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Musculoskeletal III > CERVICAL SPINE > Flashcards

CERVICAL SPINE Flashcards

1
Q

Cervical Spine

Non-musculoskeletal pathologies causing referred pain to the Thoracic Spine

A
  • Myocardial Ischemia (pain worse during exercise)
  • Thoracic Aortic Aneurysm (sudden onset)
  • Peptic Ulcers
  • Cholecystitis ​(inflammation of the gallbladder)
  • Neoplasms (previous Hx of cancer, weight loss)
  • Inflammatory pathologies
  • Fractures (thoracic)
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2
Q

Cervical Spine

Cervical Spondylosis symptoms:

A

headache, loss of motion, crepitus, pain

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3
Q
A

spondylosis

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4
Q

Cervical Spine

TRANSVERSE LIGAMENT TEST

A
  • Cervical Instability
  • Examiner places hands under the occiput with the index fingers in the space between the
    occiput and C2 spinous process.
  • The examiner shears the occiput and head anteriorly together as a unit
  • A positive test is excessive movement, no end-feel, lump in the throat or any increase in myelopathic
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5
Q

Cervical Spine

Order of the interventions​ ​ACROSS sessions will be guided by:

A

Pain reduction as needed → achieve mobility → achieve control → achieve strength and function

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6
Q

Cervical Spine

SHARP PURSER TEST:

A
  • Cervical instability (Sp 96%)
  • Stabilize C2 spinous process using a pincer grasp
  • Examiner applies a posterior translation using the palm of the hand
  • Assess displacement, end-feel, and symptoms
  • A positive test:
    • reproduction of myelopathic symptoms during neck flexion OR
    • decrease in symptoms with the posterior translation
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7
Q

Cervical Spine

diagnosis of sprain and strain of cervical spine and the associated ICF diagnosis of neck pain with movement coordination impairments is made with a reasonable level of certainty when the patient presents with the following clinical findings:

A
  • Associated with whiplash or longer symptom duration
  • Neck pain +/- UE symptoms
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8
Q

Cervical Spine

ALAR LIGAMENT TEST

A
  • Cervical Instability
  • Examiner stabilizes C2 spinous process using a pincer grasp with a firm grip
  • Examiner performs passive side bending to the right and assess for movement of C2
  • A positive test is failure to feel movement of C2

Rotation and side bend-ing tighten the contralateral alar (e.g., rotation or side bending to the right tightens the left alar), whereas flexion typically tightens both alar ligaments.

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9
Q

Cervical Spine

For our clinical reasoning regarding diagnosis, we will use a “mixed model,” combining:

A
  • Hypothetical deductive reasoning: systematic application of rules, which may result in more accurate diagnoses, but take more time
  • Inductive Pattern recognition: used by experienced clinicians, can create errors; confirmation bias.
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10
Q

Cervical Spine

Canadian Cervical Spine Rule (100% sensitivity) to determine if the patient needs an X-Ray, includes the following factors:

A
  • for patients with trauma who are alert ONLY:
    • Age >65 with paresthesias in extremities
    • Unable to rotate the neck 45 deg
    • dangerous MOI
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11
Q

Cervical Spine

TESTS FOR CERVICAL INSTABILITY

A
  • Sharp Purser Test
  • Alar ligament test
  • Transverse ligament test
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12
Q

Cervical Spine

Hoffman test is for

A

Cervical Myelopathy

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13
Q

Cervical Spine

spine stenosis is

A

narrowing of the opening of the spine

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14
Q

Cervical Spine

a spinal disorder in which vertebrae slips forward onto the bone below it

A

spondylolisthesis

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15
Q

Cervical Spine

These tools are useful for identifying a patient’s baseline status relative to pain, function, and disability and for monitoring a change in a patient’s status throughout the course of treatment:

A
  • Neck Disability Index and the
  • Patient-Specific Functional Scale
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16
Q

Cervical Spine

acute, subacute, and chronic timing

A
  • Acute: ~ 6 wks
  • Subacute: 6-12 wks
  • Chronic: over 3 mo
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17
Q

Cervical Spine

Compression of nerve roots from osteophytes, disc or tumor; dermatomal pattern

A

Cervical Radiculopathy

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18
Q

Cervical Spine

For our diagnosis of the spine, we will primarily use which classification system?

