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S3- Musculoskeletal > Cervical Spine Examination Lab > Flashcards

Cervical Spine Examination Lab Flashcards

1
Q

What 3 parts of the orthopedic examination come before screening procedures?

A
  • Patient Interview
  • Visual Inspection
  • Systems Review
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2
Q

What are the 2 things done with a patient interview?

A
  • Special Questions

- Outcome Measures

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3
Q

What is an example of an outcome measure that is done during the patient interview?

A

PSFS (Patient Specific Functional Scale)

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4
Q

What are we looking for with a visual inspection?

A
  • Alertness, Affect, Indicators of distress
  • Gross abnormalities
  • Integumentary
  • Posture Assessment (symmetry, bony/soft contours, resting posture vs ability to correct)
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5
Q

What are the 5 parts of a systems review?

A
  • Integumentary
  • Cardiopulmonary
  • Musculoskeletal
  • Neuromuscular
  • Cognition/Affect
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6
Q

What is the purpose of the Upper Quarter Screen?

A

Determine which anatomic region of the upper quarter is contributing to the patient’s symptoms and to rule out gross sensory or motor neurologic deficits.

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7
Q

With the Upper Quarter Screen we are assessing ____________ and ___________ of both the C-Spine and UE.

A
  • AROM with overpressure if AROM is painless

- resistance testing

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8
Q

What c-spine motions are we assessing during the Upper Quarter Screen?

A
  • flexion
  • extension
  • lateral flexion
  • rotation
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9
Q

What UE motions are we assessing during our Upper Quarter Screen?

A
  • shoulder flexion
  • shoulder abduction
  • shoulder flex/abd/ER (via reach behind head)
  • shoulder ext/add/IR (via reach behind back)
  • elbow flex/ext
  • wrist flex/ext
  • grip
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10
Q

Neurological Screening (Myotome Testing):

  • C1=
  • C2=
  • C3=
  • C4=
  • C5=
  • C6=
  • C7=
  • C8=
  • T1=
A
  • C1= Capital Flexion
  • C2= Capital Extension
  • C3= Neck Lateral Flexion
  • C4= Shoulder Elevation
  • C5= Shoulder Abduction
  • C6= Elbow Flexion/ Wrist Extension
  • C7=Elbow Extension/ Wrist Flexion
  • C8= Thumb Abduction
  • T1=Finger Adduction
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11
Q

Neurological Screening (Dermatome Testing):

  • C2=
  • C3=
  • C4=
  • C5=
  • C6=
  • C7=
  • C8=
  • T1=
A
  • C2= occipital area
  • C3= above collarbone
  • C4= AC joint
  • C5= lateral upper arm
  • C6= lateral thumb
  • C7= posterior 3rd digit
  • C8= medial 5th digit
  • T1= medial forearm
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12
Q

List 4 Pathological Reflexes and what a positive test looks like in each.

A
  • Hoffman’s Sign- finger flexion and thumb adduction/opposition
  • Inverted Supinator Sign- finger flexion or elbow extension
  • Babinski’s Sign- toe extension/abduction
  • Ankle Clonus- >3 beats of clonus
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13
Q

SPECIAL TESTS

A

SPECIAL TESTS

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14
Q

Describe the procedure for the End-Range Rotation Test.

A
  1. ) During patient interview, identify symptoms consistent with CAD.
  2. ) Position patient at end-range of rotation for 10s.
  3. ) Return to neutral position for 10s.
  4. ) Repeat rotation and hold for 10s in other direction.
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15
Q

What is a positive End-Range Rotation Test indicative of?

A

CAD (Cervical Arterial Dysfunction)

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16
Q

What are the signs/symptoms of CAD?

A

5 Ds and 3 Ns
D= diplopia, dizziness, dysarthria/dysphasia, drop attacks
N= nausea, nystagmus, numbness

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17
Q

Describe the procedure for the Modified Sharp Purser Test.

A
  1. ) Assess for resting symptoms
  2. ) Patient slightly flexes neck
  3. ) Posterior C2 stabilized by examiner
  4. ) With other hand, examiner places posterior force on cranium through patient’s forehead
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18
Q

What is a positive Modified Sharp Purser Test?

A
  • Provocation of myelopathic symptoms with initial flexion.

- Relief of symptoms OR excessive translation with force through forehead.

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19
Q

What is a positive Modified Sharp Purser Test indicative of?

A

Transverse ligament instability

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20
Q

Describe the procedure for the Tectoral Membrane Test.

A
  1. ) Stand at patient’s side
  2. ) Caudal hand supporting c-spine spinous processes from C2 down, cranial hand reaching caudally such that 1st and 2nd digit support inferior occiput.
  3. ) Apply a traction and posterior force with the cranial hand. “Pull head apart”
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21
Q

What is a positive Tectoral Membrane Test?

