Cervicothoracic Screening Flashcards
If a patient received trauma to their cervical neck (such as an MVA) what high risk factors would warrant an imaging referral?
- If they are over 65 years old
- Dangerous mechanism (fall from over 3 ft/5 stairs, MVC over 60mph or rollover/ejection, or bicycle collision)
- Upper extremity parasthesia
If a patient has no high risk factors after receiving trauma to their cervical spine and they have a low risk factor which allows range-of-motion assessment (such as a simple rear-end MVC, sitting position in ext. rotation, ambulatory at any time, delayed onset neck pain, or absence of midline cervical spine tenderness) what is the last factor which would warrant a referral for imaging?
The patient is not able to rotate their neck 45* to the left or right
True or False: the Canadian Cervical spine rule is more sensitive than the NEXUS low-risk criteria.
True, the Canadian Cervical Spine Rule is 99.4% sensitive and great for ruling out a cervical fracture
What are the mechanical causes of cervical myelopathy?
Systemic Causes of myelopathy?
- Trauma
- Spinal Cord Compression
- Degenerative changes
- bulging disks, thickened ligamentum flavum
- RA with subsequent atlanto-acial subluxation
- MS, ALS
- Guillain-Barre
- Multipfocal motor myopathy
What five tests are used in the cervical myelopathy rule?
how many tests need to be positive to achieve a 99% specificity?
- gait deviation
- +hoffman’s test
- inverted supinator sign
- +babinksi sign
- Age over 45 years old
3 out of 5 positive tests = 99% specificity
What are the signs and symptoms of upper cervical ligamentous laxity?
what are some causes of this laxity?
- occipital headache and numbness
- severe limitation during neck AROM in all directions
- signs of cervical myelopathy
causes
- trauma
- RA with atlanto-axial subluxation, down syndrome, kleepel-feil
- Os odontoideum
- odontoid fracture
What signs suggest a patient has a spinal infection?
what do you do if they have positive spinal infection signs?
- spine pain that is unrelenting, worse at night and does not change substantially with positional changes
- history of diabetes
- potential fever and chills or fatigue
- concurrent infection or IV drug use
- local tenderness over spinous processes
- spinal percussion is painful
Refer out for imaging and clinical lab tests
What MSK complaints will a patient that suffered a cardiovascular event have?
- jaw, neck, shoulder, arm and back pain
- myalgias, muscular fatigue, and muscle atrophy
- weakness and fatigue
- poor exercise tolerance
What signs and symptoms are common with cardiovascular events?
- chest pain
- abdominal pain
- shortness of breath
- heart palpitations
- irregular heartbeat
- dizziness, nausea
- syncope
- peripheral edema
What are the 5 D’s And 3 N’s of cervical arterial dysfunction?
- Dizziness
- drop attacks
- dysphagia
- dysarthria
- diplopia
-Ataxia
- Nausea
- numbness
- nystagmus
How will a patient who suffered a pulmonary event describe their pain?
What would be there signs and symptoms?
Pain
- sharp, localized
- aggravated by breathing
- better in upright/worse in recumbent
- better with autosplinting
SxS
- Shortness of breath (Dyspnea)
- persistent cough
- fevers, chills, and general malaise
- weak rapid pulse with fall in BP
- cyanosis
What are the signs of a pneumothroax?
- shortness of breath
- acute sharp pain in chest (upper and lateral chest wall_
- can refer pain to ipsilateral shoulder/upper trapezius region
- change in respiratory movements
- drop in blood pressure, increased venous distention in neck
- more pain in recumbent positions/better in sitting
What are common signs of GI issues? (stomach, duodenal, or pancreatic conditions)
- gnawing, cramping, burning, “heartburn” or aching
- constant or suddent onset, weight loss, nausea, vomiting, fever, malaise
- may have pain in waves or may be related to eating or drinking in timing
- early satiety, black “tarry” or light colored stools (pancreatic cancer)
True or False: cervical spine is the most common location for spinal metastases.
False, metastases are rare in C-spine, more common in thoracic (60%) and lumbar (40%) spine
What cancers can commonly cause spinal pain?
Prostate breast kidney thyroid lung lymphoma
