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T OCS > Cervical > Flashcards

Cervical Flashcards

1
Q

3 predictors of poor outcomes after neck surgery

A
  1. workers comp
  2. dermatomal sensory loss
  3. use of weak narcotics prior to sx
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2
Q

Canadian C-spine rule

A

algorithm

  1. Did you have high risk fracture episode (fall > 3 ft or fall > 5 steps?) If yes,
    do you
  2. Have any tingling into either UE? if yes-xray. If no,
  3. are you older than 65? If yes, x-ray, if no did you
  4. Have low risk factor (that allows for safe ROM)
    - simple MVA? can you sit up in the ER? walk after the trauma? no cervical midline tenderness?
  5. Can you rotate > 45 degrees? No-xray needed. If no x-ray
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3
Q

cruciform ligament

A

made up of transverse lig and longitudinal ligament

- supports dens C2 on C1

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4
Q

c/s outcome measures

A

NDI

Patient specific Functional Scale

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5
Q

Cranial cervical flexion test

A

supine with biofeedback under c/s

  • perform chin tucks at 22,25,26,28 and 30 mm/hg and hold for 10s at each pressure
  • (-) test if you can sustain 26-30 mm/hg x10” with no SCM or superficial mm compensation
  • (+) test if < 26 mmhg for 10 s, compensates with superficial mm
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6
Q

Neck flexor endurance test

A

Normal: hold 38.95s
Abnormal: with neck pain 24.1 seconds

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7
Q

thoracic manip for neck pain

A

C evidence

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8
Q

A evidence neck pain

A

Exam; NDI: 7% (think c/s has 7 vertebrae) ; PSFS (>2)

Interventions

  • manips
  • coordination,strength,endurance therex
  • patient ed and counseling
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9
Q

Traction and nerve mobs

A

level B evidence

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10
Q

Signs of a stroke

A

think FAST

  1. Facial droop- ask person to smile
  2. Arms- can pt raise both arms up or does one arm shift downward
  3. Speech- can pt repeat a simple phrase? slurred or not making sense?
  4. Time- call 911 immediately!
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11
Q

Contraindications to manual therapy at neck

A
  • Worsening neuro function (multi level root pathology)
  • unremitting severe pain
  • recent trauma
  • UMN signs
  • spinal cord damage
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12
Q

Contraindications to cervical manipulation

A

ACUTE soft tissue, ACUTE fracture
- dislocation, ligamentous rupture, RA, AS, osteoporosis, vascular disease, anticoagulation therapy, instability, tumor, infection, acute myelopathy

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13
Q

CPR for cervical myelopathy

A
  1. Age > 45
  2. (+) gait deviations (ataxic gait, wide BOS)
  3. (+) Hoffman
  4. (+) Babinski
  5. (+) inverse supinatior

3 or more = 94% post test probability

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14
Q

Manual tx for myelopathy

A
  • stay away from c/s manips! (contra)
  • but can manip upper/mid thoracic spine and intermittent cervical traction
  • saw improvements in strength
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15
Q

CPR for cervical radiculopathy

A
  1. (+) ULTT A (median nerve)
  2. (+) Spurlings
  3. (+) distraction
  4. Rot < 60 degrees to involved side

3/4: 6.1 LR

4/4: 30.3 LR

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16
Q

CPR for cervical manipulation

A
  1. (+) opinion that manip will help
  2. Acute, symptoms < 38 days
  3. ROM rotation with > 10 degrees difference side to side
  4. pain with PA to middle c/s
17
Q

Tx for cervical radiculopathy

A

MULTIMODAL

  1. Manual therapy
  2. Cervical traction
  3. DNF exercise
18
Q

CPR for cervical traction

A
  1. Age > 55
  2. (+) distraction test (30#)
  3. (+) peripheralization with p/a C4-C7
  4. (+) ULTT A
  5. (+) Shoulder abd test

3/5 LR 4.81
4/5 LR 23

19
Q

Cervical Traction parameters

A

Position neck at 24 degrees of flexion
15 min, intermittent 1 min pull, 20” rest
- initial pull force 10-12# (weight of head, 10% BW), increase throughout session (max pull 35-40#)

