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OCS Prep > Cervical Thoracic > Flashcards

Cervical Thoracic Flashcards

1
Q

neck pain with mobility deficits symptoms

A
  • central/unilateral neck pain
  • limitation in mobility that consistently reproduces neck pain
  • referred shoulder girdle/UE pain may be present
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2
Q

neck pain with mobility deficits expected exam findings

A
  • limited cervical ROM
  • neck pain reproduced at end range of active and passive motions
  • restricted cervical and thoracic segmental mobility
  • intersegmental mobility testing reveals characteristic restriction
  • neck and referred pain reproduced with provocation of the involved cervical or upper thoracic segments or cervical musculature
  • deficits in cervicoscapulopthoracic strength and motor control may be present in individuals with subacute or chronic neck pain
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3
Q

neck pain with movement coordination impairements common symptoms

A
  • MOI linked to trauma or whiplash
  • referred shoulder girdle or UE pain
  • associated varied nonspecific concussive signs and symptoms
  • dizziness/nausea
  • headache, concentration, or memory difficulties, confusion, hypersensitivity to mechanical thermal, acoustic, odor, or light stimuli; heightened affective distress
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4
Q

neck pain with movement coordination impairments expected exam findings

A
  • positive cranial cervical flexion test
  • positive neck flexor endurance test
  • positive pressure algometry
  • strength and endurance deficits of the neck muscles.
  • neck pain with mid-range motion that worsens wit end-range positions
  • point tenderness may include myofascial trigger points.
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5
Q

neck pain with movement coordination impairments expected exam findings

A
  • positive cranial cervical flexion test
  • positive neck flexor endurance test
  • positive pressure algometry
  • strength and endurance deficits of the neck muscles.
  • neck pain with mid-range motion that worsens wit end-range positions
  • point tenderness may include myofascial trigger points.
  • sensorimotor impairment may include altered muscle activation patterns, proprioceptive deficit, postural balance or control
  • neck and referred pain reproduced by provocation of the involved cervical segments
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6
Q

neck pain with headache symptoms

A
  • noncontinuous, unilateral neck pain and associated headache
  • headache is precipitated or aggravated by neck movements or sustained positions/postures
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7
Q

neck pain with headache expected exam findings

A
  • positive cervical flexion rotation test
  • headache reproduced with provocation of the involved upper cervical segments
  • limited cervical ROM
  • restricted upper cervical segmental mobility
  • strength, endurance, and coordination deficits of the neck muscles
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8
Q

neck pain with radiating pain symptoms

A
  • neck pain with radiating (narrow band of lancinating) pain in the involved extremity
  • upper extremity dermatomal paresthesia or numbness, and myotomal muscle weakness
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9
Q

neck pain with radiating pain expected exam findings

A
  • neck and neck-related radiating pain reproduced or relieved with radiculopathy testing; positive test cluster
  • may have UE sensory strength or reflex deficits associated with the involved nerve roots
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10
Q

clinical prediction rule for cervical manipulation

A
  • symptoms <38 days
  • positive expectation manipulation will help
  • cervical rotation ROM side to side difference is 10 degrees or greater
  • pain with PA testing med-cervical spine
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11
Q

treatment of acute neck pain with mobility deficits

A
  • thoracic manipulation
  • cervical mobilization or manipulation
  • cervical ROM, stretching, and isometric strengthening exercise
  • advice to stay active plus home cervical ROM and isometric exercise
  • supervised exercise, including cervicoscapulothoracic and UE stretching, strengthening, and endurance training
  • general fitness training
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12
Q

treatment of subacute neck pain with mobility deficits

A
  • cervical mobilization or manipulation
  • thoracic manipulation
  • cervicoscapulothoracic endurance exercise
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13
Q

treatment of chronic neck pain with mobility deficits

A

-thoracic manipulation
- cervical mobilization
- combined cervicoscapulothoracic exercise plus mobilization or manipulation
- mixed exercise for CST regions, neuromuscular exercise; coordination, proprioception, and postural training; stretching, strengthening, endurance training, aerobic conditioning, cognitive affective elements
- supervised individualized exercises
- stay active lifestyle approaches
- dry needling, low-level laser, pulsed or high-power ultrasound, intermittent mechanical traction, repetitive brain stimulation, TENS, electrical muscle stimulation

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14
Q

cervical myelopathy cluster

A
  • gait deviation
    • Hoffmann’s test
  • inverted supinator sign
    • Babinski test
  • age > 45

