Cervical Spine Intervention and Examination Flashcards
1
Q
Origin of cervical neck pain is often…
A
Indefinable
2
Q
Main Elements of Subjective examination
A
Nature of disorder Area of symptoms Behavior of symptoms Present History Past History Special Questions Questionnaires
3
Q
Chemical Pain Behavior
A
Acute Constant/High levels Recent onset Easy aggravation Responds to NSAIDS
4
Q
Mechanical Pain Behavior
A
Intermittent pain Variable levels/ usually local Changes in position or direction eases pain short lived symptoms Variable response to NSAIDS
5
Q
5 D’s
A
Dizziness, Drop Attacks, Disarthria, Dysphasia, Diploplia
6
Q
Disarthria
A
Trouble swallowing
7
Q
Dysphasia
A
Trouble speaking
8
Q
Diplopleia
A
Double vision
9
Q
Neck Disability Index
A
ASAP when they come into clinic
10 item condition specific self-report questionnaire
0-50 score
Minimal detectable change = 5 points
10
Q
Patient Specific Functional Scale
A
Patient identifies 3 items of difficulty
Rates each item 0-10
Final score is an average of the three
Minimal detectable change = 2.1 Points
11
Q
Common medical diagnosis for pts presenting with neck pain
A
Herniated disc Cervical Radiculopathy Stenosis Spondylosis Spondylolysis Spondylolesthesis Whiplash Cervicogenic headaches Post-surgical
12
Q
Purpose of physical exam
A
Funnel info; narrow focus
13
Q
Physical exam components
A
ROS
Cervical Spine Exam
Special tests
14
Q
Cervical FLX Norm
A
45 degrees
15
Q
Cervical EXT Norm
A
45 degrees
16
Q
Cervical side-bending Norm
A
45 degrees
17
Q
Cervical rotation Norm
A
60 degrees
18
Q
AROM movement
A
Looking at available range
Is Concordant sign reproduced?
19
Q
Derangement
A
Disruption in how surfaces come together
20
Q
Dysfunction
A
Adaptively shortened tissue
21
Q
Postural
A
Abnormal stress on otherwise healthy tissue
22
Q
Repeated movement testing
A
Sitting position with good posture
Sagittal plane 1st
23
Q
Sudden vs chronic pain indications
A
Sudden: Derangement
Chronic: Dysfunction
24
Q
Pain during movement indication
A
Derangement
25
Pain at end range indication
Dysfunction
26
Varied response to RMT indication
Derangement
27
Consistent response to RMT indication
Dysfunction
28
No response to RMT indication
Postural
29
PROM looking to assess...
Movement between segments
End-feel
Pt response to movement
30
Passive accessory motion testing
Prone or supine
Assesses movement; end feel; Pt response
Graded hypo/hyper mobile, normal end feel
31
Tests for neurological symptoms
```
Cranial nerve testing
DTR/MSR (Biceps, brachioradialis, triceps)
Myotomes
Sensation
Spurling's test
Distraction Test
Upper Limb Nerve Tension Testing
Special tests for UMN lesions
```
32
UMN lesion tests
Babinski's reflex
Hoffman's sign
Rhomberg test
Lhermitte's sign (lightning down spine)
33
Tests for vascular signs
Vertebral artery test
| Have to do this before any manipulation
34
Tests for cervical spine instability
```
Alar ligament test
Transverse ligament test
Modified Sharp pursers test
Aspinall's
Tectorial Membrane
```
35
Ataxia
Disturbance of gait
36
Palpation
In supine or sitting
| Structures on anterior, lateral, and posterior aspect of the cervical spine
37
Canadian C-spine rules
Cognitively impaired, displays neurologic symptoms in extremities
Age > 65
Fearful of moving head
Distraction based injury
Midline pain
Imaging should be done if patient meets criteria
38
Cervicogenic HA
Originate from upper cervical spine
Symptoms change with movement testing
Symptoms noted in sub-occipital region, temporal, frontal, and orbital region
39
Internal Carotid Ateriole Dissection
Temporal region
Worst headache of my life
May present with upper motor neuron signs
Medical emergency
40
Cervical Radiculopathy
Most likely have arm and neck symptoms
Likely referred pain
