Cervical MSK Flashcards
where do the Nerve roots in cervical spine come out of?
Nerve roots exit above corresponding vertebrae
There is also only 6 intervertebral discs - nod disc between C0-C1 and C1-C2 = Upper c-spx
Discs have thicker anterior - giving them that lordosis - but relativley thin to allow movement
Describe cervical radiculopathy and the Etiology (3)
S+S related to compressed or irritated N root
- Disc Herniation - Material from disc pushed back and compressing the N root (Dynamic Disc Theory)
- Stenosis - Intervertebral Foramen
a) Osteophytes
b) spondylosis
c) Ligament Thickening (swelling) - Swelling/inflamm (from Local Trauma)
Describe the DYnaimc Disc Theory
- The theory that the materials in the Disc are dynamic –> Migration of the Nucleas pulposus posterior-laterally due to pressure changes.
For example Forward flexed Position
- constant forward flexion will place pressure on the anterior aspect of the disc - so the NP wants to go from an area of high pressure to low pressure –> pushes posteriorly
The annulus Fibrosis is weakest posterior-laterally –> hence the NP will go through area of least resistance.
If NP does go Straight back–> Compress Spinal cord - Cervical Myelopathy (UMNS) +Babinski and Clonus
What are the 4 aspects of Physical examination in Cervical Spx
- Dermatome
- Myotome
- Reflexes
- Special test
What are the Myotomes and Alternatives (C1-T1)
C1-C2: Neck Forward flexion
C3: Neck Side Flexion
C4: Shoudler elevation
C5: Shoulder abduction (Alternative: Shoulder ER)
C6: Elbow Flexion (alternative: Wrist Ext)
C7: Elbow Extension (Alternative: Wrist Flexion)
C8: Thumb Extension (Alternative: Ulnar deviation)
T1: Finger abduction/adduction
What are the LMN reflexes (C5-T1)
C5- Deltoid
C6; Biceps/ brachioradialis
C7: Triceps
C8: Pronator Quadratus
T1: Abductor Digiti Minimi
What is Jendrassik’s Maneuver
For UE: patient crosses legs and ismetrically pulls ankles apart (abducts)
For LE: pt interlocks fingertips and tries to pull them apart
What does a positive UMN reflex test tell you?
+ Babinski (splaying of toes/extension of big toe) or +Clonus (sustained clonus 5+ beats)
indicates possible lesion of the spinal cord, brainstem or brain.
What are the 3 special tests for Cervical Radiculopathy?
- Cervical Distraction Test: Test when pt is currently experiencing Symptoms
Positive = decreased or abolished radicular symptoms (TEST FOR RELIEF) - Spurling’s: Apply axial load by pressing straight down on pt head –> If not symptoms in Neutral
–> Extension +rotation to UNAFFECTED SIDE
–> Extension + rotation to AFFECTED
–> Side flexion to affected side
+ = reproduction of symtpoms (towards side of side flexion) - Upper Limb Tension Test : Order of limb position = shoulder > forearm > wrist > fingers > Elbow
+ = reproduction of symptoms
Upper Limb Tension Test 1: Median N, Anterior Interosseus N (C5,6,7)
- Shoulder depression and abduction 110deg
- Forearm suppination
- Wrist Ext
- Finger + Thumb extension
- Elbow ext
ULTT2: Median Nerve, musculocutaneous N, Axillary N
- Shoulder depression and abduction 10degrees (ONLY DIFFERENCE BW 1 and 2 is degree of ABD)
2.Forearm suppination - Wrist extension
- Fingers + thumb ext
- Elbow Ext
ULTT3: Radial N
- Shoulder depression and abd 10 degrees
- FOREARM PRONATION
- Wrist flexion and Ulnar Deviation
- Fingers and Thumb Flexion
- Elbow Extension
ULTT 4: Ulnar N (C8 and T1)
- Shoulder depression and Abd (10-90deg)
- Forearm pronation (Or supination)
- Wrist extension and Radial Deviation
- Fingers + thumb ext
- Elbow Flexion
What are the Interventions for Cervical Radiculopathy Stenosis/Disc Herniation
Stenosis - open up IVF (traction, flexion)
Disc Herniation - Retraction progressions (chin tuck) - Upper C-spx goes into flexion C3-C7 –> flattens and goes into extension
