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Musculoskeletal > Cervical Spine > Flashcards

Cervical Spine Flashcards

1
Q

What factors predispose individuals for C-Spine chronicity (6)?

A

Age over 40 years
Long history of neck pain
Loss of strength in hands
Poor QOL
Worrisome/anxious attitude
Reduced vitality

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2
Q

Discogenic pain typically causes pain in a ___________ pattern.

A

Dermatomal

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3
Q

Nerve root irritation may not always present in a __________ pattern.

A

Dermatomal

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4
Q

Two examples of how a nerve root may become irritated:

A

Inflammation
Nerve root adhesion

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5
Q

Identify 10 things to touch on in patient history for c-spine:

A
  • Insidious onset
  • Headaches
  • Dizziness
  • Exact MOI
  • Lhermitte’s sign
  • Symptoms (SINS)
  • Referred pain
  • Previous episodes
  • Flag items
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6
Q

Define Lhermitte’s sign:

A

Electric shock-like sensation occurring with flexion of the neck.

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7
Q

Cardiopulmonary systems review:

A

Vital signs

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8
Q

Integumentary systems review:

A

Skin check

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9
Q

MSK systems review:

A

UQS/UE ROM screen

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10
Q

Neuromuscular systems review:

A

Dermatome/myotome
DTR screening

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11
Q

Two red flags when screening:

A

UMN signs and symptoms
History of losing of consciousness

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12
Q

5 D’s and 3 N’s:

A

Dizziness, drop attacks, dysphagia, dysarthria, diplopia

Nausea, numbness, nystagmus

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13
Q

Cervical Myelopathy important red flags (7):

A

Unsteady gait
Hoffman’s reflex
Babinski
Clonus
Hyperreflexia
Multi-segmental weakness
Multi segmental sensory changes

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14
Q

Upper cervical ligamentous instability red flags (3):

A

Post trauma
RA
Down syndrome

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15
Q

If there is cervical trauma (fracture), what protocol is followed?

A

Canadian C-spine rules

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16
Q

Upper cervical ligamentous instability may have similar signs and symptoms to what?

A

VBI (vertebrobasilar insufficiency)

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17
Q

List 4 common cervical locations for referred pain:

A

Head
Upper trap/peri scap
Upper extremity
T4-5

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18
Q

Cervical spine muscle pain referral pattern: Trapezius

A

R / L occiput, lateral head above ear to behind eye, tip of jaw, spinous process to medial border of scap, lateral aspect of upper arm.

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19
Q

Differentiate between a closing or opening restriction in the C-spine

A

Closing: restriction of ipsilateral extension. Results in side-bending and rotation to contralateral side.

Opening: restriction of ipsilateral flexion. Results in side-bending and rotation to ipsilateral side.

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20
Q

What’s more common, closing or opening restriction?

A

Closing (way more common)

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21
Q

With cervical trauma, what two tests should be done?

A

Alar ligament stress test
Modified sharp-purser test

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22
Q

If you find a positive result during alar ligament stress test, what should be done?

A

Send Pt for MRI

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23
Q

What ligament does the modified sharp-purser test involve?

A

Transverse ligament

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24
Q

If either Alar ligament stress test or modified sharp-purser test are positive, what should be done?

A

Stop testing and refer for MRI!

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25
Q

Asymmetries in the C-spine are _____________ and not ____________ for pain.

A

Correlative and not causative

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26
Q

What is crucial to observe when Pt is rotating/side-bending?

A

The eyes (2-3 seconds) for nystagmus

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27
Q

Motions testing the lower cervical spine:

A

Rotation and side bending

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28
Q

Motions testing the upper cervical spine:

A

Flexion and extension

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29
Q

What are we looking for with McKenzie’s neck protrusion and retraction?

A

Reduction of radicular symptoms

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30
Q

Disc pathology tends to be ___ level(s), while stenosis tends to be ___ level(s).

A

1 level; multiple levels

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31
Q

PPIVMs are used to assess what?

A

Joint play at a single joint and between individual joints.

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32
Q

Describe the Likert scale

A

Hypomobility, normal, hypermobility.
0-1 hypo
2 normal
3-4 hyper

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33
Q

In clinical practice, PPIVM and PROM are ________.

A

combined

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34
Q

How can you test the deep cervical flexors?

