Cervical Spine Exam & Intervention

Question 1

Factors associated w/ development of chronic neck pain

Answer 1

• less baseline pain and disability intensity
• age (> 40)
• headache
• bicycling
• worse QoL

Question 2

upper cross syndrome

Answer 2

• Inhibited neck flexors and inhibited rhomboids and serratus anterior
• tight upper trapezius and levator scapula and tight pectorals

Question 3

C1 myotome

Answer 3

capital flexion

Question 4

C2 myotome

Answer 4

capital extension

Question 5

C3 myotome

Answer 5

neck lateral flexion

Question 6

C4 myotome

Answer 6

shoulder (scapular) elevation

Question 7

C5 myotome

Answer 7

shoulder abduction

Question 8

C6 myotome

Answer 8

elbow flexion and wrist extension

Question 9

C7 myotome

Answer 9

elbow extension and wrist flexion

Question 10

C8 myotome

Answer 10

thumb abduction

Question 11

T1 myotome

Answer 11

finger adduction

Question 12

biceps DTR

Answer 12

C5

Question 13

brachioradialis DTR

Answer 13

C6

Question 14

triceps DTR

Answer 14

C7

Question 15

special tests for ruling out cervical arterial dysfunction (CAD)

Answer 15

• end-range rotation test
• VBI test
• Modified VBI test

Question 16

upper cervical stability ruling out tests

Answer 16

• modified sharp purser test
• upper cervical flexion test
• A-O membrane test
• tectoral membrane test
• alar ligament stability test

Question 17

How to perform modified sharp purser test

Answer 17

• slightly flex neck
• palpate C2 spinous process
• provide posterior force through forehead with contralateral hand
• • if symptoms produced during neck flexion and reduced with posterior force on forehead

Question 18

What test is good for confirming upper cervical instability but not good for screening?

Answer 18

modified sharp purser test

Question 19

How to perform tectoral membrane test

Answer 19

• stabilize spinous process of cervical spine and under occiput
• provide traction and posterior translation force
• • test is excessive motion

Question 20

How to perform posterior A-O membrane test

Answer 20

Stabilize cervical spine at transverse process of C1 and under occiput to provide translation force
- Excessive motion is + test

Question 21

How to perform alar ligament stability test

Answer 21

Palpate spinous process of C2 and rotate head and lateral flex head until feel C2 spinous process moving
If no movement occurs = + test
Repeat in slight flexion and extension

Question 22

The alar ligament stability test is good for _______ but not as good for ________

Answer 22

good for confirming but not as good for screening

Question 23

ruling out test for cervicogenic headaches

Answer 23

cervical flexion-rotation test

Question 24

ruling out test for radicular pain/radiculopathy

Answer 24

upper limb tension test

Question 25

How to perform cervical flexion rotation test

Answer 25

- full neck flexion and maintain chin tuck - rotate R and L - + test if symptoms produced or difference of 10 deg ROM from side to side

Question 26

CPA testing aka spring testing

Answer 26

- find spinous process and provide anterior force - want to have snot drip straight down - looking for provocation of radicular symptoms

Question 27

UPA testing

Answer 27

- same as CPA but done on articular pillars

Question 28

cervical tests for confirming

Answer 28

- spurling's compression test - cervical distraction test - valsava maneuver - brachial plexus compression test - cervical compression test - Wainner's test item cluster

Question 29

items in Wainner's test item cluster

Answer 29

- + spurling's test - + cervical distraction test - + ULTT - c-spine rotation AROM < 60 deg

Question 30

MDC for neck flexor muscle endurance test

Answer 30

17.8 sec

Question 31

Grade 1 mobilization

Answer 31

small amplitude at beginning of range

Question 32

Grade 2 mobilization

Answer 32

large amplitude within range but not end range

Question 33

Grade 3 mobilization

Answer 33

large amplitude performed up to the limit of the range

Question 34

Grade 4 mobilization

Answer 34

small amplitude performed at the limit of the range

Question 35

manual therapy absolute contraindications for PROM and manipulations

Answer 35

- malignancy of targeted region - cauda equina syndrome - red flags - neoplasm, fracture, or systemic disturbance - rheumatoid collagen necrosis - upper c-spine instability - concern for CAD (dizziness, nausea, hearing disturbances, unsteadiness)

Question 36

relative contraindications for PROM and manipulations

Answer 36

- acute nerve root irritation - blood clotting disorder - acute inflammation, stiffness, systemic disease, irritability, osteoporosis

Question 37

absolute contraindications for manipulations

Answer 37

same as PROM as well as: - practitioner lack of ability - spondylolisthesis - gross foraminal encroachment - children/teenagers - pregnancy - fusion - psychogenic disorders - immediately postpartum

Question 38

cervical thrust and non-thrust techniques for mechanical neck pain are part of which POC?

Answer 38

acute, subacute, and chronic neck pain

Question 39

cervical mobilization/manipulation in combo w/ exercises is good for what diagnosis?

Answer 39

cervicogenic headaches - evidence for pain reduction and functional improvement

Question 40

Thoracic thrust and non-thrust techniques for mechanical neck pain are better for ________ results

Answer 40

short-term

Question 41

mobilization and manipulation of c-spine w/ targeted neck strengthening is good for which muscles?

Answer 41

cervical deep flexors

Question 42

cervical mobilization with movement for which diagnosis?

Answer 42

cervical dysfunction - cervicogenic headaches and dizziness