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MPT 2 > Cervical Spine > Flashcards

Cervical Spine Flashcards

1
Q

what two scalenes form the scalenes triangle? what goes through the triangle?

A

anterior and middle
brachial plexus, subclavian artery and vein

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2
Q

scalenes OIA

A

O: TP C2-7
I: 1st and 2nd ribs
A: ipsilateral SB, contralateral rotation, accessory inspiration

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3
Q

SCM OIA

A

O: mastoid process
I: sternum, clavical
A: ipsi SB, contra rot, extension
*flexion bilaterally

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4
Q

what is the deepest and most important anterior muscle of c-spine?

A

longus cervicis (coli)

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5
Q

longus coli OIA

A

O: T3-C2 bodies
I: C3-6 TP
A: cervical flexion
*important for neck stability

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6
Q

the 2 alar ligaments run from the ___ to the ____. it is life threatening if these ligs are damaged

A

dens (sup, lat)
foramen magnum

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7
Q

how many transverse (cruciform/cruciate) ligs are there? what are they?

A

3
superior longitudinal, transverse, inferior longitudinal

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8
Q

superior longitudinal cruciate lig attaches ____ to ______

A

atlas
occiput

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9
Q

transvere cruciate lig attaches….

A

C2 bilateral

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10
Q

inferior longitudinal lig attaches __ to _____

A

atlas
C2 body

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11
Q

this ligament prevents the atlas from translating anterior on the axis during flexion and is life threatening if damaged

A

transverse lig

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12
Q

T or F: the dens will fracture before the transverse lig tears

A

T: it tears at 130kg

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13
Q

what additional subjective items should you ask about with a cervical compliant?

A

dizziness
headaches
TMJ

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14
Q

T or F: the subjective exam is strongly supported by evidence

A

T

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15
Q

T or F: outcome measures are strongly supported by evidence

A

T

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16
Q

head and neck medical screening questionnaire

A

used to determine if patient has a serious medical condition that mimics a common MSK disorder

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17
Q

neck and shoulder screening questionnaire

A

screens for diagnoses like cervical fracture, lig instability, central cord tension, tumor, and septic arthritis

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18
Q

how do you ask about pain?

A

0-10
current, best, and worst in the last 24 hrs
take average

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19
Q

MDC for pain scale

A

2

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20
Q

MDC for neck disability index

A

10

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21
Q

patient specific functional scale

A

patient gives 5 important activities that are a problem and rates from 0 (unable) to 10 (PLOF)

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22
Q

MCID for PSFS

A

2

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23
Q

why may PSFS be better than NDI

A

more meaning for patients

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24
Q

how many items on fear-avoidance beliefs questionnaire

A

16, it must be scored 0-6

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25
Q

2 subscales of FABQ

A

work = 0-42 points
physical activity = 0-24 points

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26
Q

T or F: you total the subscales to get the score for FABQ

A

F: subscales are added seperately

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27
Q

for FABQ is a higher or lower score better

A

lower

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28
Q

3 high risk factors of canadian c-spine rules

A
  • age 65 or greater
  • dangerous mechanism
  • paresthesias in extremities

*need an x-ray if they had a trauma with any of these factors

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29
Q

5 low risk factors of canadian c-spine rules

A
  • simple rear-end MVA
  • able to sit in ED
  • ambulatory at any time
  • delayed neck pain
  • no midline c-spine tenderness

*if these are present, you can safely assess ROM

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30
Q

you assess your patient after a neck trauma due to the presence of low-risk factors and they have 30 degrees of active R rotation and 35 degrees of L rotation. do they need an x-ray? why or why not?

