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Musculo 2 > Cervical Spine > Flashcards

Cervical Spine Flashcards

1
Q

Neurophysiological Effects of Mobilization

A
  1. Firing of mechanoreceptors, proprioception
  2. Firing of cutaneous and muscular receptors
  3. Altered nociception
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2
Q

Mechanical Effects of Mobs

A
  1. Stretching of joint restrictions
  2. Breaking adhesions
  3. Altered positional relationships
  4. Diminish/eliminate barriers to normal motion
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3
Q

Psychological Effects of Mobs

A
  1. Confidence gained through improvement
  2. Positive effects from manual contact
  3. Response to joint sounds
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4
Q

Ther Ex Strategies

A 
Williams Flexion
McKenzie Exercises
Core stabilization
Lumbar stabilization
Yoga/Pilates based strengthening and flexibility
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5
Q

OMPT Techniques

A 
Manipulation
Mobilization
Snag
NAGs
Mulligan mobs with movement
Maitland
Paris
Australian
Canadian
Osteopathic
McKenzie
Nordic
Cyriax
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6
Q

Soft Tissue Techniques

A

Myofascial release
Trigger point release
Dry needling

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7
Q

Neuro Approaches

A

PNF
Postural Restoration
Strain-Counter Strain
Neurodynamics

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8
Q

Contraindication to Joint Mobs

A

Joint hypermobility or instability
Joint inflammation or effusion
Hard end feel
Medically unstable
Acute pain that worsens with repeated attempts
Acute radiculopathy
Bone disease or fracture detectable on radiograph
Spinal arthropathy (ankylosing spondylitis, DISH, spondy)
Deteriorating CNS pathology
Status-post joint effusion
Blood clotting disorder

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9
Q

Precautions to Joint Mobs

A

Malignancy (>50, failure to respond, unexplained weight loss, prior history)
Total joint replacement
bone disease not detectable on radiograph (osteoporosis, osteopenia, osteomalaci, etc.)
Systemic connective tissue disorders (RA, Down’s syndrome, Marfan’s, Ehrlos-Danlos syndrome, lupus)
pregnancy or immediately after, oral contraceptives, anticoagulant therapy
Recent trauma, distal radiculopathy, cauda equina
Early healing phase
Individuals unable to reliably communicate or respond to intervention
Psychogenic patients exhibiting dependent behaviors
Long term corticosteroid use
Skin rashes or open wounds in region
Elevated pain levels

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10
Q

Total Vertebrae

A

29

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11
Q

Cervical Vertebrae

A

7

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12
Q

Thoracic Vertebrae

A

12

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13
Q

Lumbar Vertebrae

A

5

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14
Q

Sacral Vertebrae

A

5

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15
Q

Coccygeal Vertebrae

A

4

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16
Q

Number of facet joints

A

24

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17
Q

Classification of facet joints

A

Planar

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18
Q

Upper cervical facet joints are orientated in what direction?

A

Horizontal

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19
Q

Lower cervical facet position?

A

45 degrees

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20
Q

Z joints/uncovertebral joints made up of what?

A

Uncinate processes

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21
Q

Thoracic facet joints oriented?

A

Near vertical

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22
Q

Lumbar facet positions?

A

Vertical with J-shaped surface

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23
Q

What positions are major stressors to IVD?

A

Axial compression, shearing, bending, twisting (especially in combination)

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24
Q

What are the 3 sub-systems that contribute to stability?

A

Passive
Active
Central Nervous System

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25
Q

Passive stability system

A

Anatomical structures

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26
Q

Active system

A

Muscles

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27
Q

Central nervous system

A

Feedforward and feedback control

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28
Q

Neutral zone of spine

A

Region of laxity around normal resting position of spinal segment
Involves minimal loading of passive and active structures and spinal motion is produced with minimal internal resistance

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29
Q

What produces movement in spine?

A

Agonist and synergistic muscles

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30
Q

What controls and modifies movement?

A

Antagonistic muscles

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31
Q

What affects the amount of motion available at each region of the spine?

