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MSK > Cervical Functional/Special Tests > Flashcards

Cervical Functional/Special Tests Flashcards

1
Q

Scanning Cervical Exam Requirement

A

-VBI
-Alar Ligament
-Transverse Ligament

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2
Q

5 Ds

A

-Dizziness
-Dysarthria
-Dysphagia
-Diplopia
-Drop Attacks

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3
Q

3 Ns

A

-Numbness/tingling
-Nystagmus
-Nausea

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4
Q

Physical Examination Components

A
  1. Pt Hx
  2. Systems Review
  3. Observation (body, face and eyes)
  4. Screening (VBI/TL/AL)
  5. Scanning Exam (if needed)
  6. Upper and lower c-spine/UE/Thoracic AROM>PROM>RROM
  7. Flexibility
  8. Muscle
  9. Joint Play
  10. Palpation
  11. Special Tests
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5
Q

3 Mandatory Qs for Neck Pain

A
  1. Dizziness, blackouts or drop attacks?
    -Ds and Ns
    -VBI
  2. Hx of RA/arthritis or steroids?
  3. Any neuro in legs?

Optional: Down Syndrome
-ligamentous laxity

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6
Q

Canadian Cervical Spine Rule

A

-guidlines for immobilization and/or imaging after trauma to neck
-positive= refer

  1. High risk factor for immobilization (any of these)
    ->65
    - dangerous MOI
    -Numbness and tingling in extremities
  2. Low risk factor for assessment of ROM
    -Complex rearending
    -cannot sit up in ED
    -cannot ambulate
    -delayed neck pain
    -pain at midline of c-spine
  3. Can Ptt voluntarily actively rotate 45deg
    -yes: treat
    -no: immobilize and image
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7
Q

Modified Sharp Purser Test

A

-1st test done for Transverse lig and AA stability
-relocation test

  1. Pt in sitting
  2. Chin tuck to move C1 on C2 for 5s
  3. Ask about Ds and Ns and “clunk”
  4. Pt Pincer’s C2 SP and post/sup pressure on forehead

(+): S/s are reduced

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8
Q

Supine Lift-Off Test

A

-secondary test for Transverse lig and AA stability

  1. Pt supine
  2. PT finger in squish of C1 and push anteriorly

(+): Pt has excessive upper cervical mobility of C1 w/o movement of C2 and below

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9
Q

Alar Ligament Test

A

-assess alar ligs and OA stability

  1. Pt in supine
  2. PT pincer on C2
  3. PT passively SB or Rot

(+): immediate movement of C2 not felt

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10
Q

Vertebral Basilar Screen

A

-assess VBA

  1. Pt supine
  2. PT passively Extends head
  3. Rotate L
  4. Rotate R
  5. Ext w/ Rotation R
  6. Ext w/ Rotation L

ask about Ds and Ns for Each
If (+) w/ extension, test ROT to determine side

(+): Presence of Ds and Ns in any position

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11
Q

Cervical Spine Exam

A

AROM>(measure)>PROM
-seated

Upper Cervical 1st (5-10dg flx and 45 rotation):
-Flexion (chin tucks)/Extension
-Pt uses 2 hands to stabilize w/ overpressure

Lower Cervical 2nd (35-70 flx and 30-40 rot and 15-40 SB:
-Flx/Ext/LSB/Rotation
-Quadrant testing

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12
Q

Cervical MMT

A

-test in neutral

Flexion:
-C1-C2 and CN 11

Extension

Side Bending:
-C3 and CN 11

Rotation:
-C2

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13
Q

Facet Joint Dysfunction Thoracic HVLAT CPR

A

CPG:
1. S/s <30 days
2. No s/s distal to shoulder
3. Looking up doesn’t agg s/s
4. FABQ physical activity <12
5. Diminished upper t-spine kyphosis
6. Cervical ext ROM <30deg

(+) > or = 3, successful outcome w/t-spine HVLAP in 86% of Pts

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14
Q

ICF Model: Neck Pain w/ Mobility Deficits

A

-hypomobility

S/s:
-Pain in central (older stenosis) or Unilateral (younger foramena)
-limited ROM that constantly reproduces s/s
-possible referred pain

Exam:
-Dec ROM
-Neck pain at end ranges
-Restricted mobility in c and t-spine
-referred pain reproduced w/ provocation
-deficits in cervico-scapulo-thoracic strength

Treatment:
-T-spine manips
-C-spine manual
-Cervical ROM
-Strengthening

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15
Q

ICF Model: Neck Pain w/ Movement Coordination Impairments

A

-Instability

S/s:
-MOI linked to trauma/whiplash or hypermobility
-referred shoulder pain
-HA, concussion, confusion, hypersensitivity

Exam:
-(+): cranial cervical flexion test
-(+): Neck flexor muscle endurance test
-(+): Pressure algometry
-Neck pain at midposition to end
-Dec strength
-Point tenderness

Treatment:
-Pt education and prognosis
-Increase ROM
-Manual or exercise
-Pain science

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16
Q

ICF Model: Neck Pain w/ Headaches

A

S/s:
-non-continuous, unilateral neck pain (facet joint) and referred HA
-HA precipitated or aggravated by neck movements or positions

Exam:
-(+): Cervical flexion rotation test
-HA reproduced w/ provocation
-Limited ROM
-Strength and endurance deficits

Treatment:
-Mobility
-Self SNAGs to AA joint
-Manual therapy c and t-spine

17
Q

ICF Model: Neck Pain w/ Radiating Pain

A

-Radiculopathy

S/s:
-neck pain w/ UE radiating pain
-UE neruological signs

Exam:
-(+): Cervical radiculopathy CPR
-UE sensory, strength deficits

Treatment:
-Exercise and MT
-Cervical collar for short term
-Intermittent traction
-Pt education

