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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
Q

Referred, non-radicular DDD/spondylosis/stenosis pain

A

Bilateral neck pain (one side may have more pain)

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26
Q

Referred, non-radicular C5-6 pain

A

Cap-like headache

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27
Q

C2 nerve root site of radicular UE pain

A

Side of head

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28
Q

C3 nerve root UE radicular site of pain

A

Anterior & lateral neck

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29
Q

C3-C4 disc level (C3 disc) scapula referred pain location

A

C7 spinous process & superior angle of scapula

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30
Q

C3-C4 (C3 disc) UE radicular pain location

A

Supraclavicular area- over trap

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31
Q

C4-C5 (C4 disc) scapula referred pain site

A

Scapular spine & superior angle

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32
Q

C4-C5 (C4 disc) UE radicular pain location

A

Lateral arm

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33
Q

C5-C6 (C5 disc) scapula referred pain location

A

Center of scapula border

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34
Q

C5-C6 (C5 disc) UE radicular pain location

A

Pad of thumb

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35
Q

C6-C7 (C6 disc) scapula referred pain site

A

Inferior angle of scapula

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36
Q

C6-C7 (C6 disc) UE radicular pain location

A

Middle finger

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37
Q

C7-T1 (T1 disc) scapula referred pain location

A

Inferior angle of scapula

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38
Q

C7-T1 (T1 disc) UE radicular pain site

A

Hypothenar eminence & fifth finger

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39
Q

DDD/DJD (Spondylosis) Profile

A

50+

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40
Q

DDD/DJD (Spondylosis) Location of Symptoms

A

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)

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41
Q

DDD/DJD (Spondylosis) Agg Factors

A

DDD: -Flexion Postures -Sustained flexion -Cough -Sneeze

DJD: (or disc if nerve root involvement) -Extension/SB/Rotation towards side with nerve root involvement

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42
Q

Progression of the “Spondys”

A

Spondylosis–degenerative arthritis Spondylolysis–Fracture Spondylolisthesis–slippage forward on vertebra below

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43
Q

DDD/DJD (Spondylosis) History

A

-Episodic, repeated annular tearing -Long history of neck pain -History of MVA possibly

44
Q

DDD/DJD (Spondylosis) Neurodynamic Testing: Neurological Exam:

A

-No -Negative

45
Q

DDD/DJD (Spondylosis) ROM

A

-DDD: Limited CS flexion, but not worse movement -DJD: (3D movements) CS extension, rotation, SB most limited and painful

46
Q

DDD/DJD (Spondylosis) Palpation

A

Stiff/pain (if acute episode)

DDD: Central PA>Unilateral PA

DJD: Unilateral PA>Central PA

47
Q

Muscle Length (All CS disorders)

A
  • Check sub-occipital, upper trap, levator scapulae, scalenes for tightness
  • Check strength of deep cervical flexors
48
Q

Physical Outcome Measures (All CS disorders)

A

-Neck Disability Index -Northwick Park Pain Questinonaire

49
Q

DDD/DJD (location of symptoms)

A

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
Q

Disc (IDD,EDD) (location of symptoms)

A

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
Q

Disc w/ nerve root involvement (location of symptoms)

A

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
Q

Nerve root irritation/ neurogenic claudication (location of symptoms)

A

Arm pain (dermatomal with patchy vs. complete segment vs. multi-segmental)

Acute: distal worse than proximal

Chronic: proximal worse than distal

DRG: paraesthesia

53
Q

Central Stenosis (location of symptoms)

A

Neck and Arm pain, bilateral, multi-segmental

54
Q

Facet vs. Uncovertebral Joint (location of symptoms)

A

Local unilateral pain Facet: +/- referred pain to lateral neck (C3-5), top of shoulder (C5-7) and posterior back (C6-7)

55
Q

Instability vs. Hypermobility (location of symptoms)

A

Instability: catching, giving way, locking, unilateral pain, head feels heavy, feel the need to hold head up. Hypermobility: +/- pain (central or unilateral)

56
Q

DDD/DJD (Agg Factors)

A

Flexion postures, sustained flexion postures (sitting, driving), cough, sneeze (Extension/ SB/ rotation towards with nerve root involvement)

57
Q

Disc (IDD, EDD) (Agg factors)

A

Flexion postures, sustained flexion postures (sitting, driving), cough, sneeze (Extension/ SB/ rotation towards with nerve root involvement)

58
Q

Disc w/ nerve root involvement (Agg factors)

A

Flexion postures, sustained flexion postures (sitting, driving), cough, sneeze (Extension/ SB/ rotation towards with nerve root involvement)

59
Q

Nerve root irritation/ neurogenic claudications (Agg factors)

A

extension postures

60
Q

Central Stenosis (Agg factors)

A

extension postures

61
Q

Facet vs. Uncovertebral Joint (Agg factors)

A

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
Q

Instability (Agg factors)

A

Depends on severity of injury/ symptoms prolonged/ sustained positions

63
Q

Disc w/ nerve root involvement (Ease factors)

A

Lying down, unloading

64
Q

Nerve root irritation/ neurogenic claudications (Ease Factors)

A

Flexing spine

65
Q

Central Stenosis (Ease factors)

A

flexing spine

66
Q

Facet vs. Uncovertebral Joint (Ease factors)

A

variable

67
Q

DDD/DJD (history)

A

Episodic; repeated annular tearing Long history of neck pain. May have history of MVA.