A

Using a blood pressure cuff under the neck. Incrementally increase pressure to move the neck.

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35
Q

Important upper motor neuron pathology indication test on the upper extremity:

A

Hoffman’s sign

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36
Q

GCS stands for:

A

Glasgow coma scale

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37
Q

Identify the three high-risk factors that mandate radiography in the Canadian C-spine rules:

A

Age greater than 65 years
Dangerous MOI
Paresthesia in extremities

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38
Q

Identify the 5 low-risk factors that allow safe assessment of ROM:

A

Simple rear-end motor vehicle crash
Able to sit in the emergency department
Able to ambulate
Delayed onset neck pain
Absence of midline tenderness

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39
Q

Midline tenderness is a clue of what?

A

possible fracture

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40
Q

What is step 3 of the Canadian C-spine rules?

A

If all prerequisites are cleared, rotate neck 45 degrees to the right and left. If they can do this, they don’t need radiographs.

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41
Q

Two goals of P-A mobilization

A

Looking for a comparable sign
Hypo or Hyper mobility?

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42
Q

What is assessed first? UPAs or CPAs?

A

CPAs then UPAs

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43
Q

PAIVM stands for ____________.

A

Passive accessory intervertebral motion

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44
Q

2 PAIVM options for mid to lower cervical spine

A

CPA and UPA

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45
Q

What does a CPA do?

A

Assesses irritability and increases extension ROM

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46
Q

What does UPA do?

A

Assesses irritability and improves side-bending

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47
Q

Radiculopathy tends to respond favorably to what movement?

A

Extension

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48
Q

Stenosis tends to respond negatively to that movement?

A

Extension

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49
Q

Demographic for cervicalgia

A

Younger ages (<50 years)

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50
Q

ICD-10 for neck pain with mobility deficits:

A

Cervicalgia

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51
Q

ICD-10 for neck pain with radiating pain:

A

Spondylosis with radiculopathy

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52
Q

What cluster can help identify spondylosis with radiculopathy?

A

Ipsilateral cervical rotation <60, (+) ULTT, (+) cervical distraction, (+) spurling

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53
Q

If you identify this cluster, what should you suspect?

Ipsilateral cervical rotation <60, (+) ULTT, (+) cervical distraction, (+) spurling

A

Spondylosis with radiculopathy

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54
Q

ICD-10 for neck pain with headache:

A

Headache; cervicocranial syndrome

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55
Q

ICD-10 for neck pain with movement coordinated impairment:

A

Sprain and strain of cervical spine
(whiplash falls under this classification)

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56
Q

Identify 6 areas that refer pain FROM the cervical spine:

A

Head
Posterior occiput
Forehead
Shoulder
Scapula
UE

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57
Q

Identify an area that refers pain TO the cervical spine:

A

TMJ

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58
Q

A hyperextension or extension/flexion injury is termed what?

A

Whiplash associated disorder (WAD)

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59
Q

Identify 4 potential causes of WAD:

A

MVA
Falls
Pulls/thrusts on arms
Sports injury

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60
Q

Identify 6 things that can be involved in a WAD:

A

Damage to anterior longitudinal ligament
Tearing of joint capsule
Disc herniation
Muscle tears
Damage to sympathetic nervous system
TMJ injury

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61
Q

Identify the WAD stage: Symptoms of Neck pain, stiffness, tenderness. No signs.

A

WAD I

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62
Q

Identify the WAD stage: Symptoms of Neck pain, stiffness, tenderness. Signs of TTP (point tender) Decreased ROM (active > passive).

A

WAD II

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63
Q

Identify the WAD stage: Symptoms of Neck pain, stiffness, tenderness. Neurologic S/Sx

A

WAD III

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64
Q

Identify the WAD stage: Symptom of neck pain. Signs of fracture, subluxation, dislocation.

A

WAD IV

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65
Q

Why is the cervical collar controversial for WAD? What is a good strategy for use?

A

Long term use leads to dependence. God for immediately after injury, but should be weaned off. Increasing amounts of time off it every day.

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66
Q

If S/Sx of WAD persist for over 8 weeks, what should you check/rule out?

A

Instability with CT or MR

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67
Q

C1 fracture is also known as a what?

A

Jefferson fracture

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68
Q

What type of fracture is a C1 fracture and what is the MOI?

