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OCS - Current Concepts of Ortho PT > Cervical spine > Flashcards

Cervical spine Flashcards

1
Q

What levels of the spine are uncovertebral joints aka joints of luschka present?

A

C3-C7

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2
Q

What age does the uncovertebral joints aka joints of luschka start developing and when are they fully mature?

A

Age 9, Age 33

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3
Q

T/F: cervical discs have a true annulus

A

F

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4
Q

Which cervical vertebrae does not have a spinous process?

A

C1/Atlas

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5
Q

Which cervical spinous process is not bifid?

A

C7

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6
Q

What are the attachments of the nuchal ligament?

A

Occiput to spinous processes of C3-C5 and merges with the supraspinous ligament

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7
Q

What cervical ligament is most commonly injured in pediatric patients following high speed collisions?

A

Tectorial membrane - causes neurologic symptoms during flex/ext movement

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8
Q

Which scalene muscles attach to the 1st rib?

A

Ant/med scalene

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9
Q

The greater occipital nerve (C2) pierces through what muscle? And what condition can entrapment cause?

A

Semispinalis cervicis, greater occipital neuralgia

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10
Q

What are the primary symptoms of greater occipital neuralgia?

A

Constant ache, burn, throb w/ intermittent shock/shooting; may have pain behind the eye

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11
Q

Which regions do the external CA/internal CA provide blood flow?

A

External: face, neck, c-spine
Internal: brain

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12
Q

What does the carotid sinus do?

A

Senses blood pressure and oxygenation levels

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13
Q

Where is the carotid sinus located?

A

By the jaw line @ the bifurcation of the common carotid artery

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14
Q

What does the cervical plexus originate from?

A

Ventral rami of C1-C4

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15
Q

What does the brachial plexus originate from?

A

Nerve roots C5-C8

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16
Q

How much motion is at the OA joint?

A

15-20 total degrees of flexion/extension (1:2 ratio)

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17
Q

How much motion is at the AA joint?

A

Rotational about 50% total neck rotation (35-40 degrees)

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18
Q

Coupled motion of C3-C7

A

Couple ipsilaterally, meaning RR also has SB to the R

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19
Q

What is the purpose of coupling?

A

To maintain level gaze

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20
Q

What are the 5 factors that can strongly predict chronicity in WAD cases?

A
  1. High pain intensity (>6/10)
  2. High self-reported disability (NDI >30%)
  3. High pain catastrophizing (>30)
  4. High acute post-traumatic stress symptoms
  5. Cold hyperalgesia
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21
Q

What are the strongest risk factors for non-traumatic neck pain?

A

Female sex, prior hx of neck pain

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22
Q

What is horners syndrome?

A

Ptosis (dropping eyelid)
Miosis (constricted pupil)
Anhidrosis (lack of face sweat)

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23
Q

T/F: recent trauma or infections of the head and neck can be risk factors for cardiovascular disease?

A

True

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24
Q

Top signs of vertebrobasilar artery dissection

A

Unsteadiness/ataxia
Dysphagia/dysarthria/aphasia
LE weakness
UE weakness

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25
Q

Top signs of internal carotid dissection

A

Ptosis
UE weakness
Facial palsy
LE weakness

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26
Q

What is the validity of VBI testing?

A

Poor, positional testing such as sustained extension and/or rotation of the C-spine to test for VBI is NOT recommended

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27
Q

What are symptoms consistent with ligamentous instability of the craniovertebral junction?

A

headaches, severe sub-occipital muscle spasms, fear/anxiety associated with head motion

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28
Q

Is the Sharp-Purser test valid?

A

Found to be inconsistent with diagnostic accuracy

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29
Q

What population is the Sharp-Purser test appropriate for?

A

RA & neck pain

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30
Q

What are some common symptoms of cancer in the the head/neck?

A

Persistent sore throat, difficulty swallowing, ringing in the ears

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31
Q

What is the sensitivity for 2-item PHQ-2?

A

High

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32
Q

What is the minimal detectable change in the NDI?

A

5/50 for uncomplicated neck pain
10/50 for cervical radiculopathy
NOTE: can fluctuate

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33
Q

What is the first critical step to effective patient management?

A

Taking a thorough patient hx (open ended, patient led)

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34
Q

What is the classic distribution of cervicogenic headaches?

