Cervical Spine Flashcards
What serious Medical Conditions is the Head and Neck Screening Questionnaire meant to pick up?
- SubArachnoid Hemmorhage/ Stroke
- Vertebrobasilar Insufficiency
- Meningitis
- Primary Brain Tumor
- Mild TBI/ PostConcussive Syndrome
- Subdural Hematoma
Describe When Radiographs would be required according to the Canadian C Spine Rule
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
What is a Minimal Detectable Change?
The amount of change that must be observed before the change can be considered to exceed measurement error
What is Minimal Clinically Important Difference?
The smallest difference that the patients perceive as beneficial
How do you score the Neck Disability Index?
- 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
How do you score the Patient Specific Functional Scale (PSFS)?
- 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
Describe the scoring and the scales on the FABQ
- 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
Describe Common Clinical Findings and Symptoms of a patient with Neck Pain with Mobility Deficits
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
What are some tests to identify ligamentous insufficiency in the Cervical Spine?
- Sharp Purser
- Alar Ligament Integrity Test
- Central PA pressure to assess for midline tenderness and segmental mobility
What are some common Symptoms of Vertebro-Basilar Insufficieny?
- Vertigo/ Dizziness
- Tinnitus
- Ataxia/ Unsteady Gait
- Diplopia/ Visual Perceptual Disturbances
- Nausea
What are some common clinical features suggestive of Vertebro-Basilar Insufficiency?
- 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
What are some common Neurological Signs of Vertebro-Basilar Insufficiency?
- Ipsilateral Horner Syndrome
- Ipsilateral Limb Ataxia
- Gait Ataxia
- Ipsilateral Sensory abnormalities of face
- Nystagmus
What is the most common cause of VBI?
- Trauma; Specifically from high- velocity flexion distraction and rotational forces such as whiplash
Name 6 predictors useful in determining which patients will benefit from Cervical Spine Manipulation
- 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
Name 6 predictors usfeul in determining which Cervical Pain patients might benefit from Thoracic manipulation
- 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
