Cervicothoracic Medical Screening Flashcards
What are Red Flags?
Warning signs that may indicate need for re-evaluation by a medical specialist
What are Yellow Flags?
- Warning signs used specifically to assess for pain-associated psychological distress
- May indicate higher risk for delayed recovery of the development of chronic symptoms
When conducting a Cervicothoracic Medical Screen, what are medical considerations we should look for?
Viscerogenic Conditions
- Neoplastic conditions
- Inflammatory or systemic disease
- Cardiopulmonary conditions
- Cervical vascular pathology
Neuromusculoskeletal
- Spinal Fracture
- Upper Cervical Ligamentous instability
- Cervical Myelopathy
With Viscerogenic Conditions, what are the Neoplastic conditions for the Cervical Spine?
- Metastatic lesions (leukemia, Hodgkin’s Disease)
- Cervical bone tumors
- Cervical Cord tumors
- Lung Cancer; Pancoast’s tumor
- Esophageal cancer
- Thyroid cancer
With Viscerogenic Conditions, what are the Neoplastic conditions for the Thoracic Spine?
- Mediastinal tumors
- Metastatic lesions
- Pancreatic cancer
- Breast Cancer
- Multiple Myeloma
What are the Clinical Findings for Neoplastic Conditions?
- Age > 50 years
- History of Cancer
- Unexplained weight loss
- Constant pain; no relief with best rest
- Night Pain
- Cant reproduce pain
What are clinical finding for those patients with Viscerogenic conditions with Inflammatory systemic disease?
- Temperature > 37°C/98.6°F
- Blood Pressure > 160/95 mmHG
- Resting Pulse > 100 BPM
- Resting respiration > 25 breathes per minute
- Fatigue
What are clinical finding for those patients with Viscerogenic conditions with Pulmonary Conditions?
- Tracheobronchial Irritation
- Chronic bronchitis
- Pneumothorax
- Pleuritis involving the diaphragm
What are clinical finding for those patients with Viscerogenic conditions with Cardiac Conditions?
- Angina
- Myocardial infarction
- Aortic aneurysm
- Occipital migraine
- Cervical artery ischemia or dissection
- Arteritis
With Viscerogenic conditions, what is the pain pattern for Cervical Vascular Pathology?
With Viscerogenic conditions, what are the Risk Factors for Cervical Vascular Pathology?
- Current or past smoker
- Hypertension
- High cholesterol
- Migraine
- Vascular anomaly
- Family history of stroke
- Oral Contraception
- Recent infection
- Recent trauma (Mid-moderate to include OMPT)
With Viscerogenic conditions, what are Subjective findings you may see with Cervical Vascular Pathology
- Recent onset of neck pain and headache within 30 days
- Moderate to high severity
- “First and worst” neck pain and headache
When screening patients for Cervical Vascular pathology, what are the 5 Ds, 3 Ns, and 1 A?
- Dizziness
- Diplopia
- Drop attacks
- Dysphagia
- Dysarthria
- Numbness
- Nystagmus
- Nausea
- Ataxia
With Viscerogenic conditions, what objective measure should be done for Cervical Vascular Pathology?
Vitals
Neurological Exam
- CN
- Reflexes/Pathological reflexes
- Strength
- Sensation
- Gait
Cervical active and passive ROM
With Neuromusculoskeletal conditions, what are the Risk Factors for Spinal Fractures in the Cervical and Thoracic Spine?
Cervical
- C1, C2 subaxial (C3-C7)
- Falls, MVA, cycling and diving accidents
Thoracic
- Thoracic (T1-T9), Thoracolumbar junction (T10-L2)
- Blunt trauma or High-velocity injuries
- Pathological fractures (e.g. Osteoporosis)
With Neuromusculoskeletal conditions, what are the Red Flags for Spinal Fractures in the Thoracic Spine?
Minor Trauma
- >50 years of age, Osteoporosis, Corticosteroids
Major Trauma
With Neuromusculoskeletal conditions, In the Thoracic Spine, what are the Test-Item Clusters for Osteoporotic Compression Fracture?
- > 52 years
- No presence of leg pain
- BMI <22
- Does not regularly exercise
- Female Gender
–2/5 or fewer positives (low likelihood ratio)
–4/5 positives (high likelihood ratio)
With Neuromusculoskeletal conditions, what are the Risk Factors for Upper Cervical Ligamentous Instability?
- Recent trauma
- Throat infection
- Congenital collagenous compromise (Down syndrome, Ehlers-Danlos)
- Inflammatory arthritides (Rheumatoid arthritis and Ankylosing Spondylitis)
- Recent neck, head, dental surgery
With Neuromusculoskeletal conditions, what may you find in the Subjective history with Upper Cervical Ligamentous Instability?
- Neck and head pain
- Feeling of instability
- Constant need for support
- Worsening symptoms
- Facial and limb paresthesia, reproduced with active neck movements
- Overt LOB with head movements
- Feeling of a lump in the throat or metallic taste
- Limb weakness and loss of coordination
With Neuromusculoskeletal, what should take part in the Objective Examination for Upper Cervical Ligamentous Instability?
- Neurological Exam (CN, Reflexes, Derm/Myo, Gait)
- Upper Cervical Lig. Integrity Testing
–Sharp-purser Test (Sn 19-96%, Sp 71-100%)
–Alar Ligament Stress Test (Sn 80%, Sp 76.9%)
–Anterior Shear Test - Cervical AROM/PROM
With Neuromusculoskeletal Conditions, what is the Pathoanatomy of Cervical Myelopathy?
Spinal Cord Compression
- Spondylosis with stenosis
- Disk herniation
- Spondylolisthesis
- Tumor
With Neuromusculoskeletal Conditions, what may you find in the Subjective history with patients with Cervical Myelopathy?
- Age >45 years
- Gait unsteadiness
- LOB and coordination
- Limb weakness and paresthesias
- Bowl and bladder dysfunction
With Neuromusculoskeletal Conditions, what must take part in the Objective part?
Neurological Examination
- Reflexes/Pathological reflexes
- Strength (UE/LE)
- Sensation (UE/LE)
- Gait, Balance, and Coordination
With Neuromusculoskeletal Conditions, what are the Test Item Clusters for Cervical Myelopathy?
- Gait Deviation
- (+) Hoffman
- Inverted Supinator Sign
- (+) Babinski
- Age > 45 years
–1/5 positive (Low likely hood ratio)
–3/5 positive (High likely hood ratio)
