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MSK 1 > Cervical Spine Examination > Flashcards

Cervical Spine Examination Flashcards

Myotomes, Upper Quarter Screen, Special Tests, Structural Stress Testing, Palpation, Joint Mobility, and Confirmation Tests

1
Q

what is included within the Upper Quarter Screen?

A
  1. C-Spine AROM (w/overpressure if AROM painless)
  2. UE ROM (w/overpressure if AROM painlesss)
    1. Shoulder FLX and ABD
    2. Reach behind head, reach behind back
    3. Elbow FLX/EXT
    4. Wrist FLX/EXT
    5. Fist/open hand
  3. UE Resistance
    1. Shoulder FLX/ABD/ER/IR
    2. Elbow FLX/EXT
    3. Wrist FLX/EXT
    4. Grip
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2
Q

how is UE AROM graded in the upper quarter screen? UE Resistance?

A

UE AROM = full, limited, or unable

UE Resistance = strong, diminished, unable

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3
Q

List the pathologic reflexes

A
  1. Hoffman’s Sign
  2. Inverted Supinator sing
  3. Babinski’s sign
  4. Ankle clonus
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4
Q

List special tests conducted in the cervical spine exam

A
  1. End-Range Rotation Test
  2. Modified Sharp Purser
  3. Tectoral Membrane Test
  4. Posterior A-O Membrane Test
  5. Alar Ligament stability tests
  6. Cervical Flexion Rotation test
  7. Upper Limb Tension Test (ULTT)
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5
Q

Describe the procedure for the End-Range Rotation Test

A
  1. during pt interview, symptoms potentially consistent with CAD are ID
  2. Pt is in sitting or supine and than positioned at end-range C rotation for 10 sec
  3. Pt is returned to neutral for 10 secs
  4. Steps 2 & 3 are repeated w/C rotation in opposite direction
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6
Q

what indicates a positive End-Range Rotation Test?

A

concordant SxS consistent with CAD

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7
Q

What is the purpose of the Modified Sharp Purser?

A

tests the transverse ligmanet integrity

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8
Q

Describe the procedure for the Modified Sharp Purser Test

A
  1. assess for resting symptoms
  2. pt is positioned in sitting w/raised table and examiner standing to pt’s side
  3. pt slightly flexes the neck
  4. Posterior aspect of C2 is stabilized by examiner
  5. Using contralateral hand, examiner gently places a posterior force on cranium through pt’s forehead
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9
Q

what indicates a positive Modified Sharp Purser Test?

A
  1. Provocation of myelopathic symptoms w/initial slight neck flexion
  2. Relief of symptoms/excessive translation w/force through forehead
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10
Q

What is the purpose of the Tectoral Membrane Test?

A

test the upper C-spine ligmanet integrity

(is the tectoral membrane intact?)

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11
Q

describe the procedure for the Tectoral Membrane Test

A
  1. pt is sitting and examiner is standing at pt’s side
  2. cranial hand reaches caudally such that 1st and 2nd digit support inferior occiput
  3. caudal hand reaches cranially w/grasp supporting c-spine spinous processes
  4. w/cranial hand, a traction and posterior force is applied through the mastoid process
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12
Q

what indicates a positive Tectoral Membrane Test?

A

excessive translation of C0/C1 and C1/C2

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13
Q

what is the only difference between the Tectoral Membrane Test and the Posterior A-O Membrane Test?

A

Placement of caudal hand

Tectoral membrane test = caudal hand is supporting C-spine spinous processes

Posterior A-O Membrane Test = caudal hand has a pincer grasp on lateral aspects of C1

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14
Q

Describe the procedure for the Alar Ligament Stability Tests

A
  1. Pt is positioned in sitting w/examiner standing at pt’s side
  2. Examiner’s cranial hand supports cranium (palm on crown) and caudal hand has pincer grasp on spinour process of C2
  3. The following movement are performed first with head in neutral, than in slight flx, than slight ext
    1. Cranium is passively laterally flexed bilaterally
    2. Cranium passively rotated bilaterally
  4. Whole procedure done twice
    1. once with C2 stabiliized
    2. once with C2 palpated but not stabilized
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15
Q

What indicates a postive test for the alar ligament stability tests?

A
  1. movement not palpated at C2
  2. absence of a distinct stop (when C2 is stabilized)
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16
Q

Describe the procedure for the Cervical Flexion Rotation Test

A
  1. Pt is supine
  2. examiner stands at head of table facing pt
  3. Pt fully flexes neck
  4. examiner stabilzes cranium
  5. once pt relaxes neck muscles, examine passively rotates C-spine to full motion (test bilaterally)
17
Q

what indicates a positive Cervical Flexion Rotation Test?