A

Rams horn

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35
Q

What is nociceptive pain?

A

Produced by nociceptive afferents, acute mechanical or inflammatory pain

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36
Q

What is peripheral neuropathic pain?

A

neuropathic pain derived from disease of the somatosensory system

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37
Q

What is central nociplastic pain?

A

Not the result of peripheral input, similar to “central sensitization”

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38
Q

What is maladaptive cognition?

A

Illogical or incorrect beliefs related to pain, i.e. pain catastrophizing

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39
Q

What is sensorimotor dysintegration?

A

altered input or disagreement between 2 different sensory inputs (i.e. visual vs vestibular)

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40
Q

T/F: Posture has shown strong associations with pain and/or function

A

False

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41
Q

Loss of combined cervical extension and rotation may hint at what?

A

Degenerative changes of a facet joint

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42
Q

T/F: Cervical radiculopathy is associated with loss of rotation motion in the lower c-spine

A

True

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43
Q

What is the sensitivity/specificity of segmental mobility testing associated with report of neck pain?

A

Sensitivity: 0.82
Specificity: 0.79

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44
Q

What are the 4 categories for neck pain classification?

A
  1. Neck pain with mobility deficits
  2. Neck pain with movement coordination impairments (WAD)
  3. Neck pain with headache
  4. Neck pain with radiating pain
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45
Q

T/F: radiating pain into the distal UE would exclude someone from the category “neck pain with mobility deficits”

A

True

46
Q

What does the cervical rotation lateral flexion (CRLF) test assess?

A

CT junction and 1st rib mobility
NOTE: should be used in conjunction with 1st rib spring/mobility assessment

47
Q

What is a + cervical rotation lateral flexion (CRLF) test?

A

Discrepancy/limitation in lateral flexion ROM with a hard end-feel

48
Q

What are common symptoms of “Neck pain with mobility deficits”?

A
  • central/unilat neck pain
  • ROM limitations that consistently reproduce symptoms
  • associated (referred) shoulder girdle or UE pain may be present
49
Q

What are common symptoms of “Neck pain with movement coordination impairments”?

A
  • MOI linked to trauma
  • Associated (referred) shoulder girdle or UE pain
  • non specific concussive signs/symptoms
  • dizziness/nausea
  • HA/concentration issues/confusion/memory loss/hypersensitivity to stimuli
50
Q

What are common symptoms of “Neck pain with headache (cervicogenic)”?

A

-noncontinuous, unilateral neck pain and associated (referred) HA
- HA is precipitated or aggravated by neck ROM of sustained postures

51
Q

What are common symptoms of “Neck pain with radiating pain (radicular)”?

A
  • neck pain with radiating pain in involved UE
  • UE dermatomal paresthesia or numbness or myotomal muscle weakness
52
Q

What percentage of people will recover from WAD injuries without persistent issues?

A

50%

53
Q

T/F: the mechanism of whiplash event including direction and speed of impact seem to strong prognostic factors

A

False (it’s poor/weak)

54
Q

What is the craniocervical flexion (CCF) test used for?

A

To assess activation/endurance of the deep neck flexor muscle group
(10” hold x 5 reps, 10” rest, increase mmHg by 2 - start @20mmHg)

55
Q

What is the neck flexor muscle endurance test used for? And what is the reliability of the test?

A

Assess deep cervical flexor muscles, good to high reliability

56
Q

What is allodynia?

A

pain to non-painful stimuli

57
Q

What is hyperalgesia?

A

Exaggerated pain perception to painful stimuli

58
Q

Reliability for the pressure pain threshold test (PPT) is excellent for intra-rater or inter-rater agreement?

A

Intrarater

59
Q

Do tension-type, cluster, or migraines respond well to PT?

A

No

60
Q

Those with cervicogenic headaches are more likely to present with ROM deficits and painful segments in which vertebrae?

A

Upper 3

61
Q

Common findings of cervicogenic headaches?

A

intermittent unilateral symptoms, weakness of deep cervical flexors, segmental hypomobility of the upper cervical spine

62
Q

What is the cervical flexion-rotation test used for?

A

Assess upper cervical joint mobility (measurement of the PROM rotation at the AA jt)

63
Q

What is a positive cervical flexion-rotation test?

