Cervical Spine Evaluation

Question 1

Canadian C-Spine Rules

Answer 1

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

Question 2

Observation

Answer 2

Pt entering room
Movements
Facial expressions
Visual anatomy

Question 3

Ligament integrity Tests

Answer 3

Modified sharp-purser
Alar ligament stress
Transverse Ligament of atlas

Question 4

S/S of cervical instability

Answer 4

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

Question 5

Transverse Ligament Test

Answer 5

Anterior Force on transverse process of C1 lying supine

Question 6

Alar ligament Stress

Answer 6

SB or rotate, C2 should move too

Question 7

Pettman’s Distraction Test

Answer 7

Patient supine
Fixate C2
Distract Occiput

Symptom reproduction
> 1mm distraction

Question 8

Shoulder Abduction Test

Answer 8

Bakody’s sign (C4-C5 or C5-C6)

Question 9

C1-C2

C3

Answer 9

Neck Flexion

Neck Side Flexion

Question 10

C4

Answer 10

Shoulder Elevation

Diaphragm, Trap, Levator Scap, Scalenes

Question 11

C5

Answer 11

Shoulder Abduction

Rhomboids, Deltoid, Supraspinatus, Infraspinatus, Teres Minor, Biceps, Scalenes

Question 12

C6

Answer 12

Elbow Flexion/Wrist Extension

S.A., Lat, Subscap, Teres major, Pec Major

Question 13

C7

Answer 13

Elbow extension/Wrist Flexion

S.A., Lat, Pec major (Sternal head), pec minor, Triceps, pronator, flexors, extensors

Question 14

C8

Answer 14

Thumb Extension/Ulnar Deviation

Pec major (sternal), Pec minor, triceps, pollicis muscles

Question 15

T1

Answer 15

Hand intrinsic

Flexor digitorum profundus
Intrinsic hand except pollicus muscles

Question 16

Manual Therapy Absolute Contraindications

Answer 16

Infection
Acute Circulatory
Malignancy
Open wounds
Recent fracture
Hematoma
Hypersensitivity to skins
Inappropriate end feel
Advanced diabetes
Cellulitis
Severe Pain
Radiation of Pain

Question 17

Rotational Alar Ligament Stress Test

Answer 17

Positive Results

More than 20 to 30 degrees of rotation without C2 movement

Question 18

Myelopathy

Nerve Root Lesion

Peripheral nerve lesion

Answer 18

UMN

LMN

LMN

Question 19

Side Gliding

Side Bending

Rotation

Answer 19

C0-C1

Lower Cervical

C1-C2

Question 20

Traction

Neutral

Answer 20

Facet

Work here if patient too much pain to go through range

Question 21

CPR for cervical spine manipulation

Answer 21

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

Question 22

CPR for cervical radiculopathy

Answer 22

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

Question 23

CPR for neck pain and cervical traction

Answer 23

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

Question 24

Modified Sharp Purser

Transverse ligament test

Answer 24

Clunk, relief of symptoms

Soft end feel, VBI symptoms, lump in throat

Question 25

Jefferson’s fracture

Answer 25

Positive in increase translation of lateral C1

Question 26

Provocative Tests

Symptom Relief tests

Answer 26

Limb tension test
Foraminal compression
Cervical flexion/rotation

Distraction
Shoulder abduction

Question 27

Key Tests Neurological Symptoms

Answer 27

Brachial plexus tension
Distraction
Foraminal compression
Neurodynamic tension tests