A

Reproduction of myelopathic symptoms, excessive translation of C0 on C1/ C1 on C2

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22
Q

What is a positive Tectoral Membrane Test indicative of?

A

Tectoral membrane instability (upper c-spine integrity)

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23
Q

Describe the procedure for the Posterior A-O Membrane Test.

A
  1. ) Stand at patient’s side
  2. ) Caudal hand reaching cranially with pincer grasp on lateral aspects of C1, cranial hand reaching caudally such that 1st and 2nd digit support inferior occiput.
  3. ) Apply a traction and posterior force with the cranial hand. “Pull head apart”
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24
Q

What is a positive A-O Membrane Test?

A

Reproduction of myelopathic symptoms, excessive translation

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25
Q

What is a positive A-O Membrane Test indicative of?

A

Atlantooccipital membrane instability

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26
Q

Describe the procedure for the Alar Ligament Stability Test.

A
  1. ) Caudal hand with pincer grasp on spinous process of C2, cranial hand supporting cranium
  2. ) Cranium passively laterally flexed and rotated bilaterally
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27
Q

What is a positive Alar Ligament Stability Test?

A
  • movement not palpated at C2 (palpation) OR absence of a distinct stop when C2 is stabilized (stabilized)
  • reproduction of myelopathic symptoms
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28
Q

Alar Ligament Stability Test can be done in what 2 ways?

A
  • palpation

- stabilization

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29
Q

Describe the procedure for Cervical Flexion-Rotation Test.

A
  1. ) Position patient in supine
  2. ) Fully flex neck and stabilize cranium (can rest head on abdomen)
  3. ) Passively rotate c-spine to full motion bilaterally
30
Q

What is a positive Cervical Flexion-Rotation Test?

A
  • reproduction of cervicogenic headache

- limited ROM to one side by >/=10 degrees

31
Q

What is a positive Cervical Flexion-Rotation Test indicative of?

A

Assess dysfunction at the C1/C2 motion segment, presenting as headache.

32
Q

Describe the procedure for Upper Limb Tension Test (ULTT).

A
  1. ) Position patient in supine with therapist standing facing cranially on symptomatic side of table
  2. ) Depress the shoulder by bearing weight onto table
  3. ) Abduct patient’s arm to 110 degrees
  4. ) Supinate forearm
  5. ) Extend wrist and fingers
  6. ) ER shoulder
  7. ) Elbow extension
  8. ) Sensitive with neck lateral flexion
33
Q

What is a positive ULTT?

A

Provocation of concordant radicular symptoms with sensitization maneuver and/or alleviation of concordant radicular symptoms with desensitization maneuver.

34
Q

What is a positive ULTT indicative of?

A

Cervical radiculopathy

35
Q

When assessing AROM, what 4 things are we looking for?

A
  • Quantity
  • Quality
  • Provocation
  • Willingness to move
36
Q

When assessing PROM, we are assessing to ___-range and are looking for symptoms, quality, and quantity.

37
Q

When performing resistive testing, we are performing ________ resistance and are gradually ramping the intensity while assessing for ___________.

A
  • isometric

- symptoms

38
Q

Describe the procedure for a Central Posterior-Anterior (CPA) Joint Mob Test.

A
  1. ) Position patient in supine.
  2. ) Keep the elbows straight to ensure UEs align with the direction of your force throughout testing.
  3. ) Apply a mobilizing force to the spinous processes ventrally.
39
Q

Describe the procedure for a Unilateral Posterior-Anterior (UPA) Joint Mob Test.

A
  1. ) Position patient in supine.
  2. ) Keep the elbows straight to ensure UEs align with the direction of your force throughout testing.
  3. ) Apply a mobilizing force to the articular pillar ventrally on both sides.
40
Q

Describe the procedure for a AO Flexion/Extension Test.

A
  1. ) Position patient in supine.
  2. ) Examiner stands at head of the bed facing patient.
  3. ) Palpate between the mastoid process and the transverse process of C1 while stabilizing the cranium with bilateral hands.
  4. ) Gently flex the cranium on the upper c-spine.
  5. ) Repeat with extension.
41
Q

What should be observed when performing a Flexion/Extension Test?

A

Space should increase during C1-C0 flexion and decrease during extension.

42
Q

Describe the procedure for a Lateral Flexion Test.

A
  1. ) Position patient in supine.
  2. ) Examiner stands at head of the bed facing patient.
  3. ) Palpate the posterior arch of C1 while stabilizing the cranium with bilateral hands.
  4. ) Gently laterally flex the cranium on the upper c-spine.
43
Q

What should be observed when performing a Lateral Flexion Test?

A

Posterior arch of C1 should become more prominent.

44
Q

Describe the procedure for C1-C2 Mobility Testing: Rotation.

45
Q

What should be observed when performing a C1-C2 Mobility Testing: Rotation?

A

Normal quantity of movement consistent with that expected at atlantoaxial joint.

