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Cervical Eval & Treat Flashcards

1
Q

Cruciform Ligament (Transverse)

A

-Vertical and Transverse bands
-inhibit excessive translation of C1/C2
-Dens could compress stuff

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2
Q

Alar Ligaments

A

-attaches to C0 and dens
-can become OA insuficiency
-can cause neuro/vascular compromise

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3
Q

Anterior Column

A

-vertebral bodies and discs
-Weight bearing and shock absorption

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4
Q

Posterior Column

A

-articular processes
-Zygapopphhyseal (facet) joints
-Gliding mechanism for movements

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5
Q

Cervical Spinal Segments

A

-3 joints: 2 vertebral bodies and 1 disc, facet joint of sup and inf
-horizontal surfaces favor rotation
-vertical surfaces favor block rotation

-facets in “ramp” orientation

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6
Q

Amount of Motion Determinants

A

-Disc height ratio
-fibrocartilage compliance
-shape of end plates
-age
-disease
-gender

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7
Q

Type of Motion Determinants

A

-shape and orientation of articulations
-ligaments and muscles
-size and location of segment (lumbar biggest)

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8
Q

Intervertebral Discs

A

-largest avascular structure in body
-Nucleus Pulposus, Annulus Fibrosis, End plate (bone)
-Named for vertebra above
-Cervical & Lumbar: thicker anteriorly
-nutrition diffuses from endplate
-Cervical degenerates early (3rd decade)

Resists:
-compression
-shearing
-bending
-twisting
-combined motions

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9
Q

Spinal Juntions

A

CV: atlas, axis, head
CT: mobile c spine to stiffer upper t spine
TL: t-spine rotations meet limited L-spine
LS: mobile l spine to stiff SI joints

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10
Q

Mechanical Stability

A

state of equilibrium when body is still

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11
Q

Dynamic or Controlled Stability

A

Passive: resist forces at end ranges

Active: muscles coodinated to control body

CNS: feedforward and feedback control to augment stiffness

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12
Q

Zygapophyseal Joint

A

-synovial joints: articular cartilage, fibroadipose meniscoid
-supported by multifidi and ligamentum flavum
-innervated by medial branch of doral root
-move 5-8mm

Normal disc: 20-25% axial load on facet
Degenerated disc: 70% axial load on facet

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13
Q

Annulus Fibrosis

A

60-70% of water
-layered
-attaches to endplate
-transmit compression forces

Outer zone: sharpey’s fibers (fibrocarttilage)
Intermediate: fibrocartilage
Inner zone: most fibrocartilage

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14
Q

Nucleus Pulposus

A

70-90% water
-no nerve oor blood supply
-absorb compression

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15
Q

Disc Pathology Stages

A

Protrusion: disc bulge w/o rupture

Prolapse: outlayers of AP contain NP

Extrusion: AP perforated into epidural

Sequestration: disc fragments disconnect

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16
Q

End Plate Fx S/s

A

-trauma or MOI
-Acute pain
-(-) SLR
-(+) compression test

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17
Q

Internal Disc Disruption S/s

A

-separation of inner layers
-LBP or referred hip pain
-(-) SLR

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18
Q

Disc Protrusion/Prolapse S/s

A

-contained
-some AF and PLL intact
-LBP or referred hip
-pain with cough or sneeze
-(-) SLR

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19
Q

Disc Extrusion or Sequestration S/s

A

-uncontained
-LBP
-Pain with cough/sneeze
-True Sciatica (radicular pain)
-(+) SLR

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20
Q

Joint Manipulation Contraindications

A

-Serious pathology
-fracture*
-lack of skill
-Ligament rupture*
-No working hypothesis
-Worsening neuro function*
-Unremmitting night pain*
-Severe multi directional spasms
-UMN Lesions*

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21
Q

Atlas: C1

A

Forms atlanto occipital joint (OA).
-Flexion
-lacks spinous process
-Transverse Ligament attaches here

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22
Q

Axis: C2

A

-Forms atlantoaxial joint (AA).
-Rotation (60%)
-Possesses dens/odontoid process
-Links CV to C-spine

