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Thoracic and Cervical Quiz > Cervical Evaluation > Flashcards

Cervical Evaluation Flashcards

1
Q

Red flag triage

A

canadian c-spine rules to determine if imaging is necessary relating to fracture, dislocation, or instability

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2
Q

canadian c-spine rules

A
  1. patient age 65+, high energy incidnet/dangerous mechanism or paresthesia in extremities (high risk criteria) yes to any=imaging
  2. 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
  3. unable to rotate head 45 degrees
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3
Q

Concussion

A

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

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4
Q

Ligamentous stability

A

important to assess stability of upper cervical spine before initiating manual therapy (mobs/manipulation)

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5
Q

Modified sharp-purser test

A

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

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6
Q

alar ligament test

A

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

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7
Q

ataxia

A

clumsiness and agitation, diplopia, dizziness, drop attacks, dysarthria (slurred speech), dysphagia (difficulty swallowing), facial numbness, hearing disturbances, hoarseness, hypotonia (decreased muscle tone), limb weakness

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8
Q

Cervical artery dysfunction

A

decreased blood flow to the brain, information gathered in hx and physical exam

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9
Q

loss of short term memory

A 
malaise
nausea
nystagmus
pallor/tremor
papillary changes
perioral dysthesia: abnormal sense of touch
photophobia
vagueness
vomiting
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10
Q

End range rotation test

A

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

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11
Q

Vertebral artery test

A

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

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12
Q

Neuropathic origin clinical presentation

A

if 2/5 present than 64% pottest probability, if 3/5 then 94% posttest probability, 4/5 99%

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13
Q

Neuropathic origin clincial prediction rules

A 
age > 45 yrs
(+) hoffmans sign
(+) inverted supinator sign
(+) bainski
Gait abnormality
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14
Q

hoffmans sign

A

grasp middle finger, stabilizing proximal DIP jt, and flick end
(+) flexion of all other fingers and thumb

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15
Q

inverted supinator sign

A

brachioradialis reflex test (c6 n response is elbow flexion)

(+) c7 response of elbow extension and finger flexion

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16
Q

babinski test

A

great toe extension is (+)

N response is reflexion

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17
Q

lateral view

A

seated and standing

ear in relation to shoulder
amount of lordosis
position of shoulders

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18
Q

anterior/posterior view

A

shoulder height
hypertrophy of upper traps
scapula position

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19
Q

cervical palpation

A

base of occiput
spinous process
transverse process
musculature

20
Q

cervical prone PA mobilization of spinous process

A

looking for concordant pain and can repeat to assess if the motion relieves pain
use pinch grip and apply enough pressure to blanche fingernails

21
Q

cervical musculature

A

tenderness, trigger points, tension, spasm

upper trapezius, levator scapulae, suboccipitals, spleni group, paraspinals posteriorly, SCM, scalenes laterally

22
Q

MMT capital extension

A

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

23
Q

MMT cervical extension

A

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

24
Q

captial flexion

A

rectus capitis anterior and lateralis, longus capitis

25
Q

cervical flexion

A

scalenes, sternocleidomastoid

26
Q

Axial compression tests

A 
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
27
Q

Spurlings

A

pt seated with neck extended and rotated to side of complaint
apply downward compressive force
(+) cervical radiculopathy

28
Q

Nerve root compression relief test (shoulder abduction test)

A

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

29
Q

Cervical distraction relief test

A

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

30
Q

upper limb tension test

A

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 (+)

31
Q

Cervical radiculopathy tests are more effective

A

as a clister, and when all four are (+) then positive likelihood ratio =30.3

32
Q

Cervical radiculopathy tests

A

Spurling’s
AROM < 60 degrees rotation
Distraction test
Upper limb tension test (ULTT)

33
Q

Shoulder depression test

A

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

34
Q

Tinel’s sign

A

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

35
Q

Flexion-rotation test

A

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

36
Q

Cervical facet involvement

A

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)

37
Q

Adson’s test

A

thoracic outlet syndrome

(+) pulse dimished or absent

38
Q

Allen test

A

thoracic outlet syndrome
Pt rotate head contralaterally
arm in 90 degrees
(+) pulse diminished or absent

39
Q

Military brace position

A

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

40
Q

Lindgren Test

A

for elevated first rib
Pt seated, examiner stands behind with elbows
(+) decreased lateral flexion indicates elevated first rib

41
Q

Radiculopathy

A

disc
stensosis
spondylosis

42
Q

Myelopathy

A

upper motor neuro lesion

compression of spinal cord

43
Q

Facet mediated pain

A

sprain

arthritic formation

44
Q

Muscular

A

strain
spasm
trigger point
torticollis

45
Q

Instability

A

Co-1 or C1-2

46
Q

Where to send referrals

A

chiropractic
orthopedic
urgent care/ ED

Thoracic and Cervical Quiz (5 decks)

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