A

Burst fracture of anterior and posterior arches. MOI: axial compression

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69
Q

How is a C1 fracture diagnosed?

A

open mouth radiography shows spreading of lateral masses

70
Q

What is a complication associated with a C1 fracture?

A

Disruption of the transverse ligament if lateral masses spread sufficiently.

71
Q

Management of a C1 fracture. Minimally displaced vs moderately displaced.

A

Minimal: Orthosis - rigid collar (philadelphia collar)

Moderate: Halo then rigid collar

72
Q

How is C1 marked displacement managed?

A

Cranial traction
Absolute bedrest
Halo then rigid collar

73
Q

C2 Pedicle fracture is also called what?

A

Hangman’s fracture

74
Q

What causes hangman’s fracture (C2)?

A

Hyperextension

75
Q

How is a C2 fracture diagnosed?

A

Lateral view on radiograph

76
Q

How is a C2 fracture managed? Unilateral vs displaced.

A

Unilateral: Halo or rigid collar
Displaced: Halo, ORIF (if instability persists)

77
Q

Cause of a C2 dens fracture:

A

Result of high velocity trauma (MVA or fall)

78
Q

How is a C2 dens fracture diagnosed?

A

Open mouth radiography

79
Q

Spinous process avulsion fracture is also called what?

A

Clay shoveler’s fracture

80
Q

What is the cause of a spinous process avulsion fracture?

A

Massive muscle contraction

81
Q

What is the most common site of a spinous process avulsion fracture?

82
Q

T/F a spinous process avulsion fracture is painful but harmless.

83
Q

What is the cause of a cervical subluxation?

A

Flexion injury

84
Q

Management of a cervical subluxation (2):

A

Rigid collar
Posterior fusion for persistent instability

85
Q

Describe the motion of the vertebra in a cervical subluxation:

A

Body subluxes forward on one below.

86
Q

Condition characterized by ipsilateral lateral neck flexion of the head with contralateral rotation present.

A

Torticollis

87
Q

Torticollis typically involves what demographic?

88
Q

Torticollis most commonly results from what physiologic changes?

A

Unilateral shortening and thickening or excessive contraction of the SCM.

89
Q

Identify three types of Torticollis:

A

Congenital muscular
Secondary
Spasmodic

90
Q

Secondary Torticollis occurs most commonly in what demographic?

91
Q

What is the most common cause of secondary torticollis?

A

Cervical muscle spasm

92
Q

Spasmodic torticollis is also known as what? What does it involve?

A

Cervical dystonia. Involuntary twisting or clonic movements of the neck.

93
Q

Spondy means

94
Q

Degeneration of the intervertebral disc is known as what?

A

Spondylosis

95
Q

What causes cervical spondylosis?

A

The aging process. 60% of those over 45 show S/S. 85% of those over 60.

96
Q

Cervical spondylosis most commonly affects which spinal cord segments?

A

C5/C6 and C6/C7

97
Q

T/F If someone shows radiographic changes (spondylosis) it indicates they will likely be symptomatic.

A

False. Does not necessarily indicate they will be symptomatic.

98
Q

Clinical presentation is divided into 4 groups. What are they?

A

Neck pain
Neck pain with proximal referral
Radicular pain
Myelopathy

99
Q

What pathology is THE MOST serious consequence and the most common cord dysfunction after middle age?

A

Cervical spondylitic myelopathy

100
Q

If cervical myelopathy is identified, what should be done?

A

Emergency condition. Refer!

101
Q

Mechanical neck pain is termed what?

A

Cervical Facet Syndrome

102
Q

Two things that can lead to the narrowing of the spinal canals (stenosis):

A

Osteophytes
Disc degeneration

103
Q

4 S/S of cervical spinal stenosis:

A

Unilateral or bilateral
Weakness, heaviness in limbs
Aching
Several dermatomes affected

104
Q

What are the two most common causes of cervical radiculopathy?

A

Facet joint spondylosis/stenosis
Disc pathology (e.g. herniation)

105
Q

Identify the 4 stages of disc pathology:

A

Degenerative changes (protrusion/bulge)
Prolapse
Extrusion (herniation)
Sequestration

106
Q

The 5 D’s and 3 N’s are symptoms of what?

A

VBI (vertebral artery insufficiency)

107
Q

T/F 75-90% of cervical radiculopathy cases will improve with non-operative management.