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23
Q

Cervical vertebrae

A

-Seven, bifid spinous process, flat facet joints.
-C3-C7 have uncunate

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24
Q

Order of cervical muscles from superior to deep

A

SCM,Trapezius, splenius capitus, splenius cervicis, erector spinae, semispinalis capitis, Rectus capitis (ant/lat), Longus colli

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25
Common carotid
Splits into two at C3 to C4 level. Carotid sinus, contains baroreceptors for pressure and turns into the internal carotid artery. Carotid body with chemoreceptors for chemicals and turns into the external carotid artery.
26
Important arteries of the lateral neck
Common carotid, vertebral artery, subclavian artery, brachiocephalic trunk, end of aorta
27
Upper Cervical Spine Biomechanics: OA Joint
C0-C1 -Lateral flexion: with contralateral rotation coupling (mostly at (CO-C1) -lots of congruency due to lack of disc OA joint: convex (C0) on concave (C1) (opposite) -no disk -15-25 degrees -Flexion: rolls ant, slides pos (5 deg) -Extension: rolls pos, slides ant (10 deg) -LSB: (5 deg)
28
Upper Cervical Spine Biomechanics: AA Joint
C1-C2 -Lateral flexion: with contralateral rotation coupling -Flexion: 5deg -Extension: 10deg Rotation: 35-45 deg AA Joint: Biconvex -rotation -Coupled with contralateral lat flexion -contralateral move of C2 SP -60% of rotation -Biconvex (flx lower cerv, ext upp ext)
29
Lower Cervical Spine
(C2/3-C7/T1) -uncinate process limit lat flexion -more mobility -bifids til C6 Flexion: ant tilt and slide coupled with upward shift of facets (35-70 deg) Extension: pos tilt and slide coupled with downward shift of facets (55-60 deg) Lateral Flexion: coupled with ipsilateral rotation (15-40 deg) -downward slide of ipsilateral facet joints -upward slide of contralateral facet joints Rotation: coupled with ipsilateral lateral rotation (30-45 deg)
30
Vertebral Artery
C1-C6 -most vulnerable at C1/C2 transition
31
Cervical Nerve Referrals
C1-C3: refers to head and neck C4-C8: refers to shoulder, ant chest, UE, Scaps -CN 11
32
Closing Restriction
Issues with: -extension, SB, Rotation -IPSI side of pain
33
Opening Restriction
Issues with: -flexion, SB, rotation -CONTRA side of pain
34
Cervical Flexion Inclinometer ROM
-Cranium to T1 -80-90
35
Cervical Flexion Goni ROM
80-90 Stationary: Perp. floor Axis: Ear hole Movement: Base of nose -take resting, subtract from final number
36
Cervical Extension Goni ROM
50-70 Stationary: Perpendicular to floor Axis: ear hole Movement: Base of nose
37
Cervical Rotation ROM Inclinometer
-PROM -Supine -Center of forehead (frontal plane)
38
Cervical Rotation ROM Goni
-70-90 Stationary: btwn acromion Axis: Center of cranium Movement: nose
39
Cervical AROM Values
Flx: 80-90 Ex: 50-70 LSB: 22 Rot: 70-90
40
Scanning Cervical Exam Requirement
-VBI -Alar Ligament -Transverse Ligament
41
Patient Hx
Demographics: -age -occupation -Hand Dominance -Activities MOI Pain Behavior (aggs/eas) Widespread vs Local S/s -Bilat vs/ Unilat Neurological S/s Chief Complaint
42
5 Ds
-Dizziness -Dysarthria -Dysphagia -Diplopia -Drop Attacks
43
3 Ns
-Numbness/tingling -Nystagmus -Nausea
44
Pt Hx Red Flags
-immune -pigeons -trauma -light sensitivity/seizure -speech/swallowing
45
Principals of Ortho Exam
1. Gather Hx (MOI, description of s/s and pain activity) 2. To Scan or Not 3. Test Uninvolved First 4. AROM>PROM>RROM & Endfeels or Neuro 5. Joint Play/Assessment (check for pain) 6. Painful tests lasts 7. Warn Patient about possible exacerbations
