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
2
Q
What are the 2 things done with a patient interview?
A
- Special Questions
- Outcome Measures
3
Q
What is an example of an outcome measure that is done during the patient interview?
A
PSFS (Patient Specific Functional Scale)
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)
5
Q
What are the 5 parts of a systems review?
A
- Integumentary
- Cardiopulmonary
- Musculoskeletal
- Neuromuscular
- Cognition/Affect
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.
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
8
Q
What c-spine motions are we assessing during the Upper Quarter Screen?
A
- flexion
- extension
- lateral flexion
- rotation
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
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
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
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
13
Q
SPECIAL TESTS
A
SPECIAL TESTS
14
Q
Describe the procedure for the End-Range Rotation Test.
A
- ) During patient interview, identify symptoms consistent with CAD.
- ) Position patient at end-range of rotation for 10s.
- ) Return to neutral position for 10s.
- ) Repeat rotation and hold for 10s in other direction.
15
Q
What is a positive End-Range Rotation Test indicative of?
A
CAD (Cervical Arterial Dysfunction)
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
17
Q
Describe the procedure for the Modified Sharp Purser Test.
A
- ) Assess for resting symptoms
- ) Patient slightly flexes neck
- ) Posterior C2 stabilized by examiner
- ) With other hand, examiner places posterior force on cranium through patient’s forehead
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.
19
Q
What is a positive Modified Sharp Purser Test indicative of?
A
Transverse ligament instability
20
Q
Describe the procedure for the Tectoral Membrane Test.
A
- ) Stand at patient’s side
- ) Caudal hand supporting c-spine spinous processes from C2 down, cranial hand reaching caudally such that 1st and 2nd digit support inferior occiput.
- ) Apply a traction and posterior force with the cranial hand. “Pull head apart”
21
Q
What is a positive Tectoral Membrane Test?
A
Reproduction of myelopathic symptoms, excessive translation of C0 on C1/ C1 on C2
22
Q
What is a positive Tectoral Membrane Test indicative of?
A
Tectoral membrane instability (upper c-spine integrity)
23
Q
Describe the procedure for the Posterior A-O Membrane Test.
A
- ) Stand at patient’s side
- ) 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.
- ) Apply a traction and posterior force with the cranial hand. “Pull head apart”
24
Q
What is a positive A-O Membrane Test?
A
Reproduction of myelopathic symptoms, excessive translation
25
What is a positive A-O Membrane Test indicative of?
Atlantooccipital membrane instability
26
Describe the procedure for the Alar Ligament Stability Test.
1. ) Caudal hand with pincer grasp on spinous process of C2, cranial hand supporting cranium
2. ) Cranium passively laterally flexed and rotated bilaterally
27
What is a positive Alar Ligament Stability Test?
- movement not palpated at C2 (palpation) OR absence of a distinct stop when C2 is stabilized (stabilized)
- reproduction of myelopathic symptoms
28
Alar Ligament Stability Test can be done in what 2 ways?
- palpation
| - stabilization
29
Describe the procedure for Cervical Flexion-Rotation Test.
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
What is a positive Cervical Flexion-Rotation Test?
- reproduction of cervicogenic headache
| - limited ROM to one side by >/=10 degrees
31
What is a positive Cervical Flexion-Rotation Test indicative of?
Assess dysfunction at the C1/C2 motion segment, presenting as headache.
32
Describe the procedure for Upper Limb Tension Test (ULTT).
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
What is a positive ULTT?
Provocation of concordant radicular symptoms with sensitization maneuver and/or alleviation of concordant radicular symptoms with desensitization maneuver.
34
What is a positive ULTT indicative of?
Cervical radiculopathy
35
When assessing AROM, what 4 things are we looking for?
- Quantity
- Quality
- Provocation
- Willingness to move
36
When assessing PROM, we are assessing to ___-range and are looking for symptoms, quality, and quantity.
end-range
37
When performing resistive testing, we are performing ________ resistance and are gradually ramping the intensity while assessing for ___________.
- isometric
| - symptoms
38
Describe the procedure for a Central Posterior-Anterior (CPA) Joint Mob Test.
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
Describe the procedure for a Unilateral Posterior-Anterior (UPA) Joint Mob Test.
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
Describe the procedure for a AO Flexion/Extension Test.
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
What should be observed when performing a Flexion/Extension Test?
Space should increase during C1-C0 flexion and decrease during extension.
42
Describe the procedure for a Lateral Flexion Test.
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
What should be observed when performing a Lateral Flexion Test?
Posterior arch of C1 should become more prominent.
44
Describe the procedure for C1-C2 Mobility Testing: Rotation.
1.)
45
What should be observed when performing a C1-C2 Mobility Testing: Rotation?
Normal quantity of movement consistent with that expected at atlantoaxial joint.
46
Describe the procedure for C2/C3 - C4/C5 Mobility Testing: Flexion.
1.)
47
What should be observed when performing a C2/C3 - C4/C5 Mobility Testing: Flexion?
Opening of joint described as expected observation (compare symmetry and approximate motion).
48
Describe the procedure for C2/C3 - C4/C5 Mobility Testing: Extension.
1.)
49
What should be observed when performing a C2/C3 - C4/C5 Mobility Testing: Extension?
Closing of joint described as expected observation (compare symmetry and approximate motion).
50
Describe the procedure for C2/C3 - C5/C6 Unilateral Up-Glides: Mobility Testing.
1.)
51
What should be observed when performing a C2/C3 - C5/C6 Unilateral Up-Glides: Mobility Testing?
Opening of joint described as expected observation (compare symmetry and approximate motion).
52
Describe the procedure for C2/C3 - C5/C6 Unilateral Down-Glides: Mobility Testing.
1.)
53
What should be observed when performing a C2/C3 - C5/C6 Unilateral Down-Glides: Mobility Testing?
Closing of joint described as expected observation (compare symmetry and approximate motion).
54
Describe the procedure for Lower C-Spine Mobility Testing: Flexion.
1.)
55
What should be observed when performing a C-Spine Mobility Testing: Flexion?
1
56
Describe the procedure for Lower C-Spine Mobility Testing: Extension.
1.)
57
What should be observed when performing a C-Spine Mobility Testing: Extension?
1
58
CONFIRMATION TESTS
CONFIRMATION TESTS
59
Describe the procedure for Spurling's Compression Test.
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
What is a positive Spurling's Compression Test?
Provocation of concordant radicular symptoms.
61
Describe the procedure for a Cervical Distraction Test.
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
What is a positive Cervical Distraction Test?
Alleviation of concordant radicular symptoms.
63
Describe the procedure for a Cervical Compression Test.
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
What is a positive Cervical Compression Test?
Provocation of concordant radicular symptoms.
65
Describe the procedure for a Brachial Plexus Compression Test.
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
What is a positive Brachial Plexus Compression Test?
Provocation of concordant radicular symptoms.
67
Describe the procedure for a Valsava Maneuver.
1. ) Position patient in sitting.
2. ) Examiner anterior to patient to observe response.
3. ) Instruct the patient to hold breath and bear down.
68
What is a positive Valsava Maneuver Test?
Provocation of concordant radicular symptoms.
69
PERFORMANCE MEASURES
PERFORMANCE MEASURES
70
Describe the procedure for a Neck Flexor Muscle Endurance Test.
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
Describe the procedure for a Craniocervical Flexion Test.
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.