108
Q

Management of a cervical disc herniation (4):

A

Manage symptoms
Joint mobilization (CPA/UPA)
Traction
Surgical (laminectomy, discectomy)

109
Q

ACDF stands for what?

A

Anterior cervical discectomy and fusion

110
Q

How long until a patient can resume full, unrestricted activity after an ACDF?

A

3-6 months

111
Q

Cervical disc replacement is an alternative to what procedures?

A

Laminectomy and fusion

112
Q

When is a cervical disc replacement indicated?

A

disc herniation

113
Q

Red flag, yellow flag, or black for cervical spine?

Recent trauma, severe movement loss, paresthesia, constant pain, irritability.

A

Yellow flags

114
Q

Referral pattern for the SCM

A

Back and top of head
front of ear over forehead to medial aspect of eye
cheek

115
Q

Referral pattern for the splenius capitis

A

Top of head

116
Q

Referral pattern for splenius cervicis

A

posterior neck and shoulder angle
side of head to eye

117
Q

Referral pattern for semispinalis cervicis

A

back of head

118
Q

Referral pattern for semispinalis capitis

A

Band around head at level of forehead

119
Q

Referral pattern for multifidus

A

Occiput to posterior neck and shoulder angle to base of spine of scap

120
Q

Referral pattern for suboccipital

A

Lateral aspect of head to eye

121
Q

Referral pattern for scalenes

A

Medial border of scap and anterior chest down posterolateral aspect of arm to anterolateral and posterolateral aspect of hand.

122
Q

Describe upper crossed syndrome

A

Tight trapezius and pectoralis

Weak deep neck flexors and rhomboids, serratus anterior, and lower trapezius

123
Q

Combined motion testing may be assessed if _________ end-feel is normal and pain free.

A

Single-plane

124
Q

In clinical practice, PPIVM is combined with what?

A

PROM assessment

125
Q

Canadian C-spine step 1: High risk factor mandating radiography

A
  • age over 65 years
  • dangerous MOI
  • Paresthesia in extremities
126
Q

Identify the ICD10 based on the following description:

Younger age (<50 years)
Acute neck pain (<12 weeks)
Restricted cervical ROM
Segmental hypomobility of the cervical and thoracic spine
Symptoms isolated to neck

A

Cervicalgia

127
Q

Identify the ICD10 based on the following description:

Neck pain with radiating pain in involved upper extremity
Upper extremity paresthesias, numbness, and weakness
May have imaging findings of spondylosis

A

Spondylosis with radiculopathy

128
Q

PT is most effective for what type of HA?

A

Cervicogenic

129
Q

Identify the ICD10 based on the following description:

Longstanding neck pain (>12 weeks)
Abnormal/standard performance on cranial cerv. flexion test and deep flexor endurance test
Coordination, strength and endurance deficits of neck/upper quarter muscles.
Flexibility deficits of upper quarter
Ergonomic insufficiencies

A

Sprain and strain of cervical spine

130
Q

What percentage of WAD patents have symptoms lasting over 2 years

131
Q

What causes a facet dislocation?

A

Flexion-rotation or hyperflexion

132
Q

Facet dislocation appears clinically as what other pathology?

A

Torticollis

133
Q

Management of a unilateral facet dislocation includes (2):

A

Closed reduction under anesthesia
ORIF with fusion

(Varies)

134
Q

When the whole vertebra slides forward over half its width, this is called what?

A

Bilateral facet dislocation

135
Q

When the vertebral body is displaced less than half its width, this is called what?

A

Unilateral facet dislocation

136
Q

Management of a bilateral facet dislocation includes (2):

A

Cranial traction until stable for surgery
ORIF with fusion (halo)

137
Q

Secondary torticollis occurs most often in what patient population?

138
Q

What is the most common cause of secondary torticollis?

A

Cervical muscle spasm

139
Q

Management of secondary torticollis (4):

A

Identify cause and treat as appropriate:

Stretching
Joint mob
Postural education
Surgical intervention

140
Q

What type of torticollis may have a psychologic component?

A

Spasmodic torticollis

141
Q

What does a laminectomy accomplish?

A

Increases axial space available for spinal cord

142
Q

Which condition often is treated with a laminectomy?

A

Spinal stenosis

143
Q

What condition is often treated with a laminaplasty?

