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Patient Management II > Cervical Examination > Flashcards

Cervical Examination Flashcards

1
Q

History of cervical injury

A
  • past history of neck pain
  • dizziness/light headedness
  • pain
  • paresthesia
  • numbness
  • weakness
  • stiffness
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2
Q

Quality of symptoms for cervical injury

A
  • sharp
  • dull
  • stabbing
  • ache
  • electric shock like
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3
Q

Red flags for cervical spine injury

A
  • severe loss of ROM with sudden onset
  • changes in balance/gait
  • hypo/hyper reflexia
  • constant pain
  • severe radiating pain
  • moderate to severe occipital headache
  • facial pain
  • psychological changes
  • cranial nerve symptoms
  • dizziness
  • Horner syndrome
  • hemiparesthia
  • bowel & bladder changes
  • ataxia
  • nystagmus (rapid involuntary movement of the eyes)
  • drop attacks
  • hemifacial parathesia
  • dysphagia
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4
Q

History suggesting cervical spondylosis (arthritis)

A
  • age >45
  • most commonly affected levels C5, C6, & C7
  • slow gradual onset
  • unilateral pain
  • pain radiates into specific dermatomes
  • pain increases with extension & decreases with flexion
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5
Q

History suggesting disc involvement

A
  • age <60
  • most commonly effects C5 & C6
  • sudden onset
  • unilateral
  • symptoms radiate into a dermatome
  • tingling present
  • pain increases with flexion
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6
Q

History suggesting instability

A
  • traumatic MOI unless they have RA
  • complaint of nonspecific symptoms that are worse in vertical & better with head support
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7
Q

Self assessments for the cervical spine

A
  • Neck Disability Index (NDI)
  • Patient specific functional scale
  • Fear avoidance beliefs questionnaire
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8
Q

Special tests for upper cervical instability

A
  • Sharp Purser: chin tuck increases symptoms and pushing C1 back onto C2 relieves symptoms
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9
Q

Special tests for vertebral artery

A
  • Hautant: arms out close eyes hold for 10 secs then same thing but look off to the side and up
  • Cervical quadrant test: supine eyes open and passively move patient head into extension, side bending, & rotation hold 30 secs
  • Pre-manipulative position test
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10
Q

Symptoms of vertebral artery insufficiency

A
  • dizziness/vertigo
  • nausea/vomiting
  • inability to stand
  • blurred vision/diplopia
  • headache
  • facial paresthesia/facial palsy/difficulty swallowing
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11
Q

Describe deep cervical flexion test/cranial cervical flexion test

A
  • patient supine in hook lying with head/neck in midrange
  • pump up BP cuff to 20 mmhg or to fill their lordosis
  • have patient perform chin tuck in five increments increasing by 2 each time holding for 10 secs and resting for 10 secs between
  • normal is 26-30 mmhg hold for 10 secs without SCM substitution
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12
Q

Describe neck flexor muscle endurance test

A
  • patient supine in hook lying
  • chin maximally retracted & maintained isometrically as head is held 1 inch above the table
  • normal is 38 secs
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13
Q

What is the order for ULTT-A (AKA median nerve tension test)

A
  • scapular depression
  • forearm supination
  • wrist and finger extension
  • shoulder ER
  • elbow extension
  • shoulder abduction
  • side bend away
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14
Q

Describe the different cervical glides

A
  • Central PA: pushing through the spinous process
  • Unilateral PA: pushing through the facet joint on one side
  • Transverse: side bending at the facet performed in supine
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15
Q

Describe pain with compression findings

A
  • disc
  • vertebral body fracture
  • nerve root irritation (radiating)
  • flexion can target disc & vertebral body
  • extension can target nerve root & facet joint
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16
Q

Describe decreased pain with distraction

A
  • disc
  • spinal facet
  • nerve root (centralizing)
17
Q

Test item cluster for cervical spine radiculopathy

A
  • ULTT-A
  • Spurling’s
  • Distraction
  • Cervical rotation <60 degrees to ipsilateral side
18
Q

Describe the shoulder abduction test

A
  • patient seated & asked to place arm to rest over their head
  • test for radiculopathy
19
Q

Describe TMJ screen

A
  • open & close mouth while looking for deviation, pain, and/or clicking
  • lateral glide pain, clicking, or asymmetrical movements
20
Q

Exam findings for neck pain with mobility deficits

A
  • recent onset
  • absence of referred symptoms
  • restricted ROM in rotation and/or side bending
  • restricted cervical & thoracic segmental mobility
  • low NDI (<11.5)
  • bilateral movement pattern involvement
  • better when moving neck
  • neck extension does not worsen symptoms
  • medical diagnosis of spondylosis without radiculopathy
21
Q

Intervention focus for neck pain with mobility deficits

A
  • spinal mobilization/manipulation
  • AROM exercises
22
Q

Exam findings for neck pain with radiating pain

A
  • radicular/referred symptoms in the UE
  • peripheralization and/or centralization of symptoms with ROM
  • signs of nerve root compression present
  • medical diagnosis of cervical radiculopathy
23
Q

Intervention focus for neck pain with radiating pain

A
  • mechanical/manual cervical traction
  • repeated movements to centralize symptoms
  • manual therapy
  • home exercise program of cervical spine retraction & deep cervical flexor training
24
Q

Test item cluster for improvement with 3 weeks mechanical traction

A
  • age >55
  • pos. shoulder abduction test
  • pos. ULTT-A
  • symptom peripheralization with central PA
  • pos. neck distraction test
25
Q

Exam findings for neck pain with coordination deficits

A
  • lower pain & disability scores
  • longer duration of symptoms
  • no signs of nerve root compression
  • no peripheralization/centralization during ROM
26
Q

Intervention focus for neck pain with coordination deficits

A
  • strengthening & endurance exercises for the muscles of the neck and UE
  • aerobic conditioning exercises
27
Q

Exam findings for neck pain with headache

A
  • unilateral headache with onset preceded by or associated with neck pain
  • cervical AROM (can exacerbate HA)
  • cervical/thoracic segmental mobility (can exacerbate HA)
  • cranial cervical flexion test (can exacerbate HA)
28
Q

Intervention focus for neck pain with headache

A
  • spinal manipulation/mobilization
  • deep cervical flexor training
  • soft tissue/muscle trigger point treatment
  • postural education & training
29
Q

Exam findings for neck pain

A
  • high pain & disability scores
  • recent onset of symptoms
  • traumatic onset
  • may have referred pain in shoulder
  • poor tolerance to exam and/or interventions
  • medical diagnosis may be whiplash associated disorder
30
Q

Intervention focus for neck pain

A
  • gentle AROM as tolerated
  • ROM for adjacent regions
  • modalities
  • activity modification

Patient Management II (17 decks)

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