anywhere on the cord
hoafmann’s and tromners is testing what
C-spine and higher
UMN
shimizu is testing what
more likely the brain and not the neck
jaw jerk is testing what
C5 and higher (brain)
UMN
what tests are included in the in depth screening exam for the neck
history
DTR
hoffmans/trommners
rhomberg
AROM in sitting
huatards
neck torsion
sharps purser
Positional Provocative Testing
Modified Shear Test
C2 Spinous Kick Test
Tectorial Membrane
what is the purpose of the rhomberg test
determines if your balance issues are related to the function of your dorsal column (DCML) - removes the vestibular and visual component that contribute to balance
jaw jerk what is a positive sign
the swift closure of the mouth
clenching of the jaw
what do we do with the pectoral reflex
hit inferior to coracoid process
Positive: movement in the shoulder, similar to what we see with shimizu (shoulder shrug
what is the point of the pectoral reflex
to see if the pt is hyper-reflexive
what is the procedure for Scapular humeral reflex (Shimizu)
Strike: Distal third of the spine
Strike: midpoint
Strike: acromion
Positive: robust shoulder shrug
brain
Pronator drift test - procedure
hand in front of pt supinated and EC
- Hold for 20 -30 secs
what is a positive - Pronator drift test
one arm and palm turn inward and downward, change in what the hands are doing
what is the meaning of the pronator drift test
pain in neck, stiffness (combine with UMN presentation)
muscle weakness and an abnormal function of the corticospinal tract, the upper motor neurons in the brain and spinal cord that control voluntary muscle
what is the procedure for hautard’s test
tall sitting, arms out in front, close eye, turn head to left, count down from 15 secs
Do the same thing for the right side and extension
what is the purpose of hautard’s test
looking at the VBI, upper body proprioception, positional provocative testing
hautard’s test and reproduction of VBI symptoms
Headache, nausea, nystagmus, redness of face
As the pt maintains this position the symptoms get worse
While symptomatic screen cranial nerves – if they have CN signs then this
what is purpose of the neck torsion test
Differentiate cervical from vestibular
what is the procedure of the neck torsion test
sitting at the end of the table twist your body towards me while I hold your head
You are not using your vestibular system in this movement
neck torsion test outcomes
Mechanical: this rotary movement causes symptoms
Vestibular: no symptoms provocation
what are the ligamentous test for the neck
Sharp-Purser Test
Spinous shear
C2 kick test
Tectorial membrane test
Sharp-Purser Test is testing what ligament
transverse ligaments is affected – the atlas moves away from the odontoid
Sharp-Purser Test procedure
Neutral sitting position
Pt head forward 30-35 degrees
Hand in key form on C2 SP, block and stabilize it
Posterior force is directed at pt forehead
what is the positive sharps purser test
Positive: abnormal endfeel, clunk
what is the function of Spurling’s test
cervical radiculoathy
Spurling’s procedure
- Pt seated, head neck in extension, lateral flexion
- Rotation towards isp
- Apply axial pressure when pt is in this position, 10 -15 secs
what does apostive spurling test look like
Reproduction of cervical radiculopathy sym
what is Axial Compression test for
cervical radiculopathy
axial compression test procedure
- Pt head in neutral
- PT applies even pressure over pt’s head
what ligamament is the Spinous shear test looking at
Alar ligament
Spinous shear test procedure
hand on C1 transverse process
Push on right and then left side
Looking for: good firm end feel
C2 kick test testing what ligament
Alar ligament
C2 kick test procedure
o Pt supine, make sure that the pt is straight (midline)
o Hands on the side of the C2 SP
o Side bend the head to left – should feel the bone on right side
o Kick should be brisk
Tectorial membrane test ligament
the tectorial membrane
Tectorial membrane test - procedure
supine: Axial distraction – light and gentle
Positive: pain provocation
- Pain response to the distraction of the neck