A

Multilevel spondylotic myelopathy

144
Q

What is done during a laminaplasty?

A

The spinous process is removed, wedges placed to stop vertebrae from closing.

145
Q

Identify an alternative to laminectomy and fusion when treating disc herniation

A

Cervical disc replacement

146
Q

When is a cervical disc replacement indicated?

A

Disc herniation

147
Q

What are the advantages of a cervical disc replacement compared to laminectomy and fusion?

A

Maintains normal neck movement better
Reduces degeneration of adjacent segments
Allows earlier post op movement

148
Q

What are 6 classic examination findings for cervical myelopathy?

A
  • Cervical ROM loss
  • Hyperreflexia in UE and LE
  • Myelopathic hand (atrophy of intrinsics)
  • Unsteady gait
  • Positive Rhomberg and Hoffman’s
149
Q

A disorder of the cervical region that disrupts or interrupts normal neural transmission is called _______.

A

cervical myelopathy

150
Q

Cervical myelopathy gender and age demographic

A

Men over women
Age over 50 yrs old

151
Q

Myelopathy CPR (5):

A
  • Gait deviation
  • Positive Hoffman’s
  • Inverted Supinator Sign
  • Positive Babinski
  • Over 45 yrs old
152
Q

In mild cervical myelopathy how does non-operative treatment compare to surgery?

A

Equal to or better

153
Q

In moderate to severe cervical myelopathy, how does non-operative treatment compare to surgery?

A

Surgery associated with higher rates of neurological improvement

154
Q

Identify conditions that mimic cervical disc lesions (4):

A

Pancoast tumor
Neurofibroma
Osteophytes in intervertebral foramen
Neuralgic amyotrophy

155
Q

A pancoast tumor invades what structure?

A

The brachial plexus

156
Q

S/S of a pancoast tumor (3):

A

T1 weakness
Horner’s syndrome
Severe pain

157
Q

A pulmonary sulcus tumor growing outward into ribs and vertebrae is termed what?

A

Pancoast tumor

158
Q

A benign tumor of peripheral nerves is termed what?

A

Neurofibroma

159
Q

S/S of neurofibroma (3):

A

Paresthesia
N/T
Muscle weakness

160
Q

What do osteophytes in intervertebral foramen cause?

A

Nerve root compression

161
Q

S/S of osteophytes in the intervertebral foramen

A

Sensory and motor changes along affected nerve root

162
Q

Management of osteophytes in the intervertebral foramen

A

Require surgical incision

PT ineffective long term

163
Q

A viral infection of the brachial plexus is termed what?

A

Neuralgic amyotrophy

164
Q

S/S of neuralgic amyotrophy (2):

A

Shoulder and upper arm pain
Atrophy of shoulder girdle

165
Q

Neuralgic amyotrophy is a _________ infectious process.

A

Self-limiting

166
Q

Proposed CPR for cervical spine traction (5):

A
  • peripheralization
  • Positive abduction sign (shoulder)
  • over 55yrs
  • (+) ULTT1
  • relief with manual cervical traction
167
Q

Commonly used CPR for Cervical manipulation (HVLAT) in patients with mechanical neck pain (4):

A
  • symptom duration under 38 days (acute)
  • (+) expectation that manipulation will help
  • Side-to-side difference in cervical rotation ROM of 10 degrees or greater
  • Pain with PA mobs/spring testing of the middle cervical spine
168
Q

CPR for cervicothoracic manipulation in patients with mechanical neck pain (6):

A
  • S/Sx <30 days
  • no S/Sx distal to shoulder
  • No aggravation of pain with looking up
  • FABQ physical activity subscale <12
  • Decreased upper t-spine kyphosis
  • Cervical extension ROM <30 degrees
169
Q

CPR for cervicothoracic manipulation for patients with shoulder pain (5):

A
  • pain-free shoulder flexion < 127 degrees
  • Shoulder internal rotation <53 degrees at 90 degrees abduction
  • (-) Neer test
  • Not taking medications for their shoulder pain
  • Symptoms < 90 days
170
Q

How to test for CAD (3):

A
  1. clinician performs end-range cervical rotation
  2. Position is held for at least 10 seconds - observe S/Sx. Head returned to neutral for at least 10 seconds. Repeat opposite side.
  3. If minor dizziness is present, vestibular testing may be performed.

Musculoskeletal (11 decks)

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