Cervical Spine Flashcards
what two scalenes form the scalenes triangle? what goes through the triangle?
anterior and middle
brachial plexus, subclavian artery and vein
scalenes OIA
O: TP C2-7
I: 1st and 2nd ribs
A: ipsilateral SB, contralateral rotation, accessory inspiration
SCM OIA
O: mastoid process
I: sternum, clavical
A: ipsi SB, contra rot, extension
*flexion bilaterally
what is the deepest and most important anterior muscle of c-spine?
longus cervicis (coli)
longus coli OIA
O: T3-C2 bodies
I: C3-6 TP
A: cervical flexion
*important for neck stability
the 2 alar ligaments run from the ___ to the ____. it is life threatening if these ligs are damaged
dens (sup, lat)
foramen magnum
how many transverse (cruciform/cruciate) ligs are there? what are they?
3
superior longitudinal, transverse, inferior longitudinal
superior longitudinal cruciate lig attaches ____ to ______
atlas
occiput
transvere cruciate lig attaches….
C2 bilateral
inferior longitudinal lig attaches __ to _____
atlas
C2 body
this ligament prevents the atlas from translating anterior on the axis during flexion and is life threatening if damaged
transverse lig
T or F: the dens will fracture before the transverse lig tears
T: it tears at 130kg
what additional subjective items should you ask about with a cervical compliant?
dizziness
headaches
TMJ
T or F: the subjective exam is strongly supported by evidence
T
T or F: outcome measures are strongly supported by evidence
T
head and neck medical screening questionnaire
used to determine if patient has a serious medical condition that mimics a common MSK disorder
neck and shoulder screening questionnaire
screens for diagnoses like cervical fracture, lig instability, central cord tension, tumor, and septic arthritis
how do you ask about pain?
0-10
current, best, and worst in the last 24 hrs
take average
MDC for pain scale
2
MDC for neck disability index
10
patient specific functional scale
patient gives 5 important activities that are a problem and rates from 0 (unable) to 10 (PLOF)
MCID for PSFS
2
why may PSFS be better than NDI
more meaning for patients
how many items on fear-avoidance beliefs questionnaire
16, it must be scored 0-6
2 subscales of FABQ
work = 0-42 points
physical activity = 0-24 points
T or F: you total the subscales to get the score for FABQ
F: subscales are added seperately
for FABQ is a higher or lower score better
lower
3 high risk factors of canadian c-spine rules
- age 65 or greater
- dangerous mechanism
- paresthesias in extremities
*need an x-ray if they had a trauma with any of these factors
5 low risk factors of canadian c-spine rules
- 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
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?
yes, because they have less than 45 degrees of active L and R rotation
VBI 5 Ds and 3Ns
Dizziness
Diplopia
Drop attacks
Dysarthria
Dysphagia
Nystagmus
N/V
N/T
VBI test
- 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
If the VBI test is positive what do you do
you can still treat the patient, just avoid end range rotation and extension, Get in touch with PCP for follow-up
T or F: a single red flag is always predictive of a serious disease
F: a large study showed all pts had at least 1, but <1% had a serious pathology
** use clinical judgement and base on clusters
cancer red flags
- history of cancer
- night pain/pain at rest
- unexplained weight loss
- > 50 y/o or < 17 y/o
- failure to improve over predicted time
infection within vertebrae red flags
- immunosuppressed
- prolonged fever of >100.4
- history of IV drug use
- history of recent UTI, cellulitis, pneumonia
vertebral fracture red flag
- prolonged use of corticosteroids
- mild trauma >50 y/o
- > 70 y/o
- osteoporosis
- recent major trauma
- bruising over spine after trauma
abdominal aortic aneurysm red flags
- pulsating mass in abdomen
- history of astherosclerotic vascular disease
- age >60 y/o
how many view of the spine do you usually need
3 (min of 2)
what kind of x-ray to assess stability of c-spine
open mouth
*can also get CT scan
benefits of x-ray
fast
inexpensive
low radiation
what can you see on an AP view of an x-ray
- vertical shape
- osteophytes
- disc space
- scoliosis
- rib symmetry
what can you see on an oblique view of an x-ray
- neural foramen and fascia
- osteophytes
- stenosis
what can you see on a lateral view of an x-ray
- integrity of ALL (parallel lines)
- lordosis/kyphosis
- collapsing/wedging
- osteophytes
- forward shift of C1-2
benefits of CT scan
fast, better statistical properties, best for cortical bone, good for soft tissue when MRI is contraindicated
is metal contraindicated on CT scan
no
this imaging is ideal for soft tissue and trabecular bone
MRI
T1 MRI
fat is bright, water is dark
T2 MRI
water is brightest, fat is bright-ish
T2 fat sat/STIR MRI
water is bright, fat is dark
* better for bony pathology
what two imaging have the highest radiation exposure? lowest? none?
