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MSK 2 > Cervical Spine Classification/Diagnoses > Flashcards

Cervical Spine Classification/Diagnoses Flashcards

1
Q

disc degenerative process in 1st & 2nd decade

A

-lateral tears of AF & enlarge towards the medial aspect of the disc (IDD)

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2
Q

What can result in a degenerating disc if there are tears from both sides?

A

-can result in complete transverse splitting of the disc (2nd & 3rd decades) = EDD

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3
Q

What can the CS disc degenerative process result in?

A

-segmental instability

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4
Q

How does/can splitting of the AF during the disc degeneration process lead to nerve root compression?

A

-splitting of the AF can allow the NP to move toward the spinal canal, ultimately causing disc protrusion or extrusion resulting in nerve root compression

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5
Q

CS HNP/Prolapse profile

A

-uncommon in younger people -most common in 45-55 y/o due to degeneration

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6
Q

Which cervical spine segment is HNP/Prolapse uncommon in?

A

C2-3

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7
Q

After what years of life is HNP/acute extrusion not expected in the CS?

A

-past 40-50 years old

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8
Q

Mechanism of injury for cervical spine HNP

A

-strain or tear of anterior AF (extension activities) or strain of PLL due to bulging disc (flexion activities)

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9
Q

Most common level of nerve root involvement

A

C7 & C6

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10
Q

If nerve root compression is anterior which structures are likely causing the compression?

A

Likely caused by protruding disc & osteophytes of the uncovertebral region

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11
Q

If nerve root compression is posterior what are the likely structures causing the compression?

A

Likely caused by superior articular process & ligamentum flavum

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12
Q

Is the upper, middle, or lower CS more predisposed to osteophyte compression?

A

Mid-cervical spine

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13
Q

Why is the mid-cervical spine more predisposed to osteophyte compression?

A
  1. Higher unicate process 2. Smaller A-P diameter of intervertebral foramina 3. Longer course of nerve roots in close proximity to the UVJ at C4-6 levels 4. Greatest segmental mobility at C5-6
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14
Q

Acute torticollis definition

A

Injury to ligaments, joints & muscles from sustained sleeping position

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15
Q

Acute torticollis profile

A

Young & middle-aged adults

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16
Q

Acute torticollis mechanism of injury

A

Awake with symptoms

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17
Q

Acute torticollis OE exam findings

A

Extreme pain & loss of ROM

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18
Q

Musculoskeletal local, unilateral pain

A

ZAJ/facet, UVJ

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19
Q

Musculoskeletal pain at the site of origin: catching, head feels heavy

A

Instability

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20
Q

Musculoskeletal pain local at the site of origin that’s not facet, UVJ, or instability?

