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OCS Cards > Cervical > Flashcards

Cervical Flashcards

1
Q

What decade of life produces greatest prevalence of neck pain?

A

50s

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2
Q

What ligament attaches to the dens and the occipital condyles?

A

Alar ligament

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3
Q

What ligament covers the dens, attaches horizontally at C1, arises medially from the transverse ligament and attaches superiorly to occiput/inferiorly at C2?

A

Transverse ligament

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4
Q

What are the attachment sites for the alar ligament?

A

Dens and occipital condyles

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5
Q

The transverse ligament composes what greater ligamentous structure with superior and inferior longitudinal fibers of this ligament?

A

Cruciform ligament

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6
Q

What is the broad expansive ligament that extends from the spinous processes started at C7 to the external occipital protuberance?

A

Ligamentum nuchae

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7
Q

What motion does ligamentum nuchae limit in the cervical spine?

A

Flexion/ hyperflexion

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8
Q

What nerve innervates the suboccipital muscles?

A

Suboccipital nerve

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9
Q

What muscles comprise the neck flexors? (assist in rotation)

A

Longus capitis and longus colli

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10
Q

What two portions of the scalene group attach to the 1st rib?

A

Anterior and middle

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11
Q

Where does the posterior scalene have attachments to in the rib cage?

A

2nd rib

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12
Q

What are the 4 main neck extensors?

A

1) splenius capitis
2) splenius cervicis
3) semispinalis capitis
4) semispinalis cervicis

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13
Q

In terms of arthrokinematics: what occurs in the upper cervical spine? (One theory)

A

While in neutral - SB and rotation will occur in opposite directions // while flexed/extended will occur in the same direction

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14
Q

In terms of arthrokinematics: what occurs in the lower cervical spine? (Two theories)

A

1) Rotation and SB to the same side, no matter if flex/extension
2) Rotation and SB while flexed will be the same direction - rotation and SB while extended will be the opposite direction

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15
Q

What are subjective red flags for cervical fracture/ligamentous instability?

A

1) major trauma (MVA, fall from height)
2) RA
3) Down’s syndrome

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16
Q

What are objective red flags for cervical fracture/ligamentous instability?

A

Midline tenderness,
Positive ligamentous testing (Sharp purser - Alar)
Apprehension with/inability to rotation > 45 deg

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17
Q

What are subjective red flags for central cord lesions in the cervical spine?

A

1) older age
2) hx of trauma (MVA/fall)
3) incontinence

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18
Q

What are objective red flags for central cord lesions in the cervical spine?

A

Gait disturbance
Hyperreflexia LEs
UE (hand) sensory/motor deficits & atrophy

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19
Q

What are subjective red flags for a Pancoast tumor?

A

1) men over 50 y.o. with hx of smoking
2) “nagging” shoulder pain along vertebral border of scapula
3) burning pain down arm in ulnar nerve distribution (C8-T1)

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20
Q

What are objective red flags for a Pancoast tumor?

A

Wheezing with auscultation

Horner’s syndrome (ptosis, constricted pupil, sweating disturbance)

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21
Q

What are subjective red flags for septic arthritis for the SC joint?

A

1) insidious onset of chest pain (localized to SC joint)

2) hx of IV drug use, diabetes, trauma, infection

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22
Q

What are objective red flags for septic arthritis for the SC joint?

A

Tender SC joint
Limited shoulder movement
Swelling over the SC joint
Fever

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23
Q

What are the high risk factors for radiography with the Canadian C Spine rules?

A

1) age > 65
2) paresthesia in extremities
3) dangerous MOI (fall, MVA)

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24
Q

What are the low risk factors for radiography with the Canadian C Spine rules?

A

1) Ability to sit / ambulate
2) Delayed onset of neck pain
3) Absence of midline tenderness
4) lower impact MVA

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25
Q

What ROM in the neck is necessary to demonstrate bilaterally for the Canadian C Spine rules?

