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Cervical Spine Flashcards

1
Q

what is the percent of the population that will have neck pain within their lifetime

A

70%

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2
Q

Neck pain is almost as prevalent as what

A

Low back pain

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3
Q

What percent all patients seen does neck pain make up

A

25%

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4
Q

What percent of those with neck pain will develop chronic disabling problems

A

20%

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5
Q

What are the main elements of the subjective exam for the cervical spine (7)

A
  1. Nature and kind of disorder
  2. Area of symptoms
  3. Behavior of symptoms
  4. Present history
  5. Past history
  6. Special questions
  7. Questionnaires
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6
Q

What is it called when pain goes from distal to proximal

A

Centralization

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7
Q

What is it called when pain goes from proximal to distal

A

Peripheralization

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8
Q

What are the 2 types of behavior of symptoms

A
  1. Chemical pain

2. Mechanical pain

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9
Q

What are the characteristics of chemical pain (6)

A
  1. Constant pain
  2. High levels of pain
  3. Often diffuse
  4. Recent onset
  5. Easy aggravation of pain by all movement
  6. Takes time to calm down
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10
Q

How does chemical pain respond to NSAIDs

A

Favorably

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11
Q

True or False:

Your treatment should be gentle for patients with chemical pain

A

True

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12
Q

What are the characteristics of mechanical pain (6)

A
  1. Intermittent pain
  2. variable levels of pain
  3. Usually local
  4. Fairly recent to chronic
  5. Changes in position or movement in a particular direction ease pain
  6. Symptoms are short lived
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13
Q

How does mechanical pain respond to NSAIDs

A

Variable response

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14
Q

True or False:

Your treatment can be rougher for patients with mechanical pain

A

True

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15
Q

True or False:

Mechanical pain can be slightly referred

A

True

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16
Q

What can dizziness or light headedness mean

A

Vascular issue or vestibular issue

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17
Q

What can trouble talking or swallowing mean

A

CNS problem or instability after trauma

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18
Q

What can change in vision mean

A

Vertebral artery excluded

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19
Q

What can difficulty walking or drop attacks mean

A

Injury or nerve impingement to conduction pathways

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20
Q

What can difficulty holding small objects or writing mean

A

Compression of the spinal cord

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21
Q

Is numbness or tingling in both hands or feet a good thing

A

Absolutely not

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22
Q

What can difficulty concentrating or remembering things mean

A

Poor arterial blood flow or traumatic injuries

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23
Q

True or False:

It is normal for patients to feel symptoms unilaterally

A

True

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24
Q

What stand for NDI

A

Neck Disability Index

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25
Q

What is the NDI

A

10 item condition specific self report questionnaire

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26
Q

What do 7 questions measure

A

Functional status

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27
Q

What do the remaining 3 questions measure

A
  1. Pain intensity
  2. Concentration
  3. Headache
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28
Q

What is the NDI scored from

A

0-50

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29
Q

What is a good score

A

Lower scores

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30
Q

What is the minimum change needed to detect change

A

5 points

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31
Q

What is the patient specific functional scale specific to

A

Daily Life

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32
Q

What is the patient specific functional scale

A

Generic scale where the PT asks the patient to identify 3 items that they find difficult due to their injury

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33
Q

What is each item rated on

A

A scale from 0-10

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34
Q

What does 0 mean

A

Unable to perform activity

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35
Q

What does 10 mean

A

Task is not a problem

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36
Q

How do you determine the final score

A

Average the 3 scores

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37
Q

What is the minimum amount of change that must occur the see change

A

2.1

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38
Q

What is the minimum important clinical difference

A

2.0

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39
Q

True or False:

If there are multiple complaints/symptoms you should ask about each individually

A

True

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40
Q

What is spondylosis

A

Degeneration of the intervertebral disc

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41
Q

What is spondylolysis

A

Fracture of pars interarticularis

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42
Q

What is spondylolisthesis

A

One vertebrae slips over another

43
Q

What is the purpose of the physical examination (3)

A
  1. Confirm initial hypothesis
  2. Clarify options for treatment
  3. Determine if patient is appropriate for PT
44
Q

What is the order of cervical spine examination (8)

A
  1. Observations
  2. Active ROM
  3. Repeated movements
  4. Passive ROM
  5. Passive accessory motion testing
  6. Muscle performance testing
  7. Special tests
  8. Palpation
45
Q

True or False:

Special tests are used during every examination

46
Q

How does acute torticollis present

A

Side bend and rotated away from the painful side

47
Q

What do you look at during observations (4)

A
  1. Performed in sitting or standing
  2. Visual inspection of head and neck
  3. Observe shoulder girdle
  4. Function
48
Q

What do you observe when looking at function (3)

A
  1. Transfers
  2. Gait
  3. Willingness to move
49
Q

What is worse hypermobility or instability

A

Instability

50
Q

When looking at AROM what do you do (3)

A
  1. Look at available range first
  2. Describe quality of motion
  3. Keep track of symptoms and how they change
51
Q