46
Physical Examination Components
1. Pt Hx 2. Systems Review 3. Screening (VBI/TL/AL) 4. Observation 5. Scanning Exam (if needed) 6. AROM>PROM>RROM & Flexibility 7. Muscle 8. Joint Play 9. Palpation 10. Special Tests
47
Canadian Cervical Spine Rule
-guidlines for immobilization and/or imaging after trauma to neck -positive= refer 1. High risk factor for immobilization (any of these) ->65 - dangerous MOI -Numbness and tingling in extremities 2. Low risk factor for assessment of ROM -Complex rearending -cannot ambulate -cannot sit in ED -IMMEDIATE neck pain -pain at midline of c-spine 3. Can Ptt voluntarily actively rotate 45deg -yes: treat -no: immobilize and image
48
Cervical Conditions DDx
-Ligamentous instability -Myelopathy -Malignancy -Spinal Fx's -Vascular Pathologies
49
Forward Head/Postural Syndrome
-Cervical hyperlordosis -Shoulder Protraction -CT Hyperkyphosis
50
Cervical Hyperlordosis
-TMJ overcloses -Posterior Compression -CV hyperextension -OA flx hypomobile -AA rot hypomobile -OA ext hypermobile -CV instability
51
Shoulder Protraction
-GH instability -AC instability
52
CT Hyperkyphosis
-T-spine ext hypo -Shoulder complex hypo -RC tendinopathy
53
Mechanical Neck Pain
-non trauma, radic, non-msk -icnreases with age -can become chronic
54
Acute Disc Herniation
-uncommon <30 -common ~50
55
Disc Degeneration
-after endplate damage -drop in height -80% of neuro deficits correspond with disc left
56
Cervical Radiculopathy
-compression of spinal nerve root -inflammation or impingement -common with hyperext -often in middle age
57
C2-3 Disc Herniation
-rare
58
C4 Spinal Root Compression
-posterior neck -medial scapular border pain
59
Radiculopathy Diaphragm Involvement
-C3-5 -difficulty breathing
60
C5 Spinal Root Compression
-numbness on superior shoulder
61
C6 Involvement
-radiating pain from neck to lateral aspect of upper arm, forearm, and hand
62
C7 involvement
-radiating pain from posterior neck to scapula, posterior upper arm, forearm, and hand -MC site for cervical radiculopathy
63
C8 involvement
-radiating pain from neck to medial aspect of upper arm, forearm and hand
64
Cervical Spondylosis
-chronic degenerative condition -related to bony changes causing myelopathy/radiculopathy -can be asymptomatic -changes facets and IVD
65
Facet Joint Dysfunction
-unilateral neck pain (slept wrong) -2ndary to synovial membrane getting caught in z-joint -closing/opening restrictions
66
Facet Joint Dysfunction CPR
CPG: 1. S/s <30 days 2. No s/s distal to shoulder 3. Looking up doesn't agg s/s 4. FABQ physical activity <12 5. Diminished upper t-spine kyphosis 6. Cervical ext ROM <30deg (+) > or = 3, successful outcome w/t-spine HVLAP in 86% of Pts
67
Cervical Spine Instability
-inability of spine under load, to limit displacement so as not to damage structures -cant control the motion -2ndary trauma, surgery, disease S/s: -Hx of trauma -catching, locking, giving away -unpredictable s/s -altered ROM -neck weakness and pain -HAs
68
Whiplash-Association Disorders
-rapid deceleration or acceleration -damage to soft tissue structures/joints/nerve issues Common Mechanism: -MVAs -Sport-related -pulls and thrusts on arm -falls, landing on trunk or shoulder
69
Headaches
-Migraine (half of face) -Tension (band) -Cluster (behind the eye, focused) -Cervicogenic (from lateral neck to head)
70
Migraine HA
-35-45ys -4h to 3 days -Mod to severe -Unilateral/pulsating
71
Tension HA
-20-40ys -Mins to hours -Mild to mod -Bilateral/pressure -Treated w/ posture, stress management, MT
