Cervical Spine complaint

Question 1

Common traumatic cervical spine injuries?

Answer 1

Myofascial and SCIWORA

Question 2

SCIWORA

Answer 2

spinal cord injury with out radiographic abnormality

Question 3

Describe a SCIWORA

Answer 3

Normal CT of cervical spine but presence of neurological symptoms

Question 4

What must you do with a SCIWORA case?

Answer 4

KEEP IN NECK BRACE/IMMOBILIZED until MRI or consult with neurosurgeon

Question 5

Common atraumatic cervical spine injuries?

Answer 5

Musculoskeletal = most common
Neurologic = radiculopathy and myelopathy
Referred pain = thoracic outlet

Question 6

Most common cause of acute/chronic neck pain in adults???????

Answer 6

CERVICAL SPONDYLOSIS

Question 7

How does cervical spondylosis look on an x-ray

Answer 7

Degenerating disks and presence of osteophytes

Question 8

Any deficit relating to the spinal cord; distal extremity weakness and clumsiness

Answer 8

Myelopathy

Question 9

Any deficit relating to the nerve roots; burning, sharp pain down arm

Answer 9

Radiculopathy

Question 10

Most common level of cervical radiculopathy?

Answer 10

C5-C6

Question 11

How do you diagnose meningitis?

Answer 11

Lumbar puncture

Question 12

Signs of meningitis?

Answer 12

Fever, malaise, rash, stiff neck, headache

Question 13

What is thoracic outlet syndrome?

Answer 13

Space between first rib and clavicle is compressing the neurovascular bundles there

Question 14

Signs of thoracic outlet syndrome?

Answer 14

Arm pain, numbness, weakness, gets worse when elevating hands and arms above head and HAND MUSCLE WASTING

Question 15

Most patients with atraumatic neck pain and no red flag symptoms do NOT need?

Answer 15

Imaging

Question 16

What should you not check on a patient with a traumatic cervical injury until cleared radiographically or by a neurosurgeon?

Answer 16

Neck ROM!

Question 17

Special tests for cervical radiculopathy?

Answer 17

Neck compression, neck distraction and spurlings tests

Question 18

Neck compression test

Answer 18

pt is seated and apply a downward force on top of their head while in neutral
(+) = pain, paresthesia, numbness down arm

Question 19

Neck distraction test

Answer 19

One hand under chin, one on occiput and pull up

(+) = ALLEVIATION of symptoms

Question 20

What are the 3 stages to Spurling’s test?

Answer 20

Compression
Compression and extension
Compression, extension and side bending towards affected side

Question 21

When should you stop doing the stages of the spurling’s test?

Answer 21

If there is reproduction of symptoms:

(+) = pain, paresthesia, numbness down arm

Question 22

Special tests for thoracic outlet syndrome?

Answer 22

ROOS, Adson’s, Costoclavicular/military/halstead, Wright’s hyperabduction test

Question 23

ROOS test

Answer 23

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

Question 24

Adson’s test (away)

Answer 24

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

Question 25

Where is Adson's test (away) testing for compression of the neurovascular bundle?

Answer 25

Between the scalenes

Question 26

Adson's test (toward)

Answer 26

``` 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 ```

Question 27

Where is Adson's test (toward) testing for compression of neurovascular bundle?

Answer 27

Between rib and clavicle

Question 28

Positive test for Adson's?

Answer 28

Loss/change in radial pulse or reproduction of symptoms (pain, paresthesia, numbness)

Question 29

Costoclavicular/military/halstead test

Answer 29

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

Question 30

Where is the costoclavicular/military/halstead test testing for compression of the neurovascular bundle?

Answer 30

Between rib and clavicle

Question 31

Wright's Hyperabduction test

Answer 31

ABduct patient's arm ABOVE head with some extension and monitor radial pulse (+) = change in radial pulse or reproduction of symptoms

Question 32

Where is Wright's Hyperabduction test testing for compression of the neurovascular bundle?

Answer 32

Pectoralis muscle

Question 33

What can be seen on a C spine lateral x-ray?

Answer 33

Hangman's fracture

Question 34

What is injured with a hangman's fracture?

Answer 34

Hyperextension causes a fracture of vertebral arch of C2, ligaments and spondylolysthesis of C2

Question 35

What can be seen on an open mouth x-ray?

Answer 35

Dens, C1 and C2 facets = jefferson fracture of C1 visualized

Question 36

What can be seen on an anterior AP view x-ray?

Answer 36

Facet dislocation or widening of a spinous process of the cervical spine

Question 37

What can be seen on a 45 degree oblique x-ray of the cervical spine?

Answer 37

Osteophyte encroachment - spondylosis

Question 38

What 2 joints have different biomechanics in the cervical spine?

Answer 38

OA and AA

Question 39

OA

Answer 39

Occiput - Atlas (C1)

Question 40

AA

Answer 40

Atlas (C1) - Axis (C2)

Question 41

What movements can be expected for C2-C7?

Answer 41

Rotation and sidebending in the SAME direction

Question 42

What movements can be expected for OA?

Answer 42

Rotation and sidebending in OPPOSITE directions

Question 43

What movement can be expected for AA?

Answer 43

JUST ROTATION

Question 44

Major motions of the OA joint?

Answer 44

Flexion and extension

Question 45

What is thought to cause C2-C7 motion being in the same direction?

Answer 45

Uncinate processes

Question 46

Main contraindications for HVLA in cervical region?

Answer 46

Rheumatoid arthritis and Downs syndrome (alar L.) Vertebral A. disease and Carotid disease (thrombosis) Radiculopathy, etc.