A

> 45 deg of rotation

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26
Q

What is the MCD (minimal change detected)?

A

The amount of change needed before the change can be considered to exceed measurement error

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27
Q

What is the MCID (minimal clinically important difference)?

A

The smallest difference patients perceive as beneficial

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28
Q

What is the MCD/ MCID for the numeric pain rating scale?

A

MCD 2.1

MCID 1.3

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29
Q

What is the MCD/ MCID for the NDI?

A

MCD 5 points / 10%

MCID 5 points / 10%

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30
Q

What are the most common activities listed for the Patient Specific Functional Scale? (3)

A

1) backing up car
2) sleeping
3) computer use

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31
Q

What is the MCD /MCID for the PSFS?

A

MCD 2.1

MCID 2 points

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32
Q

What outcome measure’s work subscale is sensitive in identifying those who may develop prolong work incapacity?

A

FABQ - work subscale

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33
Q

Who developed the inorganic signs for the cervical spine?

A

Sobel - higher presentation with inorganic signs, higher risk for prolong disability

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34
Q

Name the special test: pt seated, passive flex cervical spine 20-30 deg, one hand on forehead/opposite hand on C2 vertebra -> press forehead posteriorly (Name, positive outcome, spec/sens)

A

Sharp Purser test
Positive test: cranial movement with force without axis moving, myelopathic sxs during flexion, decrease of sxs with posterior movement
Spec: 0.96 - Sens: 0.69

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35
Q

Name the special test: pt supine, pinch grip on C2 spinous process, SB neck and feel spinous process move into index finger/thumb (Name, positive outcome, spec/sens)

A

Alar ligament
Positive test: delay in movement of spinous process
Spec 0.96 - Sens 0.70

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36
Q

What are the Hoffman criteria for instability? (5)

A

1) no midline tenderness
2) no focal neurological deficit
3) normal alertness
4) no intoxication
5) no painful, distracting injury
99% sensitivity to screen

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37
Q

What are three key assessments done for identifying VBI in screening?

A

1) subjective complaints
2) head and neck pain <90% of time> most often unilateral and suboccipital
3) MOI - most commonly trauma, whiplash with flexion-distraction and rotational force - with ACUTE onset

38
Q

What are clinical features of VBI?

A

Dizziness, vertigo, giddiness, light headedness, nausea with vomitting, numbness (unilateral facial - not so much limbs), ataxia (most common), diploplia, limb weakness (uncommon)

39
Q

What are neurological signs for VBI?

A

ipsilateral Horner’s syndrome (ptosis, sweating, constricted pupil)
ipsilateral limb ataxia
gait ataxia
ipsilateral sensory abnormalities of face (CN V)
diminished/absent corneal reflex
nystagmus, cerebellar or vestibular
facial expressions/CN VII deficits
CN IX-XII abnormalities (taste disturbed, slurred speech, dysarthria, dysphagia, dysphonia, trap reflex, tongue protrusion with deviation to involved side, tongue atrophy)

40
Q

What landmark is used for inclinometry for the cervical spine?

A

External auditory meatus

41
Q

What percent of patients with neck pain may suffer with facet or synovial fold/meniscoid entrapment?

A

50%

42
Q

Overall, is manual therapy (mob vs manip) isolated or better in combination with exercise?

A 
Isolated = weak evidence
Combination = relatively strong
43
Q

Is the mechanism of pain relief for spinal manipulation thought to be mechanical or neurophysiological?

A

Neurophysiological - central pain control by stimulating descending inhibitory pain mechanisms, like dPAG

44
Q

Mob vs. manip in the cervical spine? Difference in pain, disability or patient satisfaction

A

Gross et al (systematic review) found moderate to low quality evidence that HVLA produced no difference

45
Q

What two authors found significant improvement in pain and disability for cervical HVLA?

