Cervical Clinical Presentations pt. 1 Flashcards
what is ankylosing spondylitis
chronic inflammatory spondyloarthropathy
ossification of ligaments of spine, IV discs/end plates, facet structures
what are u at risk for with ankylosing spondylitis
spinal cord injury 11.4x greater
epidural hematoma
low impact trauma most commonly at C5-C7
osteoporosis
who is more likely to have anklyosing spondylitis
men
most likely 3rd decade
complaints of anklyosing spondylitis
back pain worse at night/in morning but improves with exercise and worst at rest
decreased chest expansion
back stiffness
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?
anklyosing spondylitis
what is klippel feil syndrome
congenital failed C-spine segmentation
patient presenting with short neck, low posterior hairline, limited C-spine ROM, what are they presenting with?
klippel feil syndrome
what do >50% of pt’s with klippel feil syndrome also have?
scoliosis
what are complications of klippel feil syndrome
instability and spinal stenosis
what is cervical arterial dysfunction
CAD, also known as vertebral basilar insuffiency (VBI), intimal tear with penetration of circulating blood into the vessel wall and formation of a hematoma
what are the consequences of CAD
retinal or brain ischemia
compression or stretching causes local symptoms
subarachnoid or intra-cerebral hemorrhage
mean age typically seen with CAD
39-45 y/o
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
cervical arterial dysfunction
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
cervical arterial dysfunction
what are the “D’s and N’s” with CAD
dizziness
dysarthria
dysphagia
diplopia
drop attacks
nystagmus
nausea
numbness (face, lips, extremities)
when is ipsilateral horners syndrome seen
in more than or equal to 50% of pt’s with CAD
what is horners syndrome
ptosis - dropping upper eyelid
miosis - constriction of pupil
enophthalmos - sinking of the orbit
anhydrosis - dry eyes
what is present with CAD
hypertension
what positional testing for CAD
sustained end range rotation test
modified sphinx
VBI test
pre-manipulative positioning
what is VBI tests
- placing pt in extreme position of cervical spine motion and observing SxS
- may place more emphasis on Hx, interview, BP and neuro testing
what is cervical spine myelopathy
spinal cord compression as a result of impingement from surrounding structures
what ligament is involved with cervical myelopathy
ossification of PLL
what are the symptoms of cervical myelopathy
neck pain/stiffness
shoulder pain
imbalance/falls
UE dysesthesia
may involve LE first and cause weakness
what are some neurologic signs seen with cervical myelopathy
gait impairment
spasticity
pathologic reflexes are hyperreflexia
dis-coordinated extremity movements
radicular signs - weakness
balance impairment
