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MM III > Cervical Spine > Flashcards

Cervical Spine Flashcards

1
Q

What are the functions of the CS?

A
  1. protect vital tissues
  2. provide rapid movement response
  3. position the eyes
  4. provides foundation for mm of UE and scapula
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2
Q

T or F: there is NO disc structure at C0-2

A

T

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3
Q

Where is the transition point in the CS for mobility?

A

C2-3

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4
Q

Mechanics in the lower CS spine (C2-3 and below) involves coupled motion in the ____ direction

A

same

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5
Q

Mechanics in the upper CS involves coupled motion in the ____direction

A

opposite

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6
Q

T or F: 44% of pts with neck pn will go on to dev chronic sxs

A

T

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7
Q

Nerve roots exit ____ the named level

A

above

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8
Q

what is the difference between radiculopathy and myelopathy?

A

Radiculopathy: nerve root, sensory/motor changes

Myelopathy: spinal cord, UMN signs/sxs

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9
Q

What n innervates the diaphragm and what is it’s nerve roots?

A

Phrenic n (C3-4-5) keeps us alive!

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10
Q

What are risk factors for neck pain?

A

Activity: cycling

Health: smoking, previous neck pn

psychological: depression, job strain, work sitting, low co-worker social support, widower or separated

demographic: female, age (45-59), FHP (correlated in adults/older adults but not adolescents)

occupation: heavy labor, office & computer works, HC worker, unemployed

Physical work: sedentary/repetitive work, working w/ neck flexed/arms at or above shoulder height, head caring (loads on head)

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11
Q

what NDI score range indicates no disability?

A

0-4

(out of 50)

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12
Q

what NDI score range indicates mild disability?

A

5-14

(out of 50)

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13
Q

what NDI score range indicates moderate disability?

A

15-24

(out of 50)

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14
Q

what NDI score range indicates severe disability?

A

25-34

(out of 50)

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15
Q

what NDI score range indicates complete disability

A

> /= 35 (out of 50)

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16
Q

what is a pancoast’s tumor? and what are sxs?

A

lung cancer of upper lobe that invades lower brachial plexus (C7-T1)

pn in shoulder/scapula, pn referral down arm, cough, chest pn (uncommon)

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17
Q

What is horner’s syndrome? and sxs?

A

occurs when tumor invades the sympathetic chain

sxs: enophthalmos (sunken in eyes), ptosis (drooping eye lid), miosis (excessive constrition of pupil), anhidrosis (lil-non sweat)

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18
Q

What are the 4 “Child’s Classification Categories of Neck Pain”?

A

Neck pain with….

  1. Mobility deficits
  2. Headache
  3. Movement Coordination impairments
  4. Radiating pain
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19
Q

What 2 assessments are recommended for Neck Pain with Mobility Deficits?

A
  1. Cervical AROM
  2. CS/TS segmental mobility
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20
Q

What 3 assessments are recommended for Neck Pain with HEADACHES?

A
  1. Cervical AROM
  2. CS/TS segmental mobility
  3. Cranio-cervical flexion test
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21
Q

What 3 assessments are recommended for Neck Pain with MOVEMENT COORDINATION IMPAIRMENTS?

A
  1. Cranio-cervical flex test
  2. Deep neck flexor endurance test
  3. Flexibility deficits of UQ mm
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22
Q

What 4 assessments are recommended for Neck Pain with RADIATING PN?

A
  1. Cervical AROM
  2. Spurling’s test
  3. ULTT
  4. Neck distraction test
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23
Q

Stage I (High acuity) is characterized by what pain range and NDI score range? What is the goal for a pt classified in stage I?

A

Mod-severe pn
NDI: >24
Goal: dec pn

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24
Q

Stage II (Mod acuity) is characterized by what pain range and NDI score range? What is the goal for a pt classified in this stage?

A

mild-mod pn
NDI: 15-24
Goal: address relative impairments

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25
Q

Stage III (min acuity) is characterized by what pain range and NDI score range? What is the goal for a pt classified in this stage?

A

0-min pain
NDI: 0-14
Goal: return to work/sport

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26
Q

Review CPG recommended interventions for each classification category

A

Good job!

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27
Q

What is the Canadian Cervical Spine Rule used for?

A

Decision rule for detection of clinically important injury ( fx, dislocation, ligamentous instability)

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28
Q

What is the first Question you consider for the Canadian Cervical Spine Rule?

A

Any HIGH-risk factor that mandates radiography?

