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
Which cancers more commonly effect the cervico-thoracic spine?
thyroid and esophageal cancer Hodgkin's lymphoma Pancoast's tumor Multiple myeloma breast cancer
Ture or False: If a patient has an injury to a C-spine artery pain is usually not a common complaint due to arteries not being innervated.
False, pain is a predominant symptoms in these patients as arterial walls are liberally supplied with pain fibers
What are the components of the neruovascular physical exam?
BP BMI Pulse check Neuro exam Functional positional tests Ligamentous Tests Eye exam
True or False: Generally we as PTs should avoid performing cervical thrust manipulations to patients with recent onset of head and neck pain but we should perform thoracic manipulations
True, as well as ROM exercises for the neck and scapulothoracic and upper extremity stretching and strengthening
When do roughly 72% of patients that reported feeling adverse symptoms say they felt their symptoms start?
Withing minutes after manipulation, most commonly they report onset during the manipulation
