Cervical Spine Flashcards
1
Q
what is the percent of the population that will have neck pain within their lifetime
A
70%
2
Q
Neck pain is almost as prevalent as what
A
Low back pain
3
Q
What percent all patients seen does neck pain make up
A
25%
4
Q
What percent of those with neck pain will develop chronic disabling problems
A
20%
5
Q
What are the main elements of the subjective exam for the cervical spine (7)
A
- Nature and kind of disorder
- Area of symptoms
- Behavior of symptoms
- Present history
- Past history
- Special questions
- Questionnaires
6
Q
What is it called when pain goes from distal to proximal
A
Centralization
7
Q
What is it called when pain goes from proximal to distal
A
Peripheralization
8
Q
What are the 2 types of behavior of symptoms
A
- Chemical pain
2. Mechanical pain
9
Q
What are the characteristics of chemical pain (6)
A
- Constant pain
- High levels of pain
- Often diffuse
- Recent onset
- Easy aggravation of pain by all movement
- Takes time to calm down
10
Q
How does chemical pain respond to NSAIDs
A
Favorably
11
Q
True or False:
Your treatment should be gentle for patients with chemical pain
A
True
12
Q
What are the characteristics of mechanical pain (6)
A
- Intermittent pain
- variable levels of pain
- Usually local
- Fairly recent to chronic
- Changes in position or movement in a particular direction ease pain
- Symptoms are short lived
13
Q
How does mechanical pain respond to NSAIDs
A
Variable response
14
Q
True or False:
Your treatment can be rougher for patients with mechanical pain
A
True
15
Q
True or False:
Mechanical pain can be slightly referred
A
True
16
Q
What can dizziness or light headedness mean
A
Vascular issue or vestibular issue
17
Q
What can trouble talking or swallowing mean
A
CNS problem or instability after trauma
18
Q
What can change in vision mean
A
Vertebral artery excluded
19
Q
What can difficulty walking or drop attacks mean
A
Injury or nerve impingement to conduction pathways
20
Q
What can difficulty holding small objects or writing mean
A
Compression of the spinal cord
21
Q
Is numbness or tingling in both hands or feet a good thing
A
Absolutely not
22
Q
What can difficulty concentrating or remembering things mean
A
Poor arterial blood flow or traumatic injuries
23
Q
True or False:
It is normal for patients to feel symptoms unilaterally
A
True
24
Q
What stand for NDI
A
Neck Disability Index
25
What is the NDI
10 item condition specific self report questionnaire
26
What do 7 questions measure
Functional status
27
What do the remaining 3 questions measure
1. Pain intensity
2. Concentration
3. Headache
28
What is the NDI scored from
0-50
29
What is a good score
Lower scores
30
What is the minimum change needed to detect change
5 points
31
What is the patient specific functional scale specific to
Daily Life
32
What is the patient specific functional scale
Generic scale where the PT asks the patient to identify 3 items that they find difficult due to their injury
33
What is each item rated on
A scale from 0-10
34
What does 0 mean
Unable to perform activity
35
What does 10 mean
Task is not a problem
36
How do you determine the final score
Average the 3 scores
37
What is the minimum amount of change that must occur the see change
2.1
38
What is the minimum important clinical difference
2.0
39
True or False:
| If there are multiple complaints/symptoms you should ask about each individually
True
40
What is spondylosis
Degeneration of the intervertebral disc
41
What is spondylolysis
Fracture of pars interarticularis
42
What is spondylolisthesis
One vertebrae slips over another
43
What is the purpose of the physical examination (3)
1. Confirm initial hypothesis
2. Clarify options for treatment
3. Determine if patient is appropriate for PT
44
What is the order of cervical spine examination (8)
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
True or False:
| Special tests are used during every examination
False
46
How does acute torticollis present
Side bend and rotated away from the painful side
47
What do you look at during observations (4)
1. Performed in sitting or standing
2. Visual inspection of head and neck
3. Observe shoulder girdle
4. Function
48
What do you observe when looking at function (3)
1. Transfers
2. Gait
3. Willingness to move
49
What is worse hypermobility or instability
Instability
50
When looking at AROM what do you do (3)
1. Look at available range first
2. Describe quality of motion
3. Keep track of symptoms and how they change
51