72
Cluster HA
-20-40ys -1-8 episodes throught the day -Severe -Unilateral/congestion/eye watering
73
Cervicogenic HA
-Any age -Variable -Mild -Unilateral/dec ROM/Rams's horn Treatment: -C2-C3 in neutral -C2 under C1 in rotation -C1 under occiput
74
3 Mandatory Qs for Neck Pain
1. Dizziness, blackouts or drop attacks? -Ds and Ns -VBI 2. Hx of RA/arthritis or steroids? 3. Any neuro in legs? Optional: Down Syndrome -ligamentous laxity
75
Arthritis and Steroid Affects
-ligamentous instability
76
Closing Restriction
Issues with: -extension, SB, Rotation -IPSI side of pain
77
Opening Restriction
Issues with: -flexion, SB, rotation -CONTRA side of pain
78
Cervical Radiculopathy CPR
1. C-spine rot to painful side <60deg 2. (+) Spurling test 3. (+) ULLT#1 4. (+) Cervical Distraction (relieves) 4/5: 90% 3/5: 65%
79
ICF Model: Neck Pain w/ Mobility Deficits
-hypomobility S/s: -Pain in central (older stenosis) or Unilateral (younger foramena) -limited ROM that constantly reproduces s/s -possible referred pain Exam: -Dec ROM -Neck pain at end ranges -Restricted mobility in c and t-spine -referred pain reproduced w/ provocation -deficits in cervico-scapulo-thoracic strength Treatment: -T-spine manips -C-spine manual -Cervical ROM -Strengthening
80
ICF Model: Neck Pain w/ Movement Coordination Impairments
-Instability S/s: -MOI linked to trauma/whiplash or hypermobility -referred shoulder pain -HA, concussion, confusion, hypersensitivity Exam: -(+): cranial cervical flexion test -(+): Neck flexor muscle endurance test -(+): Pressure algometry -Neck pain at midposition to end -Dec strength -Point tenderness Treatment: -Pt education and prognosis -Increase ROM -Manual or exercise -Pain science
81
ICF Model: Neck Pain w/ Headaches
S/s: -non-continuous, unilateral neck pain (facet joint) and referred HA -HA precipitated or aggravated by neck movements or positions Exam: -(+): Cervical flexion rotation test -HA reproduced w/ provocation -Limited ROM -Strength and endurance deficits Treatment: -Mobility -Self SNAGs to AA joint -Manual therapy c and t-spine
82
ICF Model: Neck Pain w/ Radiating Pain
-Radiculopathy S/s: -neck pain w/ UE radiating pain -UE neruological signs Exam: -(+): Cervical radiculopathy CPR -UE sensory, strength deficits Treatment: -Exercise and MT -Cervical collar for short term -Intermittent traction -Pt education
83
Neck Pain and use of Thoracic HVLAT CPR
1. S/s <30 days 2.No s/s distal to shoulder 3. Looking up dec s/s 4. FABQ <12 5. Diminished thoracic kyphosis 6. Cervical extension ROM <30deg >3/6: inc chance of helping
84
C0-C1 Joint Referral
-back of neck to mid skull
85
C1-C2 Joint Referral
-Occiput
86
C2-C3 Joint Referral
-Occiput to mid skull
87
Anterior Cervical Discectomy and Fusion
-anterior approach of cervical disc removal
88
Anterior Corpectomy and Fusion
-anterior approach -removal of bone and fusion
89
Laminoplasty
-widen lamina space w/o removal -done for multi-level myelopathy -preserves spinal motion
90
Contraindications for Manual Therapy
-infection -Fever -Cancer -Acute Circulatory Condition -Open Wound -Fracture -Hematoma -Advanced DM -Hypersensitivity -Abnormal Endfeel -RA -Cellulitis -Constant, Severe pain -Extensive radiation of pain -Condition not evaluated
91
Precautions for Manual Therapy
-Joint effusion or inflammation -RA (non-exacerbation) -Osteoporosis -Pregnancy (over spine) -Dizziness -Steroid or anti-coagulant

MSK (48 decks)

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