46
Q

Describe the procedure for C2/C3 - C4/C5 Mobility Testing: Flexion.

47
Q

What should be observed when performing a C2/C3 - C4/C5 Mobility Testing: Flexion?

A

Opening of joint described as expected observation (compare symmetry and approximate motion).

48
Q

Describe the procedure for C2/C3 - C4/C5 Mobility Testing: Extension.

49
Q

What should be observed when performing a C2/C3 - C4/C5 Mobility Testing: Extension?

A

Closing of joint described as expected observation (compare symmetry and approximate motion).

50
Q

Describe the procedure for C2/C3 - C5/C6 Unilateral Up-Glides: Mobility Testing.

51
Q

What should be observed when performing a C2/C3 - C5/C6 Unilateral Up-Glides: Mobility Testing?

A

Opening of joint described as expected observation (compare symmetry and approximate motion).

52
Q

Describe the procedure for C2/C3 - C5/C6 Unilateral Down-Glides: Mobility Testing.

53
Q

What should be observed when performing a C2/C3 - C5/C6 Unilateral Down-Glides: Mobility Testing?

A

Closing of joint described as expected observation (compare symmetry and approximate motion).

54
Q

Describe the procedure for Lower C-Spine Mobility Testing: Flexion.

55
Q

What should be observed when performing a C-Spine Mobility Testing: Flexion?

56
Q

Describe the procedure for Lower C-Spine Mobility Testing: Extension.

57
Q

What should be observed when performing a C-Spine Mobility Testing: Extension?

58
Q

CONFIRMATION TESTS

A

CONFIRMATION TESTS

59
Q

Describe the procedure for Spurling’s Compression Test.

A
  1. ) Position patient in sitting with a neutral neck position.
  2. ) Establish resting symptoms.
  3. ) With examiner posterior to patient, patient laterally flexes to the symptomatic side. (Stop here per positive test if concordant radicular symptoms observed)
  4. ) Provide combined axial compression and lateral flexion overpressure to the patient’s crown.
60
Q

What is a positive Spurling’s Compression Test?

A

Provocation of concordant radicular symptoms.

61
Q

Describe the procedure for a Cervical Distraction Test.

A
  1. ) Position patient in supine.
  2. ) Examiner standing at head of the bed facing patient.
  3. ) Cradle the occiput with one hand, while keeping the shoulder of that hand in contact with the patient’s forehead for stabilization.
  4. ) Contralateral hand can overlay other hand or be placed under patient’s chin.
  5. ) Establish resting symptoms.
  6. ) Apply a traction force with body weight.
62
Q

What is a positive Cervical Distraction Test?

A

Alleviation of concordant radicular symptoms.

63
Q

Describe the procedure for a Cervical Compression Test.

A
  1. ) Position patient in sitting with a neutral neck position.
  2. ) Establish resting symptoms.
  3. ) With examiner posterior to the patient, apply axial compression to the patient’s crown.
64
Q

What is a positive Cervical Compression Test?

A

Provocation of concordant radicular symptoms.

65
Q

Describe the procedure for a Brachial Plexus Compression Test.

A
  1. ) Position patient in sitting.
  2. ) Establish resting symptoms.
  3. ) With examiner posterior or laterally to patient, apply a compressive force just above the clavicle.
66
Q

What is a positive Brachial Plexus Compression Test?

A

Provocation of concordant radicular symptoms.

67
Q

Describe the procedure for a Valsava Maneuver.

A
  1. ) Position patient in sitting.
  2. ) Examiner anterior to patient to observe response.
  3. ) Instruct the patient to hold breath and bear down.
68
Q

What is a positive Valsava Maneuver Test?

A

Provocation of concordant radicular symptoms.

69
Q

PERFORMANCE MEASURES

A

PERFORMANCE MEASURES

70
Q

Describe the procedure for a Neck Flexor Muscle Endurance Test.

A
  1. ) Position patient in supine hook lying.
  2. ) Position patient into maximal retraction.
  3. ) Patient maintains retraction while lifting head ~1 inch off of table.
  4. ) Line drawn on skin folds.
  5. ) If position begins to be compromised, verbal cues to hold the head up or tuck the chin.
  6. ) Time patients ability to hold until (1) loss of capital flexion position or (2) head touches examiners hands >1s.
71
Q

Describe the procedure for a Craniocervical Flexion Test.

A
  1. ) Position patient in supine hook lying.
  2. ) Pressure biofeedback unit placed behind subjects upper neck.
  3. ) Bladder inflated to =20mmHg.
  4. ) Using the pressure gauge for visual feedback, the patient progressively targets and holds 5 pressure levels for 10s (22, 24, 26, 28, and 30mmHg).
  5. ) 10s rest taken between each trial.
  6. ) Test stopped when the resting pressure of the bladder decreases >20mmHg OR the subject cannot perform the motion without substitutions.

S3- Musculoskeletal (27 decks)

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