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PHTH 565 Cervical > Cervical summary > Flashcards

Cervical summary Flashcards

1
Q

What motions are coupled in the cervical spine?

A

SF and ROT

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2
Q

what portion does more SF ?

A

mid

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3
Q

What drys up faster cervical or lumbar disc ?

A

Cervical

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4
Q

Where does the mid cervical refer to ?

A

medial boarder of scap

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5
Q

What is a major contra to cervical Rx

A

RA do not dot MOBS on RA pt’s

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6
Q

Do you need to scan everyone with neck pain?

A

Yes

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7
Q

What has a better prognosis immediate pain or insidious

A

immediate worse prof.

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8
Q

When can you do a passive test overpressure on the c spine

A

ONLY if painfree active ROM and no neuro or log or vascular damage

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9
Q

What is indicative of serious path in the neck?

A

Painful weakness of short neck flexors could mean instability or #
** Do NOT overpressure if 5d’s are there***

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10
Q

Pt presents with weakness of hand intrinsics what are your concerns?

A

T1 tumor

**NOT associated with disc issues **

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11
Q

What do PAVMs tell u?

A

if a jt is stiff/hyper/ and end feel

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12
Q

Contraindications for PA Pressure in the neck?

A 
Local fracture
local inflam
active neo
infection acute trauma 
local instability 
vascular patho of the carotid  or vert arteries

PRECAUTIONS
Osteoporosis
Anti-coagulatns

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13
Q

what is the most common degenerative spot in teh c spine

A

c5/6

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14
Q

Where and what does the alar ligament do?

A

Runs from Dens on C2 to the tubercles on the medial occipital condyle
*“check ligament” checks side to side movements

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15
Q

What does the transverse lig of the atlas do?

A

It runs like a cruciate lig and keeps the dens held anterior in the arch of the axis

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16
Q

What are common outcome measures for the neck

A

Neck disability index (NDI) (50 pts or 100% is pt rated MAX disability
*CIChange is 5 pts

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17
Q

What do NDT’s test when is it ++?

A

nerve mobility - see if restriction b/w interfaces its passes (IVF, muscle, Facet jt.)

  • if it reproduces sympt. or restriction in mobility its ++ Vs other side
  • if ++ use 1-3 graded tech (watch irritability)
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18
Q

Pt presents and is very irritable and their condition is worsening what are these indications of and would you use NDT

A
  • ## they are contra along with neuro SIGNS, undiag condition, spinal cord or CE compromise
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19
Q

What are the NDT tests?

A 
ULNT 1= Median nerve bias (abduction)
ULNT 2 = Median nerve (Depression) 
UNLT 3 = Radial nerve bias 
UNLT 4 = Ulnar nerve 
(know what directions increase/dec tension)
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20
Q

What is the normal response of the Median nerve bias?

A

stretch sensation in the antecubital fossa, tingling in thumb and first 3 fingers

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21
Q

What is the normal response for the Radial nerve.

A

stretch pain sensation in lateral forearm &/or stretch P in lateral upper arm

22
Q

Ulnar nerve bias normal response?

A

stretch P hypothenar eminence and med 2 fingers or pins/needles same distribution

23
Q

WHat is the standardized position for NDT?

A

supine legs straight opps . arm at side (pt could be on diagonal as well )

24
Q

What are the known positions of vert artery compromise?

A

Ext, rotation, traction

25
Q

What are S & S of vert art compromise? WHAT arteries do these include?

A 
5D's
Nystagmus
Perioral numbness 
ataxia
nausea 
vomiting
tinnitus 
5D's 
(carotids and opposite vertebral artery) 
NEVER DO EXT/ROTATION AND TRACTION TOGETHER !!!
26
Q

What are positive tests for the craniovertebral region of the neck?

A

soft end feel w. p or spasm
lump in throat/shortness of breath (could be d/t swelling post MVA or haematoma, retropharyngeal)
- spinal cord signs
- ver artery signs
ANY OR ALL OF THESE ARE ++ TESTS PT PUT INTO A HARD COLLAR REFER BACK TO DOC FOR POSSIBLE MRI
* Positives are rare though

27
Q

What structures are tested in the anterior (Shap purser/supine anterior shear) tests?

A

Transverse lig/dens

28
Q

What is tested in the vertical stability test?

A

Tectorial mem., AO, AA, ant and post membr

29
Q

What is tested with the kinetic test/stability test

A

alar ligament/jt. capsule

30
Q

What are the stability tests in the CV regions

A

1) anterior shear, sharp pursar
2) vertical stability of AA/AO
3) Rotational kinetic test/stabilty test

31
Q

When performing the sharp purser test your patient gets symp *& signs w flex which is made better post test. What does this mean?

A

This is indicative of a positive test and means that the C1 vert on flex was ant subluxed on C2 and the posterior pressure on c1 put it back into place and decreased the signs

32
Q

YOu think you pt has a stiff segment in the neck while doing a Flex PIVM what do you do next?
WHat if there was excessive mobility?

A

Test it with PAVM to confirm

  • excessive = need to do stability tests!
  • PIVMS = you can then grade appropriately to decrease pain via mechanorecpetor effect or vascular pumping
33
Q

WHat are the:
History
Signs & Rx
FOr postural neck pain?

