Cervical Evaluation Flashcards
Red flag triage
canadian c-spine rules to determine if imaging is necessary relating to fracture, dislocation, or instability
canadian c-spine rules
- patient age 65+, high energy incidnet/dangerous mechanism or paresthesia in extremities (high risk criteria) yes to any=imaging
- simple rear end MVA, sitting position, ambulatory at any time, absence of midline tenderness, delayed onset of pain (low risk criteria) presence of any of these five allows for removal of cervical collar to asess AROM
- unable to rotate head 45 degrees
Concussion
important to r/o if the presence of associated trauma and related s/s
headaches, dizziness, irritability, sadness, fatigue, feeling slowed down, difficulty sleeping, difficulty remembering, difficulty concentrating
Ligamentous stability
important to assess stability of upper cervical spine before initiating manual therapy (mobs/manipulation)
Modified sharp-purser test
transverse ligament
stand to side of pt
pt in slight flexion (if pain, stop)
block with key pinch grip over C2 and apply PA force withile stabilizing forehead with other hand
(+) translation or reduction of SX
alar ligament test
pt seated and place their head into flexion
stabilize the c2 spinous process by grabbing it firmly, laterally
rotate the head with opposite hand, feel for c2 spinous process movement
side flex the head with opposite hand, feel for c2 spinous process movement
want to feel movement at C2 meaning ligament is intact
ataxia
clumsiness and agitation, diplopia, dizziness, drop attacks, dysarthria (slurred speech), dysphagia (difficulty swallowing), facial numbness, hearing disturbances, hoarseness, hypotonia (decreased muscle tone), limb weakness
Cervical artery dysfunction
decreased blood flow to the brain, information gathered in hx and physical exam
loss of short term memory
malaise nausea nystagmus pallor/tremor papillary changes perioral dysthesia: abnormal sense of touch photophobia vagueness vomiting
End range rotation test
pt seated and will count backwards from 100
hold at each end range position for 10 seconds and look for nystagmus or associated Sx
rotate fuuly to one side, then return to neutral, then rotate to the other side, then back to center
Vertebral artery test
pt is supine or seated
passively move neck into extension and lateral flexion
then rotate to same side and hold for 30 seconds
(+) nystagmus or pt reports dizziness or other related Sx
Neuropathic origin clinical presentation
if 2/5 present than 64% pottest probability, if 3/5 then 94% posttest probability, 4/5 99%
Neuropathic origin clincial prediction rules
age > 45 yrs (+) hoffmans sign (+) inverted supinator sign (+) bainski Gait abnormality
hoffmans sign
grasp middle finger, stabilizing proximal DIP jt, and flick end
(+) flexion of all other fingers and thumb
inverted supinator sign
brachioradialis reflex test (c6 n response is elbow flexion)
(+) c7 response of elbow extension and finger flexion
babinski test
great toe extension is (+)
N response is reflexion
lateral view
seated and standing
ear in relation to shoulder
amount of lordosis
position of shoulders
anterior/posterior view
shoulder height
hypertrophy of upper traps
scapula position
cervical palpation
base of occiput
spinous process
transverse process
musculature
cervical prone PA mobilization of spinous process
looking for concordant pain and can repeat to assess if the motion relieves pain
use pinch grip and apply enough pressure to blanche fingernails
cervical musculature
tenderness, trigger points, tension, spasm
upper trapezius, levator scapulae, suboccipitals, spleni group, paraspinals posteriorly, SCM, scalenes laterally
MMT capital extension
rectus capitis posterior major and minor, longissmus capitis, obliquus capitis superior and inferior, splenius capitits, semispinalis capitis
pt prone with head off end of table and examiner resistance over occiput
extends head by tilting chin upward in nodding motion
Look at the wall. hold it. don’t let me tilt your head down
MMT cervical extension
longissimus cervicis, semispinalis cervicis, iliocostalis cervicis, splenius cervicis
pt prone with head off table and examiner resistance over parieto-occipital area
extends neck without tilting chin
push up on my hand but keep looking at the floor. hold it. don’t let me push you down
captial flexion
rectus capitis anterior and lateralis, longus capitis
cervical flexion
scalenes, sternocleidomastoid
Axial compression tests
cervical nerve root compression Pt seated with head in neutral apply downward pressure to top of head (+) cervical radiculopathy if negative perform with pt in lateral flexion, lateral flexion, then perform spurling's
Spurlings
pt seated with neck extended and rotated to side of complaint
apply downward compressive force
(+) cervical radiculopathy
Nerve root compression relief test (shoulder abduction test)
pt seated with hand (ipsilateral to reposted Sx) placed on top of head
relieves traction force of the limb
(+) reduction or relief of sx
if sx increase think thoracic outlet syndrome
Cervical distraction relief test
positive indicates nerve root compression
pt seated or supine
place one hand behind occiput, other hand under mandible
gradually apply distraction force
(+) reduction or relief of sx
upper limb tension test
median nerve/ cervical radiculopathy or brachial plexus involvement
pt supine and stabilize their arm on your thigh
go hand to hand, put your fingers and thumb over their fingers and thumn
block over shoulder so scapula doesn’t elevate
abduct should to 110-120 degrees
keep elbow bent at 90
extend wrist to 90 and then supinate
also push thumb back into extension
then passively extend elbow and if reproduces arm Sx then test is (+)
Cervical radiculopathy tests are more effective
as a clister, and when all four are (+) then positive likelihood ratio =30.3
Cervical radiculopathy tests
Spurling’s
AROM < 60 degrees rotation
Distraction test
Upper limb tension test (ULTT)
Shoulder depression test
brachial plexus neuropathy
pt seated with head laterally flexed contralateral to Sx
apply lateral overpressure to head and downward pressure to shoulder
(+) reproduction of Sx indicates brachial plexus injury
Tinel’s sign
brachial plexus neuropathy
Pt seated with neck slightly flexed
percuss over area of each nerve root at transverse process
Can also percuss over interscalene triangle
(+) reproduction of sx
Flexion-rotation test
cervicogenic headache
rules in and out a cervicogenic headache at C1-C2
looking for limitation of rotation and reproduction of the headache, limitation of 15 degrees or more to one side is (+)
if sx happen when rotate to the right then right side cervicogenic headache
Cervical facet involvement
central PA mobilization (palpation for segmental tenderness)
Spurlings test- pain with radiculopathy
Unilateral PA mobilization over facet (in no pain, then likely coming from something other than facet)
Adson’s test
thoracic outlet syndrome
(+) pulse dimished or absent
Allen test
thoracic outlet syndrome
Pt rotate head contralaterally
arm in 90 degrees
(+) pulse diminished or absent
Military brace position
costoclavicular syndrome test (TOS)
Pt seated and locate radial pulse
elbow and shoulder positioned in full extension and external rotation
Pt rotates head to contralateral from tested side
(+) diminished or absent pulse
Lindgren Test
for elevated first rib
Pt seated, examiner stands behind with elbows
(+) decreased lateral flexion indicates elevated first rib
Radiculopathy
disc
stensosis
spondylosis
Myelopathy
upper motor neuro lesion
compression of spinal cord
Facet mediated pain
sprain
arthritic formation
Muscular
strain
spasm
trigger point
torticollis
Instability
Co-1 or C1-2
Where to send referrals
chiropractic
orthopedic
urgent care/ ED