4/5 = 99%

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15
Q

intermittent traction parameters

A
  • supine
  • 60 sec pull force, 20 sec relaxation force (off cycle force is 50% of pull force)
  • force is 12 lbs
  • angle of pull is 15 to 24 degrees
  • 15 minutes
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16
Q

cervicogenic headache symptoms

A
  • 50/50 F/M
  • unilateral without sideshift
  • located occipital to frontoparietal and orbital
  • chronic or episodic
  • moderate to severe
  • lasts 1 hour to weeks
  • non-throbbing, non lancinating, pain usually starts in neck
  • triggers: neck movement, postures, limited ROM, pressure over C0-C3
  • similar migraine associated symptoms but milder, decreased ROM
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17
Q

migraine symptoms

A
  • 75/25 F/M
  • 60% unilateral with sideshift
  • located in frontal, periorbital, temporal
  • 1-4 per month
  • moderate to severe
  • lasts 4-72 hours
  • throbbing, pulsating
  • triggers: multiple, not neck movement
  • associated with nausea, vomiting, visual changes, phonophobia, photophobia
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18
Q

tension-type headache symptoms

A
  • 60/40 F/M
  • diffuse bilaterally
  • diffuse location
  • 1-30 per month
  • mild-moderate
  • lasts days to weeks
  • triggered by multiple things, not neck movements
  • associated with decrease appetite, phonophobia, photophobia
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19
Q

intercranial pathology

A
  • sudden onset of severe headache with increasing intensity
  • persistently unilateral headaches
  • headaches that wake patient in night or morning
  • generalized stiff neck or other signs of meningitis
  • weight loss, fever, malaise
  • focal neurologic symptoms
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20
Q

5 D’s, and 3 N’s

A

dizziness
drop attacks
diplopia (double vision)
dysarthria (speaking)
dysphagia (swallowing)

ataxia

nausea
numbness
nystagmus

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21
Q

cervical flexion rotation test

A

positive if less than 32 degrees

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22
Q

cranial cervical flexor test

A

chin tuck, not retraction

normal shoulder be 26-30mmHg pressure for 10 sec without compensation

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23
Q

neck flexor muscle endurance test

A

chin tuck with lift up to 2.5cm

normal is >38 seconds

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24
Q

cervicogenic headache cluster

A
  • decreased AROM cervical extension
  • palpably painful somewhere from OA to C3-4 joint dysfunctions
  • deep cervical flexor strength impairments w cranio-cervical flexion test
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25
Q

6 muscles tight with cervicogenic headaches

A

upper trap
levator
scalenes
SCM
pec major
pec minor

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26
Q

acute treatment of neck pain with HA

A
  • supervised instruction in active mobility exercise
  • C1-2 SNAG
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27
Q

subacute treatment of neck pain with HA

A
  • cervical manipulation and mobilization
  • C1-2 SNAG
28
Q

chronic treatment of neck pain with HA

A
  • cervical or cervicothoracic manipulation or mobilization combined with shoulder girdle and neck stretching, strengthening and endurance exercise
29
Q

nonischemic signs of CAD

A
  • horners syndrome
  • pulsatile tinnitus
  • cranial nerve palsies (9-12)
30
Q

less common nonischemic signs of CAD

A
  • ipsilateral carotid bruit
  • scalp tenderness
  • neck swelling
  • CN 6 palsy
  • orbital pai
  • anhidrosis
31
Q

ischemic signs of CAD

A
  • TIA
  • ischemic stroke
  • retinal infarction
  • amaurosis fugax (temporary loss of vision in one or both eyes due to lack of blood flow)
32
Q

how fast do CAD symptoms present after manipulation

A

72% within minutes
most within set up

33
Q

stable angina

A
  • chest pain/pressure
  • occurs during exercise
  • predictable
  • alleviated with rest or nitroglycerin
34
Q

unstable angina

A
  • unpredictable pattern
  • does not respond to nitroglycerin
  • signs consistent with MI
  • angina >30 min
35
Q

pericarditis s/sx

A
  • swelling in LE
  • anxiety
  • difficulty breathing and increased pain when supine
  • relieved by sitting up and leaning forward
  • sharp, stabbing pain
  • dry cough
  • fatigue
  • fever
  • chest pain with possible left UE symptoms
36
Q

pulmonary embolus s/sx

A
  • sudden onset of dyspnea
  • chest pain
  • tachypnea
  • wheezing
  • hypotension
  • chest pain with possible left UE symptoms
37
Q

pleurisy s/sx

A
  • sharp stabbing pain
  • aggravating with deep breaths, coughing, ribcage movements
  • chest pain with possible shoulder pain
  • shortness of breath
  • cyanosis
  • tachypnea
38
Q

pneumothorax s/sx

A
  • impaired chest expansion on involved side
  • decreased breath sounds
  • hyperresonance with percussion
  • sharp chest pain
  • aggravated with deep breath or cough
  • SOB
  • easy fatigue
  • tachycardia
  • cyanosis
39
Q

pneumonia s/sx

A
  • chills
  • fever
  • malaise
  • nausea
  • vomiting
  • cough that produces colored sputum
  • SOB
  • confusion
  • HA
  • loss of appetite
  • sharp/stabbing chest pain
40
Q

esophageal ulcer s/sx

A
  • pain with swallowing
  • pain with lying down
  • black, tarry colored stools
  • red color in vomit
  • relief or increase pain with eating
41
Q

gastric ulcer s/sx

A
  • eating increases symptoms
  • more common in elderly
  • common in those who use NSAID’s
  • dull gnawing or burning pain
42
Q

duodenal ulcer s/sx

A
  • dull, gnawing or burning pain
  • inc symptoms when the stomach is empty
  • relieved with eating or taking antacids

can refer to right shoulder

43
Q

cholecystitis

A

murphys sign: press left thumb just under costal margin and ask patient to take deep breath
- a sharp pain with a sudden stop in inspiration is a positive

