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Dexter's Class > Cervical Spine > Flashcards

Cervical Spine Flashcards

1
Q

Resting, Close packed, capsular pattern position

A

Resting: midway between flexion and extension
Close Packed Position: full extension
Capsular pattern: side flexion and rotation equally limited extension

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2
Q

What is the most common mechanism of non-penetrating injury to the vertebral artery?

A

neck extension

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3
Q

S/S of vertebral artery injury

A
  • dizziness
  • vertigo
  • headaches
  • loss of consciousness
  • visual disturbances
  • gait disturbances
  • UE paresthesias
  • nausea
  • —secondary s/s include:
  • 5 D’s
  • nystagmus (eyes jutter)
  • tinnitus (ringing in ears)
  • pallor
  • facial paresthesia
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4
Q

What are the 5 D’s

A
  1. dysphasia (difficulty comprehending and formulating sentences)
  2. dysarthria (difficulty physically forming words; involves speech muscles)
  3. diplopia (double vision)
  4. dizziness
  5. drop attacks (falling while remaining conscious with no provocation)
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5
Q

Patient History Questions: (know the questions and rationale for asking them)

Question #1:

A

What is the patient’s age?

  • spondylosis is commonly seen in those over 25
  • generalized disease of aging initiated by IV disc degeneration
  • symptoms of OA- 60 yo or older
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6
Q

Question #2:

A

What are the symptoms, and which are most severe?

  • location of symptoms may help determine cervical spine level (eg. tingling in middle finger may indicate problem at C6 or C7)
  • increased chance of recovery from neck pain: younger age, no previous neck pain, good health, good coping and social support; after a MVI: few initial symptoms, less symptom severity, grade I WAD
  • slight increased chance of recovery: being employed, changing jobs, no prior pain problems; after MVI: good prior health, no lawyer involvement, lower collision speed
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7
Q

Question #3:

A

What was the MOI?

  • burners or stingers usually occur from a blow to part of the brachial plexus or from stretching or comprising the plexus.
  • whiplash-type injury or whiplash associated disorder (WAD)–can look at Quebec severity classification
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8
Q

Question #4:

A

Has the patient had neck pain before?

  • Factors that decrease chances of getting a new episode of neck pain:
  • –no previous neck pain, no other MS problems, good psychological health, younger age (peak risk in 40s-50s), male, less repetitive or precision work
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9
Q

Questions #5:

A

What is the patient’s usual activity or pastime?

  • type of work; sewing, typing, working at a desk?
  • wear glasses? bifocals or trifocals? –upper cervical symptoms may result from excessive nodding at patient tries to focus through correct part of glasses
  • push and pull activities (mowing, sawing, etc.)
  • extension can aggravate symptoms in patients with radicular s/s
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10
Q

Question #6:

A

Did the head strike anything, or did the patient lose consciousness?
-if MVI: type of seatbelt (lap, shoulder, none), did patient see accident coming

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11
Q

Question #7:

A

Did the symptoms come on right away?

  • bone pain usually occurs immediately; muscle or ligaments pain can come on immediately (tear) or occur several hours or days later (stretching due to MVI)
  • 70% whiplash patients report immediate symptoms
  • how long have symptoms been present?
  • myofascial pain syndromes demonstrate generalized aching and at least 3 trigger points which have lasted for at least 3 months with no hx of trauma
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12
Q

Question #8:

A

What are the sites and boundaries of the pain?

  • symptoms for nerve root C4 injury or above that level
  • cervical radiculopathy: presents primarily with unilateral motor and sensory symptoms into the upper limb, muscle weakness, sensory alteration, reflex hypo activity
  • acute radic= disc herniation; chronic= spondylosis
  • cervical myelopathy: injury to SC itself; present with spastic weakness, paresthesia, possible incoordination in one or both lower limbs, proprioceptive, sphincter dysfunction
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13
Q

Question #9:

A

Is there any radiation of pain?

  • correlate answer with dermatome and sensory peripheral nerve findings
  • is pain deep, superficial, shooting, burning, or aching?
  • burner= lightning-like pain, burning pain into shoulder and arm, followed by period of heaviness or loss of arm function
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14
Q

Question #10:

A

Is the pain affected by laughing, coughing, sneezing, or straining?
-increase of intrathoracic or intraabdominal pressure

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15
Q

Question #11:

A

Does the patient have any HA? If so, where? How frequently do they occur?

  • medications: how much, what kind?
  • precipitating factors: food, stress, posture?
  • craniovertebral joint dysfunction commonly accompanies headaches: C1 HA occur at base and top of head, C2 HA referred to temporal area

signs that headaches have a cervical origin:

  • occipital or suboccipital component
  • neck movement alters
  • painful limitation of neck movements
  • abnormal head or neck posture
  • suboccipital or nuchal tenderness
  • abnormal mobility at C0-C1
  • sensory abnormalities in the occipital and suboccipital areas
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16
Q

Question #12:

A

Does a position change alter the HA or pain?
-Bakody’s sign: decreased or relieved pain by placing hand or arm of affected side on top of the head; usually indicative of problems in C4 or C5 area

17
Q

Question #13:

A 
Is paresthesia (pins and needles feeling) present?
-may all relate to cervical myelopathy
18
Q

Question #14:

A

Does the patient experience any tingling in the extremities?
-bilateral symptoms usually indicate systemic disorders (diabetes, alcohol abuse) that are causing neuropathies or central space-occupying lesions

19
Q

Question #15:

A

Are there any lower limb symptoms?

  • may indicate a severe problem affect the SC
  • may include: numbness, paresthesia, stumbling, difficulty walking, lack of balance or agility, signs of sphincter or sexual dysfunction—related to cervical myelopathy
20
Q

Question #16:

A

Does the patient have any difficulty walking? Difficulty with balance?

  • positive responses: cervical myelopathy
  • abnormality of cranial nerves combined with gait alterations: systemic neurological dysfunction
21
Q

Question #17:

A

Does the patient experience dizziness, faintness, or seizures?

  • semicircular canal problems or vertebral artery problems can lead to dizziness
  • vertebral artery problems also associated with: drop attack, diplopia, nystagmus (dancing eyes), scotomas (depressed visual field), and loss of acuity may indicate severity of injury, neurological injury, and sometimes increases intracranial pressure
22
Q

Question #18:

A

Does the patient exhibit or complain of any sympathetic symptoms?
-severe injury (whiplash/acceleration) can lead to hypertonia of SNS: some symptoms include: ringing in the ears (tinnitus), dizziness, blurred vision, photophobia, rhinorrhea (runny nose), sweating, lacrimation, and loss of strength

23
Q

Question #19:

A

is the condition improving, worsening, or staying the same?

-indication of progress

24
Q

Question #20:

A

Which activities aggravate the problem? Which ease?

  • If symptoms are not varied by change of position, the problem is not likely to be mechanical in origin
  • lesions of C3, C4, C5 may affect diaphragm
25
Q

Question #21:

A

Does the patient complain of any restrictions when performing movements?

26
Q

Question #22:

A

Is the patient a mouth breather?

-encourages forward head posture and increases activity of accessory respiratory muscles

27
Q

Question #23:

A

Is there any difficulty in swallowing (dysphagia) or have there been any voice changes?

  • may be caused by neurological problems, mechanical pressure or muscle incoordination
  • swallowing and the voice becomes weaker as the neck is extended
28
Q

Question #24:

A

What can be learned about patient’s sleeping position?

-hugging a pillow or abducting the arms while sleeping can increase stress on the lower cervical nerve roots

29
Q

Question #25:

A

Does the patient display any cognitive dysfunction?

Dexter's Class (14 decks)

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