A

Sprains/strains

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21
Q

Referred, non-radicular IDD pain

A

Unilateral pain

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22
Q

Referred, non-radicular protrusion pain

A

Bilateral pain/arm pain in partial or complete dermatomal line

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23
Q

Referred, non-radicular prolapse pain

A

Arm pain > back pain; dermatomal pattern

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24
Q

Referred, non-radicular extrusion pain

A

Arm pain > back pain; poly-segmental

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25
Referred, non-radicular DDD/spondylosis/stenosis pain
Bilateral neck pain (one side may have more pain)
26
Referred, non-radicular C5-6 pain
Cap-like headache
27
C2 nerve root site of radicular UE pain
Side of head
28
C3 nerve root UE radicular site of pain
Anterior & lateral neck
29
C3-C4 disc level (C3 disc) scapula referred pain location
C7 spinous process & superior angle of scapula
30
C3-C4 (C3 disc) UE radicular pain location
Supraclavicular area- over trap
31
C4-C5 (C4 disc) scapula referred pain site
Scapular spine & superior angle
32
C4-C5 (C4 disc) UE radicular pain location
Lateral arm
33
C5-C6 (C5 disc) scapula referred pain location
Center of scapula border
34
C5-C6 (C5 disc) UE radicular pain location
Pad of thumb
35
C6-C7 (C6 disc) scapula referred pain site
Inferior angle of scapula
36
C6-C7 (C6 disc) UE radicular pain location
Middle finger
37
C7-T1 (T1 disc) scapula referred pain location
Inferior angle of scapula
38
C7-T1 (T1 disc) UE radicular pain site
Hypothenar eminence & fifth finger
39
DDD/DJD (Spondylosis) Profile
50+
40
DDD/DJD (Spondylosis) Location of Symptoms
DDD: Bilateral Sx (can be one side greater than other) +/- Cloward Sign (referred pain to medial border of scapula) Facet: +/- referred pain to lateral neck (C3-C5), top of shoulder (C5-C7) and Posterior back (C6-C7)
41
DDD/DJD (Spondylosis) Agg Factors
DDD: -Flexion Postures -Sustained flexion -Cough -Sneeze DJD: (or disc if nerve root involvement) -Extension/SB/Rotation towards side with nerve root involvement
42
Progression of the "Spondys"
Spondylosis--degenerative arthritis Spondylolysis--Fracture Spondylolisthesis--slippage forward on vertebra below
43
DDD/DJD (Spondylosis) History
-Episodic, repeated annular tearing -Long history of neck pain -History of MVA possibly
44
DDD/DJD (Spondylosis) Neurodynamic Testing: Neurological Exam:
-No -Negative
45
DDD/DJD (Spondylosis) ROM
-DDD: Limited CS flexion, but not worse movement -DJD: (3D movements) CS extension, rotation, SB most limited and painful
46
DDD/DJD (Spondylosis) Palpation
Stiff/pain (if acute episode) DDD: Central PA\>Unilateral PA DJD: Unilateral PA\>Central PA
47
Muscle Length (All CS disorders)
- Check sub-occipital, upper trap, levator scapulae, scalenes for tightness - Check strength of deep cervical flexors
48
Physical Outcome Measures (All CS disorders)
-Neck Disability Index -Northwick Park Pain Questinonaire
49
DDD/DJD (location of symptoms)
DDD: Bilateral symptoms (one side can be greater); +/- referred pain to medial border of scapula Facet: +/- referred pain to lateral neck (C3-5), top of shoulder (C5-7) and posterior back (C6-7)
50
Disc (IDD,EDD) (location of symptoms)
Local unilateral pain, spreads with progression; referral to medial border of scapula Referred pain to head from C3-7 discs: Mastoid, TMJ Parietal (C3-C5); temple, jaw (C3-4); Occiput, CVJ (C3-6)
51
Disc w/ nerve root involvement (location of symptoms)
Local unilateral pain and arm pain (dermatomal with patchy vs. complete segment vs. multi-segmental) +/- referred pain to medial boarder of scapula (cloward signs)
52
Nerve root irritation/ neurogenic claudication (location of symptoms)
Arm pain (dermatomal with patchy vs. complete segment vs. multi-segmental) Acute: distal worse than proximal Chronic: proximal worse than distal DRG: paraesthesia
53
Central Stenosis (location of symptoms)
Neck and Arm pain, bilateral, multi-segmental
54
Facet vs. Uncovertebral Joint (location of symptoms)
Local unilateral pain Facet: +/- referred pain to lateral neck (C3-5), top of shoulder (C5-7) and posterior back (C6-7)
55
Instability vs. Hypermobility (location of symptoms)
Instability: catching, giving way, locking, unilateral pain, head feels heavy, feel the need to hold head up. Hypermobility: +/- pain (central or unilateral)
56
DDD/DJD (Agg Factors)
Flexion postures, sustained flexion postures (sitting, driving), cough, sneeze (Extension/ SB/ rotation towards with nerve root involvement)
