Cervical Spine Flashcards
Objectives:
What are the basic components of the Cervical Physical Examination?
What are the clinical presentations for common orthopedic cervical spine pathologies?
What Tests and Measures might be used to assess these common orthopedic cervical spine pathologies?
What is the relationship between Soft Tissue Tension Testing and treatment specificity?
What are general management strategies for cervical spine pain and associated pathologies?
Reference Card
What red flags do we have to identify for the C-Spine?
Re: post-trauma?
Upper Cervical Instability
Fracture
*and bone density/Osteoporosis
What red flags do we have to identify for the C-spine?
Re: Myelopathic symptoms?
5Ds
1A
3Ns
What are the 5Ds, 1A, and 3Ns?
Dizziness, Drop Attacks, Diplopia, Dysarthria, Dysphatia
Ataxia
Nausea, Numbness, Nystagmus
What other red flags do we always need to screen for with C-Spine?
Bone density, Significant osteoporosis *important in conjunction w/ trauma
Prior history of Cx!
What is the purpose of the physical exam?
The goal is NOT to determine if the patient is appropriate for skilled PT, but moreso that it helps us construct our diagnostic impression and insures patients safety.
- that being said, it CAN reveal a cause for concern to lead to PT not being appropriate, but thats not the goal of it
Where should you start with your cerv. physical exam? and where should you end?
and WHY?
start with things that are least aggravating and then move to the things that are more aggravating.
Do this to be able to get the most out of your exam, and ascertain the most amount of information you can from the patient before they reach their limit.
if you were going to do: a neuro assessment, palpation, strength testing, STTT, and a postural assessment…. in what order should you do them?
postural assessment neuro assessment palpation strength testing STTT
Are myotomes manual muscle tests?
NO because…. myotomes determine neurological involvement, while MMT determines soft tissue involvement weather it be atrophy, tears, etcetera.
If we assess ROM…. what would this consist of?
AROM, PROM, AAROM w/ OP, Repeated movements.
What is the McKenzie Concept with regards to cervical assessments?
Repeated movements with an appropriate loading response should lead to -> decreased pain, increased ROM or centralization of symptoms.
Repeated movements with an INAPPROPRIATE loading response will lead to… increased pain or peripheralization… so then… if flexion increases symptoms, try extension. and similarly if the LOADING causes the symptoms… try unloading the symptoms.
When is the McKenzie method good to use?
when a patient feels better in one position over another.
“Ya know… when i lean forward, my back feels better!”
you start by going towards the patients bias… to then hopefully get them more comfortable in their avoidance
When is the McKenzie method less likely to be useful?
if the patient experiences pain in any position, and there isn’t a relieving position that they/you can find.
How could you progress from simply repeated motions to a more complex movement to help a patient?
Retraction -> Retraction w/ Over-pressure -> retraction mobilization
How many repetitions do you need to use for Mckenzie?
15-20 reps minimum. and once their symptoms have been abolished or improved, then you don’t need to retest….. also, you can use this for both assessment and treatments!
What is the benefit of using palpation in the Cervical Spine exam?
with soft tissue, tenderness may indicate involvement of a structure or a reactive spasm.
with tenderness on bony structures it may indicate possible fracture at the spinous process or transverse process
tenderness at the facet may indicate arthropathy.
how do you go about testing the deep cervical flexors
you can do a craniocervical flexion test with pressure cuff, and they have to hold the position for longer than 10 seconds.
when you are testing strength do you think it’s important to assess flexibility of muscles?
yes. because it could directly influence outcomes of certain tests such as the the deep cervical flexor craniocervical flexion test with the pressure cuff.
what is the difference between an accessory motion testing, and physiological potion testing?
with accessory motion testing, you are going one joint at a time whereas with physiological motion testing you go hands on and you are assessing all at once… i.e. testing c5/6 vs the entire cervical spine.
what is sharp purser test?
tests stability of the A-A segment
and transverse ligament involvement
“The clunk test”
what are some of the alar ligament tests?
supine and “kick test”
what is the tectorial membrane ligament test?
FIND OUT FROM LAB!!!
what are comparable signs?
“Am I causing your symptoms?”
“Does this replicate your symptoms”
With the Neck CPG….. if you have neck pain with mobility deficits what will the patient symptoms be and how could you intervene?
symptoms: uni neck pain, motion limitations, potential referred arm pain
interventions: manip/mobs on C+/T spine, coordination strength, endurance and stretching
with the Neck CPG… if you have neck pain w/ radiating pain…. what might the patient present with and how could you intervene?
symptoms: neck pain w radiating to involved UE, UE numbness, paresthesias and weakness may be present
interventions: mech/manual traction, thoracic manip, UE neural mobs`
with the Neck CPG… if your patient is in the category of neck pain with movement coordination impairments, what symptoms may they have and what interventions are beneficial?
symptoms: neck pain with or without referred UE pain, and they may have had whiplash and a longer duration of symptomatology.
interventions: coordination, strengthening, endurance, stretching exercises, and patient counseling
with the neck CPG.. if your patient has neck pain with headache category what would they present with and what interventions would you do?
presentation: noncontinuous unilateral neck pain with headaches. headaches affected by neck movement or sustained positioning.
interventions: manipulation/mob of cervical spine, coordination strenghtening endurance and stretching exercises.