A

restriction of rotation ROM w/ a cut off of less than 32 degrees OR a 10 degree reduction to either side

64
Q

What is Cloward sign?

A

Numbness/tingling that radiates into the medial scapular border

65
Q

T/F: There is no gold standard to identify cervical radiculopathy outside of nerve conduction and electromyography tests?

A

True

66
Q

Cluster of 4 findings for cervical radiculopathy

A
  1. limited ipsilat rotation to <60°
    • ULTT A (median)
    • Spurlings
    • neck distraction test (+ = decrease in symptoms)
67
Q

What is the most sensitive test in the cervical radiculopathy cluster?

A

+ ULTT A (median bias) - can be used to rule out when negative

68
Q

What are the probability of cervical radiculopathy if 4/4 tests are +? And if 3/4 are +?

A

4/4 = 95%
3/4 = 65%

69
Q

T/F: spurlings test is indicated if the reporting symptoms are present?

A

False - because provocation of additional symptoms are not warrented

70
Q

Should you use the neck distraction test if the patient has no UE or scapular region symptoms?

A

No

71
Q

What is the most common area/segments for cervical nerve root involvement?

A

C5-C6

72
Q

What are positives when testing ULTT A?

A
  • reproduction of all or part of pt’s symptoms
  • side-to-side differences of greater than 10° of elbow extension or wrist extension
  • contralat SB increases pt’s symptoms OR ipsilat SB decreases symptoms
73
Q

What is a contraindication to using the Valsalva test?

A

hypertension

74
Q

Interventions for ACUTE neck pain with mobility deficits

A
  • thoracic manip
  • cervical mob/manip
  • ROM/stretching/isometrics
  • stay active/general fitness
75
Q

Interventions for SUBACUTE neck pain with mobility deficits

A
  • cervical mob/manip
  • thoracic manip
  • cervicoscapulothoracic endurance activities
76
Q

Interventions for CHRONIC neck pain with mobility deficits

A
  • thoracic manip
  • cervical mobs
  • cervicoscapulothoracic exercise in combo w/ mob/manips
  • dry needling/laserUS/intermittent traction/TENS
77
Q

Interventions for ACUTE neck pain with movement coordination impairments (WAD)

A
  • education (remain active/act as usual)
  • HEP (pain-free ROM)
  • minimize collar use
78
Q

Interventions for SUBACUTE neck pain with movement coordination impairments (WAD)

A
  • education
  • combined exercise (AROM, isometric +manual +modalities)
  • supervised exercise
79
Q

Interventions for CHRONIC neck pain with movement coordination impairments (WAD)

A
  • education (prognosis/encouragement/pain management)
  • cervical mobilization + individualized progressive exercise
  • TENS
80
Q

Interventions for ACUTE neck pain with headache

A
  • Exercise: C1-C2 self SNAG
81
Q

Interventions for SUBACUTE neck pain with headache

A
  • cervical manip/mob
  • exercise: C1-C2 self SNAG
82
Q

Interventions for CHRONIC neck pain with headache

A
  • cervical manip/mob
  • thoracic manip
  • exercise for cervical and scapulothoracic region
  • combined manual therapy + exercise
83
Q

Interventions for ACUTE neck pain with radiating pain

A
  • exercise: mobilizing and stabilizing elements
  • low-level laser
  • possible short-term collar use
84
Q

Interventions for CHRONIC neck pain with radiating pain

A
  • Combined exercise + manual therapy for c/t-spine (mob/manip)
  • Education counseling to encourage participation in occupational and exercise activity
  • intermittent traction
85
Q

Thoracic manipulation has supporting evidence for use in which stages of neck pain with mobility componant? (acute, subacute, chronic)

A

All stages

86
Q

What is the speed and duration of intervention mobilizations?

A

2Hz/sec (“row, row, row your boat”), generally performed 2-3 bouts of 30”

87
Q

Maitland grade of mobilization: Grade I

A
  • Low/small amplitude
  • Beginning of range (before any resistance)
88
Q

Maitland grade of mobilization: Grade II

A
  • Large amplitude
  • Beginning of range before any resistance noted
89
Q

Maitland grade of mobilization: Grade III

A
  • Large amplitude
  • Mid-range working into resistance and towards the end resistance
90
Q

Maitland grade of mobilization: Grade IV

A
  • Small amplitude
  • End-range of resistance
91
Q

What is cervical upglide HVLA used for?

