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Cervical Spine Flashcards

1
Q

What serious Medical Conditions is the Head and Neck Screening Questionnaire meant to pick up?

A
  • SubArachnoid Hemmorhage/ Stroke
  • Vertebrobasilar Insufficiency
  • Meningitis
  • Primary Brain Tumor
  • Mild TBI/ PostConcussive Syndrome
  • Subdural Hematoma
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2
Q

Describe When Radiographs would be required according to the Canadian C Spine Rule

A

Series of Questions

  • Does the patient have 2 or more of these high risk factors
    1. Age > 65
    2. Parasthesias in Extremities
    3. Dangerous MOI; Fall from height > 1 meter, MVA speeds greater than 100 km/hr or rollover or ejection in MVA, Bike or Motorcycle Accident
  • Does the patient have any factors that limit assessment of AROM; Assessment of AROM depends on:
    1. Assume a sitting position
    2. Ambulate
    3. Onset of neck pain not immediate
    4. Absence of Midline tenderness
    5. MVA not consistent with above risk factors
  • If pnt cannot have AROM Assessed, they need Radiographs
  • If pnt can have AROM assessed and it is < 45 degrees, they need radiographs
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3
Q

What is a Minimal Detectable Change?

A

The amount of change that must be observed before the change can be considered to exceed measurement error

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4
Q

What is Minimal Clinically Important Difference?

A

The smallest difference that the patients perceive as beneficial

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5
Q

How do you score the Neck Disability Index?

A
  • Total of 10 items
  • 6 Responses for Each Item, each scored 0-5
  • Total is expressed as percentage, the higher the percentage, the higher the perceived disability
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6
Q

How do you score the Patient Specific Functional Scale (PSFS)?

A
  • Patiient provides 5 functional items they are having difficulty with
  • Graded 0-10
  • 0 is the inability to perform the activity, 10 is the ability to perform as well as before injury occurred
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7
Q

Describe the scoring and the scales on the FABQ

A
  • FABQ work subscale consists of 7 items
  • FABQ Physical Activity subscale consists of 4 items
  • Possible 42 points for Work, and 24 for Physical Activity
  • Higher scores demonstrate higher fear avoidance
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8
Q

Describe Common Clinical Findings and Symptoms of a patient with Neck Pain with Mobility Deficits

A 
Clinical Findings
- Age < 50
- Acute Neck Pain
- Symptoms isolated to the Neck
- Restricted Cervical ROM
Symptoms
- Unilateral Neck Pain
- Neck Motion Limitations
- Onset of Sx often linked to a recent awkward movement or position
- Possible associated upper extremity pain
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9
Q

What are some tests to identify ligamentous insufficiency in the Cervical Spine?

A
  • Sharp Purser
  • Alar Ligament Integrity Test
  • Central PA pressure to assess for midline tenderness and segmental mobility
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10
Q

What are some common Symptoms of Vertebro-Basilar Insufficieny?

A
  • Vertigo/ Dizziness
  • Tinnitus
  • Ataxia/ Unsteady Gait
  • Diplopia/ Visual Perceptual Disturbances
  • Nausea
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11
Q

What are some common clinical features suggestive of Vertebro-Basilar Insufficiency?

A
  • Unilateral and Suboccipital pain in the head and neck
  • Patient Never Experienced pain like it before
  • Pnt report of stiff neck with no motion loss
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12
Q

What are some common Neurological Signs of Vertebro-Basilar Insufficiency?

A
  • Ipsilateral Horner Syndrome
  • Ipsilateral Limb Ataxia
  • Gait Ataxia
  • Ipsilateral Sensory abnormalities of face
  • Nystagmus
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13
Q

What is the most common cause of VBI?

A
  • Trauma; Specifically from high- velocity flexion distraction and rotational forces such as whiplash
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14
Q

Name 6 predictors useful in determining which patients will benefit from Cervical Spine Manipulation

A
  • Initial Scores on NDI < 11.5
  • Having Bilateral Involvement
  • Not performing Sedentary work > 5 hours per day
  • Feeling better while moving the neck
  • Did not feel worse while extending the neck
  • Diagnosis of Spodylosis without Radiculopathy
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15
Q

Name 6 predictors usfeul in determining which Cervical Pain patients might benefit from Thoracic manipulation

A
  • Symptom Duration < 30 days
  • No Symptoms distal to shoulder
  • Subject reports that looking up does not aggravate Sx
  • FABQ Physical Activity Subscale < 12
  • Diminished Upper Thoracic Kyphosis (T3-5)
  • Cervical Extension < 30 deg
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16
Q

What are some common clinical findings and symptoms associated with Neck Pain with Headache Patients?

A
  • Unilateral Headache
  • Headache worsened with palpation of posterior neck
  • Restricted Cervical ROM and Segmental Mobility
  • Substandard performance on the Cranial Cervical Flexion Test
  • Headache worsened by sustained positions and neck movements
17
Q

What are some characteristics that differentiate patients who get migraines and Cervicogenic Headache patients?

