Cervical Spine

Question 1

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?​

Answer 1

Reference Card

Question 2

What red flags do we have to identify for the C-Spine?

Re: post-trauma?

Answer 2

Upper Cervical Instability

Fracture

*and bone density/Osteoporosis

Question 3

What red flags do we have to identify for the C-spine?

Re: Myelopathic symptoms?

Answer 3

5Ds
1A
3Ns

Question 4

What are the 5Ds, 1A, and 3Ns?

Answer 4

Dizziness, Drop Attacks, Diplopia, Dysarthria, Dysphatia

Ataxia

Nausea, Numbness, Nystagmus

Question 5

What other red flags do we always need to screen for with C-Spine?

Answer 5

Bone density, Significant osteoporosis *important in conjunction w/ trauma

Prior history of Cx!

Question 6

What is the purpose of the physical exam?

Answer 6

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

Question 7

Where should you start with your cerv. physical exam? and where should you end?

and WHY?

Answer 7

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.

Question 8

if you were going to do: a neuro assessment, palpation, strength testing, STTT, and a postural assessment…. in what order should you do them?

Answer 8

postural assessment
neuro assessment
palpation
strength testing
STTT

Question 9

Are myotomes manual muscle tests?

Answer 9

NO because…. myotomes determine neurological involvement, while MMT determines soft tissue involvement weather it be atrophy, tears, etcetera.

Question 10

If we assess ROM…. what would this consist of?

Answer 10

AROM, PROM, AAROM w/ OP, Repeated movements.

Question 11

What is the McKenzie Concept with regards to cervical assessments?

Answer 11

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.

Question 12

When is the McKenzie method good to use?

Answer 12

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

Question 13

When is the McKenzie method less likely to be useful?

Answer 13

if the patient experiences pain in any position, and there isn’t a relieving position that they/you can find.

Question 14

How could you progress from simply repeated motions to a more complex movement to help a patient?

Answer 14

Retraction 
->
Retraction w/ Over-pressure
->
retraction mobilization

Question 15

How many repetitions do you need to use for Mckenzie?

Answer 15

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!

Question 16

What is the benefit of using palpation in the Cervical Spine exam?

Answer 16

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.

Question 17

how do you go about testing the deep cervical flexors

Answer 17

you can do a craniocervical flexion test with pressure cuff, and they have to hold the position for longer than 10 seconds.

Question 18

when you are testing strength do you think it’s important to assess flexibility of muscles?

Answer 18

yes. because it could directly influence outcomes of certain tests such as the the deep cervical flexor craniocervical flexion test with the pressure cuff.

Question 19

what is the difference between an accessory motion testing, and physiological potion testing?

Answer 19

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.

Question 20

what is sharp purser test?

Answer 20

tests stability of the A-A segment
and transverse ligament involvement

“The clunk test”

Question 21

what are some of the alar ligament tests?

Answer 21

supine and “kick test”

Question 22

what is the tectorial membrane ligament test?

Answer 22

FIND OUT FROM LAB!!!

Question 23

what are comparable signs?

Answer 23

“Am I causing your symptoms?”

“Does this replicate your symptoms”

Question 24

With the Neck CPG….. if you have neck pain with mobility deficits what will the patient symptoms be and how could you intervene?

Answer 24

symptoms: uni neck pain, motion limitations, potential referred arm pain
interventions: manip/mobs on C+/T spine, coordination strength, endurance and stretching

Question 25

with the Neck CPG… if you have neck pain w/ radiating pain…. what might the patient present with and how could you intervene?

Answer 25

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`

Question 26

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?

Answer 26

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

Question 27

with the neck CPG.. if your patient has neck pain with headache category what would they present with and what interventions would you do?

Answer 27

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.