68
Q

Disc (IDD, EDD) (history)

A

Gradual vs. sudden onset

69
Q

Disc w/ nerve root involvement (history)

A

history of back pain

70
Q

Central Stenosis (history)

A

gradual

71
Q

Facet vs. Uncovertebral Joint (history)

A

Gradual or sudden unguarded movement

72
Q

Instability (history)

A

Gradual or episodic (history of major trauma, surgery, systemic disease or degenerative changes to motion segment)

73
Q

DDD/DJD (Neurodynamic Testing)

A

NO

74
Q

Disc (IDD, EDD) (Neurodynamic Testing)

A

IDD: no EDD: yes

75
Q

Disc w/ nerve root involvement (Neurodynamic Testing)

A

yes, ULNT 1

76
Q

Nerve root irritation/ stenosis/ neurogenic claudications (Neurodynamic testing)

A

yes ULNT 1

77
Q

Central Stenosis (Neurodynamic Testing)

A

yes, ULNT 1

78
Q

Facet vs. Uncovertebral Joint (neurodynamic testing)

A

No

79
Q

Instability (neurodynamic testing)

A

No

80
Q

DDD/DJD (Neuro Exam)

A

neg

81
Q

Disc (IDD, EDD) (Neuro Exam)

A

neg

82
Q

Disc w/ nerve root involvement (neuro exam)

A

no, possibly, yes

83
Q

Nerve root irritation/ stenosis/ neurogenic claudications (Neuro Exam)

A

Dorsal and Ventral: diminished reflexes

Dorsal: sensation

Ventral: Motor loss

84
Q

Central Stenosis (Neuro Exam)

A

Dorsal and Ventral: diminished reflexes

Dorsal: sensation

Ventral: Motor loss

85
Q

Facet vs. Uncovertebral Joint (Neuro exam)

A

neg

86
Q

Instability (neuro exam)

A

neg

87
Q

DDD/DJD (ROM)

A

Limited CS Flexion but not worse movement CSE, Rot and SB most limited and painful

88
Q

Disc (IDD, EDD) (ROM)

A

Flexion

89
Q

Disc w/ nerve root involvement (ROM)

A

Flexion, Extension, SB

90
Q

Nerve root irritation/ stenosis/ neurogenic claudications (ROM)

A

Extension limited and painful/ SB/ Quadrant

91
Q

Central Stenosis (ROM)

A

Extension limited and painful/ SB

92
Q

Facet vs. Uncovertebral Joint (ROM)

A

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
Q

Instability (ROM)

A

Depends on stage of disorder. May have extreme limitations in movement or may have excessive movement with ROM, provocation and mobility testing.

94
Q

Instability (special tests)

A

Instability of UCS: + alar and/or transverse ligament

95
Q

DDD/DJD (palpation)

A

Central PA > unilateral PA stiff/ pain if in acute episode

96
Q

Disc (IDD,EDD) (palpation)

A

Central PA > unilateral PA stiff and pain

97
Q

Disc w/ nerve root involvement (palapation)

A

Central PA and unilateral PA stiff and pain

98
Q

Nerve root irritation/ stenosis/ neurogenic claudications (palpation)

A

Unilateral PA may be stiff/ painful

99
Q

Central Stenosis (palpation)

A

Central PA, unilateral PA stiff/ painful

100
Q

Facet (palpation)

A

Unilateral PA stiff/ painful

101
Q

Instability (palpation)

A

Pain/ spasm with central PA pressure/ Stiffness to adjacent segments

102
Q
A

C5/C6 Disc Referral

Cap-Like Headache

103
Q

CS

A

Cervical Discogenic (DDD/IDD)

104
Q

CS

A

CS Disc Referall–Cloward Sign

C3/4

C4/5

C5/6

C6/7

C7/T1

105
Q

CS

A

CS Facet Referral

(handprint pain)

Green: C2/3

Purple: C3/4

Blue: C4/5

Red: C5/6

Yellow: C6/7

106
Q

CS

A

DDD/DJD

107
Q

CS

A

Disc with Nerve Root involvement

(Cloward sign by scapula)

MSK 2 (16 decks)

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