A

Puentedura & Dunning - greater reduction in pain, disability, improvement in rotation

46
Q

What are the six factors that inc probability of success with cervical manipulation?

A

1) initial NDI score <11.5
2) bilateral involvement pattern
3) not performing sedentary work more than 5 hr/day
4) feel better while moving
5) did not feel worse with neck extension
6) dx of spondylolysis without radiculopathy
4 or more factors inc probability of success from 60 to 89%

47
Q

What are the 4 factors identified by Puentedura as a CPR that pts with neck pain will benefit from thrust manip?

A

1) sxs duration <38 days
2) positive expectation that manip will help
3) side to side differences >/= to 10 deg rotation
4) pain with posteroanterior spring test of mid cervical spine
3 of 4 attributes had +LR 13.5

48
Q

Fernandez-de-las-Penas found what implications with performance of C5-6 manipulation for elbow pain?

A

Increased pain pressure threshold (PPT) over lateral epicondyle - reduced number of treatments

49
Q

Cleland established a CPR for patients who would benefit from thoracic manipulation for neck pain: 6 factors

A

1) sxs duration <30 days
2) no sxs distal to shoulder
3) looking up did not aggravate sxs
4) FABQ- physical <12
5) diminished upper thoracic kyphosis (T3-5)
6)cervical extension <30 deg
3 variables with 54 to 86% improvement, more than 3 even greater

50
Q

What produced greater reduction in pain, reduced disability score and perceived improvement in GRoC scale: manipulation of t-spine or non-thrust mobilization

A

Manipulation - versus sham had had 15.5 improvement on VAS

51
Q

What are descriptors for cervicogenic headache?

A
  • unilateral headache, associated pain in neck/suboccipital area
  • sxs aggravated by neck movement/posture
  • restricted cervical ROM
  • restricted cervical segmental mobility
  • abnormal/substandard performance of CCFT
52
Q

What percentage of rotation occurs at C1-2?

A

50%

53
Q

What articulation has been found to have high frequency of sxs involved in neck pain with headaches?

A

C1-2

54
Q

If active ROM is limited to less than 45 deg, what articulation may be restricted?

A

C1-2; produces 40-45 deg of rotation - 4-8 degrees from each level C3-7

55
Q

Name the special test: pt supine; maximal passive flexion, actively rotate neck (positive test indicates)

A

Flexion rotation test - less than 45 deg = positive test
Less than 32 deg Ogince
High sens/spec 91/90

56
Q

What is the MDC (beyond scope of error) with change for the FRT in the cervical spine?

A

7 deg

57
Q

In CGH vs migraine: which has more restriction in flexion and extension?

A

CGH

58
Q

In CGH vs migraine: which has significantly higher instances of painful upper cervical joint dysfunction?

A

CGH

59
Q

How is muscle strength and endurance assessed in the cervical spine?

A

Cranial cervical flexion test - started at 20 mm Hg - graded manner at 5 increments (22, 24, 26, 28, 30); goal to hold 10 seconds with 10 seconds rest between stages

60
Q

What headache presentation has significant forward head posture/position?

A

Chronic tension type headache

61
Q

How is endurance assessed for upper cervical flexion?

A

Timed test of upper cervical flexion (without SCM activation) and lift head 1 inch off table

62
Q

What are mean times for neck flexor endurance testing for subjects without pain and with neck pain?

A

Without 39 seconds
With pain 24.1 seconds

10 second difference between men and women

63
Q

What was the comparison in those with CGH vs controls?

A

Deficits in peak torque 16%
Deficits in endurance 35%
As well as deficits in precise contraction level

64
Q

In those diagnosed with whiplash type disorders, isometric strength was reduced 90% - if no neurologic disorder/atrophy - what accounts for strength loss?