A

yes, because they have less than 45 degrees of active L and R rotation

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31
Q

VBI 5 Ds and 3Ns

A

Dizziness
Diplopia
Drop attacks
Dysarthria
Dysphagia

Nystagmus
N/V
N/T

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32
Q

VBI test

A
  • supine, start with head in neutral
    -rotate to end range, overpressure, and hold for 10 seconds
    -back to neutral hold for 10 seconds
    -rotate other way with overpressure and hold for 10 seconds
    -watch/ask about 5Ds, 3Ns
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33
Q

If the VBI test is positive what do you do

A

you can still treat the patient, just avoid end range rotation and extension, Get in touch with PCP for follow-up

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34
Q

T or F: a single red flag is always predictive of a serious disease

A

F: a large study showed all pts had at least 1, but <1% had a serious pathology
** use clinical judgement and base on clusters

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35
Q

cancer red flags

A
  • history of cancer
  • night pain/pain at rest
  • unexplained weight loss
  • > 50 y/o or < 17 y/o
  • failure to improve over predicted time
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36
Q

infection within vertebrae red flags

A
  • immunosuppressed
  • prolonged fever of >100.4
  • history of IV drug use
  • history of recent UTI, cellulitis, pneumonia
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37
Q

vertebral fracture red flag

A
  • prolonged use of corticosteroids
  • mild trauma >50 y/o
  • > 70 y/o
  • osteoporosis
  • recent major trauma
  • bruising over spine after trauma
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38
Q

abdominal aortic aneurysm red flags

A
  • pulsating mass in abdomen
  • history of astherosclerotic vascular disease
  • age >60 y/o
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39
Q

how many view of the spine do you usually need

A

3 (min of 2)

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40
Q

what kind of x-ray to assess stability of c-spine

A

open mouth
*can also get CT scan

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41
Q

benefits of x-ray

A

fast
inexpensive
low radiation

42
Q

what can you see on an AP view of an x-ray

A
  • vertical shape
  • osteophytes
  • disc space
  • scoliosis
  • rib symmetry
43
Q

what can you see on an oblique view of an x-ray

A
  • neural foramen and fascia
  • osteophytes
  • stenosis
44
Q

what can you see on a lateral view of an x-ray

A
  • integrity of ALL (parallel lines)
  • lordosis/kyphosis
  • collapsing/wedging
  • osteophytes
  • forward shift of C1-2
45
Q

benefits of CT scan

A

fast, better statistical properties, best for cortical bone, good for soft tissue when MRI is contraindicated

46
Q

is metal contraindicated on CT scan

A

no

47
Q

this imaging is ideal for soft tissue and trabecular bone

A

MRI

48
Q

T1 MRI

A

fat is bright, water is dark

49
Q

T2 MRI

A

water is brightest, fat is bright-ish

50
Q

T2 fat sat/STIR MRI

A

water is bright, fat is dark
* better for bony pathology

51
Q

what two imaging have the highest radiation exposure? lowest? none?

A

high = CT, bone scan
low = radiograph
none = MRI

52
Q

why does poor posture cause spine pain

A

weight becomes anterior/posterior to the joint and the muscles have to work harder

53
Q

In FHP, the upper cervical facets become ______ and the connective tissues _______. There is a tendency toward facet ___mobility

A

compressed
shorten
hypo

54
Q

In FHP, the mid-lower cervical/thoracic facets are ____ and ___. there is a tendency toward facet ___mobility.

A

up and forward
hyper

55
Q

what muscles become weak in FHP? which ones become overworked and tight

A

weak = anterior neck (longus colli), rhomboids, mid/lower traps
tight = posterior neck, pecs, lats, teres major, subscap

56
Q

What does FHP do to the abdominal wall

A

constricts it, lessening diaphragmatic breathing and accessory muscles have to work harder

57
Q

results of FHP

A
  • tissues held in shortened range lose sarcomeres
  • abnormal movement and firing
  • ligamentous creep
58
Q

abnormal stress to normal tissue…

A

may produce pain w/o causing damage

59
Q

T or F: normal stress applied to abnormal tissue will not produce pain

A

F: it does! and abnormal stress would increase pain

60
Q

common subjective findings with capsular restrictions

A
  • limited mobility
  • pain only at end range
  • no pain with rest
  • no weakness
  • no N/T
61
Q

capsular restrictions are usually the result of…

A

poor posture
past trauma
repeated inflammation

62
Q

objective findings with capsular restrictions

A
  • limited AROM/PROM that open facets
  • hypomobile PAs
  • possibly hypermobile in surrounding area (could be where pain is)
63
Q

arthritis in the spine is also known as…

A
  • spondylosis
  • osteoarthritis
  • DDD
  • DJD
64
Q

spondylosis most commonly affects

A

facet joints and discs

65
Q

DJD

A
  • thickening of subchondral bone/capsule
  • causes increase calcium deposits and joint surface erosion
66
Q

DDD

A
  • hardening of NP
  • causes decreased disk height and annular strength
67
Q

With DJD, sometimes if spurs have already developed surgery may be the best option. why?