57
Disc (IDD, EDD) (Agg factors)
Flexion postures, sustained flexion postures (sitting, driving), cough, sneeze (Extension/ SB/ rotation towards with nerve root involvement)
58
Disc w/ nerve root involvement (Agg factors)
Flexion postures, sustained flexion postures (sitting, driving), cough, sneeze (Extension/ SB/ rotation towards with nerve root involvement)
59
Nerve root irritation/ neurogenic claudications (Agg factors)
extension postures
60
Central Stenosis (Agg factors)
extension postures
61
Facet vs. Uncovertebral Joint (Agg factors)
More pain with combined movements (3D—facet; 2D—UVJ) more pain with standing vs. sitting end-range extension (compress cartilage)/ flexion (stretch capsule) Examples: cradle phone—UVJ; turning head to look over shoulder—facet
62
Instability (Agg factors)
Depends on severity of injury/ symptoms prolonged/ sustained positions
63
Disc w/ nerve root involvement (Ease factors)
Lying down, unloading
64
Nerve root irritation/ neurogenic claudications (Ease Factors)
Flexing spine
65
Central Stenosis (Ease factors)
flexing spine
66
Facet vs. Uncovertebral Joint (Ease factors)
variable
67
DDD/DJD (history)
Episodic; repeated annular tearing Long history of neck pain. May have history of MVA.
68
Disc (IDD, EDD) (history)
Gradual vs. sudden onset
69
Disc w/ nerve root involvement (history)
history of back pain
70
Central Stenosis (history)
gradual
71
Facet vs. Uncovertebral Joint (history)
Gradual or sudden unguarded movement
72
Instability (history)
Gradual or episodic (history of major trauma, surgery, systemic disease or degenerative changes to motion segment)
73
DDD/DJD (Neurodynamic Testing)
NO
74
Disc (IDD, EDD) (Neurodynamic Testing)
IDD: no EDD: yes
75
Disc w/ nerve root involvement (Neurodynamic Testing)
yes, ULNT 1
76
Nerve root irritation/ stenosis/ neurogenic claudications (Neurodynamic testing)
yes ULNT 1
77
Central Stenosis (Neurodynamic Testing)
yes, ULNT 1
78
Facet vs. Uncovertebral Joint (neurodynamic testing)
No
79
Instability (neurodynamic testing)
No
80
DDD/DJD (Neuro Exam)
neg
81
Disc (IDD, EDD) (Neuro Exam)
neg
82
Disc w/ nerve root involvement (neuro exam)
no, possibly, yes
83
Nerve root irritation/ stenosis/ neurogenic claudications (Neuro Exam)
Dorsal and Ventral: diminished reflexes Dorsal: sensation Ventral: Motor loss
84
Central Stenosis (Neuro Exam)
Dorsal and Ventral: diminished reflexes Dorsal: sensation Ventral: Motor loss
85
Facet vs. Uncovertebral Joint (Neuro exam)
neg
86
Instability (neuro exam)
neg
87
DDD/DJD (ROM)
Limited CS Flexion but not worse movement CSE, Rot and SB most limited and painful
88
Disc (IDD, EDD) (ROM)
Flexion
89
Disc w/ nerve root involvement (ROM)
Flexion, Extension, SB
90
Nerve root irritation/ stenosis/ neurogenic claudications (ROM)
Extension limited and painful/ SB/ Quadrant
91
Central Stenosis (ROM)
Extension limited and painful/ SB
92
Facet vs. Uncovertebral Joint (ROM)
Facet: Rot toward side of pain+ SB toward side of pain + (Ext) OR Rot away from side of pain + SB away from side of pain + (Flexion) Facet: Rotation with ipsi SB (capsular) vs contra SB (articular) UVJ: Sidebend with ipsi rot (capsular) vs contra rot (articluar) With SB, may see hinge-like motion with pivot point on contralateral side with aging (instead of normal gliding movement provided by the UVJ)
93
Instability (ROM)
Depends on stage of disorder. May have extreme limitations in movement or may have excessive movement with ROM, provocation and mobility testing.
94
Instability (special tests)
Instability of UCS: + alar and/or transverse ligament
95
DDD/DJD (palpation)
Central PA \> unilateral PA stiff/ pain if in acute episode
96
Disc (IDD,EDD) (palpation)
Central PA \> unilateral PA stiff and pain
97
Disc w/ nerve root involvement (palapation)
Central PA and unilateral PA stiff and pain
98
Nerve root irritation/ stenosis/ neurogenic claudications (palpation)
Unilateral PA may be stiff/ painful
99
Central Stenosis (palpation)
Central PA, unilateral PA stiff/ painful
100
Facet (palpation)
Unilateral PA stiff/ painful
101
Instability (palpation)
Pain/ spasm with central PA pressure/ Stiffness to adjacent segments
102
C5/C6 Disc Referral Cap-Like Headache
103
CS
Cervical Discogenic (DDD/IDD)
104
CS
CS Disc Referall--Cloward Sign C3/4 C4/5 C5/6 C6/7 C7/T1
105
CS
CS Facet Referral (handprint pain) Green: C2/3 Purple: C3/4 Blue: C4/5 Red: C5/6 Yellow: C6/7
106
CS
DDD/DJD
107
CS
Disc with Nerve Root involvement (Cloward sign by scapula)

MSK 2 (16 decks)

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