A

Treatment Based Classification (TBC) System

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19
Q

Cervical Spine

spondylosis, spondylolysis, spondylolisthesis

A
  • spondylosis : arthritis
  • spondylolisthesis: vertebrae slips forward onto the bone below it.
  • spondylolysis: a defect/stress fracture in the pars interarticularis of the vertebral arch
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20
Q

Cervical Spine

The following physical examination measures may be useful in classifying a patient in the ICF impairment-based category of neck pain with spondylosis with radiculopathy or cervical disc disorder with radiculopathy

A
  • Upper limp tension test
  • Spurling’s test
  • Distraction test
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21
Q

Cervical Spine

Caused by compression of spinal cord from osteophytes or disc degeneration

A

Cervical Myelopathy

22
Q

Cervical Spine

once serious medical pathology (such as cervical fracture or myelopathy) has been ruled out, patients with neck pain are often classified as having either

A

a nerve root a nerve root compromise or a “mechanical neck disorder”

23
Q

Cervical Spine

Clinicians should consider {….} as predisposing risks factors for the development of chronic neck pain

A
  • age greater than 40
  • coexisting low back pain
  • loss of strength in the hands
  • poor quality of life
  • worrisome attitude
  • and less vitality
  • a long history of neck pain
  • bicycling as a regular activity
24
Q

Cervical Spine

Clinical prediction rule tests for cervical radiculopathy

A
  • + Spurling Test
  • + Distraction
  • + ULTTA (Median nerve)
  • Less than 60 degrees of rotation on involved side
25
Q

Cervical Spine

a defect/stress fracture in the pars interarticularis of the vertebral arch

A

spondylolysis

26
Q

Cervical Spine

For our evaluation process, we will focus on two categories of information:

A
  • Biomechanical/patho-anatomical (e.g., symmetry, movement patterns, etc.)
  • Patient response (e.g., pain provocation primarily)
27
Q

Cervical Spine

Babinski test procedure

A
  • Patient is sitting or standing
  • Examiner applies a stimulus to the plantar aspect of the foot with the blunt end of a reflex hammer from lateral to medial
  • +ve test is great toe extension
28
Q

Cervical Spine

divisions of the thoracic spine

A
  • Upper thoracic spine (T1-T3)
  • Middle thoracic spine (T4-T7)
  • Lower thoracic spine (T8-T12)
29
Q

Cervical Spine

Hoffman test procedure

A
  • Patient is sitting or standing
  • Examiner supports forearm and stabilizes the middle finger down to the DIP joint (stabilize prox. PIP joint with pincer grip) and cradles the hand (allow space for thumb to move)
  • Examiner flicks the patient’s fingernail at the DIP joint
  • +ve test is thumb adduction/opposition and slight flexion of the fingers
30
Q

Cervical Spine

ICF diagnosis of neck pain with mobility deficits is made with a reasonable level of certainty when the patient presents with the following clinical findings:

A
  • žYounger individuals <50
  • Acute neck pain (<12 weeks)
  • symptoms isolated to the neck
  • žRestricted cervical ROM
31
Q

Cervical Spine

Most often, the term spondylosis is used to describe

A

osteoarthritis of the spine, but it is also commonly used to describe any manner of spinal degeneration

32
Q

Cervical Spine

ICF diagnosis of neck pain with headaches is made with a reasonable level of certainty when the patient presents with the following clinical findings:

A
  • Unilateral HA associated with neck/suboccipital area symptoms that are aggravated by neck movements or positions
  • HA reproduced with neck movements
  • Restricted cervical ROM and segment mobility
33
Q

Cervical Spine

Order of interventions WITHIN a single session will be guided by:

A

Soft tissue mobilization → joint mobilization → stretching → neuromuscular retraining

34
Q

Cervical Spine

Common symptoms of cervical myelopathy include

A
  • Hyper-reflexia (below the level of compression)
  • Sensory changes non-dermatomal pattern
  • Clonus of the ankle (Sp 96%; +LR 4)
  • Babinski (Sp 92%) and Hoffman reflexes
  • Weakness below level of compression
  • Gait clumsiness
35
Q

Cervical Spine

Contraindications to Orthopaedic Manual Therapy​ interventions in cervical patients

A
  • Multi-level nerve root pathology
  • Worsening neurological function
  • Unremitting, severe, non-mechanical pain
  • Unremitting night pain (preventing patient from falling asleep)
  • Relevant recent trauma
  • Upper motor neuron lesions
    • e.g. Spinal cord damage
36
Q

Cervical Spine

what is the gold standard diagnostic test for cervical radiculopathy?