NP move form area of high Pressure to Low
What are the Two Brachial Plexus Injuries
- Erb-Duchenne Paralysis
- upper Nerve roots C5-C6
- paralysis of shoulder and elbow
- mm of hand not affected
- WAITERS TIP - arm hanging by side and forearm pronation
Position: arm hanging by side, shoulder internal rotation, elbow extension, forearm pronation
- Sensation over deltoid and radial surface of forearm affected - due to N root
Cause: Shoulder Dystocia during birth - shoulder gets stuck during labor the head gets pulled - stretching and causing upper brachial plexus injury
- Klumpke’s paralysis
- injury to lower nerve roots c8,T1 - weakness and paralysis in mm of forearm, hand and triceps
- Involvement of T1 –> HORNERS SYNDROME with PTOSIS (drooping eyelid) and MIOSIS (excessive pupil constriction) - may develop
Position : Elbow flexion, Wrist and MCP extension, PIP and DIP flexion
Claw hand - due to involvement of ulanr nerve - sensation on ulnar side of forearm and hand is afefcted
cause: traction on abducted arm (common at childbirth) - falling and grabbing somethin on the way down
Describe Facet Syndrome
syndrome caused by facet joints
- pain worse with compression - stress on facet joints
- pain can be REFFERED into neck and scapula
- Tested using coupled and combined movements
What are Physiological Coupled movements of the C-spx
- Cervical Facet joints are angled towards the eyes at 45degrees - allows for moevemnt
PHYSIOLOGICAL ARTHROKINEMATIC : Side bending and rotation occur towards the same side**
- Coupled movements into extension used to rule out facet Joint involvement
Non-physiological couple moevements of C-spx
- oppose normal arthrokinematics
- Side flexion and rotation are performed to opposite sides (Left side flexion - Right rotation –> causes more shearing of the joint)
- NON-Phys movements are more provocative - should only be performed if physiological moveemnts are pain free
WHAT IS VBI
Vertebrobasilar Insufficiency
- compression of vertebral artery - causing ischemia to the brain stem, pons, cerebellum, medulla
What are the 5Ds and 3Ns
5 D’s
1. Diziness
2. Diplopia
3.Dysarthria - slurred speach
4. Dysphagia - issue with swallowing
5. Drop Attacks - sudden fainting
3Ns
1. Nystagmus
2. Nausea
3. Other Neurological (numbness)
Special Test for VBI
Vertebral Artery Quadrant test
- patient in supine
- therapist passivley takes head into side flexion and extension - holds for 10-30s (NEEDS TO HAVE EYES OPEN - dizziness and Nystagmus monitor)
—–No SYMPTOMS—-
Ipsilateral Neck rotation added - hold for 10-30s
+= Diziness or Nystagmus. Indicates contralateral side artery is compressed
Describe Torticollis
- unilateral shortened SCM causing
1. Ipsilateral Sideflexion
2. COntralateral rotation - Decreased AROM and PROM in opposite direction (side flexion away and rotation towards same side)
Rx: Stretch affected side SCM
Strengthen opposite SCM
Positioning + handling to stimulate symmetry
What is congenital torticollis - etiology
- unkown
- believed to be due to childbirth trauma \
or Intrauterine malpositioning : baby tightly packed in uterus - awkward position that tigthens structures on that side
What is Positional Plagiocephaly
Relate it to Torticollis in babies (positioning)
- result of uneven pressure distribution for prolonged periods when in lying
- babies with less tummy time will have flatter head on the back due to pressure
Tx: Cranial remodeling orthosis
Frequent repositioning
Torticollis
- always holding baby in right hand - gravity takes head down to right side - baby rotates to look at parents face –> treatment : hold baby on opposite arm
- Crib against wall - baby always turns head to where the stimulus is - Acquired torticollis
