Cervical Scanning Examinations Flashcards
History
- PMH of significant such as long-term steroid use or cardiac history. Previous treatment for cancer
- Autoimmune disease - rheumatoid arthritis, systemic diseases
- Trauma - MVA less than 6 weeks, history of the accident, high velocity, x-rays taken?
Observation
- Torticollis - antalgica or congenital, hearing loss of one ear?
Active, Passive, Resisted Movements, Combine Movements, Flexion/Extension Quadrants
- Compression stress test - reproduce arm symptoms below the scapula/shoulder
- Traction stress test - soft tissue or ligament pain
- Special tests: figure 8, Lingrens test, Manubrium test, Roos test, etc.
Neurological Testing
- Sensory - light touch or pinprick determines severity of sensory loss, peripheral nerve or nerve root?
- Motor
- Deep tendon reflexes
Motor - key muscles of the upper quadrant
C4 - levator C5 - deltoids C6 - biceps, supinator, wrist extensors C7 - triceps, long finger flexors C8 - ulnar deviators T1 - hand intrinsics
Deep tendon reflexes upper quadrant
C5 - deltoids
C6 - brachioradialis
C7 - triceps
C8 - abductor digiti minimi
Facilitation
“facilitation is the maintenance of a pool of premotor neurons or preganglionic sympathetic neurons in one or more segments of the spinal cord in a state of partial or sub-threshold excitation; in this state less afferent stimulation is required to trigger the discharge of impulses. It is also a neurophysiological theory regarding the neural mechanism of somatic dysfunction.”
Causes of Facilitation
- long term input of aberrant sensory input, particularly nociceptive input
Effects of Facilitation: Segmentally Distributed
- skeletal muscle hypertonus
- hyperesthesia
- non-fatiguable weakness
- increased deep tendon reflexes
- vasomotor hypertonus
- trophodema
- orange peel skin (peau d’orange)
Clinical Aspects of facilitation
- restriction of active and possibly passive movement
- altered axis of rotation resulting in increased shear & torque on the joint
- structural fatigue of the muscle
- adaptive shortening of the muscle
- myalgia from ischemia
- palpation tenderness
- referred tenderness
Traction Stress Test
- test is done in two positions:
1. Head flexed about 20 degrees to sensitize the tectorial membrane
2. Neutral to test the posterior longitudinal ligament
Alar Ligament Stress Test (sequence)
-In order to test left ligament stabilize C2 with your left hand with a large thumb/long finger grip then introduce O/A side bending to the right. To test right ligament reverse the hand hold. You should have an immediate or close to immediate stop as if you were testing the ACL in the knee
Prone CS Exam
- Palpation of soft tissue or atrophy
2. Upper thoracic spring testing
Lower cervical testing
Testing triplanar movement in neutral, flexion, extension
Uncovertebral Joint Glides
Inferior medial in flexion/extension (palpation more lateral) along transverse processes and the glide is inferior medial toward opposite SC joint. Triplanar motion in neutral, flexion, extension.
Lingren Test
Cervicothoracic Junction/First ring screening - screening examination of the upper thoracic spine. Patients head is rotated fully then sidebending is introduced. Positive for significant loss of motion in sidebending. Correlate with biomechanical exam.
Figure “8” Test
Screening for clinical instability at end range of cervical spine and or end range instability. Passive segmental exam in “figure 8”
Manubrium Test
Screening of the upper thoracic region with cervical motion
Soft disc herniation
“Non-degenerative” and the disc has not lost height or water content
Three basic types of disc herniations:
- Prolapse
- Extruded
- Sequestered
List of pathological conditions that can affect cervical nerve roots other than disc herniations
- Auto-immune
- Viral neuritis
- Plexitis secondary to trauma
- Neural scarring
- Hypertonicity of the scaleni muscle groups
- Neural sensitization
- Nerve degenerative conditions/diseases
Examination of the Upper Quadrant
-cervical scan
-biomechanical examination
-upper limb screen & special testing
-special testing of neural sensitivity - skilled handling: active, passive, palpation
Note: ideally 2 of the 3 examination components of neural mobility are strongly positive & relevant to the patient’s signs/sx
Examination of Mechanically Sensitive Nervous Tissue
*Considered a special test outside of the cervical scanning examination
Mechanically Sensitive Nervous Tissue: Active movement
-gentle active movement of the shoulder into scaption
Mechanically Sensitive Nervous Tissue: Active assistive
-same movement with wrist extended next time side bend CS away from U.E.
Mechanically Sensitive Nervous Tissue: Passive
-gentle passive movements starting at shoulder girdle then progressive to elbow extension or elbow flexion
Mechanically Sensitive Nervous Tissue: Palpation
-palpate nerve trunks starting at neck & into arm
Criteria for addressing neural tissue in treatment plan:
-if 2 of the 3 mechanically sensitive neural tissue tests are positive the neural tissue should be addressed in the treatment plan
Capsular pattern of CS
-SB & rotations equally limited, extension
Cervical spondylosis tests
- cervico ocular reflex (COR)
- tonic neck reflexes (TNR)
- vestibular ocular reflexes (VOR)
- cervico-colic reflex (CCR)
Cervico ocular reflex (COR)
- works with VOR & CCR control extra-ocular muscles. Maintains eye position with opposite movements of head. receptors located in cervical muscles
- light headedness
- dizziness (one of the first complaints to physicians) - common with older patients complaining of neck pain
Tonic neck reflex (TNR)
-alters limb muscle activity when body moves in relation to head, integrated with higher spinal centers to control balance
Vestibular ocular reflexes (VOR)
-high frequency movements of head, works in conjunction with all other reflexes
Cervico-colic reflex (CCR)
-limits unintentional movements of the head, small movements of head. Muscle spindles in sub occipital muscles obliquus capitis inferior & rectus capitis posterior major
Exam of Cervical Spondylosis
- usually across neck pain
- limited SB & ext: disc is more fibrosed, calcification of ligament, spinal canal getting smaller
- trigger points
- neurological normal
- c/o HA & dizziness