Parasthesias follow a dermatomal pattern
Neuroscreen reveals weakness in particular myotome
41
Thoracic Outlet Syndrome
Variety of symptoms including neck pain and shoulder pain
Arm feels heavy or weak
Hands feel cold
Difficulty with repetitive arm movements at or above shoulder level
42
Wainner's CPR for cervical radiculopathy
Cervical Spine rotation less than 60 degrees
Positive Spurlings test
Positive distraction test
Positive upper limb nerve tension test
43
Basic Managing Principles
```
Stage of recovery
Exam Findings
Pts beliefs/goals
Evidence to support intervention
Test-treatment-retest-treatment
```
44
PROM positioning and order
Supine
Examiner cradles head
Least painful to most painful movements
45
Passive accessory motion specific movements
P:A CVP
P:A UVP
Transverse VP
A:P UVP
46
Resisted Isometric Testing
Provides clinician w/ info regarding tissue reactivity
47
MMT
Provides clinician w/ info regarding strength
48
Cervical Spine Exam Order
```
Observation
AROM
Repeated Movements
PROM
Passive Accessory Motion
Muscle Performance testing
Special Tests
Palpation
```
49
Components of observation
```
Visual Inspection of Head and Neck
"Poking Chin"
"Wry Neck"
Shoulder girdle position
Function (Transfers, Gait, Movement)
```
50
RMT movements
```
Protraction
Retraction
Retraction w/ extension
Sidebending
Rotation
```
51
UNLT Testing
```
Mechanical and phsyiologic ability of the nervous system
Peripheral nerves (Median, Radial, Ulnar)
```
52
Positive findings of UNLT Testing
One or more:
Reproduces concordant sign
Sensitizing movement alters pain
Difference from side to side (ROM: 10 degrees)
53
Vertebral Artery Tests
```
Rotation in sitting
Variations:
Ext; lateral flx
Ext; rotation (Wallenberg's position)
Ext; rotation; lateral flx
```
54
What should be noted during palpation?
```
Soft or bony
Tenderness or pain
Muscle tone
Skin texture and temperature
Skin mobility
```
55
RMT Intervention
Ideally in sitting
Pt generated force before clinician
Alternate positions of prone or supine
Performed every few hours
56
Interventions addressing hypomobility
Patient education
Thrust and non-thrust manipulation to c-spine
Soft tissue mobilization and stretching of restricted connective tissue
AROM/PROM into restriction
Postural Education
Muscle performance training
57
Interventions addressing hypermobility
Patient education
Local Modalities in acute/irritable conditions
Stabilization activities (Muscle endurance/motor learn)
Address postural muscle strength/endurance
58
Sensitivity
SNOUT
Negatives are strong
Positives dont mean much
59
Specificity
SPIN
Negatives dont mean much
Positives rule in
60
Pain/Inflammation Control
Local Modalities
Pt Education (Activity modification, Breathing Techniques)
Manual Therapy (Traction <5 min) (Gr. I & II non-thrust)
AROM/PROM in pain free range
Progress towards a mobility
61
Grade I mobilization Parameters
1-3 sets, no pain, between 30-60 seconds
62
Grade II mobilization Parameters
1-3 sets, no pain, between 30-60 seconds
63
Grade III Mobilization parameters
3-5 sets, 3-5 minutes, into resistance or pain
64
Grade IV Mobilization parameters
3-5 sets, 3-5 minutes, into resistance or pain
65
Neuromobilization
In the presence of radicular symptoms or neurogenic symptoms
Test is treatment
Sliders and Tensioners
Passive movements should be graded
66
Slider
No tension on nerve, pulled through the tunnel
| No longer than 3 minutes
67
Tensioner
Putting tension on nerve to realign fibers
| No longer than 3 minutes
68
Patient Education
Inform the patient about their prognosis and plan of care
Limitations concerning stage of healing
Learn how to manage symptoms independently
Postural awareness
Prevention of future episodes
HEP (What, why, how often, how long)