  1. Age 65+
  2. Dangerous mech (fall from 3+ ft/5 stairs, axial load to head, high-speed MVC)
  3. Paresthesias in extremities
  • if any of the above are true, refer for imaging!
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29
Q

If a pt does not have any high-risk factor that mandates radiography what question do you consider next?

A

Any LOW-risk factor that allows safe assessment of ROM?

  1. Simple rear-end MVC
  2. Sitting position in ED
  3. Ambulatory at any time
  4. Delayed onset of neck pn
  5. Absence of midline CS tenderness
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30
Q

If a pt does NOT have any HIGH-risk factors that mandate radiography AND DOES have a low-risk factor that allows for safe assessment of ROM, how do you proceed?

A

Assess neck AROM rotation

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31
Q

According to the Canadian Cervical Spine Rule, if a pt is unable to ROT neck R/L 45 deg, how should you proceed?

A

Refer to imaging

32
Q

T or F: the Canadian Cervical Spine Rule is really good at ruling OUT a clinically important injury related to the CS but poor at ruling IN.

A

T

Sn = 0.99-1.0
Sp= 0.43

33
Q

what are S&S of upper cervical instabilty? (ie Atlantoaxial instability)

A
  1. Suboccipital pn (C2)
  2. Bilat UE/LE paresthesias
  3. Clumsiness/LOB
  4. Nystagmus
  5. HAs
  6. Blurred vision
  7. UMN signs
    • HYPERreflexia
    • Spasticity
    • Abnormal gait
    • Clumsiness
    • Babinski’s sign
34
Q

What are potential causes of atlantoaxial instability (upper cervical instability)?

A
  1. congenital body malformation
  2. DS
  3. Inflammatory (RA, Psoriatic arthritis, AS, osteomyelitis)
  4. Trauma
  5. Chronic corticosteroid use
35
Q

How do you interpret a +LR > 10 and a -LR < 0.1

A

generate large and often conclusive shifts in probability

36
Q

How do you interpret a +LR 5-10 and a -LR 0.1-0.2

A

generate mod shifts in probability

37
Q

How do you interpret a +LR 2-5 and a -LR 0.2-0.5

A

generate small but sometimes important shifts in probability

38
Q

How do you interpret a +LR 1-2 and a -LR 0.5-1

A

alter probability to a small and rarely important degree

39
Q

What are the S&S of vertebrobasilar insufficiency?

A

5 D’s:
Dizziness
Diplopia
Dysarthria
Dysphagia
Drop attacks
+
Nausea & vomiting
Sensory changes

40
Q

T or F: the Vertebral Artery test/ VBI test is not a good screening tool

A

T

It has poor sensitivity so a neg test is NOT a meaningful finding

41
Q

What is included in the cluster test for radiculopathy?

A
  1. ULNT median
  2. Cervical rot (<60 deg)
  3. Cervical distraction test
  4. Spurling’s

*best diagnostic accuracy for radiculopathy is w/ clustering of tests (If all 4 +, Sp = 0.99, Sn = poor)

42
Q

How would a CT be beneficial as an imaging technique for the CS?

A

CT would show the relationship of bone to neural canal in transverse plane

43
Q

How would an MRI be beneficial as an imaging technique for the CS?

A

Visualization of spinal cord and soft tissues

44
Q

How would an Myelogram be beneficial as an imaging technique for the CS?

A

visualization of spinal cord and nerve roots (w. contrast injected into subarachnoid space)

45
Q

What imaging technique would you use to get a good image of a disc?

A

Discogram (inject contrast material into disc)

46
Q

Review Table 4: Neck Pain impairment/function-based fx, exam, and intervention recommended classification criteria!!

A

Good job!

47
Q

What are expected sxs of a pt with Neck Pain w/ MOBILITY DEFICITS?

A
  • Unilat neck pn
  • lim neck motion
  • onset of sxs often linked to recent unguarded/awk mvmt/position
  • assoc (referred) UE pn (may be present)
48
Q

What are expected sxs of a pt with Neck Pain w/ HA?

A
  • noncontinuous, unilat neck pn and assoc (referred) HA
  • HA is precipitated/aggravated by neck mvmts/sustained postures
49
Q

What are expected sxs of a pt with Neck Pain w/ MOVEMENT COORDINATION IMPAIRMENTS?

A
  • neck pn & assoc (referred) UE pn
  • sxs often linked to a precipitating trauma/whiplash & may be present for an extended period of time
50
Q

What are expected sxs of a pt with Neck Pain w/ RADIATING PN?

A
  • neck pn w/ assoc radiating (narrow band of lancinating) pn in involved UE
  • UE paresthesia, numbness, weakness (may be present)
51
Q

Which cervical discs have the GREATEST occurrence of disc disease?

