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MM III > Cervical spine > Flashcards

Cervical spine Flashcards

1
Q

What jobs does the c-spine do?

A
  1. Position of head for vision and balance
  2. Needed for rapid motion
  3. Protects “vital tubes”
  4. Use of sensory organs
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2
Q

Which bones are in the upper cervical spine? Lower?

A

Upper: occiput, atlas, axis
Lower: C3-7

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3
Q

What is the annual incidence of c-spine pain?

A

10-20%

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4
Q

T/F: Chronic neck pain is the 2nd most common cause of disability

A

F: Chronic neck pain is the 4th most common cause of disability, 21st in burden of disability

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5
Q

T/F: Cervical pain is more common in women than men

A

True

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6
Q

T/F: Cervical pain peaks at age 70y +

A

F: Peak at 35-49y

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7
Q

List some risk factors for neck pain

A

Cycling, smoking, hx of neck pain, depression, job strain, low social support, heavy labor workers, desk workers, sedentary work, repetitive work, work with neck flexed, work with arms above shoulder height

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8
Q

T/F: Most cases of neck pain have a specific pathoanatomic cause

A

False

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9
Q

List non-MSK causes of neck pain

A

infection, tumor, cardiac, endocrine, GI, neuro, pulmonary, systemic disease

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10
Q

What would you ask when taking a c-spine pain history?

A

Demographics, employment/ work, current condition, medical care, functional status, social history, medical hx, family hx, onset, trauma?

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11
Q

C-Spine exam

A

Neuro sx, b/b, weight loss/ night pain/ fever, dizziness/ fainting, HA, TMJ, facial pain, pulmonary sx, effect of cough/ sneeze on pain, cardiac sx, sleeping, posture, litigation

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12
Q

List the score categories for the NDI

A 
0-4 No disability
5-14 Mild
15-24 Mod
25-34 Severe
35+ Complete
*Multiply score by 2 to get %*
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13
Q

How is the NDI performed?

A

Self-reported questionnaire

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14
Q

What is the FABQ and how is it scored?

A

It is a self-reported questionnaire that measures fear avoidance beliefs for PA (5 items) and work (11 items). Ea item is scored from 0-6. Higher score means higher fear.

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15
Q

What are the signs of radiculopathy due to neurological impingement?

A

Nerve root impingement: sensory/ motor changes

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16
Q

What are the signs of myelopathy due to neurological impingement?

A

Spinal cord impingement: UMN signs/ sx (weakness, spasticity, + Babinski, increased DTRs, clumsy, abnormal gait)

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17
Q

Which nerve rootsinnervate the phrenic nerve to the diaphragm?

A

C3-4-5

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18
Q

Neck sx of tracheobronchial conditions?

A

inflammation, infection, tumor

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19
Q

Sx that may be referred to neck:

A

Pain, dyspnea (labored breathing), dysphasia (difficulty swallowing), persistent cough, fever/ chills, hemoptysis

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20
Q

What are sx of cervical tumors?

A

Neck pain, sore throat, dysphagia, growing mass, UMN signs (if spinal cord involvement)

21
Q

What is a pancoasts tumor and what are the sx?

A

Lung cancer in upper lobe that invades brachial plexus; extra pulmonary sx: shoulder pain, cough, chest pain

22
Q

List two types of infection in the c-spine

A

Osteomyelitis (neck pain, stiffness, fever; discitis (neck pain, stiffness, fever, disc space narrowing, myelo- or radicular signs in later stages

23
Q

What are 3 CV conditions that can refer to the neck?

A

Acute myocardial infarction, acute coronary insufficiency, carotodynia

24
Q

1 GI condition that can refer to neck and its sx:

A

Esophageal conditions (infection, tumor, varices); dysphagia, ant neck pain

25
Q

What % of its with neck pain develop chronic sx?

A

44%

26
Q

What are + associations with PT use for neck pain?

A

Older age, female, lower education, workers comp, being in litigation

27
Q

What % of PT cases are neck cases?

A

~27%

28
Q

What are the guideline recommendations for neck pain?

A

NDI, cervical mob/ mania with exercise, thoracic coord, strengthening, endurance, neural mobs, traction, education

29
Q

What are the 5 categories for neck pain?

A 
Mobility
Centralization
Exercise & Conditioning
Headaches
Pain Control
30
Q

How does mobility present?

A

Recent onset of sx

No radicular sx

31
Q

How does centralization present?

A

Radicular sx

Sx distal to elbow

32
Q

How does exercise & condition present?

A

No radicular sx

Chronic sx

33
Q

How does headaches present?

A

Primary c/o HA

Cervicogenic HA

34
Q

How does pain control present?

A

Acute onset of sx

Trauma

35
Q

What is the tx for mobility?

A

MT + exercise

36
Q

What is the tx for centralization?

A

Activities to promote centralization

37
Q

What is the tx for exercise and conditioning?

A

Conditioning/ strengthening exercises

38
Q

What is the tx for HA?

A

MT, neck flexor/ scap strengthening

39
Q

What is the tx for pain control?

A

Gentle ROM and activity

40
Q

What is the name of the screening for red flags developed by George et al, JOSPT 2015?

A

Optimal Screening for Prediction of referral Outcome (OSPRO). 23 item screening tool identified 100% of positive responders

41
Q

Why is avoidance response such big deal in c-spine pain?

A

Psychosocial factors predictive of prolonged disability at 12 months

42
Q

What are the 5 categories of cervical intervention?

A 
Thoracic mania
Cervical manual
ICTraction
DNF/ CCF
Exercise
43
Q

What is the job of the canadian c-spine rules?

A

decision rule for detection of any fracture, dislocation, or ligamentous instability demonstrated by diagnostic imaging. High sensitivity (You can trust a negative)

44
Q

What are the 2 cervical ligaments you need to clear?

A

Alar, transverse

45
Q

What are 3 causes of AA instability?

A

ligamentous/ bony/ muscular support. (Can be due to congenital bony malformation, down’s, inflammation, trauma, chronic corticosteroid use)

46
Q

What are s/s of upper cervical instability?

A

Suboccipital pain, B UE/ LE paresthesias, clumsiness, loss of balance, nystagmus, HA, blurred vision, UMN signs (hyperreflexia, spasticity, abnormal gait, clumsy, + Babinski)

47
Q

What % of pts with RA have cervical involvement?

A

50%

48
Q

What are the 5 factors for cervical myelopathy?

A
  1. Age >45 y
    • Hoffmann
    • Inverted Supinator
    • Babinski
    • Gait abnormality
49
Q

3 upper cervical ligament tests in pt with dens fx presenting with HA

A
  1. Sharp Purser
  2. Alar ligament
  3. Transverse ligament aka anterior shear test

MM III (2 decks)

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