44
Q

kidney disorders s/sx

A
  • chills
  • fever
  • nausea
  • vomiting
  • renal colic
45
Q

axillary nerve entrapment

A
  • shoulder abduction and flexion weakness
  • decreased sensation in lateral upper arm
  • MOI: direct blow to shoulder
46
Q

long thoracic nerve entrapment

A
  • serratus anterior weakness
  • scapular winging
  • shoulder girdle pain
  • MOI- excessive shoulder use, trauma to lateral chest wall, prolonged traction to nerve
47
Q

suprascapular nerve entrapment

A
  • observable wasting of supra and infraspinatus muscle
  • weakness in abduction and shoulder ER
  • MOI: repetitive microtrauma, traction injury
48
Q

pancoast tumor s/sx

A
  • men >50 years old
  • history of cigarette smoking
  • nagging shoulder pain
  • pain has progressed from nagging to burning in nature
  • symptoms extend into the ulnar nerve distribution
  • may have venous distention of the ipsilateral arm
49
Q

T4 syndrome s/sx

A
  • between 30-50 years of age
  • more frequently in women 4:1
  • recent new job/hobby involving stooping or bending
  • poor posture
  • diffuse neck, head and upper extremities
  • paraethesias
  • hands feel hot/cold, heavy, swollen
  • non-dermatomal aches and pains
50
Q

s/sx/causes of upper cervical ligamentous laxity

A
  • occipital HA and numbness
  • severe limitation during neck AROM in all directions
  • signs
  • trauma
  • RA, down syndrome, klippel-feil
  • Os odontoideum
  • odontoid fracture
51
Q

myocardial ischemia

A
  • anterior chest pain or heaviness and sometimes nausea, occasionally presents with pain radiating to the back
52
Q

dissecting thoracic aortic aneurysm

A
  • felt in chest but can radiate to back and lower back
53
Q

peptic ulcer pain

A
  • posterior wall of the stomach or duodenum may also radiate to back, can be triggered or relieved by eating
54
Q

gall bladder pain

A
  • may be referred to right infrascapular region and accompanied by nausea and vomiting
55
Q

pacreas pain

A
  • posterior abdominal structure that may refer pain to back, around level of thoracolumbar junction
56
Q

renal pain

A
  • felt in costovertebral area or the flank
57
Q

pain from thoracic interspinous ligaments and thoracic zygapophyseal joint

A
  • described as dull and aching, it tends to be poorly localized, not corresponding to dermatomes, and is felt deeply in tissues
58
Q

treatment of acute neck pain with movement coordination

A
  • education of the patient to return to normal, nonprovocative pre-accident activities as soon as possible; minimize use of cervical collar; perform postural and mobility exercises to decrease pain and increase ROM
  • reassurance to the patient that recovery is expected to occur within 2-3 months
  • manual mobilization + strengthening, endurance, flexibility, postural, coordination, aerobic exercise
59
Q

treatment of chronic neck pain with movement coordination

A
  • patient education and advice focusing on assurance, encouragement, prognosis, and pain management
  • mobilization + progressive submax exercise program including CT strengthening, endurance, flexibility, coordination, cognitive behavioral therapy
  • TENS
60
Q

treatment for acute neck pain with radiating pain

A
  • exercise: mobilizing and stabilizing elements
  • low level laser
  • short term use of collar
61
Q

treatment for acute neck pain with radiating pain

A
  • combined exercise: stretching and strength plus manual therapy for cervical and thoracic region: manipulation or mobilization
  • intermittent traction
62
Q

best test to rule in cervical radiculopathy

A

DTR of biceps brachii

63
Q

cervical radiculopathy definition

A

decreased strength, sensation and reflexes in a dermatomal/myotomal pattern or with the clinical prediction rule

64
Q

Cervical laminoplasty is indicated for:

A

lateral stenosis
spondylitic myelopathy
degenerative changes

65
Q

common complications following cervical surgery

A

hoarseness
dysphagia
infection

66
Q

Compared to other areas of the spine, the cervical spine tends to have MORE problems with which of the following pathologies:

A

Degeneration of disc and joints

OCS Prep (11 decks)

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