A

getting them in a good posture could make it worse if spurs are already there

68
Q

spondylosis causes _____ blood supply

A

decreased

69
Q

T or F: spondylosis is typically a chronic condition

A

T

70
Q

what age is peak spine health

A

25

71
Q

T or F: in the early stage of spondylosis, damage is reversible

A

T: there is only minor involvement of the disc/facet
*this is why early PT is important

72
Q

T or F: spondylosis can occur at any age

A

T

73
Q

what happens in the intermediate instability phase of spondylosis

A
  • laxity of joint capsule/lig
  • annular loss of proteoglycans
  • decreased flexibility
  • joint surface starts to erode
74
Q

what happens in the final stabilization phase of spondylosis

A
  • several joints become hypomobile so other joints increase their mobility
  • stiff but may not be painful
  • stenosis may occur
75
Q

with spondylosis, pain is usually worse when

A
  • in the morning
  • if too much movement
  • at end range
76
Q

what typically decreases pain with spondylosis

A

mobility/activity
*important to find the sweet spot between too much movement and not enough

77
Q

DDD typically causes pain with ___ while DJD causes pain with _______

A

sitting
standing/walking

78
Q

lateral stenosis is narrowing of the…

A

neural foramen

79
Q

lateral stenosis usually has a positive ____ test

A

quadrant
*because you are closing the facets

80
Q

stenosis is the ___ and radiculopathy is a ______

A

diagnosis
symptom

81
Q

can you have stenosis without radiculopathy

A

yes, but you cannot have a radiculopathy without stenosis

82
Q

what could cause lateral stenosis

A

HNP
DDD/DJD
poor posture

83
Q

radiculopathy is rare in the _____ spine

A

thoracic
*if there is it is usually due to a compression fx or trauma

84
Q

subjective findings with radiculopathy

A
  • not usually relieved with rest
  • deep, burning, sharp pain
  • specific dermatomal pattern or may think its entire arm/hand
  • possible weakness (grip)
85
Q

is radiculopathy usually unilateral or bilateral

A

unilateral

86
Q

objective findings with radiculopathy

A
  • positive neural tension
  • LMN symptoms
  • reproduced with foramen narrowing
  • decreased pain with traction
87
Q

what is the most common disc herniation

A

C6/7

88
Q

T or F: there is a decreased likelihood of disc herniations with advanced age

A

T

89
Q

cervical myelopathy

A

compression of the spinal cord in the cervical spine

90
Q

symptoms of cervical myelopathy

A
  • impaired fine motor skills
  • pain/stiffness in neck
  • loss of balance, difficulty walking
91
Q

what kind of image for myelopathy

A

MRI

92
Q

can we typically help with myelopathy

A

no, need to refer out, treatment is spinal decompression surgery

93
Q

possible causes of thoracic outlet

A
  • trauma
  • poor posture
  • hypertrophied scalenes
94
Q

thoracic outlet usually involves the…

A

1st rib

95
Q

common age/sex for thoracic outlet

A

middle aged women

96
Q

subjective findings for thoracic outlet

A
  • edema, skin tightness, cyanosis (vascular)
  • heaviness
  • hight pain
  • N/T, usually C8/T1
97
Q

problems with OA/occiput-C1 usually cause headaches where

A

over orbit

98
Q

problems with C2-3 usually causes headaches where

A

lateral head inner ear

99
Q

problems with C6 usually cause headaches where

A

globally

100
Q

problems with T4 usually cause what kind of headache

A

feels like head is in a vice

MPT 2 (11 decks)

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