A 
Disc-vertebral height ratio
Compliance of fibrocartilage
Dimension/shape of adjacent vertebral endplates
Age
Disease
Gender
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32
Q

What are the two types of coupling in the cervical spine?

A

Opposite in Upper

Same in Lower

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33
Q

What happens to the facet joints in flexion/extension and side-bending?

A

Flexion/extension- up&forward/down&back in same direction
Side-bending- movement in opposite directions

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34
Q

Fryette’s First Law

A

In neutral, side-bending and rotation occur in opposite direction

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35
Q

Fryette’s Second Law

A

In flexion or extension, side-bending and rotation occur in same direction

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36
Q

Fryette’s Third Law

A

When put in one position, movement in other positions becomes limited

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37
Q

Restriction of Ext/SB/Rot to same side of pain indicates?

A

Can’t Close issue

Articular problem

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38
Q

Restriction of Flex/SB/Rot to opposite side of pain indicates?

A

Can’t Open

Capsular issue

39
Q

Disease causing altered structural alignment in skull?

A

Arnold Chiari Syndrome/Malformation

40
Q

Where does the majority of cervical rotation occur?

A

Atlanto-occipital region

41
Q

Injury to atlanto-occipital/cervicoencephalic areas can lead to?

A

Cognitive dysfunction
Cranial nerve dysfunction
Sympathetic system dysfunction

42
Q

Atlanto-occipital joints

A

Principal motion=15-20 degrees of flex/ext

10 degrees of side-bending

43
Q

Atlanto-axial joints

A

Principal motion= 50 degrees rotation
10 degrees flex/ext
5 degrees SB
Most mobile articulations in spine

44
Q

Cervicobrachial Region injury symptoms

A 
Neck/arm pain
Headaches
Restricted ROM
Paresthesia
Altered dermatomes and myotomes
Radicular signs
45
Q

What do IVDs do in cervical spine?

A

Make up 25% height

Give lordotic curve to spine

46
Q

Purpose of nucleus pulposus?

A

Buffer axial compression

47
Q

Purpose of annulus fibrosis?

A

Withstand tension

48
Q

What are the 4 parts of the vertebral artery?

A
  1. Proximal
  2. Transverse
  3. Suboccipital
  4. Intracranial
49
Q

Path of proximal portion of VA

A

Origin at subclavian artery to point of entry into C-spine at ~C6

50
Q

Transverse Path

A

entry into C-spine up through transverse foramen of C2 through transverse canal
Prone to compression from osteophytes, subluxation from facet joints

51
Q

Suboccipital Path

A

From exit of C2 to penetration into spinal canal
Divided into 4 parts:
1. Within transverse foramen of C2
2. Between C2 and C1
3. Within transverse foramen of C1
4. Between posterior arch of C1 and entry into foramen magnum
Vulnerable to impingement from extension, excursion of transverse mass of C1, ossification of atlanto-axial membrane

52
Q

Intracranial Path

A

from foramen magnum to formation of basilar artery at lower pons
Following penetration, VA goes medially to oblongata, then up to medulla to meet up with other VA to become basilar artery
This portion is prone to atherosclerotic plaques and stenosis

53
Q

Branches of VA

A
  1. Meningeal branches-supply bone and dura mater
  2. Anterior Spinal
  3. Posterior Spinal
  4. Muscular branches- supply deep suboccipital muscles
  5. Posterior Inferior Cerebellar Artery
54
Q

Vertebrobasilar Insufficiency

A 
Damage and occlusion of VA due to:
Atherosclerotic involvement
Sickle Cell
RA
Arterial fibroplasias
Arteriovenous fistula
Congenital syndromes
55
Q

External causes of VBI

A

Extra-cranial Compression
Neck hyperextension
Vertebrobasilar infarction (extra-cranial dissection)

56
Q

Internal causes of VBI

A

Atherosclerosis
Thrombosis
Arterial fibrodysplasia
Arteriovenous fistulas

57
Q

What is Klippel-Trenaunay Syndrome?

