Cervical Spine Evaluation Flashcards
Canadian C-Spine Rule’s for Acute Trauma Patient
- Are they cognitively intact?
- Are they under 65 y.o.
- Can they move more than 45 d Rot (even with pain)
- No crazy MOI
- No midline pain at rest
- No paresthesia in arms following trauma
Checking ligament integrity in Upper Cervical Spine
- Modified Sharp-Purser Test
- Alar Ligament Stress Test
- Transverse Ligament of Atlas Test
S/S of Cervical Instability
- Severe Muscle spasm
- Resistance and apprehension to movement (esp. flexion)
- Lump in throat
- Lip/fascial paresthesia
- Severe HA
- 5 D’s And 3N’s
- Soft end feel
Cervical Instability Clearing Tests used for what?
Tests to determine if patient should even be in our office. We want to clear or filter them to rule out rare but serious pathology
Positive finding for Modified Sharp-Purser Test
Feel a clunk
Patient feels relief of symptoms
Transverse ligament is also part of what ligament
Cruciform ligament
Transverse ligament test positive findings
Soft end feel, VBI symptoms, lump in the throat
Failure of transverse ligament causes what symptoms
Dizziness, nausea, lip/face/limb paresthesia, nystagmus, myelopathy
What is a positive finding when doing Anterior shear or sagittal stress test
Nystagmus, pupillary changes, dizziness, soft end feel, nausea, fascial/lip paresthesia, lump sensation in the throat…. excess displacement during the shearing movement
How to perform Alar Ligament Stress Test
Slightly flexed
Hold C2
SB or rotate
C2 should move opposite direction isntantly or within first 20-30 degrees…. IF NOT THEN STOP
Positive Test for Rotational Alar Ligament Stress Test
more than 20-30 deg without moment of C2 - contralateral alar ligament tear..
2. excessive motion in opposite direction indicates instability due to increase in neutral zone in joint
Positive sign of Pettman’s distraction test
- symptom reproduction
2. > 1 mm distraction
Jefferson’s Fracture
Fracture of C1
Nodding vs. flexion
Nodding in UCS during flexion movement… Flexion occurs in LCS
Upper limb scan to see if there is anything else causing complaint
- peripheral joints
- Myotomes
- Sensory Scan
C1-C2 Test Action
Neck Flexion
C1-C2 Muscles
- Rectus lateralis
- Rectus capitis anterior
- Longus Coli
- Longus Cervicis
- SCM
C3 Test Action
Neck Lateral Flexion
C3 Muscles
- Longus capitis
- Longus Cervicis
- Trapezius
- Scalenus medius
C4 Test Action
Shoulder elevation
C4 Muscles
- Diaphragm
- trapezius
- levator capulae,
- scalenus anterior
- scalenus medius
C5 test action
shoulder abduction
C5 muscles
- Rhomboid major/minor
- Deltoid
- Supraspinatus
- infraspinatus
- teres minor
- biceps
- scalenus anterior and medius
C6 test action
elbow flexion and wrist extension
C6 Muscles
- Serratus anterior
- Latissimus dosi
- Pectoralis major (sternal head)
- Triceps
- Pronator teres
- Scalenus medius/posterior
Sensory Scan
- Myelopathy
- Nerve root lesion
- Peripheral nerve lesion
- UMN lesion
- LMN lesion
- LMN lesion
Biceps reflex spinal segment
C5, C6
Brachioradialis reflex spinal segment
C6
Triceps spinal segment reflex
C7/ maybe C8
Hoffmann Sign
UMN lesion suspected. flick fingernail of middle finger and check for flexion of thumb
Functional Assessment
- ADL
- Functional strength tests
- Whiplash disability questionnaire (WDQ)
- Bournemouth questionnaire
- neck disability index
2 types of special tests
Provocative
Symptom relief
Provocative tests
ULNT
Foraminal compression (spurlings, jacksons)
cervical flexion rotation test
Symptom relief test
distraction test
shoulder abduction
Cloward’s Sign
Referred pain to medial scapula - pain from a disc/nerve root issue
Maximal foraminal compression test
need some radiating symptoms in order to be positive. Negative test if just feel neck pain
Clincal prediction rule for cervical radiculopathy
positive spurlings
positive relief with distraction
less than 65 deg ROM w/ rotation
Positive upper Limb Tension Test
- All present 90% certain
- 3 present - 60%
Bakody’s Sign
Shoulder abduciton relief test for C4-C5 or C5-C6.
Decreased neurological symptoms
Upper limb tension test 1
Median nerve
anterior interosseous nerve
Upper limb tension test 2
median, axillary, and musculocutaneous nerves
upper limb tension test 3
radial nerve
upper limb tension test 4
ulnar nerve (c8-T1)
