Cervical Spine Flashcards
Facet Joint Pain: key sxs
-Referred: HA, upper traps, periscapular.
-SB & rotation ROM limited ipsi.
-Ext ROM limited.
Facet Joint Pain: treatment
Manual
Stretching
DJD: key sxs
-Typically lower (C5-7).
-Segmental hypomobility (stiff).
-Posture usually related.
DJD: treatment
ROM & stretching
Traction
Posture exercises
CPR for manipulations w/ mechanical neck pain
-Symptoms <30 days.
-No symptoms distal to shoulder.
-Looking up does not agg.
-FABQ <12
-Decreased kyphosis
-Ext ROM <30
Whiplash red flags
-Numbness into arms.
-Bowel/bladder.
-Age >50.
-Dizzy/syncope.
-Cervical instability.
-Blurry vision.
-Memory changes.
Cervicogenic HA: common causes
-C2-3 facet joint.
-Lateral AA joint damage.
-Mm tension or strain.
-C1-4 DJD.
-Tumor/infection of c-spine.
Cervicogenic HA: key sxs
-Unilateral HA.
-Triggered by neck movement or awkward postures.
-ROM limitations.
-P! starts in neck & spreads to headache.
Cervicogenic HA: red flags
-Non-mechanical presentation.
-Sudden onset.
-Systemic illness.
-Head trauma.
-(+) UMN tests.
-5D’s & 2N’s.
Radiculopathy CPR
(+) ULTT A
(+) Spurling
(+) Distraction
Rotation ROM <60 ipsi
Disc Dysfunction: key sxs
Radiculopathy
Myelopathy (spinal cord)
Sensation & strength deficits following dermatome & myotome
Disc Dysfunction: red flags
-Multi-level weakness.
-Multi-level sensory loss.
-Bilateral UE symptoms.
-Gait abnormalities.
-(+) Clonus, Babinski, Hoffman’s
Instability vs hypermobility definitions
Instability: pathologic condition d/t fx or congenital abnormality.
Hypermobility: more than normal motion (Beighton-Hicks).
Instability & Hypermobility red flags
-(+) upper cervical stability test.
-Nausea
-Dizziness
-Nystagmus
-Myelopathy symptoms
Instability treatment
Refer to MD
Hypermobility treatment
-Restore lordosis
-Gentle mobs (usually hypomobile segment above/below).
-Deep neck flexor strengthening.
Canadian C-Spine Rules: 3 questions
- High-Risk factors?
- Low-Risk factors?
- Able to rotate 45deg to B sides?
Canadian C-Spine Rules: high risk factors
-Age >65
-Dangerous MOI
-Paresthesia in extremities
Canadian C-Spine Rules: low risk factors
-Simple MVC
-Sits in waiting room
-Ambulatory
-Delayed onset neck P!
-No midline neck tenderness
Canadian C-Spine Rules: what criteria indicates xray?
-Yes to any high risk factors.
-No to any low risk factors.
-No to rotation AROM 45deg.
Canadian C-Spine Rules: when is xray not indicated?
No high risk factors, AND meets all low risk criteria, AND can rotate 45deg.
Red flags indicating myelopathy
-Sensory loss in hands.
-Atrophy hand intrinsics.
-Unsteady gait.
-Hoffman’s.
-Bowel/bladder.
-Multisegmental weakness or sensory changes.
Red flags indicating neoplasm
-Age >50
-Hx of cancer.
-Unexplained weight loss.
-Constant P!
-Night P!
Red flags indicating upper cervical instability
-Occipital HA & numbness.
-Severe AROM limitations.
-Signs of myelopathy.
-Recent trauma.
-Prolonged corticosteroid.
Red flags indicating vertebral artery insufficiency
5 Ds:
-Drop attacks.
-Dizziness.
-Dysphagia.
-Dysarthria.
-Diplopia.
(+) CN signs.
Red flags indicating vertebral artery dissection
5 D’s:
-Drop attacks.
-Dizziness.
-Dysphagia.
-Dysarthria.
-Diplopia.
3 N’s:
-Nystagmus
-Nausea
-Numbness of face
Red flags indicating systemic issue
-Fever
-BP > 160/95
-RR >25
-Fatigue
-P! at rest
-Immunosuppression
Spurling Test: procedure, purpose, (+)
Radiculopathy.
Apply pressure to top of head in side-bent position.
(+) = reproduce sxs.
Distraction Test: procedure, purpose, (+)
Radiculopathy.
Apply traction.
(+) = reproduce sxs.
Alar Ligament Test: procedure, purpose, (+)
Instability (Alar).
Side bend while palpating C2.
(+) = don’t feel spinous process bump immediately.
Sharp-Pursor Test: procedure, purpose, (+)
Instability (Transverse).
Slight flex, stabilize C2 spinous, apply A>P pressure to forehead.
(+) = reduction of symptoms & head slides back, possible clunk.
Tectorial Membrane Test: procedure, purpose, (+)
Instability (Tectorial).
Gentle traction.
(+) = dizziness, drop attacks, nausea, nystagmus, paresthesia, or ataxia.
Vertebral Artery Insufficiency Test: procedure, (+)
Supine, head off edge of table.
1. Max rotate to one side, hold 20sec, return to neutral.
If no symptoms, then…
2. Repeat with rotate + SB.
If no symptoms, then…
3. Repeat with rotate + SB + ext.
(+) = dizziness, nystagmus, slurred speech, vision or hearing changes.
Craniocervical Flexion Test: procedure, purpose, (+)
Strength & endurance of deep neck flexors.
BP cuff under lordosis part of c-spine, inflate to 20mmHg.
Perform craniocervical flex to 22mmHg, hold 10sec.
Repeat in increments of 2mmHg up to 30.
(+) = substitution, inability to hold pressure, jerky motions.
(+) indicates weakness.
Upper Cervical UPA promotes what motion?
Ipsilateral rotation
Lower Cervical UPA promotes what motion?
Contralateral rotation
