Cervical Dx and Tx

Question 1

Hangman’s fracture

Answer 1

Hyperextension of cervical spine resulting in traumatic spondylolisthesis of C2 with fracture of the vertebral arch of C2, as well as tearing of ligaments between C2 and C3

Question 2

While viewing AP radiograph of C spine, spinous processes should lie in a straight line, except if they are bifid. If there is malalignment, what may be present?

Answer 2

Unilateral facet joint dislocation

Question 3

While viewing AP radiograph of C spine, the distance between the spinous processes should be equal. no space should be 50% wider than the one immediately above or below. If it is, it is characteristic of what?

Answer 3

Anterior cervical dislocation

Question 4

What radiographical view enables assessment of C1 and C2, although associated fractures may be better viewed on lateral projection?

Answer 4

Open mouth radiograph

Question 5

T/F: lateral masses of C1 should overhang the lateral masses of C2

Answer 5

False; if this is present, it is likely a burst fracture

Question 6

45 degree oblique view of C spine will demonstrate what structures?

Answer 6

Intervertebral foramina

Possible presence of osteophyte encroachment of spondylosis (right posterior oblique demonstrates left foramina and vice versa; narrowing is indication for MRI)

Question 7

Contraindications to HVLA in cervical area

Answer 7

Advanced RA and Down syndrome may be associated with alar ligament instability

Vertebral artery disease may be associated with thrombosis

Advanced carotid disease

Question 8

37 y/o female presents with complaints of diarrhea that started 2 weeks prior with a MVC. SD at which of the following levels is most likely parasympathetic facilitation contributing to her symptoms?

A. OA
B. C4
C. C7
D. T4
E. T7

Answer 8

A. OA

[bc that’s where vagus n. comes out]

Question 9

19 y/o female presents complaining of headaches. States she has been having headaches since age 17 after MVA whiplash injury and finds they are worsened by stress .OSE findings include OA preference to right rotation and restriction from R to L translation. These findings worsen in extension. What is the diagnosis?

Answer 9

OA F RR SL

Question 10

OSE reveals restriction of rotation to the right at the AA. Which of the following is the correct direction for the patient’s activating force during MET?

A. Rotating right
B. Rotating left
C. Sidebending right
D. Sidebending left

Answer 10

B. Rotating left

Question 11

16 y/o male presents complaining of headaches, numbness, and tingling in first 3 digits on his palmar side. On exam you dinf that his C6 dermatome seems to be affected. Which of the following spinal segments is likely affected?

C5-C6

Or

C6-C7

Answer 11

C5-C6

Because nerves in c-spine exit above spinal segment

Question 12

Patient presents with right neck pain. OSE reveals restricion to cervical extension and rotation to the right. After doing ST/MFR, you find C4 is rotated L, restricted to extension, and prefers L->R translation. Which of the following is correctly named SD?

A. C4 E RL SL
B. C4 F RL SL
C. C4 E RR SL
D. C4 F RL SR

Answer 12

B. C4 F RL SL

Question 13

Compression test

Answer 13

Physician applies an axial compresssion of head in neutral

Positive test = pain down arm in nerve root distribution

Indicates = nerve root compression (cervical radiculopathy)

Question 14

Spurling’s maneuver

Answer 14

1. Compression of head in neutral
2. Compression of head in extension
3. Sidebend away from affected side then toward the affect side and add compression

Positive test = pain down arm in nerve root distribution

Indicates = nerve root compression (cervical radiculopathy)