Cervical Clinical Presentations pt. 2 Flashcards
what increases risk for ligamentous cervical instability
hx of trauma
throat infxn
congenital collagenous compromise
inflammatory arthritis
recent neck/head/dental surgery
neck pain
occipital headache/numbness
limitation with activities performed at end range C-spine ROM
radicular or myelopathic symptoms
what are these symptoms example of?
upper cervical instability
what are 2 other symptoms that could be signs of upper cervical instability?
- reports needing to support head with hands
- tires easily with prolonged static upright positioning of head
what physical signs will you see with cervical instability
limitation in ROM
muscle guarding
potentially radicular or myelopathic signs
special tests for upper cervical instability
modified shard purser test
alar ligament stability test
lateral shear test
tectoral membrane test
posterior A-O membrane test
what are common sites of C-spine fx
occipital condyles
C1
C2
traumatic spondylolysthesis
common mechanisms for C-spine fx
axial loading
presentation of c-spine fx
limited ROM
neck pain
C-spine spasm
difficulty swallowing
radicular pain
CAD SxS
myelopathy SxS
what is a jefferson fx
C1
specific type of atlas fx
4 part burst fx
spondylolysis
defect of pars interarticularis
stress fx forming - starting to weaken
spondylolysthesis
anterior displacement of vertebral body
fx formed starting to move
degenerative spondy
most common spondylolysthesis
C3/4 and C4/5
spondylolysthesis is graded how?
I:
II:
III:
IV:
V:
% vertebral body slips
I: 0-25%
II: 25-50%
III: 50-75%
IV: >75%
V: 100% dislocated
what are the canadian C-spine rules for
whether a C-spine injury warrants a CT
what are the 5 criteria in order to be classified as having a low probability of injury?
NEXUS low risk rule
no midline cervical tenderness
no focal neurologic deficit
normal alertness
no intoxication
no painful, distracting injury
spondylosis
affects vertebral bodies and discs
osteophyte complexes form around margin bodies
osteoarthrosis
facets
zygapophyseal joints and A-A joints
osteophytes, joint narrowing
what is central canal stenosis
narrowing of vertebral canal
what is examples of central canal stenosis
z-joint hypertrophy
bulging disc
thickening/ossification of ligamentous structures
spondylolysthesis
what is lateral canal stenosis
encroachment of spinal nerve in lateral foramen/lateral recess of spinal canal
what will you see with lateral canal stenosis
loss of disc height with degenerative processes
z-joint and uncovertebral joint hypertrophy
spondylolysthesis
hx for lateral canal stenosis
insidious but progressive onset
symptoms of lateral canal stenosis
radicular symptoms in cervical root distributions
what is acute zygapophysial joint arthropathy commonly associated with
extension mechanism
when will you see pain with acute zygapophysial joint arthropathy
joint compression ROM
segmental provocation
cervical compression & spurlings
somatic referred pain
altered pain perception in CNS
pain in anatomic location that is innervated by nerves other than the ones that innervate the source of the pain
radicular pain
pain related to nerve root irritation
when disc material evokes chemical inflammation from disc herniation
radiculopathy
conduction block of motor and sensory axons
symptoms of radicular pain
shooting/lancing pain down nerve root distribution
“band like”
pain w activities that close down foramen
physical signs of radicular pain present
relief w opening neuroforamen
painful/limited ROM with motions/positions that compress foramen
