Cervical Evaluation

Question 1

Red flag triage

Answer 1

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

Question 2

canadian c-spine rules

Answer 2

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

Question 3

Concussion

Answer 3

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

Question 4

Ligamentous stability

Answer 4

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

Question 5

Modified sharp-purser test

Answer 5

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

Question 6

alar ligament test

Answer 6

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

Question 7

ataxia

Answer 7

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

Question 8

Cervical artery dysfunction

Answer 8

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

Question 9

loss of short term memory

Answer 9

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

Question 10

End range rotation test

Answer 10

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

Question 11

Vertebral artery test

Answer 11

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

Question 12

Neuropathic origin clinical presentation

Answer 12

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

Question 13

Neuropathic origin clincial prediction rules

Answer 13

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

Question 14

hoffmans sign

Answer 14

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

Question 15

inverted supinator sign

Answer 15

brachioradialis reflex test (c6 n response is elbow flexion)

(+) c7 response of elbow extension and finger flexion

Question 16

babinski test

Answer 16

great toe extension is (+)

N response is reflexion

Question 17

lateral view

Answer 17

seated and standing

ear in relation to shoulder
amount of lordosis
position of shoulders

Question 18

anterior/posterior view

Answer 18

shoulder height
hypertrophy of upper traps
scapula position

Question 19

cervical palpation

Answer 19

base of occiput
spinous process
transverse process
musculature

Question 20

cervical prone PA mobilization of spinous process

Answer 20

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

Question 21

cervical musculature

Answer 21

tenderness, trigger points, tension, spasm

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

Question 22

MMT capital extension

Answer 22

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

Question 23

MMT cervical extension

Answer 23

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

Question 24

captial flexion

Answer 24

rectus capitis anterior and lateralis, longus capitis

Question 25

cervical flexion

Answer 25

scalenes, sternocleidomastoid

Question 26

Axial compression tests

Answer 26

``` 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 ```

Question 27

Spurlings

Answer 27

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

Question 28

Nerve root compression relief test (shoulder abduction test)

Answer 28

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

Question 29

Cervical distraction relief test

Answer 29

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

Question 30

upper limb tension test

Answer 30

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 (+)

Question 31

Cervical radiculopathy tests are more effective

Answer 31

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

Question 32

Cervical radiculopathy tests

Answer 32

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

Question 33

Shoulder depression test

Answer 33

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

Question 34

Tinel's sign

Answer 34

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

Question 35

Flexion-rotation test

Answer 35

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

Question 36

Cervical facet involvement

Answer 36

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)

Question 37

Adson's test

Answer 37

thoracic outlet syndrome | (+) pulse dimished or absent

Question 38

Allen test

Answer 38

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

Question 39

Military brace position

Answer 39

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

Question 40

Lindgren Test

Answer 40

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

Question 41

Radiculopathy

Answer 41

disc stensosis spondylosis

Question 42

Myelopathy

Answer 42

upper motor neuro lesion | compression of spinal cord

Question 43

Facet mediated pain

Answer 43

sprain | arthritic formation

Question 44

Muscular

Answer 44

strain spasm trigger point torticollis

Question 45

Instability

Answer 45

Co-1 or C1-2

Question 46

Where to send referrals

Answer 46

chiropractic orthopedic urgent care/ ED