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Musculoskeletal Rehab > Cervical Spine Examination & Intervention Part 1 > Flashcards

Cervical Spine Examination & Intervention Part 1 Flashcards

1
Q

What are some risk factors for Cervical Myelopathy (compression on spinal cord)?

A
  • Sensory disturbance
  • Muscle wasting of hand intrinsic muscle
  • Unsteady Gait
  • Hoffman’s Reflex
  • Hyperreflexia
  • Bowel and bladder disturbances
  • Multisegmental weakness and/or sensory changes
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2
Q

What are some risk factors of Neoplastic Conditions (cancer)?

A
  • Age over 50
  • Previous history of cancer
  • Unexplained weight loss
  • Constant pain (no relief at bed rest)
  • Night pain
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3
Q

What are some risk factors & key findings for Upper Cervical Ligamentous Instability (Ligament that hold dens)?

A
  • Occipital headache and numbness
  • Severe limitations during active range of motion in neck
  • Signs of cervical myelopathy
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4
Q

What are some risk factors and key findings for Vertebral Artery Insufficiency?

A
  • Drop attacks
  • Dizziness (lightheadedness related to neck movement)
  • Dysphasia
  • Dysarthria
  • Diplopia
  • Positive cranial nerve signs
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5
Q

What are some risk factors and key findings for Inflammatory or Systemic Disease?

A
  • Temp >100F
  • BP > 160/95 mmHG
  • Resting pulse > 100bpm
  • Resting respiration >25bpm
    -Fatigue
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6
Q

What are some risk factors and key findings of fracture?

A
  • Age > 65yr
  • Trauma/dangerous mechanism
  • Prolonged use of corticosteroids
  • Severe limitation during assessment of neck active range of motion
  • Positive neurologic signs
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7
Q

What would be found in an exam to put a patient in mobility category?

A
  • Recent onset of symptoms
  • No radicular/referred symptoms in upper quarter
  • Restricted ROM with side to side rotation and/or discrepancy in lateral flexion ROM
  • No signs of nerve root compression or perpheralozation of symptoms in upper quarter with cervical ROM
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8
Q

What would be found in an exam to put a patient in the centralization category?

A
  • Radicular/ Referred symptoms in the upper quarter
  • Peripheralization and/or centralization of symptoms with ROM
  • Signs of nerve root compression present
  • May have pathoanatomic diagnosis of cervical radiculopathy
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9
Q

What would be found in an exam when putting a patient in the condition and increase exercise tolerance?

A
  • Lower pain and disability scores
  • Longer duration of symptoms
  • No signs of nerve root compression
  • No peripheralization/centralization during ROM
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10
Q

What would be found in an exam when putting a patient in pain control?

A
  • High pain and disability scores
  • Very recent onset of symptoms
  • Symptoms that follow trauma
  • Referred or radiating symptoms extending into the upper quarter
  • Poor tolerance for examination or most interventions
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11
Q

What might be found in an exam when putting a patient in reduce headache category?

A
  • Unilateral headache with onset preceded by neck pain
  • Headache pain triggered by neck movement or positions
  • Headache pain elicited by pressure on posterior neck
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12
Q

What are the components of a subjective exam?

A
  • Patient Profile
  • Area of symptoms
  • Behavior of symptoms
  • History
  • Special questions
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13
Q

What are some components of the patient profile?

A
  • Occupation (tasks, hours, conditions)
  • Length of employment (previous work)
  • Physical restrictions or limitations
  • hobbies, or rec activity (type, amount, frequency)
  • Limitations or restrictions
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14
Q

What are some concerns from a patient profile?

A
  • Stressful/harmful work conditions (degree of physical stress at work)
  • Extreme physical activity
  • Sedentary lifestyle
  • Fear avoidance beliefs
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15
Q

What are the components to area of symptoms?

A
  • Formulate initial hypothesis
  • Develop a symptom map
  • Identify future questions
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16
Q

What are some clues for area of symptoms?

A
  • Atypical locations
  • Constant or non-varying pain (especially in non acute pts)
  • Difficulty describing symptoms
  • Quality of pain (musculo?)
17
Q

What is the behavior of symptoms for chemical pain?

A
  • Constant pain
  • High levels of pain
  • Often diffuse
  • Recent onset
  • Easy aggravation of pain by all movements
  • Takes time to calm down
  • Responds favorably to NSAIDs
18
Q

What is the behavior of symptoms for mechanical pain?

A
  • Intermittent pain
  • Variable levels of pain
  • usually local
  • Fairly recent to chronic
  • Changes in position or movement in particular direction ease pain
  • Symptoms short-lived
  • Variable response to NSAIDs
19
Q

What are some components of behavior of symptoms?

A
  • Aggravating and Easing factors
20
Q

What are some suggestive questions for cervical variant?

A

What is it like:
- Looking over your shoulder
-Looking up
- Working or reaching overhead
- Reading/Writing
- Driving
- Coughing or sneezing

21
Q

What are some concerns when listening to aggravating factors?

A
  • Symptoms not influenced by activity
    -Difficulty describing age factors
  • Worse in “unloaded” positions
22
Q

What are some concerns from easing factors?

A
  • Difficulty describing easing factors
  • No relief in any position
  • No relief with bedrest
  • No relief noted with treatment
    -Basically its concerning if nothing makes them feel better
23
Q

What are concerns of the 24 hour pattern?

A

-Symptoms worst at night
-Prolonges AM stiffness
-Symptoms do not change through course of day

24
Q

What are some questions that you can ask when taking current history?

A
  • When did this problem begin?
    -If chronic (when did it most recently worsen)
  • How did it begin?
    -Any recent changes in your lifestyle
  • Any recent changes in your job duties?
  • Have you had any treatment for this problem?
  • How are you now compared to when it first happened?
25
Q

What are some questions that can be asked when taking a past history?

A
  • Have you ever had this problem or anything like it?
  • Have you had any treatment for this problem?
  • Have you had any other episodes between that first time and this most recent one?
26
Q

What are some concerning things from the history?

A
  • Rapid progression w/spread of symptoms
  • No relief with rest
  • Different from previous episodes
  • Insidious onset
27
Q

What are some topics that should be covered in special questions?

A
  • Fatigue
  • Weight change (unexplained)
    -Fever/Chills/sweats
  • Cord compression (Paresthis, weakness or balance problems)
  • Vertebral artery (dizziness or lightheadedness)
  • Bowel & bladder
  • Malaise
  • Mentation/Cognition
    -Medications

Musculoskeletal Rehab (13 decks)

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