A

Condition affecting development of blood vessels, soft tissues, and bones

58
Q

Clinical Manifestations of VBI

A 
Dizziness/Vertigo
Drop attacks
Diplopia
Dysarthria
Dysphagia
Nausea
Numbness
Nystagmus
Tinnitus
Headache
Wallenberg, Horner Syndrome
Paresthesia/ Hemi
Scotoma/vision obstruction
Periodic LOC
Lip/perioral anesthesia
Hemifacial paralysis
Hypereflexia (Babinksi, Hoffman, Oppenheim)
Clonus
Ataxia
Dysphaisa
59
Q

Imaging Studies for VBI

A

Conventional Angiography- shows lumen
MRA- less invasive, highly sensitive and specific
Doppler Sonography- allows direct visualization of vascular tree

60
Q

What should clinician do throughout treatment?

A

Observe for nystagmus, Observe for pupil size changes
Assess quality of speech
Require pt to report any change in symptoms, regardless of seeming insignificance

61
Q

5 D’s And 3 N’s

A 
Dizziness
Diplopia
Drop attacks
Dysarthria
Dysphagia
Ataxia
Nystagmus
Numbness
Nausea
62
Q

Horner’s Syndrome

A

Decreased pupil size
Drooping eyelid
Decreased sweating on affected side of face

63
Q

Proper training techniques include avoiding

A

Excessive Rotation
Non-physiologic movements in the joints
Aggressive, forceful maneuvers (instead gradually build from gentle mobs to higher amplitude and velocity

64
Q

3 things necessary for doing cervical mobs

A
  1. Proper training
  2. Proper evaluation
  3. Gain consent
65
Q

Contraindications for VBI treatment

A 
Infection
Acute circulatory problems
Malignancy
Open wounds
Recent fracture
Hematoma
Hypersensitivity
Inappropriate end feel
Advanced diabetes
Cellulitis
Severe pain
Extensive radiation of pain
66
Q

Precautions for VBI treatment

A 
Joint inflammation
RA
Neurological signs
Osteoporosis
Pregnancy
Dizziness
Steroid/anticoagulant therapy
67
Q

Canadian C-spine Rules

A 
Cognitively in tact
Under 65
>45 degree rotation
No crazy injury circumstances (High speeds, distraction)
No pain at rest in midline
No paresthesia in arms

If yes, no X-rays

68
Q

3 tests to check ligament integrity in UCS

A

Modified Sharp-Purser
Alar Ligament Stress Test
Transverse Ligament of Atlas Test

69
Q

Signs and Symptoms of Cervical Instability

A 
Severe muscle spasms
Resistance and apprehension to movement
Lump in throat
Lip or facial paresthesia
Severe HA
Dizziness, nausea, vomiting, nystagmus, pupillary changes, other VBI indicators
Empty end feel
70
Q

Sharp-Purser Test

A

Push anteriorly on C2 and posteriorly on forehead

Feel for clunk and look for reproduction of symptoms

71
Q

Transverse Ligament Test

A

Pt lying supine

Pull anteriorly on occiput and hold for 15-20 seconds

72
Q

Anterior Shear Test/Sagittal Stress Test

A

Same as Transverse Ligament Test

73
Q

Alar Ligament Stress Test

A

Pt sitting with your hands on C2 spinous process and forehead
Rotate pt head side to side and SB to each side

74
Q

Longitudinal Ligament/Tectorial Membrane (Pettman’s Distraction Test)

A

Pt supine
Fixate C2 and distract occiput until end feel
Positive test= reproduction of symptoms or >1mm distraction

75
Q

Atlantoaxial Lateral Shear Test

A

Pt supine

Stabilize C1 and pushes C2 over, then repeats in opposite directions

76
Q

Jefferson’s Fracture/Odontoid Fracture Test

A

Pt supine with head and neck neutral
One hand supports occiput, other hand contacts lateral mass
Apply medial force through atlas