high = CT, bone scan
low = radiograph
none = MRI
why does poor posture cause spine pain
weight becomes anterior/posterior to the joint and the muscles have to work harder
In FHP, the upper cervical facets become ______ and the connective tissues _______. There is a tendency toward facet ___mobility
compressed
shorten
hypo
In FHP, the mid-lower cervical/thoracic facets are ____ and ___. there is a tendency toward facet ___mobility.
up and forward
hyper
what muscles become weak in FHP? which ones become overworked and tight
weak = anterior neck (longus colli), rhomboids, mid/lower traps
tight = posterior neck, pecs, lats, teres major, subscap
What does FHP do to the abdominal wall
constricts it, lessening diaphragmatic breathing and accessory muscles have to work harder
results of FHP
- tissues held in shortened range lose sarcomeres
- abnormal movement and firing
- ligamentous creep
abnormal stress to normal tissue…
may produce pain w/o causing damage
T or F: normal stress applied to abnormal tissue will not produce pain
F: it does! and abnormal stress would increase pain
common subjective findings with capsular restrictions
- limited mobility
- pain only at end range
- no pain with rest
- no weakness
- no N/T
capsular restrictions are usually the result of…
poor posture
past trauma
repeated inflammation
objective findings with capsular restrictions
- limited AROM/PROM that open facets
- hypomobile PAs
- possibly hypermobile in surrounding area (could be where pain is)
arthritis in the spine is also known as…
- spondylosis
- osteoarthritis
- DDD
- DJD
spondylosis most commonly affects
facet joints and discs
DJD
- thickening of subchondral bone/capsule
- causes increase calcium deposits and joint surface erosion
DDD
- hardening of NP
- causes decreased disk height and annular strength
With DJD, sometimes if spurs have already developed surgery may be the best option. why?
getting them in a good posture could make it worse if spurs are already there
spondylosis causes _____ blood supply
decreased
T or F: spondylosis is typically a chronic condition
T
what age is peak spine health
25
T or F: in the early stage of spondylosis, damage is reversible
T: there is only minor involvement of the disc/facet
*this is why early PT is important
T or F: spondylosis can occur at any age
T
what happens in the intermediate instability phase of spondylosis
- laxity of joint capsule/lig
- annular loss of proteoglycans
- decreased flexibility
- joint surface starts to erode
what happens in the final stabilization phase of spondylosis
- several joints become hypomobile so other joints increase their mobility
- stiff but may not be painful
- stenosis may occur
with spondylosis, pain is usually worse when
- in the morning
- if too much movement
- at end range
what typically decreases pain with spondylosis
mobility/activity
*important to find the sweet spot between too much movement and not enough
DDD typically causes pain with ___ while DJD causes pain with _______
sitting
standing/walking
lateral stenosis is narrowing of the…
neural foramen
lateral stenosis usually has a positive ____ test
quadrant
*because you are closing the facets
stenosis is the ___ and radiculopathy is a ______
diagnosis
symptom
can you have stenosis without radiculopathy
yes, but you cannot have a radiculopathy without stenosis
what could cause lateral stenosis
HNP
DDD/DJD
poor posture
radiculopathy is rare in the _____ spine
thoracic
*if there is it is usually due to a compression fx or trauma
subjective findings with radiculopathy
- not usually relieved with rest
- deep, burning, sharp pain
- specific dermatomal pattern or may think its entire arm/hand
- possible weakness (grip)
is radiculopathy usually unilateral or bilateral
unilateral
objective findings with radiculopathy
- positive neural tension
- LMN symptoms
- reproduced with foramen narrowing
- decreased pain with traction
what is the most common disc herniation
C6/7
T or F: there is a decreased likelihood of disc herniations with advanced age
T
cervical myelopathy
compression of the spinal cord in the cervical spine
symptoms of cervical myelopathy
- impaired fine motor skills
- pain/stiffness in neck
- loss of balance, difficulty walking
what kind of image for myelopathy
MRI
can we typically help with myelopathy
no, need to refer out, treatment is spinal decompression surgery
possible causes of thoracic outlet
- trauma
- poor posture
- hypertrophied scalenes
thoracic outlet usually involves the…
1st rib
common age/sex for thoracic outlet
middle aged women
subjective findings for thoracic outlet
- edema, skin tightness, cyanosis (vascular)
- heaviness
- hight pain
- N/T, usually C8/T1
problems with OA/occiput-C1 usually cause headaches where
over orbit
problems with C2-3 usually causes headaches where
lateral head inner ear
problems with C6 usually cause headaches where
globally
problems with T4 usually cause what kind of headache
feels like head is in a vice
