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Musculoskeletal Rehab > Cervical Spine Examination Part 2 > Flashcards

Cervical Spine Examination Part 2 Flashcards

1
Q

What is the Neck Disability Index (NDI)?

A
  • Must be given before care starts
  • 10 item condition-specific self-report questionnaire
    -7 items measure functional status
    -3 items measure (pain intensity, concentration, headache)
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2
Q

How is the NDI measured?

A

0-50 score (lower scores more desirable)/50 x 100
- Minimal detectible change = 5 points or 10%
- 30% considered a useful cut off score for prognosis
- >30% poorer prognosis

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3
Q

What is the Numeric Pain Scale?

A

-Patients asked to say the intensity of their current pain, worst pain and best pain
-Uses 11 point scale (range from 0-11)
- Take an average of the 3 ratings to represent the patients level of pain over 24 hrs
-Minimal clinical important difference = 2 pts

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4
Q

What is the patient specific functional scale?

A

-Generic scale where PT has patient to say 3 things they find difficult to complete because of the injury, symptoms or disorder
- Patient rates each item from 0-10
- 10 = unable to perform
- 0 = able to perform as well as they could be for injury, symptoms or disorder
- Minimal detectable change = 2.1 pts
- minimal clinically important difference = 2pts

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5
Q

What is the global rating of change?

A
  • Scale ranging from -7 (very great deal worse) to 0 (about same) to +7 (a great deal better)
  • Scores of +4 and +5 are indicative of moderate changes in patient-perceived status
  • Scores of +6 and +7 indicate large changes in patient status
  • Score of +5 or greater at any follow up periods can be categorized as success
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6
Q

What is the Fear-Avoidance Beliefs Questionnaire?

A
  • Designed to quantify fear & avoidance beliefs in patients with neck pain
  • 2 sub scale: 7 item scale to measure fear-avoidance beliefs about work (FABQW)
    - 4 item scale to measure fear-avoidance beliefs about physical activity
  • Each item scored from 0 to 6, with possible scores ranging from 0-24 for FABQPA and from 0 to 42 for the FABQW
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7
Q

What are the scores from the Fear-Avoidance Beliefs Questionnaire that indicate modifications to rehabilitation programs may be needed?

A

FABQ physical activity scale >15
FABQ work scale >34

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8
Q

What is the purpose of the physical examination?

A
  • Support or refute initial hypothesis from subjective exam
  • Clarify options for treatment
  • Determine if the patient is appropriate for physical therapy intervention or needs a referral?
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9
Q

What are some components of a cervical spine exam?

A
  1. Observation (posture, structural alignment)
  2. Active ROM
  3. Repeated Movements
  4. Passive ROM
  5. Passive Accessory Motion Testing
  6. Neuro Exam
  7. Palpation
  8. Special Tests
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10
Q

What are you looking for in the observation portion of cervical spine exam?

A
  • Performed in sitting or standing
  • Visual inspection of Head & Neck (poking chin & forward head)
  • Observe Shoulder girdle (one shoulder elevated in comparison to other & rounded shoulders)
  • Function (ability to transfer)
    -Gait analysis (frequent loss of balance/unsteady gait)
    -Willingness to move (especially after trauma)
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11
Q

What are some components of AROM in cervical examination?

A
  • Looking at available ROM
    -Describe quality of movement and report any deviations
  • Keep track of location of symptoms and how they change with each movement
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12
Q

What are normal measurements of cervical flexion, extension, side bending & rotation?

A

Flexion: 45°
Extension: 45°
Side bending: 45°
Rotation: 60°

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13
Q

Besides flexion, extension, sidebending & rotation what are some active movements of the cervical spine?

A
  • Retraction (upper cervical flexion/lower cervical extension)
  • Protraction (upper cervical extension/lower cervical flexion)
  • Combined Movements (Ext,SB,ROT): quick screen to assess pain provocation, especially when trying to rule out cervical involvement
  • Over pressure: applied at end of AROM to clear motion/direction as potential source of pain/limitation
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14
Q

What is repeated movement testing?

A
  • Movement used for the purpose of assessment & management of pain
  • Test can become treatment
  • Looking for either peripheralization or Centralization
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15
Q

How is repeated movement testing performed?

A
  • Conducted in sitting position with good posture
  • Movements include:
    - Retraction
    - Retraction with extension
    - Protraction
    - Rotation or Sidebending
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16
Q

How is PROM of cervical spine performed?

A
  • Usually performed in supine position for max patient relaxation
  • Examiner uses cradle hold or chin cradle hold to move patients head into desired ROM
17
Q

What is an examiner looking to asses in PROM?

A

-Movement between segments (passive physiological intervertebral movement)
- End-feel
- Patient’s response to movement
- Check least painful movement to most painful

18
Q

How is passive accessory intervertebral motion testing performed?

A
  • Prone or Supine
  • Assessing movement, end feel & patients response to movement (any concordant signs)
    -Graded as hypo mobile, hyper mobile & normal end-feel
19
Q

What is an example of general passive accessory motion testing?

A
  • Distraction/traction
20
Q

What are the specific passive accessory motion testing?

A
  • Posterior to anterior CVP
  • Posterior to anterior UVP
21
Q

What are deep neck flexor tests testing and what are they are?

A
  • Endurance
  • Craniocervical flexion test
  • Neck flexor endurance test
22
Q

What are some components of muscle performance testing?

A

-Resisted isometric testing
-MMT
-Deep neck flexor testing

23
Q

What are tests for neurological symptoms?

A
  • Cranial Nerve Testing
  • DTRs/MSR (biceps C5, Brachioradials C5-6, Triceps C7)
  • Myotomes (C2-T1)
  • Sensation (dermatomal pattern)
  • Upper Limb Nerve Tension Testing (ULNTT)
  • Special tests for UMN lesions
24
Q

What specific tests are used to identify UMN lesions?

A
  • Babinski Reflex
  • Hoffmann’s Sign
25
Q

What is ULNT testing looking at?

A

Mechanical & physiologic ability of the nervous system

26
Q

What is the best peripheral nerve to test regarding C-spine?

A

Median

27
Q

What are the positive finding for ULNT testing?

A

-Reproduces patients pain
-Sensitizing movement alters pain
-Difference from side to side

28
Q

How and where is palpation performed?

A

-Supine (preferred) or sitting
- Palpate structures on anterior, lateral and posterior aspect of the cervical spine

29
Q

What is noted during palpation?

A
  • Soft or bony
  • Tenderness or pain
  • Muscle tone
  • Skin texture & temperature
  • Skin, muscle, nerve mobility

Musculoskeletal Rehab (13 decks)

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