A

rotation deficits (not exclusively), OPENING

92
Q

How to perform cervical upglide HVLA?

A
  1. Contralateral rotation
  2. Ipsilateral side-bending
  3. Force towards opposite eye
93
Q

What is cervical downglide HVLA used for?

A

Side-bending deficits, CLOSING

94
Q

How to perform cervical downlide HVLA?

A
  1. Ipsilateral side-bending
  2. Contralateral rotation
  3. Force towards contralateral hip
95
Q

What is the timeframe for the majority of recovery from a WAD injury?

A

First 3 months

96
Q

Forward head posture causes limited OA flexion or extension ROM?

A

Decreased OA flexion

97
Q

How to perform atlanto-occipital (OA) joint flexion mobilization?

A

Supine, roll cranium into flexion, rest of spine stays neutral, can ipsilat rotate to 30°, force through forhead towards plinth

98
Q

What is the verbal cue for atlanto-occipital (OA) joint flexion contract-relax?

A

“Look up”, 10” hold x 3 reps

99
Q

Sliders (nerve glides) are optimal for which levels of irritability of radicular symptoms?

A

moderate to high

100
Q

What are the 5 symptoms of cervical myelopathy (aka Cooks cluster)?

A
  1. > 45 y/o
    • hoffman
    • babinski
  4. Gait dysfunction/ataxia/wide BOS
    • inverted supinator sign
101
Q

Does Cook’s cluster for cervical myelopathy have poor/moderate/high sensitivity (rule IN) or specificity (rule OUT)?

A

Moderate to high specificity (rule IN) & poor sensitivity (rule out)

NOTE: 3+ variables present = high probability

102
Q

Canadian C-spine: What are the 3 High-Risk Factors that mandate immobilization?

A
  1. Age ≥ 65 y/o
  2. Paresthesias in extremities
  3. Dangerous mechanism (fall from ≥3’ or 5 steps, axial load, MVA > 100km/hr (62mph), rollover/ejection, bicycle, rec vehicles)
103
Q

Canadian C-spine: What are the Dangerous Mechanisms?

A
  1. Fall from elevation >3 feet/5 stairs
  2. Axial load to head, e.g. diving
  3. MVC speed high (> 100km/hr or 62mph), rollover, ejection
  4. Motorized recreational vehicles e.g. ATV
  5. Bicycle collision with object e.g. post, car
104
Q

Canadian C-spine: What are the 4 Low-Risk Factors which allow safe assessment of ROM?

A
  1. Simple rear-end MVC
  2. Ambulatory at any time at scene
  3. No neck pain at scene when asked
  4. No pain during midline C-Spine palpation
105
Q

Canadian C-spine: What are the exceptions to simple rear-end MVC’s?

A
  1. Pushed into oncoming traffic
  2. Hit by bus/large truck
  3. Rollover
  4. Hit by high speed vehicle (>100km/hr)
106
Q

Canadian C-spine: What are the 3 steps in the Canadian C-Spine rule?

A
  1. High-Risk Factors - mandate immobilization
  2. Low-Risk Factors - safe assessment of ROM
  3. ROM Assessment
107
Q

Canadian C-spine: How is the 3rd step performed?

A

Can the patient voluntarily actively rotate neck 45° left and right when requested, regardless of pain?

108
Q

Canadian C-spine: What must you have to rule in C-Spine immobilization?

A

Yes to any High-Risk Factor
and/or
No to any Low-Risk Factor
and/or
Cannot turn head 45°

109
Q

What are exclusion criteria from the Canadian C-Spine rule?

A
  1. Boarded and collared for reason other than C-spine
  2. age < 16 years
  3. penetrating trauma from stabbing or gun shot
  4. acute paralysis (paraplegia, quadriplegia)
  5. known vertebral disease
  6. referred as a c-spine from hospital or care facility
  7. pregnancy
110
Q

Is Canadian c-spine used to rule IN or OUT?

A

Rule OUT, test is sensitive

OCS - Current Concepts of Ortho PT (12 decks)

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