What is a good way to denote symptoms that mimic their symptoms
An asterisk
52
What is normal flexion, extension, side bending, and rotation of the cervical spine
Flexion: 45
Extension: 45
Side bending: 45
Rotation: 60
53
What is retraction
Upper cervical flexion and lower cervical extension
54
What is protraction
Upper cervical extension and lower cervical flexion
55
Why do we apply overpressure at the end of AROM
To clear motion/direction as potential source of pain/limitation
56
What does no pain with overpressure mean
The motion is cleared
57
If you have pain on the left side of your neck which type of rotation/side bending would be painful
To the same side
58
Can combined motions be measured
Not really
59
What is repeated movement testing used for
Assessment and management of pain
60
What are the 3 classifications
1. Derangement
2. Dysfunction
3. Postural
61
Which classifications have limitation in mobility
Derangement and dysfunction
62
Which classifications have full ROM
Postural
63
Which direction does dysfunction have limited function
The direction of pain
64
Which way do you do repeated motion testing for derangements
The directions that is painful
65
What are the types of movements for repeated movement testing in the cervical spine (5)
1. Retraction
2. Retraction with extension
3. Protraction
4. Rotation
5. Side bending
66
Which plane do you usually begin with during RMT
Sagittal
67
When do you do rotation or side bending first
In the presence of a structural deformity
68
What type of classifications are acute
Derangements
69
What type of classifications are chronic
Dysfunctions and derangements occasionally
70
What classification has pain during movement
Derangement
71
What classification has pain at end range
Dysfunction
72
Does RMT have an affect on the postural classification
Nope
73
What position is PROM of the cervical usually performed in
Supine
74
What hold does the examiner use to move the patients head
Cradle hold or chin hold
75
What is the examiner looking to assess with PROM (3)
1. Movement between segments
2. End feel
3. Patient response
76
What order do you assess motion
Least painful to most painful
77
What does PPIVM mean
Passive Physiologic Intervertebral Motion
78
What do you compare to during PROM
The same segment or segment above and below
79
How far down the spine should you test
To T3
80
What are the general passive accessory motions (4)
1. Side gliding (lateral glide)
2. Anterior gliding
3. Posterior gliding
4. Distraction/traction
81
What are the specific passive accessory motions (4)
1. Posterior to anterior CVP
2. Posterior to anterior UVP
3. Transverse VP
4. Anterior to posterior UVP
82
What is the lateral glide test able to determine
Hypomobile segment and which side
83
What does resisted isometric testing provide the clinician
Info regarding tissue reactivity
84
What does MMT provide the clinician
Info regarding strength
85
What are the tests for neurological symptoms (8)
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
Is spurling's test a provocation or relieving test
Provocing
87
Is distraction test a provocation or relieving test
Relieving
88
True or False:
| A positive DTR/MSR, myotome, or sensation test may make the patient inappropriate for PT
True
89
What do ULNT testing look at
Mechanical and physiologic ability of the nervous system
90
What are the 3 peripheral nerves that are tested with ULNT
1. Median
2. Radial
3. Ulnar
91
What is a positive finding for ULNT testing (3)
1. Reproduces pain
2. Sensitizing movement alters pain
3. Difference from side to side
92
True or False:
| You only need one of the positive findings to have a positive test for ULNT testing
true
93
What are the tests used to identify UMN lesions (4)
1. Babinski reflex
2. Hoffmann's sign
3. Rhomberg test
4. Lhermitte test
94
What is the Rhomberg test
Staying with feet together and arms wrapped around body and close eyes
95
Positive Rhomberg test
Large sway or falling over
96
What is the Lhermitte test
Sitting and flex chin to chest
97
What is a positive Lhermitte test
Lightning pain down the spine when the flex
98
What are the 5 D
1. Dizziness
2. Dysphasia
3. Diplopia
4. Dysarthria
5. Drop attacks
99
What is dysphasia
Difficulty swallowing
100
What is diplopia
Double vision
101
What is dysarthria
Difficulty speaking
102
What is the vertebral artery test
Rotation in sitting
103
What is a positive vertebral artery test
Dizziness, nystagmus, blurry vision, sudden fall
104
Why do we do vertebral artery test
To screen if appropriate for manipulation