A

Learned pain avoidance behavior - looking at isometric strength in cardinal planes

65
Q

In the O’Leary study for those diagnosed with whiplash type disorders, what was better focus of strengthening? (CCFT strengthening or neck flexor endurance strengthening)

A

Craniocervical flexion coordination - better pain pressure thresholds, mechanical hyperalgesia, perceived pain relief

66
Q

What motion is suggested for regular performance in those diagnosed with whiplash type disorders?

A

Cervical rotation - coupled wtih reassurance, encouragement for regular movement

67
Q

What three areas are specific exercises for cervical spine targeting for strength?

A

1) craniocervical flexion/ head nods
2) cervical flexor endurance progression - lifted off table /returned
3) lower cervical extensor training - quadriped or prone - while maintaining neutral craniocervical flexion

68
Q

What are the 4 factors to identify cervical radiculopathy? CPR

A

1) cervical rotation < 60 deg to involved side
2) ULTT 1/A positive
3) distraction test relieves sxs
4) Spurlings positive on involved side
4 variables - 99% specificity/24% sensitivity (+LR 30.3)
3 variables - 94% specificity/ 39% sensitivity (+LR 6.1)

69
Q

What are clinical indications of upper motor neuron pathology?

A
  • hyperreflexia
  • diffuse sensory changes/not dermatomal
  • clonus ankle
  • pos Hoffman’s or Babinski
  • clumsiness/ataxic gait
  • weakness below compression
70
Q

What is a positive Babinksi sign?

A

Fan sign = abduction of small toes and great toe extension

Specificity 99%, sensitivity 51%

71
Q

What is a positive Hoffman reflex?

A

Flick distal phalanx of middle finger; flexion of IP joint of thumb and adduction of index finger
94% sensitive

72
Q

What are clinical indicators for lower motor neuron pathology?

A
  • hyporeflexia
  • absent DTRs
  • decreased sensation to light touch following dermatomal pattern
  • muscle weakness in myotomal pattern
73
Q

Muscle for myotomal testing C5

A

Deltoid

74
Q

Muscle for myomtomal testing C6

A

Biceps - ECRL/brevis (wrist extended, radially deviated, forearm pronation)

75
Q

Muscle for myotomal testing C7

A

Triceps - flexor carpi radialis (wrist flexed, radially deviated, forearm supinated)

76
Q

Muscle for myotomal testing C8

A

Abductor pollics brevis

77
Q

Muscle for myotomal testing T1

A

First dorsal interossei

78
Q

Dermatomal testing C5

A

Lateral forearm

79
Q

Dermatomal testing C6

A

Distal thumb

80
Q

Dermatomal testing C7

A

Distal middle finger

81
Q

Dermatomoal testing C8

A

Distal fifth finger

82
Q

Dermatomal testing T1

A

Medial forearm

83
Q

DTR testing C5

A

Biceps (5-6)

84
Q

DTR testing C6

A

Brachioradialis (5-6)

85
Q

DTR testing C7

A

Triceps (7)

86
Q

What reflex is commonly absent in cervical radiculopathy?

A

Biceps - inc from 23% to 59% inc chance

87
Q

What two muscle groups are commonly associated with nerves around the cervical spine that inc radicular or radiating pain?

A

Scalenes and pectoralis minor

88
Q

What ULTT is an excellent screening tool for cervical radiculopathy?

A

ULTT 1/A - median nerve

89
Q

Is Spurlings more sensitive or specific in detection of cervical radiculopathy?

A

Specific - 90% with +LR 3.5

90
Q

Does the systematic review regarding traction favor intermittent or continuous traction?

A

Favored intermittent - no support for continuous

91
Q

What is the CPR for intermittent cervical traction? (5 factors)

A

1) peripheralization with lower cervical mobility testing (c4-7)
2) positive shoulder abduction sign
3) age >55 years
4) pos ULTT 1/A
5) relief of sxs with manual distraction test
4 or more variables = 98% probability of success, +LR 23.1
3 variables = 53.2% probability of success, +LR1.44

OCS Cards (23 decks)

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