18
Q

UE ROM

A

-Cervical
-Shoulder, elbow, wrist, and fingers
-Thoracic

Flx/ext/abd/IR/ER

  1. AROM –> reproduction of local s/s
  2. AROM –> reproduction of remote s/s
  3. AROM –> no impact on s/s
19
Q

Trapezius Muscle Length

A

-only check if motion IS limited
must check length if you prescribe stretch later

  1. Pt supine
  2. Flex head > contra SB > ipsi rotation
  3. PT depresses ipsi shoulder

Normal: 45deg of rot w/ soft end range
Decreased:<45 or hard end range

20
Q

Levator Muscle Length

A

-only check if motion IS limited
must check length if you prescribe stretch later

  1. Pt supine
  2. Flex head > contra SB and ipsi rotation
  3. PT depresses ipsi shoulder

Normal: 45deg of rot w/ soft end range
Decreased:<45 or hard end range or TTP

21
Q

Scalenes Muscle Length

A

-only check if motion ISN’T limited
must check length if you prescribe stretch later

  1. Pt supine w/ head off plinth
  2. Extend and contra SB while stabilizing ipsi
  3. PT stabilizes ipsi shoulder

Normal: 45deg of SB
Decreased:<45 of SB

22
Q

SCM Muscle Length

A

-only check if motion ISN’T limited
must check length if you prescribe stretch later

  1. Pt supine w/ head off plinth
  2. Contra SB and extension
  3. PT stabilizes ipsi shoulder > rotates ipsi

Normal: Equal range Bilat
Decreased: Unequal range bilat

23
Q

OA Joint Mobilization

A

-Normal, Hypo, Hyper

Opening R:
-CV flexion w/ L Sideglide

Opening L:
-CV Flexion w/ R sideglide

Closing on R:
-CV ext w/ R sideglide

Closing on L:
-CV ext w/ L sideglide

24
Q

AA Joint Mobilization

A

-rotation only
-Normal, hypo, hyper

  1. Pt flexes mid-cervical to lock out upper
  2. Pt rotates neck to each side
25
Q

PA Springing Joint Mobility

A

-assess C2-T1
-Pt in prone

C7 will disappear w/ ext

26
Q

Sideglides Joint Mobility

A

-C2-T1
-Sideglides on facet joints
-Normal, hypo, hyper

Flexion (Opening Restriction):
1. PT Flex neck at segment assessed
2. Sideglides to L to open R
3. Sideglides to R to open L

Extension (Closing Restriction):
1. PT extends neck at segment assessed
2. Sideglides to L to close L
3. Sideglides to R to close R

27
Q

Palpation

A

-Reproduction of s/s
-hypertonicity
-Atrophy

-Subocc
-Traps
-Levator
-SCM
-Scalenes

28
Q

Closing Restriction

A

Issues with:
-extension, SB, Rotation
-IPSI side of pain

29
Q

Opening Restriction

A

Issues with:
-flexion, SB, rotation
-CONTRA side of pain

30
Q

Cervical Compression and Distraction

A

Normal: flx/ext, LSB, rot
Provocation: compression and distraction, 5-8s

Pain Reproduced w/ Compression:
-herniation
-end plate/fx
-arthritis
-nerve root

Pain Reproduced w/ Distraction
-spinal lig tear
-tear of annulus fibrosis
-spasm
-dural irritability
-cervical instability

31
Q

Quadrant Testing

A

-spine pathology

-Flx and RSB: disc on left or LOR
-Flx and LSB: disc on right or ROR
-Ext and RSB: foramen on right or RCL
-Ext and LSB: foramen on left or LCL

32
Q

Spurling Test

A

-test for cervical radiculopathy
-Compresses foramina

  1. Pt seated
  2. PT asked Pt to SB > applies overpressure for 5-8s
  3. Repeat on opp

(+): reproduction of s/s into Ipsi shoulder

33
Q

Cervical Radiculopathy CPR

A
  1. C-spine rot to painful side <60deg
  2. (+) Spurling test
  3. (+) ULLT#1
    4 (+) Cervical Distraction (relieves)

4/5: 90%
3/5: 65%

34
Q

Cranio-Cervical Flexion Test

A

-assesses neck endurance of deep flexors
-for movement coordination deficis

  1. Pt in supine hooklying w/ biofeedback cuff behind head
  2. Cuff inflated to 20 mmHg
  3. Pt nods for 10s at 22mmHg
  4. Rest for 10s and start again adding 2 mmHg
  5. Test ends when Pt can no longer hold

Activation Score: max pressure held for 10s
Performance Index: max pressure held for 10s x reps

35
Q

Neck Flexor Endurance Test

A

-assesses neck flexor endurance and motor control

  1. Pt in supine in hookyling
  2. Pt tucks chin and lifts head 1 inch off the table
  3. Test ends when you can no longer hold up head

(+) for women: <38.9s
(+) for men: <29.4

36
Q

Cervical Flexion-Rotation Test

A

-assesses for presence of cervicogenic HA
-provocation test

  1. Pt in supine w/ maximal neck flx and hold
  2. Apply pressure through rotation to both sides and note any change in s/s

(+): Rotation ROM loss to 1 side >10deg compaired to opp OR reproduction of s/s

37
Q

Shoulder Abduction Test

A

-assess for presenve of radicular s/s
-usually rules out shoulder

  1. Pt seated w/ hand on top of head

(+): s/s arre reduced or relieved

not a good screening test

38
Q

Canadian C-Spine Rule Not Applicable

A

MSK (37 decks)

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