What is a good way to denote symptoms that mimic their symptoms

A

An asterisk

52
Q

What is normal flexion, extension, side bending, and rotation of the cervical spine

A

Flexion: 45
Extension: 45
Side bending: 45
Rotation: 60

53
Q

What is retraction

A

Upper cervical flexion and lower cervical extension

54
Q

What is protraction

A

Upper cervical extension and lower cervical flexion

55
Q

Why do we apply overpressure at the end of AROM

A

To clear motion/direction as potential source of pain/limitation

56
Q

What does no pain with overpressure mean

A

The motion is cleared

57
Q

If you have pain on the left side of your neck which type of rotation/side bending would be painful

A

To the same side

58
Q

Can combined motions be measured

A

Not really

59
Q

What is repeated movement testing used for

A

Assessment and management of pain

60
Q

What are the 3 classifications

A
  1. Derangement
  2. Dysfunction
  3. Postural
61
Q

Which classifications have limitation in mobility

A

Derangement and dysfunction

62
Q

Which classifications have full ROM

63
Q

Which direction does dysfunction have limited function

A

The direction of pain

64
Q

Which way do you do repeated motion testing for derangements

A

The directions that is painful

65
Q

What are the types of movements for repeated movement testing in the cervical spine (5)

A
  1. Retraction
  2. Retraction with extension
  3. Protraction
  4. Rotation
  5. Side bending
66
Q

Which plane do you usually begin with during RMT

67
Q

When do you do rotation or side bending first

A

In the presence of a structural deformity

68
Q

What type of classifications are acute

A

Derangements

69
Q

What type of classifications are chronic

A

Dysfunctions and derangements occasionally

70
Q

What classification has pain during movement

A

Derangement

71
Q

What classification has pain at end range

A

Dysfunction

72
Q

Does RMT have an affect on the postural classification

73
Q

What position is PROM of the cervical usually performed in

74
Q

What hold does the examiner use to move the patients head

A

Cradle hold or chin hold

75
Q

What is the examiner looking to assess with PROM (3)

A
  1. Movement between segments
  2. End feel
  3. Patient response
76
Q

What order do you assess motion

A

Least painful to most painful

77
Q

What does PPIVM mean

A

Passive Physiologic Intervertebral Motion

78
Q

What do you compare to during PROM

A

The same segment or segment above and below

79
Q

How far down the spine should you test

80
Q

What are the general passive accessory motions (4)

A
  1. Side gliding (lateral glide)
  2. Anterior gliding
  3. Posterior gliding
  4. Distraction/traction
81
Q

What are the specific passive accessory motions (4)

A
  1. Posterior to anterior CVP
  2. Posterior to anterior UVP
  3. Transverse VP
  4. Anterior to posterior UVP
82
Q

What is the lateral glide test able to determine

A

Hypomobile segment and which side

83
Q

What does resisted isometric testing provide the clinician

A

Info regarding tissue reactivity

84
Q

What does MMT provide the clinician

A

Info regarding strength

85
Q

What are the tests for neurological symptoms (8)

A
  1. Cranial nerve testing
  2. DTR/MSR
  3. Myotomes
  4. Sensation
  5. Spurling’s test
  6. Distraction test
  7. Upper limb nerve tension testing (ULNTT)
  8. Special tests for UMN lesions
86
Q

Is spurling’s test a provocation or relieving test

87
Q

Is distraction test a provocation or relieving test

88
Q

True or False:

A positive DTR/MSR, myotome, or sensation test may make the patient inappropriate for PT

89
Q

What do ULNT testing look at

A

Mechanical and physiologic ability of the nervous system

90
Q

What are the 3 peripheral nerves that are tested with ULNT

A
  1. Median
  2. Radial
  3. Ulnar
91
Q

What is a positive finding for ULNT testing (3)

A
  1. Reproduces pain
  2. Sensitizing movement alters pain
  3. Difference from side to side
92
Q

True or False:

You only need one of the positive findings to have a positive test for ULNT testing

93
Q

What are the tests used to identify UMN lesions (4)

A
  1. Babinski reflex
  2. Hoffmann’s sign
  3. Rhomberg test
  4. Lhermitte test
94
Q

What is the Rhomberg test

A

Staying with feet together and arms wrapped around body and close eyes

95
Q

Positive Rhomberg test

A

Large sway or falling over

96
Q

What is the Lhermitte test

A

Sitting and flex chin to chest

97
Q

What is a positive Lhermitte test

A

Lightning pain down the spine when the flex

98
Q

What are the 5 D

A
  1. Dizziness
  2. Dysphasia
  3. Diplopia
  4. Dysarthria
  5. Drop attacks
99
Q

What is dysphasia

A

Difficulty swallowing

100
Q

What is diplopia

A

Double vision

101
Q

What is dysarthria

A

Difficulty speaking

102
Q

What is the vertebral artery test

A

Rotation in sitting

103
Q

What is a positive vertebral artery test

A

Dizziness, nystagmus, blurry vision, sudden fall

104
Q

Why do we do vertebral artery test

A

To screen if appropriate for manipulation

Musculo (18 decks)

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