77
Q

Vertebral Artery Torsion Test

A

Pt sitting

Stand in front of pt and shake pt head, observe eyes

78
Q

Wallenberg’s Position

A

Pt sitting with neck extended and rotated to one side

Hav pt count backwards from 20

79
Q

What directions of ROM do you screen

A

ALL

Flex, ext, SB, rotation

80
Q

UE Myotomes, test actions, and muscles involved

A

C1-C2- Neck flexion (rectus lateralis and capitus anterior, longus capitis, coli, and cervicis, and sternocleidomastoid)
C3- Neck side flexion (longus capitis and cervicis, trapezius, and scalenus medius)
C4- Shoulder elevation (diaphragm, traps, levator scap, anterior scalene, middle scalene)
C5- Shoulder abduction (rhomboids, deltoid, supraspinatus, infraspinatus, teres minor, biceps, anterior ad middle scalene)
C6- Elbow flexion and wrist extension (serratus anterior, lats, subscap, teres major, pec major, biceps, coracobrachialis, brachialis, brachioradialis, supinator, extensor carpi radialis longus, anterior, middle, and posterior scalene)
C7- Elbow extension and wrist flexion (serratus anterior, lats, pec major, pec minor, pronator teres, flexor carpi radialis, flexor digitorum superficialis, extensor carpi radialis longus and brevis, extensor digitorum, extensor digiti minimi, middle and posterior scalene)
C8- Thumb extension and ulnar deviation (pec major, pec minor, triceps, flexor digitorum superficialis and profundus, flexor pollicis longus, pronator quadratus, flexor carpi ulnaris, abductor pollicis longus, extensor pollicis longus and brevis, extensor indicis, abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, middle and posterior scalene
T1- Hand intrinsics (flexor digitorum profundus, intrinsic muscles of the hand except extensor pollicis brevis, flexor pollicis brevis, opponens pollicis

81
Q

Myelopathy is a form of?

A

UMN lesion

82
Q

What are forms of LMN lesions?

A

Nerve root and peripheral nerve lesion

83
Q

Reflexes

A

Biceps= C5-C6
Brachioradialis= C6
Triceps= C7-C8
Hoffman- flick middle finger and watch thumb

84
Q

What are the 2 types of special tests and describe them

A

Provactive- Upper limb tension tests, foraminal compression tests, cervical flexion rotation tests
Symptom relief- distraction tests, shoulder abduction test

85
Q

Key Tests for Cervical Neurological Symptoms

A

Brachial Plexus tension test
Distraction test
Foraminal compression test
Upper limb neurodynamic tension test

86
Q

Spurling’s Compression

A

Pt sitting with head flexed to uninvolved side, examiner press down
Repeat on involved side

87
Q

Jackson’s Compression Test

A

Same as Spurling’s with rotation

88
Q

Maximal Foraminal Compression Test/ Spurling’s Upper/Lower Quadrant

A

Pt sitting with neck passively placed in extension, ipsilateral side-bending, and ipsilateral rotation for lower quadrant
Pt sitting in cervical protraction and the other positions
Apply gentle compression with triplanar overpressure

89
Q

Distraction Test

A

Lift or distract head from neck and look for improvement in symptoms

90
Q

Shoulder Abduction (Relief) Test

A

Pt has arm elevated with forearm and hand on head

Positive if pt has decrease in symptoms

91
Q

Cervical Flexion Rotation Test

A

Pt supine, then moves into active flexion
Examiner applies forceful rotation to both sides and inquires about symptoms
Positive= pain provocation or >10 degree loss in ROM

92
Q

Cervical Muscle Strength

A

Pt supine, examiner places pt head into retraction and pt holds head 1 in. off table
See how long pt can hold head in position

93
Q

Upper Limb Nerve Tension Tests

A 
Median 1- (anterior interosseous nerve) shoulder, wrist, and elbow extension, finger extension, shoulder ER
Median 2 (axillary and musculocutaneous)- shoulder abduction to 90, elbow, wrist, and finger extension, downward force on shoulder
Radial- shoulder and elbow extension, wrist flexion, finger flexion, downward force on shoulder
Ulnar- "3-point goggles"

Musculo 2 (1 decks)

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