Cervical Instability Flashcards
1
Q
Cervical Instability
A
2
Q
Cervical Instability Symptoms
A
- Muscle Spasms
- Reluctant to move head
- soft or empty feel
- lump in throat sensation
- lip or facial paraesthesia
- headaches
- dizziness
- nystagmus
- nausea
- vomitting
- pupillary changes
Can be provoked by active or passvie movement of the head
3
Q
Cervical Instability Clinical Indications
A
- Poor tolerance to prolonged static postures
- fatigue and inabilty to hold head up
- improvment with external support
- frequent need for self manipulation
- feeling of instability, shaking or lack of control
- sharp pain with sudden movements
Diagnostic Test Accuracy
- Sensitivity is poor - high false negative
- Specificity - good
Pre screening for cervical instability in a clinical setting is difficult
4
Q
Cervical Instability Clinical Notes
A
- Tests are designed to detect instability in the segments that make up the cervical spine
- All procedures should be done with care
- only be done if you plan on doing end range techniques
- if instability is present then they are contraindicated
5
Q
Sharp-Purser Test
A
Purpose:
- To determine potential subluxation of the atlas on the axis
- indicates insufficiency of the transverse ligament which maintains the postion o the odontoid process relative to c1
- if the transverse ligament is torn, c1 will translate forward on c2 during flexion of the cervical spine
- test may be postive if pt has a fractured odontoid process
Procedure:
- Pt is sitting and practitioner is at the side
- Primary is thumb on pt’s C2 and secondary is on forehead
- pt flexes neck and apply slow, gentle AP pressure to create a posterior shear of atlas on axis
Postive:
- Positive if there is a head slide as pressure is applied
- a clunk can indicate relocation of atlas
- pt can have symptoms as head flexes
Indication of positive:
- Cervical instability could mean potential rupture of the transverse ligament
- Odontoid fracture
6
Q
Rotational Alar Ligament Stress Test
A
Purpose:
- Test for instability at the atlanto-axial joint and test integrity of the alar ligament
- was first designed to assess for instabilty for pt’s with RA
Procedure:
- Pt is seated with head in neutral and practioner is to the side
- primary is on the lamina and c2 sp, gently. Secondary is ontop of the head
- Rotate pt’s head, C1 on C2
Positive:
- more then 20-30 of rotation without c2 movement indicates injury to the contralateral alar ligament
- if this test is positive then the alar ligament stress test should be positive in the same direction
Indication of postive:
- Cervical instability
- alar ligament disruption
- odontoid dysplasia
- odontoid dysplasia
Note:
- Alar ligament restrains rotation
7
Q
Transverse Ligament Stress Test
A
Purpose:
- Potential subluxation of the atlas on the axis, which can indicate cervical instability, odontoid fracture, atlanto-axial hypermobility or transverse ligament disruption
Procedure:
- pt is supine and examiner’s hands are supporting the occiput with palsm and both hands
- primary and secondary are index fingers on the posterior arch
- with head in neutral, lift the head and c1 contacts
- creates anterior shear of c1 on c2 and is held for 10-20 seconds
Positive:
- Production of cervical instability symptoms , lump in throat, vomitting, dizziness
Indication of Positive:
- Cervical instability
- rupture of transverse ligament
- odontoid fracture
- hypermobilty of atlanto-axial
8
Q
Atlantoaxial Lateral Shear Test
A
Purpose:
- To assess for possible instabilty at the atlanto-axial articulation, odontoid process fracture, transverse ligament tear or odontoid dysplasia
Procedure:
- Supine with head on pillow
- Examiner places 1 index on TP of c1 and contralateral TP of C2
- push both L-M direction causing a shearing on one vertebrae on another
Positive:
- This test is positive if there is excessive movement between the vertebrae and/or symptoms are reproduced
Indication of positive:
- Cervical Instability
- Rupture of tranverse ligament
- odontoid fracture
- atlanto-axial hypermobility
Notes:
- Explain that there may be pain due to contacts
- Test can be done c1-c7
9
Q
Lateral Flexion Alar Ligament Stress Test
A
Purpose:
- Test of instability of the atlanto-axial joint and test the alar ligament
- suspect of cervical instability, odontoid fracture or odontoid dysplasia
Procedure:
- Supine with head in neutral
- Practitioner places pincer grip to stablize c2
- primary on top of the head
- lateraly flex the head while stablizing c2
Positive:
- Excessive movement or reproduction of instability symptoms can indicate a positive test
Indication of Positive:
- Cervical instability
- Alar ligament rupture
- Dens fracture
- Odontoid dysplasia
10
Q
Saggital Stress Test
A
Purpose:
- Test integrity of supporting structures, ligaments and joint capsule or if suspect cervical instability, myelopathy or spondylolisthesis
Procedure:
- Supine with head neutral on pillow
- Practitioner places bilateral contacts on articular pillar on the segment to be tested
- Then slowly and carefully apply an anterior force to create an above and below shear
- feel for tissue stretch follwed by a stop in a normal spine
Positive:
- positive if there is excessive between two vertebrae and or symptoms are produced that indicate cervical instability
Indication of Positive:
- Cervical instability
- cervical myeopathy
- cervical spondylolisthesis
Clinical Note:
- Can be performed c1 to c7
- Excessive force is not needed
