Cervical Spine Examination and Treatment Flashcards
Canadian C-Spine rules for Acute Trauma Patients
- ) Are they cognitively intact?
- ) Are they under 65 y.o?
- ) They can move more than 45d Rotation (even if it causes pain)?
- ) No crazy injury circumstances (distraction, based/high speeds, etc.)
- ) No pain at rest in midline?
- ) No Paresthesia in arms following trauma.
Ligament Integrity tests for UCS
- Modified Sharp-Purser Test
- Alar Ligament Stress Test
- Transverse Ligament of Atlas Test
S&S of Cervical Instability
- Severe Muscle Spasms
- Apprehensive to movement (flexion)
- Lump in throat
- Lip or facial paresthesia
- Severe HA
- VBI indications
- Soft End Feel
Modified Sharp-Purser Test
- Transverse Ligament Test
- Blocks C2 spinous process and applies pressure on patients forehead in the posterior directions
- Feel for clunk. pt might feel relief of symptoms
Examples of patients we should not be treating
- Non-mechanical neck pain patients
- Undetected fractures
- Ligament- injuries, insufficiences
- Vascular compromised individuals
- Any other contraindications to treatments
Transverse Ligament Test
- Better reliability than Sharp-Purser
- Shear forward on post tubercle of C1 and lift their head up
Positive Test: Soft end feel, VBI symptoms, lump in throat, increase of symptoms
Anterior Shear/Sagittal Stress Test
- Integrity of supporting ligaments and capsular tissue of cervical spine
- Positive Test: nystagmus, pupillary changes, dizziness, soft end feel, nausea, facial or lip paresthesia, lump sensation in throat
Alar Ligament Stress Test
Positive Test: reproduction of symptoms and abnormal feel
C2 should move opposite direction instantly or within first 20-30d
Rotational alar ligament stress test
detects instability of atlantoaxial articulation
Positive Test: more than 20-30d of rotation without movement of C2. Excessive motion in opposite direction indicates instability
Lateral Flexion Alar Ligament Stress Test
Detects instability of atlantoaxial articulation and tests integrity of alar ligament
Positive Test: excessive movement or reproduction of pt symptoms
Longitudinal Ligament/Tectorial Membrane (Pettman’s Distraction Test)
Detects instability in longitudinal ligament by distracting occipit until end-feel
Positive Test: symptoms reproduction
Atlantoaxial lateral shear test
Detects instability of atlantoaxial articulation
Positive Test: Nystagmus, pupillary changes, dizziness, soft end feel, nausea, facial or lip paresthesia, lump sensation in throat
Jefferson’s Fracture/Odontoid fracture test
Identify loss of integrity of the odontoid process
Positive Test: increased translation of the lateral mass
T/F: Vascular Clearing Tests are proven to be conclusively effective in indicating stretching and occlusion of the vertebral artery or internal carotid artery
False
It is NOT proven to be conclusively effective
Vertebral Artery Test
Differentiate between vertebral artery compromise and positional vertigo
Positive Test: signs of vertebral artery compromise
Negative Test: Potentially result of positional vertigo
Nodding vs Flexion - where does each occur
Nodding: Upper Cervical Spine
Flexion: Lower Cervical Spine
Myotome: C1 - C2
Test Action: Neck Flexion
Muscle: SCM, rectus lateralis, rectus capitis anterior, longus capitis, longus coli, longus cervicis
Myotome: C3
Test Action: Neck side flexion
Muscle: Traps, Longus capitis, Longus cervicis, scalene medius
Myotome: C4
Test Action: Shoulder elevation
Muscle: Diaphragm, Traps, levator scap, scalene anterior, scalene medius
Myotome: C5
Test Action: shoulder abduction
Muscle: Rhomboid major/minor, deltoid, supraspinatus, infraspinatus, teres minor, biceps, scalenus anterior and medius
Myotome: C6
Test Action: Elbow Flexion and Wrist extension
Muscle: Serratus Anterior, Latissiums Dorsi, Subscap, teres major, pec major, biceps, coracobrachialis, brachialis, brachioradialis, supinator, ECRL, scalenus anterior, medius, and posterior
Myotome: C7
Test Action: Elbow extension and Wrist Flexion
Muscle: SA, Lats, Pec Major/Minor, Triceps, pronator teres, FCR, Flexor Digitorum Superficialis, ECRL, ECRB, extensor digitorum, Extensor digiti minimi, scalenus Medius and Posterior
Myotome: C8
Test Action: Thumb extension and ulnar deviation
Muscle: Pec Major/minor, triceps, flexor digitorum superficialis, flexor digitorum profundus, FPL, pronator quadratus, FCU, Abductor pollicis longus, extensor policis longus/brevis, extensor indicis, abductor pollicis brevis, opponens pollicis, scalenus medius and posterior
Myotome: T1
Test Action: Hand instrinsics
Muscle: Flexor digitorum profundus, intrinsic muscle of the hand, flexor pollicis brevis, opponens pollicis