DIFFERENT THAN LUMBAR
Lumbar
QIW, 12 min, 40-60% BW force

20
Q

Thoracic outlet tx

A

conservative: stretch what’s tight
- mobilize tight structures (1st rib, spine)
- Lengthen shortened muscles: scalenes, LS, Pec minor
- teach diaphragmatic breathing
- Neural gliding techniques

Tests:
Cervical rotation Lateral Flexion test
- contralateral rotation, ipsilateral lateral flexion
(+) if you cant laterally flex ( C7 TP blocked by elevated first rib)

21
Q

Whiplash MOI

A

MVA- coup-contracoup

  • s shaped spinal curve
  • upper cervical flexion, lower cervical extension

facet capsulses can be stretched, pinched or torn

22
Q

Clinical predictor on acute–> chronic neck pain following whiplash

A
  1. NDI > 15
  2. Tampa scale for kinesiophobia > 41

5-6% development to chronic if NO to both above
up to 83% development of chronic pain if YES to both above

23
Q

Cervicogenic headache treatment

A
  1. strengthen deep neck flexors
  2. self SNAGS
  3. manual therapy (mobs or manip)
24
Q

Cervicogenic headache dx

A
  1. limited cervical ext ROM
  2. pain with palpation to c3/c4
  3. weakness in deep neck flexors with CC cervical flexion test
25
Q

Neck pain with radiating pain treatment

A

Acute

  • nerve mobs and traction (B)
  • mobilizing/stabilizing (C)
  • cervical collar (C)
  • stretching, thoracic mob/manip (C)

Chronic (B)

  • intermittent traction
  • stretching
  • strengthening
  • C/S, and T/S manips
  • education
26
Q

Neck pain with mobility deficits tx

A

Acute

  • cervical AROM (B)
  • thoracic manips (B)
  • scapulothoracic strengthening (B)
  • cervical mobs (C)

Subacute

  • neck/shoulder endurance therex (B)
  • throacic/cervical mob/manip (C)

Chronic (multimodal)

  • cervical/thoracic manip (B)
  • strengthening/stretching, endurance training, cognitive affectiev elements (B)
  • neck/shoulder/trunk endurace therex (C)
  • pt ed (C)
27
Q

Neck pain with movement coordination (motor control) therex

A

Most commonly due to sprain/strain of c/s

Acute

  • active exercise protocol, pt ed to return to pre-accident activities, postural/mobility exercises to decrease pain and increase ROM (B)
  • mobs and exercise (B)
28
Q

CPR to know who responds well with cervical radic

A

Age < 55
non dominant arm affected
looking down does not increase symptoms
Multimodal approach used ( manual, traction and exercise DNF)

29
Q

Risk factors for pancoast tumor

A
  1. men > 50
  2. Hx of smoking
  3. pain in shoulder along vertebral border of scap
    - can progress to pain down the arm into ulnar nerve distribution

Can demonstrate

  • horners syndrome
  • wheezing
30
Q

Septic arthristis (AC jt)

A
  • chest pain localized to SC jt
  • hx of IV drug use, diabetes, trauma, infection, fever
  • Tender SC jt, swelling at SC jt
31
Q

Subarachnoid hemorrhagic/ischemic stroke

A
  • elevated BP, severe headache

- hx HTN, altered mental status, vertigo, vomiting

32
Q

Difference between neck with mobility and movement coordination

A

neckpain with mobility= more ACUTE < 12 weeks

neckpain with movement coordination- more CHRONIC

33
Q

Signs of neck pain with mobility issues

A
  1. loss of cervical AROM
  2. limited flexion rotation test
  3. hypomobility in cervical/thoracic spine
34
Q

Signs of neck pain with radiating pain

A
  1. (+) spurlings
  2. (+) distraction
  3. (+) ULTT A
  4. Valsalva
35
Q

Signs of neck pain with movement coordination

A

Including whiplash

  1. (+) cervical neck flexor endurance test
  2. (+) craniocervical flexion test
36
Q

Signs of neck pain with headaches

A
  1. upper cervical ROM
  2. (+) flexion rotation test
  3. upper cervical mobility

T OCS (16 decks)

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