Cervical Spine Evaluation Flashcards
Canadian C-Spine Rules
Are they cognitively intact? Are they under 65 y/o? Move more then 45 d rot (even if causes pain) No crazy injury circumstance No pain at rest in midline No paresthesia in arms following trauma
Observation
Pt entering room
Movements
Facial expressions
Visual anatomy
Ligament integrity Tests
Modified sharp-purser
Alar ligament stress
Transverse Ligament of atlas
S/S of cervical instability
Muscle spasms
Apprehension to movement (flexion especially)
Lump in throat
Lip/facial paresthesia
Severe HA
Dizziness, Nausea, vomiting, Nystagmus, pupillary changes
Soft/spongy end feel
Transverse Ligament Test
Anterior Force on transverse process of C1 lying supine
Alar ligament Stress
SB or rotate, C2 should move too
Pettman’s Distraction Test
Patient supine
Fixate C2
Distract Occiput
Symptom reproduction
> 1mm distraction
Shoulder Abduction Test
Bakody’s sign (C4-C5 or C5-C6)
C1-C2
C3
Neck Flexion
Neck Side Flexion
C4
Shoulder Elevation
Diaphragm, Trap, Levator Scap, Scalenes
C5
Shoulder Abduction
Rhomboids, Deltoid, Supraspinatus, Infraspinatus, Teres Minor, Biceps, Scalenes
C6
Elbow Flexion/Wrist Extension
S.A., Lat, Subscap, Teres major, Pec Major
C7
Elbow extension/Wrist Flexion
S.A., Lat, Pec major (Sternal head), pec minor, Triceps, pronator, flexors, extensors
C8
Thumb Extension/Ulnar Deviation
Pec major (sternal), Pec minor, triceps, pollicis muscles
T1
Hand intrinsic
Flexor digitorum profundus
Intrinsic hand except pollicus muscles
Manual Therapy Absolute Contraindications
Infection Acute Circulatory Malignancy Open wounds Recent fracture Hematoma Hypersensitivity to skins Inappropriate end feel Advanced diabetes Cellulitis Severe Pain Radiation of Pain
Rotational Alar Ligament Stress Test
Positive Results
More than 20 to 30 degrees of rotation without C2 movement
Myelopathy
Nerve Root Lesion
Peripheral nerve lesion
UMN
LMN
LMN
Side Gliding
Side Bending
Rotation
C0-C1
Lower Cervical
C1-C2
Traction
Neutral
Facet
Work here if patient too much pain to go through range
CPR for cervical spine manipulation
Initial NDI less than 11.50
Presence of bilateral involvement
Not perform sedentary more than 5 hours a day
Feel better to move neck
No feeling worse when extending neck
Diagnosis of spondylosis w/o radiculopathy
four or more 89% change of positive immediate response
CPR for cervical radiculopathy
Positive spurlings
Positive ULTT median nerve
Positive cervical distraction test
Less than 60 degrees of cervical rotation toward involved side
3/4: 94% specificity/moderate corr
4/4: 99% specificity/strong corr
CPR for neck pain and cervical traction
pt reported Peripheralization with lower cervical spine testing Positive shoulder abduction test Age >54 years Positive ULTT A Positive cervical distraction
3/5 79.2%, moderate
4/5 94.8% strong
Modified Sharp Purser
Transverse ligament test
Clunk, relief of symptoms
Soft end feel, VBI symptoms, lump in throat
Jefferson’s fracture
Positive in increase translation of lateral C1
Provocative Tests
Symptom Relief tests
Limb tension test
Foraminal compression
Cervical flexion/rotation
Distraction
Shoulder abduction
Key Tests Neurological Symptoms
Brachial plexus tension
Distraction
Foraminal compression
Neurodynamic tension tests