A

concordant HA provocation

limited ROM to one side by >/= 10 deg

18
Q

Describe the procedure for the ULTT

A
  1. pt is in supine
  2. examiner standing on symptomatic side of table
  3. Depress the shoulder w/elbow closest to pt, stabilize pt’s scapula by bearing weight through elbow onto table
  4. support under pt’s distal upper arm, abduct shoulder to 110
  5. supinate forearm
  6. extend wrist and fingers
  7. ER shoulder
  8. Elbow extension slowly
  9. laterally flex neck
19
Q

what indicates a positive ULTT?

A

provocation of concordant radicular symptoms w/sensitization maneuver and/or alleviation of condordant radicular symptoms w/desensitization maneuver

20
Q

List several structural stress tests that are performed during a Cervical Spine Examination

A
  1. AROM (in sitting)
    1. Flexion
    2. Extension
    3. Rotation
    4. Lateral Flexion
    5. Retraction
    6. Protraction
  2. PROM (seated or supine)
    1. Flexion
    2. Extension
    3. Rotation
    4. Lateral Flexion
  3. Other
    1. contractile unit length (scalenes, Upper trap, SCM, pec major, pec minor)
  4. Resistive testing
    1. Flexion
    2. Extension
    3. Rotation
    4. Lateral Flexion
21
Q

List Joint Mobility Tests performed during a Cervical Spine Examination

A
  1. Central Posterior-Anterior (CPA)
  2. Flexion/Extension
  3. Lateral Flexion
  4. Unilateral P-A (UPA)
  5. C1-C2 Mobility testing
  6. C2/C3 - C4/C5 Mobility Testing
  7. C2/C3 - C5/C6 Unilateral Up/Down-Glides
  8. Lower C-soine mobility testing
22
Q

Describe the procedure for CPA testing

A
  1. pt in prone
  2. palpate spinous process of C-spine
  3. stack thumbs over spinous process and apply a ventral force
  4. repeat at each C-spine level
23
Q

Describe how to perform Flexion/Extension joint mobility testing at the C-Spine

A
  1. pt in supine
  2. examiner position
    1. standing at pt’s head
    2. table height ~umbilicus height
    3. palpation finger between mastoid process and TP of C1
    4. Stabilize cranium w/bilateral hands
  3. Gently flex cranium on upper C-spine
  4. repeat w/extension
24
Q

what should you be observing for during Flexion/Extension Joint Mobility testing of the C-Spine?

A

the space where your palpation fingers are should increasing during C1-C0 flexion and should decrease during extension

25
Q

describe the procedure for lateral flexion joint mobility testing of the C-spine

A
  1. pt in supine
  2. examiner position
    1. standing at pt’s head
    2. table height ~umbilicus
    3. palpation finger on posterior arch of C1
    4. Stabilize cranium w/bilateral hands
  3. Gently laterally flex cranium on Upper C-Spine
  4. observe posterior arch of C1, should become more prominent
26
Q

describe how to perform UPAs

A
  1. pt is prone
  2. palpate articular pillars/lateral masses of C-vertebrae
  3. stack thumbs and apply a ventral force keeping elbows nearly straight
27
Q

List several confirmation tests that may be conducted during a Cervical Spine Examination

A
  1. Spurling’s Compression
  2. Cervical Distraction Test
  3. Valsa maneuver
  4. Cervical Compression Test
  5. Brachial Plexus Compression Test
28
Q

describe the procedure for a Spurling’s Compression Test

A
  1. pt is sitting w/neutral neck position
  2. examiner is behind pt
  3. Resting symptoms are established first
  4. pt than laterally flexes to symptomatic side (stop if radicular symptoms observed during motion)
  5. combine axial compression and lateral flexion overpressure applyied to pt’s crown
  6. positive test is provocation of radicular symptoms
29
Q

describe the procedure for a Cervical Distraction Test

A
  1. pt is supine
  2. examiner stands at pt’s crown, facing cuadally
  3. cradle occiput w/one hand; press your anterior shoulder into pt’s forehead
  4. resting symptoms observed/established
  5. traction is applied gradually
  6. change in symptoms is observed (location and intensity)
  7. positive test = alleviation of radicular symptoms
30
Q

Describe the procedure for the Cervical Compression Test

A
  1. pt is sitting w/neutral neck position
  2. Examiner is behind pt
  3. resting symptoms established
  4. axial compression is applied to pt’s crown
  5. positive test = provocation of radicular symptoms
31
Q

Describe the procedure for the Brachial Compression Test

A
  1. pt is sitting
  2. examiner is behind or lateral to pt
  3. resting symptoms are ID
  4. a compressive force is applied w/examiner’s hand just above the clavicle on the symptomatic side
  5. positive test = provocation of radicular symptoms

MSK 1 (17 decks)

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