A

C6/7: 60-70% (C7)

52
Q

What are Cloward’s areas?

A
  • Irritation of ant cervical disc results in interscapular pn (location of pn is relted to level of disc irritation
53
Q

C6/7 (C7) has the greatest occurrence of disc disease, based off of cloward’s areas, if a pt has irritation of the anterior cervical disc at this level, where would they feel pain?

A

Interscapular area: at the level of T7 and the inf angle of scapula

54
Q

what is the most serious consequence of cervical spondylosis?

A

cervical spondylitic myelopathy

55
Q

What are sxs of cervical spondylitic myelopathy?

A
  • Bilat neuro sxs in UE & LE
  • Gait clumsiness
  • Loss of hand dexterity
  • Severe: B&B changes
56
Q

What is the test cluster for cervical spondylitic myelopthy?

A
  1. Babinksi
  2. Inverted supinator sign
  3. Hoffman’s reflex
  4. Reflex testing
57
Q

What factors make prognosis worse for a pt w/ cervical spondylitic myelopathy?

A
  • age > 50
  • duration of sxs > 12 mo
  • involvement of multiple levels
58
Q

According to the McKenzie Classification, what are the 3 syndromes of mechanical pain?

A
  1. Postural syndrome
  2. Dysfunction syndrome
  3. Derangement syndrome
59
Q

Postural syndrome is one of the 3 syndromes of mechanical pn according to the McKenzie Classification. What is it and what are it’s characteristics?

A

= proposed as caused by mech deformation or vascular insufficiency of normal tissue as a result of sustained loading

  • gradual onset, dull, symmetric pn
  • full cervical AROM
  • no referred pn
  • neck pn w/ sustained end range positions may take > 15 min
60
Q

Dysfunction syndrome is one of the 3 syndromes of mechanical pn according to the McKenzie Classification. What is it and what are it’s characteristics?

A

= caused by mech deformation or vascular insufficiency of abnormal tissue (shortened & fibrosed or lengthened)

  • intermittent neck pn
  • loss of cervical AROM
  • neck pn at end-range
  • no arm pn
61
Q

Derangement is one of the 3 syndromes of mechanical pn according to the McKenzie Classification. What is it and what are it’s characteristics?

A

= (disc primarily) caused by internal disruption or displacement of tissues (thought to be disc related)

  • loss of cervical AROM
  • constant neck pn
  • pn radiated into shoulder/arm
  • neck/arm pn affected by repeated movement (peripheralization: pn inc in limb, centralization: pn lessens in limb)
62
Q

What is the most common CS postural impairment?

A

FHP

63
Q

what is the effect os FHP on the CS & mm activity?

A
  1. increased facet loading
  2. slight ext of upper CS: forward gaze
  3. inc post cervical mm activity
64
Q

What are predictors that a pt would benefit from cervical trx + exercise?

A
  1. Age 55+
    • Shoulder abd test (hand on head)
    • ULTT A (median N)
  4. Sx peripheralization w/ central P/A motion testing at lower cervical (C4-7) spine
    • neck distraction test

If 4+, then 94.8% probability
If 3+ then 79.2% probability

65
Q

23 years ago, the PT intervention choices for Neck pn were:

A
  1. heat
  2. flexibility
66
Q

what is whiplash?

A

an abnormal acceleration deceleration of head beck and torso

67
Q

T or F: 20-25% of pts with WAD will become chronic

A

T

68
Q

What are chronicity prognostic indicators for WAD that have high evidence?

A
  • elevated pain scale & disability ratings
    -excessive initial self-reported pain intensity (7/10)
  • extreme disability (NDI >40/100)
    -low self-efficacy
  • catastrophizing
  • lower educational level
  • reduced cervical ROM
    -Anxiety
    -large # of initial sxs
69
Q

T or F: increase sensitivity to cold is assoc w/ ongoing disability after whiplash?

A

T

70
Q

What ligament test would you perform first?

A

sharp-purser

71
Q

what is a jefferson’s fx?

A

C1 fx from axial load

72
Q

what is a hangman’s fx?

A

C2 pedicle fx from sudden hyperext

73
Q

what is a odontoid fx?

A

C2 dens fx from combined hyperext/rot

74
Q

what is the intervention for a pt with a STABLE fx w/o compression of neural elements?

A

immobilization in a rigid cervical orthosis for 8012 weeks

75
Q

what is the intervention for a pt with an unstable fx(s) w/ or w/o neurological deficit?

A

generally require operative tx (early ORIF) indicated to obtain stability

MM III (3 decks)

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