Cervical Exam (12) Flashcards
What are the 5 D’s, 3 N’s, and A s/s for vertebral artery involvement
Dysphagia
Dysarthria
Drop attacks
Dizziness
Diplopia
Nystagmus
Numb
Nausea
Ataxia
What to do it there if sub hx and systems review has trauma or concern of instab or vasculogenic disease
Vasculogenic screen
What to do if vasculogenic screen +
Refer to vascular specialist
If vasculogenic screen (-), what to do?
Upper cervical screen
What to do if the upper cervical screen is +
Refer to ED or physician
What is subjective hx and systems review has no evidence of trauma/instab/VBI
Bio mechanical, traditional screen
Canadian c/s rule
What are 3 high risk factor which mandate radiography? What if they’re yes?
Age greater than or equal to 65
OR
Dangerous mech
OR
Paresthesia in extremities
Radiography
Canadian c/s rule
What are 5 low risk factor which mandate radiography? If no?
Simple rear end MVC
OR
Sitting position in ED
OR
Ambulatory at any time
OR
Delayed onset of neck pain
OR
Absence of midline c/s tenderness
Radiography
Canadian c/s rule
If any low-risk factor are yes, what to do
See if pt able to actively rot 45 degrees
Canadian c/s rule
What if pt unable to rot 45 degrees
Radiography
2 reasons why upper cerv screen NOT ALLOWED
- rot < 45 degrees in one direction
-splinting entire neck that doesn’t allow motion
Upper cerv screen for trauma/concern instab/vasculogenic disease if
X-rays clear
Trauma or concern instab/vasculogenic disease, if not X-rays do what
Clear with Canadian c/s rules
If X-rays are + for trauma/instab/vasculogenic disease
Immediate referral to MD
If pt had trauma or concern instab, vasculogenic disease and X-ray -, what do you do
Vasculogenic risk assessment
+ means refer to vasc MD
- means do upper cervical exam
Upper cervical screen from least to most provocative
+ means refer to ED or contact MD
- means cont to traditional c/s exam
If pt has no evidence of trauma, VBI, or lig patho: rot primary limitation
Upper cervical biomech (traditional) exam
If pt has no evidence of trauma, VBI, or lig patho: SB primary limitation
Cervical exam (traditional and/or biomech)
Special ? For myelopathy
Bilateral tingling in hands and/or ft, gait probs
3 purposes of upper c/s screen
-screen for serious patho
-assess neuro status
-assess vasculogenic risk
What is one big thing about upper cervical spine assessment
Hands off initially
Order of upper c/s exam (6)
- Active rot (hands off; ipsilateral before contra)
- Active SB
- Active flex - sharp purser, compression in neutral
- Neuro screen
- Vasculogenic screen
- Craniovertebral stress tests
What decreased motion indicates biomech/traditional exam
SB
3 general principles of biomech/traditional exam
-assess mvmnt against gravity
-no assisting motion
-OP if no pain with AROM
8 components of traditional/biomech exam
-observe, inspect, posture
-AROM B sh
-AROM c/s inclinometer, OP (if no pain), resist antagonist (if no pain)
-neuro exam
-PROM eyes open
-special test as indicated
-palp ALWAYS
-deep neck feel strength assess