A

Cervicogenic Headache patients

  • Have less cervical ROM into Flexion and Extension
  • Have Significantly higher instances of of painful upper cervical joint dysfunction and muscle tightness
18
Q

Describe Cranial Cervical Flexion Test

A
  • Inflate pressure cuff to 20 mmHg
  • Put it under the cervical lordosis while patient in supine
  • Tell patient to nod head as if saying yes with upper neck
  • Hold Position for 10 seconds
  • Repeat with 22,24,26, 28, and 30 mmHg
19
Q

What is considered an abnormal/ Substandard performance of the Cranial Cervical Flexion Test

A
  • Unable to generate an increase in pressure of 6 mmHg
  • Unable to hold pressure for 10 seconds
  • Uses Superficial Neck Muscles
  • Extending neck forcefully against pressure cuff to achieve pressure
20
Q

What are some clinical findings associated with Neck Pain with Movement Coordination Impairments?

A
  • Chronic Neck Pain
  • Poor Performance on Cranial Cervical Flexion Test and Deep Flexor Endurance Test
  • Flexibility Deficits in Upper Quarter Muscles (Scalenes, Levator Scap, Pec Minor, etc)
  • Ergonomic Inefficiency
  • Associated Upper Extremity Pain
21
Q

What are some clinical findings associated with Neck Pain with Radiating Pain?

A
  • Positive on the Wainner Radiculopathy Rule
  • Signs of Nerve Root Compression
  • Success with reducing upper extremity symptoms with initial intervention procedures
  • Radicular pain into Upper Extremity
22
Q

Describe the Clinical Prediction Rule by Wainner that predicts Cervical Radiculopathy

A
  • Positive Upper Limb Tension Test A (Median Bias)
  • Positive Spurlings A
  • Involved Side Cervical Rotation < 60 deg
  • Positive Distraction Test
23
Q

What are some common signs of Cervical Myelopathy or Upper Motor Neuron Pathology?

A
  • Hyper-reflexia
  • More diffuse Sensory Changes, not necessarily in Dermatomal Pattern’
  • Clonus of Ankle
  • Positive Babinski
  • Positive Hoffmans
  • Clumsiness of Gait
  • Generalized weakness below level of involvement
24
Q

What are some common signs of Lower Motor Neuron Pathology?

A
  • Hypo-reflexia
  • Absent Deep Tendon Reflexes
  • Decreased sensation to light touch in dermatomal pattern
  • Muscle Weakness in myotomal pattern
25
Q

What are the Key Muscles, Dermatomal areas and reflexes to test for Neurological Screen of C5?

A
  • Deltoid Muscle
  • Lateral Forearm Sensation
  • Biceps Brachii Reflex
26
Q

What are the Key Muscles, Dermatomal areas and reflexes to test for Neurological Screen of C6?

A
  • Biceps Brachii, Extensor Carpi Radialis Longus/Brevis Muscles
  • Distal Thumb Sensation
  • Brachioradialis Reflex
27
Q

What are the Key Muscles, Dermatomal areas and reflexes to test for Neurological Screen of C7?

A
  • Triceps and Flexor Carpi Radialis Muscles
  • Distal Middle Finger Sensation
  • Triceps Reflex
28
Q

What are the Key Muscles, Dermatomal areas and reflexes to test for Neurological Screen of C8?

A
  • Abductor Pollicis Brevis Muscle
  • Distal Fifth Finger Sensation
  • No Reflex
29
Q

What are the Key Muscles, Dermatomal areas and reflexes to test for Neurological Screen of T1?

A
  • First Dorsal Interossei Muscle
  • Medial Forearm Sensation
  • No Reflex
30
Q

Describe the scale used to measure reflexes

A
  • 0: Absent
  • 1+: Hyporeactive Reflex
  • 2+: Normal
  • 3+: Hyperreactive but WNL of variation
  • 4+: Hyperreactive
31
Q

What are 4 variables described by Cleland that predict if Neck Pain with radiating pain patient will succeed with PT interventions?

A
  • Age < 54
  • Dominant Arm is not Affected
  • Looking down does not worsen Symptoms
  • Multimodal treatment including traction, manual therapy, and DNF Strengthening for at least 50% of the visits
32
Q

What are the five variables in the Clinical Prediction Rule to determine if a patient will benefit from intermittent cervical traction?

A
  • Patient reported peripheralization with lower cervical spine (C4-7) mobility testing
  • Positive shoulder Abduction Sign
  • Age greater or equal to 55
  • Positive ULTTA
  • Relief of Symptoms with manual distraction test
33
Q

What is another classification system for neck pain

A

Categories

  • Mobility
  • Centralization
  • Conditioning and Exercise Tolerance
  • Pain Control
  • Reduce Headache

OCS (13 decks)

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