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MSK > Cervical Eval & Treat > Flashcards

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 of 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.

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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
Q

Common carotid

A

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.

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26
Q

Important arteries of the lateral neck

A

Common carotid, vertebral artery, subclavian artery, brachiocephalic trunk, end of aorta

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27
Q

Upper Cervical Spine Biomechanics: OA Joint

A

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)

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28
Q

Upper Cervical Spine Biomechanics: AA Joint

A

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)

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29
Q

Lower Cervical Spine

A

(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)

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30
Q

Vertebral Artery

A

C1-C6
-most vulnerable at C1/C2 transition

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31
Q

Cervical Nerve Supply

A

C1-C3: refers to head and neck
C4-C8: refers to shoulder, ant chest, UE, Scaps
-CN 11

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32
Q

Closing Restriction

A

Issues with:
-extension, SB, Rotation
-IPSI side of pain

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33
Q

Opening Restriction

A

Issues with:
-flexion, SB, rotation
-CONTRA side of pain

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34
Q

Cervical Flexion Inclinometer ROM

A

-Cranium to T1
-80-90

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35
Q

Cervical Flexion Goni ROM

A

80-90
Stationary: Perp. floor
Axis: Ear hole
Movement: Base of nose

-take resting, subtract from final number

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36
Q

Cervical Extension Goni ROM

A

50-70
Stationary: Perpendicular to floor
Axis: ear hole
Movement: Base of nose

37
Q

Cervical Rotation ROM Inclinometer

A

-PROM
-Supine
-Center of forehead (frontal plane)

38
Q

Cervical Rotation ROM Goni

A

-70-90
Stationary: btwn acromion
Axis: Center of cranium
Movement: nose

39
Q

Cervical AROM Values

A

Flx: 80-90
Ex: 50-70
LSB: 22
Rot: 70-90

40
Q

Scanning Cervical Exam Requirement

A

-VBI
-Alar Ligament
-Transverse Ligament

41
Q

Patient Hx

A

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
Q

5 Ds

A

-Dizziness
-Dysarthria
-Dysphagia
-Diplopia
-Drop Attacks

43
Q

3 Ns

A

-Numbness/tingling
-Nystagmus
-Nausea

44
Q

Pt Hx Red Flags

A

-immune
-pigeons
-trauma
-light sensitivity/seizure
-speech/swallowing

45
Q

Principals of Ortho Exam

A
  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
Q

Physical Examination Components

A
  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
Q

Canadian Cervical Spine Rule

A

-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
    -neck pain
    -pain at midline of c-spine
  3. Can Ptt voluntarily actively rotate 45deg
    -yes: treat
    -no: immobilize and image
48
Q

Cervical Conditions Rule Out

A

-Ligamentous instability
-Myelopathy
-Malignancy
-Spinal Fx’s
-Vascular Pathologies

49
Q

Forward Head/Postural Syndrome

A

-Cervical hyperlordosis
-Shoulder Protraction
-CT Hyperkyphosis

50
Q

Cervical Hyperlordosis

A

-TMJ overcloses
-Posterior Compression
-CV hyperextension
-OA flx hypomobile
-AA rot hypomobile
-OA ext hypermobile
-CV instability

51
Q

Shoulder Protraction

A

-GH instability
-AC instability

52
Q

CT Hyperkyphosis

A

-T-spine ext hypo
-Shoulder complex hypo
-RC tendinopathy

53
Q

Mechanical Neck Pain

A

-non trauma, radic, non-msk
-icnreases with age
-can become chronic

54
Q

Acute Disc Herniation

A

-uncommon <30
-common ~50

55
Q

Disc Degeneration

A

-after endplate damage
-drop in height
-80% of neuro deficits correspond with disc left

56
Q

Cervical Radiculopathy

A

-compression of spinal nerve root
-inflammation or impingement
-common with hyperext
-often in middle age

57
Q

C2-3 Disc Herniation

A

-rare

58
Q

C4 Spinal Root Compression

A

-posterior neck
-medial scapular border pain

59
Q

Diaphragm Involvement

A

-C3-5
-difficulty breathing

60
Q

C5 Spinal Root Compression

A

-numbness on superior shoulder

61
Q

C6 Involvement

A

-radiating pain from neck to lateral aspect of upper arm, forearm, and hand

62
Q

C7 involvement

A

-radiating pain from posterior neck to scapula, posterior upper arm, forearm, and hand
-MC site for cervical radiculopathy

63
Q

C8 involvement

A

-radiating pain from neck to medial aspect of upper arm, forearm and hand

64
Q

Cervical Spondylosis

A

-chronic degenerative condition
-related to bony changes causing myelopathy/radiculopathy
-can be asymptomatic
-changes facets and IVD

65
Q

Facet Joint Dysfunction

A

-unilateral neck pain (slept wrong)
-2ndary to synovial membrane getting caught in z-joint
-closing/opening restrictions

66
Q

Facet Joint Dysfunction CPR

A

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
Q

Cervical Spine Instability

A

-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
Q

Whiplash-Association Disorders

A

-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
Q

Headaches

A

-Migraine (half of face)
-Tension (band)
-Cluster (behind the eye, focused)
-Cervicogenic (from lateral neck to head)

70
Q

Migraine HA

A

-35-45ys
-4h to 3 days
-Mod to severe
-Unilateral/pulsating

71
Q

Tension HA

A

-20-40ys
-Mins to hours
-Mild to mod
-Bilateral/pressure
-Treated w/ posture, stress management, MT

72
Q

Cluster HA

A

-20-40ys
-1-8 episodes throught the day
-Severe
-Unilateral/congestion/eye watering

73
Q

Cervicogenic HA

A

-Any age
-Variable
-Mild
-Unilateral/dec ROM/Rams’s horn

Treatment:
-C2-C3 in neutral
-C2 under C1 in rotation
-C1 under occiput

74
Q

3 Mandatory Qs for Neck Pain

A
  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
Q

Arthritis and Steroid Affects

A

-ligamentous instability

76
Q

Closing Restriction

A

Issues with:
-extension, SB, Rotation
-IPSI side of pain

77
Q

Opening Restriction

A

Issues with:
-flexion, SB, rotation
-CONTRA side of pain

78
Q

Cervical Radiculopathy CPR

A
  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
Q

ICF Model: Neck Pain w/ Mobility Deficits

A

-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
Q

ICF Model: Neck Pain w/ Movement Coordination Impairments

A

-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
Q

ICF Model: Neck Pain w/ Headaches

A

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
Q

ICF Model: Neck Pain w/ Radiating Pain

A

-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
Q

Neck Pain and use of Thoracic HVLAT CPR

A
  1. S/s <30 days
    2.No s/s distal to shoulder
  2. Looking up dec s/s
  3. FABQ <12
  4. Diminished thoracic kyphosis
  5. Cervical extension ROM <30deg

> 3/6: inc chance of helping

84
Q

C0-C1 Joint Referral

A

-back of neck to mid skull

85
Q

C1-C2 Joint Referral

A

-Occiput

86
Q

C2-C3 Joint Referral

A

-Occiput to mid skull

87
Q

Anterior Cervical Discectomy and Fusion

A

-anterior approach of cervical disc removal

88
Q

Anterior Corpectomy and Fusion

A

-anterior approach
-removal of bone and fusion

89
Q

Laminoplasty

A

-widen lamina space w/o removal
-done for multi-level myelopathy
-preserves spinal motion

MSK (37 decks)

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