Cervical Spine complaint Flashcards
Common traumatic cervical spine injuries?
Myofascial and SCIWORA
SCIWORA
spinal cord injury with out radiographic abnormality
Describe a SCIWORA
Normal CT of cervical spine but presence of neurological symptoms
What must you do with a SCIWORA case?
KEEP IN NECK BRACE/IMMOBILIZED until MRI or consult with neurosurgeon
Common atraumatic cervical spine injuries?
Musculoskeletal = most common
Neurologic = radiculopathy and myelopathy
Referred pain = thoracic outlet
Most common cause of acute/chronic neck pain in adults???????
CERVICAL SPONDYLOSIS
How does cervical spondylosis look on an x-ray
Degenerating disks and presence of osteophytes
Any deficit relating to the spinal cord; distal extremity weakness and clumsiness
Myelopathy
Any deficit relating to the nerve roots; burning, sharp pain down arm
Radiculopathy
Most common level of cervical radiculopathy?
C5-C6
How do you diagnose meningitis?
Lumbar puncture
Signs of meningitis?
Fever, malaise, rash, stiff neck, headache
What is thoracic outlet syndrome?
Space between first rib and clavicle is compressing the neurovascular bundles there
Signs of thoracic outlet syndrome?
Arm pain, numbness, weakness, gets worse when elevating hands and arms above head and HAND MUSCLE WASTING
Most patients with atraumatic neck pain and no red flag symptoms do NOT need?
Imaging
What should you not check on a patient with a traumatic cervical injury until cleared radiographically or by a neurosurgeon?
Neck ROM!
Special tests for cervical radiculopathy?
Neck compression, neck distraction and spurlings tests
Neck compression test
pt is seated and apply a downward force on top of their head while in neutral
(+) = pain, paresthesia, numbness down arm
Neck distraction test
One hand under chin, one on occiput and pull up
(+) = ALLEVIATION of symptoms
What are the 3 stages to Spurling’s test?
Compression
Compression and extension
Compression, extension and side bending towards affected side
When should you stop doing the stages of the spurling’s test?
If there is reproduction of symptoms:
(+) = pain, paresthesia, numbness down arm
Special tests for thoracic outlet syndrome?
ROOS, Adson’s, Costoclavicular/military/halstead, Wright’s hyperabduction test
ROOS test
Have patient Abduct and ER shoulders to 90, flex elbows to 90, then alternately open and close fists slowly for 3 minutes
(+) = pain, paresthesia, weakness, cyanosis down arm, swelling
Adson’s test (away)
Patient is seated and stand behind them Arm is extended, slight abduction and ER Find radial pulse to monitor Have patient extend head and look away from affected side Inhale and hold breath
Where is Adson’s test (away) testing for compression of the neurovascular bundle?
Between the scalenes
Adson’s test (toward)
Patient is seated and stand behind them Arm is extended, slight abduction and ER Find radial pulse to monitor Have patient extend head and look toward affected side Inhale and hold breath
Where is Adson’s test (toward) testing for compression of neurovascular bundle?
Between rib and clavicle
Positive test for Adson’s?
Loss/change in radial pulse or reproduction of symptoms (pain, paresthesia, numbness)
Costoclavicular/military/halstead test
Patient is seated and stand behind them
Extend their arm and shoulder towards you
Find radial pulse to monitor
Compress down on their shoulder
(+) = change in radial pulse or reproduction of symptoms
Where is the costoclavicular/military/halstead test testing for compression of the neurovascular bundle?
Between rib and clavicle
Wright’s Hyperabduction test
ABduct patient’s arm ABOVE head with some extension and monitor radial pulse
(+) = change in radial pulse or reproduction of symptoms
Where is Wright’s Hyperabduction test testing for compression of the neurovascular bundle?
Pectoralis muscle
What can be seen on a C spine lateral x-ray?
Hangman’s fracture
What is injured with a hangman’s fracture?
Hyperextension causes a fracture of vertebral arch of C2, ligaments and spondylolysthesis of C2
What can be seen on an open mouth x-ray?
Dens, C1 and C2 facets = jefferson fracture of C1 visualized
What can be seen on an anterior AP view x-ray?
Facet dislocation or widening of a spinous process of the cervical spine
What can be seen on a 45 degree oblique x-ray of the cervical spine?
Osteophyte encroachment - spondylosis
What 2 joints have different biomechanics in the cervical spine?
OA and AA
OA
Occiput - Atlas (C1)
AA
Atlas (C1) - Axis (C2)
What movements can be expected for C2-C7?
Rotation and sidebending in the SAME direction
What movements can be expected for OA?
Rotation and sidebending in OPPOSITE directions
What movement can be expected for AA?
JUST ROTATION
Major motions of the OA joint?
Flexion and extension
What is thought to cause C2-C7 motion being in the same direction?
Uncinate processes
Main contraindications for HVLA in cervical region?
Rheumatoid arthritis and Downs syndrome (alar L.)
Vertebral A. disease and Carotid disease (thrombosis)
Radiculopathy, etc.
