Cervical Clinical Presentations pt. 1

Question 1

what is ankylosing spondylitis

Answer 1

chronic inflammatory spondyloarthropathy

ossification of ligaments of spine, IV discs/end plates, facet structures

Question 2

what are u at risk for with ankylosing spondylitis

Answer 2

spinal cord injury 11.4x greater
epidural hematoma
low impact trauma most commonly at C5-C7
osteoporosis

Question 3

who is more likely to have anklyosing spondylitis

Answer 3

men
most likely 3rd decade

Question 4

complaints of anklyosing spondylitis

Answer 4

back pain worse at night/in morning but improves with exercise and worst at rest
decreased chest expansion
back stiffness

Question 5

physical inspection of a pt is seen with “chin on chest” position (thoracic kyphosis, flattened lumbar curvature), multi-directional ROM limitations in the spine and radiographic imaging of sacroilitis - what are they presenting with?

Answer 5

anklyosing spondylitis

Question 6

what is klippel feil syndrome

Answer 6

congenital failed C-spine segmentation

Question 7

patient presenting with short neck, low posterior hairline, limited C-spine ROM, what are they presenting with?

Answer 7

klippel feil syndrome

Question 8

what do >50% of pt’s with klippel feil syndrome also have?

Answer 8

scoliosis

Question 9

what are complications of klippel feil syndrome

Answer 9

instability and spinal stenosis

Question 10

what is cervical arterial dysfunction

Answer 10

CAD, also known as vertebral basilar insuffiency (VBI), intimal tear with penetration of circulating blood into the vessel wall and formation of a hematoma

Question 11

what are the consequences of CAD

Answer 11

retinal or brain ischemia
compression or stretching causes local symptoms
subarachnoid or intra-cerebral hemorrhage

Question 12

mean age typically seen with CAD

Answer 12

39-45 y/o

Question 13

past hx of trauma to cervical spine, HTN, migraines, cardiac disease, hx of strokes, blood clotting disorders/anticoagulant therapy, steroids, hx of smoking, infxn, diabetes all can risk factors for what pathology

Answer 13

cervical arterial dysfunction

Question 14

a pt has neck and face pain, bilateral dysesthesia, motor dysfunction, pulsatile tinnitus and describes the “worst HA they ever had”, what are they presenting with

Answer 14

cervical arterial dysfunction

Question 15

what are the “D’s and N’s” with CAD

Answer 15

dizziness
dysarthria
dysphagia
diplopia
drop attacks
nystagmus
nausea
numbness (face, lips, extremities)

Question 16

when is ipsilateral horners syndrome seen

Answer 16

in more than or equal to 50% of pt’s with CAD

Question 17

what is horners syndrome

Answer 17

ptosis - dropping upper eyelid
miosis - constriction of pupil
enophthalmos - sinking of the orbit
anhydrosis - dry eyes

Question 18

what is present with CAD

Answer 18

hypertension

Question 19

what positional testing for CAD

Answer 19

sustained end range rotation test
modified sphinx
VBI test
pre-manipulative positioning

Question 20

what is VBI tests

Answer 20

• placing pt in extreme position of cervical spine motion and observing SxS
• may place more emphasis on Hx, interview, BP and neuro testing

Question 21

what is cervical spine myelopathy

Answer 21

spinal cord compression as a result of impingement from surrounding structures

Question 22

what ligament is involved with cervical myelopathy

Answer 22

ossification of PLL

Question 23

what are the symptoms of cervical myelopathy

Answer 23

neck pain/stiffness
shoulder pain
imbalance/falls
UE dysesthesia
may involve LE first and cause weakness

Question 24

what are some neurologic signs seen with cervical myelopathy

Answer 24

gait impairment
spasticity
pathologic reflexes are hyperreflexia
dis-coordinated extremity movements
radicular signs - weakness
balance impairment

Question 25

what 5 items are included in the clinical prediction rule for cervical myelopathy

Answer 25

1. gait deviation
2. hoffmans
3. inverted supinator
4. babinski
5. pt age >45

Question 26

research properties for CPR for cervical myelopathy:

1/5 positive tests:
3/5 positive tests:
5/5 positive tests:

Answer 26

94%
99%
100%