A

Hx - grandual onset/bilat Sympt local or referred
Agg - prolonged postures (sitting/lying)
Ease - by moving
Signs - FHP, poor T-spine posture, decreased CV flex, painful ext, P/A tender W. spasm
Rx–> exs postural/ergo advice/ soft tissue

34
Q

WHat are the:
History
Signs & Rx
For Spondylosis/DDD (degenerative disc disease)

A

Hx - >problems, c/o stiffness wtih static postures better with some motion
Agg: static postures
Ease - with motion
Signs - Xray = OA and osteophytes , cap pattern
P/A - stiff +/- pain
END FEEL - hard capsular/bony (osteophytic)
Rx- PAs, exs, postural /ergo advice/soft tissue rx.

35
Q

What is the cap pattern of the neck?

A

bilateral= SF/Rot/painful ext / full flexion

36
Q

WHat are the:
History
Signs & Rx
FOr cervical disc lesion

A

Hx- acute onset/ interscapu.ar pain +/- radicular pain (trauma or poor positioning)
Agg- with specific mvot. , compression ** Flexion***
Ease - lying down. traction
Signs - deformity, neck held in flexion or side flexion
- reduced motion part. flex/rotation/SF to the side of P
- +/- nerve root signs
- +/- dural signs
Rx - traction, soft tissue, exs.postural /ergo info

37
Q

WHat are the:
History
Signs & Rx
For cervical radiculopathy ?

A

Cause - dis, Z jt swelling/ thickening, degen. changes - osteophytes, UV Jt degen. (anything that can compress nerve root)
Hx - acute could be slow to progress
Signs - decreased motion - ext/sf/rot same side d/t P and + spurlings,
- opposite move. may be tight (Flex, contra sf/rot)
- neuro sign +/- nerve root +/- dural signs
P/A - painful and stiff; unilateral stiff /painful
Rx - traction, PA (Rx pP and stiff, soft tissue, exs, ergo educ

38
Q

WHat are the:
History
Signs & Rx
For Isolated Z jt dysfunction

A

Hx - onset - acute; could be gradual
- pain uni & local +/- referred to arm, scap hd
Agg: motion
Eased: rest
Signs: restriction motion - stretch pattern - F/SF/Rot away
compression pattern = Ext/SF/Rot towards
- segmental muscle guarding
Rx - Educa., soft tissue, PA’s unilateral,

39
Q

What is the stretch and compression patterns of an effected Z jt dysfunction/

A

F/SF/ Rot away

compression = ext/SF/Rot towards

40
Q

WHat are the:
History
Signs & Rx
For Cervical instability?

A

Hx - trauma/repeat episodes/consistently inconsistent / posture
- local +/- referred P
Agg - static postures / sleep positions
Signs -poor posture, HF, flattened C curve d/t spasm/ guarding decreased ROM
- Segmental multifidus spasm
- weak deep neck flexors
P/A’s reactive spasm +/- P or increased translation (may be hypo segment around this one)
Rx - stab program, strengthening, soft tissue, exs post educe.

41
Q

WHat are the:
History
Signs & Rx
FOr generalized mechanical dysfunction?

A

+/- postural imbalance
+/- muscle imbalance
+/- segmental dysfunction - restriction or hyper mobility
Rx - per findings

42
Q

WHat are the:
History
Signs & Rx
for acceleration /deceleration injury.

A

also called WAD, cervical sprain/strain
Management: early motion key ** pt participation and self management
- foundation to rehab early intervention by pt effective at decreasing P imp mobility
Goals to Rx:
- base off Ax/ occupt./sport change depending on response

43
Q

What are the quebec WAD’s scale

A

Grade I - neck P, stiffness, tenderness only no physical signs
Grade II - neck complaint, and MSk signs (decreased ROM, Pt tenderness)
Grade III- neck complaint, neurologicla signs (weakness, sensory deficit, decreased reflexes)
Grade IV - neck complaint and fracture or dislocation

44
Q

What are some aspects of Rx for WAD injuries

A

exercises: ROM (want ot stim healing)
Man therapy: joint mob/manipulation/myofasical
mechanical forces - traction/ supports

45
Q

What are the major components to Rx a WAD Injury

A

1) Application of controlled forces
2) optimize physical performance (jt rom, strength, flexibility…)
3) Pain management techniques
4) Client education
5) Ongoing evaluation

** prevent a soft tissue impairment from becoming a soft tissue disability**

46
Q

What are the components to therapeutic exs. program for the neck? What can alter the mechanics of the neck?

A

1) mobility
2) stability
3) strength
4) Specificity
- muscle imbalance which causes some to shorten others to lengthen then changes relationship

47
Q

What muscles are typically tight in cervical region?

A 
Pecs 
upper traps
lev scap 
SCM
Rectus capitis major and minor
superior and inferior obliques
48
Q

What muscles tend to be weak in the neck?

A 
Deep neck flexors 
rhomboids
mid and and lower traps
suprahyoids
mylohyloid
longus coli
49
Q

how would you instruct someone on deep neck flexor strengthening?

A

tongue to roof of mouth
lips together teeth apart dont clench jaw
hold 10sec
- start with 10 reps x1 daily progress up

50
Q

What are your Rx principals for DNF as per prescription?

A
  • st. w. core stability and DNF
  • P in neck inhibits DNF alters movt patterns
  • Cerviocognic headaches –> type 1 - type 2 fibers
  • Scapular stability for cervical posture and pain syndromes
  • Assess their DNF stg. and ability in diff positions
  • st. with DNF (inner unit) work to outer unit (arm movt. scap stability)
  • Longus coli and capitis
51
Q

When you are starting your cervical Ax what anterior stability test should you start with and why?

A

st. with sharp pursur b/c its active and safe

PHTH 565 Cervical (1 decks)

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