A

nerve conduction velocity

37
Q

Cervical Spine

Inverted supinator sign procedure

A
  • Patient is sitting
  • The examiner rests the patient’s forearm on his/her forearm in slight pronation
  • Examiner applies a stimulus with a reflex hammer just proximal to the styloid process of the radius
  • A +ve test is finger flexion or slight elbow extension
38
Q

Cervical Spine

The following physical examination measures may be useful in classifying a patient in the ICF impairment-based category of neck pain with mobility deficits

A
  • Cervical AROM
  • Cervical and thoracic segmental mobility
39
Q

Cervical Spine

If dizziness occurs when getting up from the bed and it lasts for seconds may be due to

A

BP issue (orthostatic)

40
Q

Cervical Spine

Red Flags in neck pain

A
  • Neoplastic conditions (night pain, unexplained weight loss)
  • Systemic disease (hypertension, fever)
  • Upper cervical ligamentous instability (AROM limitations, occipital headache)
  • Vertebral Basilar Insufficiency (drop attack, dysphasia, dysarthria, diplopia)
  • Cervical myelopathy (sensory and muscle wasting in hands, Hoffman’s reflex, hyperreflexia, bowel bladder disturbances)
41
Q

Cervical Spine

Inverted supinator sign is for

A

Cervical Myelopathy

UMN sign

42
Q

Cervical Spine

Five tests included in the Cervical Myelopathy Clinical Prediction Rule:

A
  • Hoffman test
  • age over 45
  • gait disturbances
  • Babinski
  • Inverted supinator sign
43
Q

TBC (Treatment Based Classification)

Unilateral neck pain
Neck motion limitations
+/- referred arm pain

Diagnosis and treatment

A

Neck pain with mobility deficits

  • Manipulation and/or mobilization cervical (A) and/or thoracic spine (C)
  • Coordination, strengthening/endurance (A), stretching exercises (C)
44
Q

TBC

Neck pain with radiating pain in involved UE
UE numbness, paresthesias, and/or weakness may be present

Diagnosis and Treatment:

A

NECK PAIN WITH RADIATING PAIN

  • Manual/mechanical traction (B)
  • Neural mobilization (B)
  • Thoracic spine manipulation (C)
  • Scapular exercises
45
Q

Cervical Spine

Associated with whiplash or longer symptom duration
Neck pain +/- UE symptoms

Diagnosis and Treatment:

A

NECK PAIN WITH MOVEMENT COORDINATION IMPAIRMENTS

  • Patient counseling (A)
  • Coordination, strengthening, stretching, and endurance exercises (A)
46
Q

TBC

Non continuous unilateral neck pain with headache
Headache affected by neck movements

Diagnosis and treatment:

A

NECK PAIN WITH HEADACHES

  • Manipulation and/or mobilization cervical spine (A)
  • Coordination, strengthening, stretching, and endurance exercises (A)
47
Q

Cervical Spine

Key examination techniques for neck pain with movement coordination impairments:

A
  • Cranio cervical flexion test (CCFT)
  • Deep neck flexor endurance test (DNF)
48
Q

Cervical Spine

Key examination techniques for neck pain with headaches:

A
  • Cervical AROM
  • Cranio cervical flexion test
  • Segmental examination AA/AO
49
Q

Cervical Spine

Key examination techniques for neck pain with mobility deficits:

A
  • Cervical AROM measurements
  • Cervical and thoracic segmental examination
50
Q

Cervical Spine

PAIVM (passive accessory intervertebral motion) consists in two parts:

A
  1. motion
  2. pain (high reliability)
51
Q

Cervical Spine

Mm energy techniques used when

A
  • Elastic end feel
  • acute pain
  • mm spam, tightness, shortness, PT guarding
  • (oculomotor stimulation , reciprocal inhibition)
52
Q

Cervical Spine

which type of headache is presents with bilateral symptoms

A

tension type

  • Migraines and cervicogenic are unilateral

Musculoskeletal III (5 decks)

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