Cervical And Thoracic Outlet Flashcards
Observation requirements?
Posture seated and standing; cervical lordosis, thoracic kyphosis
Scars, swelling bruising, atrophy, fasciculations, tremors
Anterior neck: thyroid, fullness in supraclavicular fossa
What is Rusts sign?
Patient presents stabilizing their head with the hands
What is required for gait?
Observe gait for any signs of cervical myelopathy.
Loss of balance, stiffness, unsteadiness, loss of power, broad based stance (myelopathy)
Scuffing of big toe,
What is required of palpation?
Bony tenderness (fracture or path) Interspinous pain (ligament sprain) Facet joint tenderness (joint dysfunction) Soft tissue (trigger points) Neck must be flexed when palpating bony structures of the neck Anterior neck fro lymphadenopathy, muscle spasm, thyroid disease
Spinous process percussion?
Fracture or bone pathology
Range of motion?
Normal ranges?
First, active range of motion Passive, Ranges: Flexion: 80-90 Extension: 70 Lateral flexion: 20-45 Rotation: 70-90
Maximum cervical compression test?
How and why?
Seated patient actively extends the neck then laterally flexes and rotates the head towards the side of arm pain. Patient holds position for 30 seconds to check for reproduction of pain.
If no pain after 30 seconds, apply a light downward force.
Designed to reproduce radicular pain, can also produce facet pain.
Cervical distraction test?
How and why?
Patient seated, lift head to distract.
Repeat with head in flexion, if no relief is obtained.
Relief is seen by relieving pressure caused by narrowed IVF compression nerve roots.
Doorbell sign
How and why?
Patient seated, push deep into the IVF
Reproduction or increased arm pain indicates nerve root irritation
Shoulder abduction relief test (bakodys sign)
How and why?
Patient puts hand on head, if pain is relieved in this posture can suggest cervical radiculopathy
Shoulder depression test
How and why?
Apply downward force on shoulder while laterally flexing the head the opposite direction.
Traction’s the brachial plexus and nerve roots, arm pain increased = radicular irritation can also irritate local musculature and ligaments
Lhermitte sign
Why and how?
Seated, legs out straight. Passively flex neck to end range.
Positive = electric like sensation down the spine, into extremities.
Cervical myelopathy, spinal cord tumour or multiple sclerosis.
What is the sensitivity of combining the test when 3/4 are positive vs 4/4 positive?
Likelyhood ratios
3/4 = 6:1 4/4 = 30:3
Roos test
How and why?
Seated, shoulders abducted to 90* elbows flexed to 90* palms forward. Patient contracts hands rapidly for 1 minute.
If symptoms are recreated (numbness in hand) could be positive for TOS
Adson’s test
Why and how?
Seated, patients hand externally rotated and slightly abducted. Fully extend and rotate head towards hand
Monitor pulse while patient hold full inspiration.
Reproduction of symptoms + lowered pulse suggests compression of neurovascular bundle.
Compression between scalene or cervical rib
