Cervy Spine Flashcards
What is the difference between direct and indirect spinal cord trauma?
Direct: external objects, tethering, biomechanical compression/traction
Indirect: Surrounding bones (spurs), ST, blood vessels
What are 3 common referral patterns for cervical spine pain?
- Trigeminal region
- TMJ
- Cervicogenic HAs
Injury to the anterior cervical spine and prevertebral swelling can lead to hypersensitivity of which structures?
Sympathetic trunk
Carotid
Name 2 ways that osteophytes and lig flav/facet hypertrophy can lead to spinal cord/nerve damage
- Create fulcrum for spine/cord to flex over
2. Pinch spinal cord (pincer phenomena)
POM for hyperflexion injury leading to anterior subluxation
Immobilize with cervical collar for 10 days
Adjunctive physio
Light cervical manipulative techniques added in subacute stage
Isometric and tubing exercises
What vascular structure should always be checked for injury after a cervical spine fracture?
Vertebral artery
Common clinical features of cervical instability
Tenderness in cervical region Paraspinal muscle spasm Cervical radiculopathy HA Hypermobility and soft end-feel in passive motion testing Referred pain in shoulder/paraspinal region Neck pain with sustained postures Cervical myelopathy Decreased cervical lordosis Poor cervical muscle strength
Symptoms of cervical instability
Intolerance to prolonged static postures
Fatigue and inability to hold head up
Better with external support, including hands or collar
Frequent need for self-manipulation
Feeling of instability, shaking, or lack of control
Frequent episodes of acute attacks
Sharp pain, possibly with sudden movements
Head feels heavy
Neck gets stuck or locks with movement
Better in unloaded position such as lying down
Catching, clicking, clunking, and popping
Past history of neck dysfunction or sensation trauma
Trivial movements provoke symptoms
Muscles feel tight or stiff
Unwillingness, apprehension, or fear of movement
Temporary improvement with clinical manipulation
Exam findings of instability
Poor coordination/neuromuscular control, including poor recruitment and dissociation of cervical segments with movement
Abnormal joint play
Motion that is not smooth throughout range of motion, including segmental hinging, pivoting, or fulcruming
Aberrant movement
Hypomobility of upper thoracic spine
Palpable instability during test movements
Decreased cervical muscle strength
Fear, apprehension, or decreased willingness to move during examination
Increased muscle guarding, tone, or spasms with test movements
Jerkiness or juddering of motion during cervical movements
Catching, clicking, clunking, popping sensation heard during movement assessment
Pain provocation with joint play testing
What is the Sharp-Purser Test?
AP pressure on forehead while applying pressure to C1 SP (test for cervical instability)
Positive = provocation of pain, apprehension, or increased movement (indicates compromised integrity of c-spine structures
Which 3 structures are assessed with the Sharp-Purser test?
Atlanto-axial joint integrity
Stabilizers of dense on atlas
Transverse ligament integrity
How do you perform the transverse ligament stress test?
Hold patient’s head with palms and 3rd-5th fingers with index finger on C1 arch
Lift head in forward translation, with index finger pushing on posterior arch of C1
Hold 20s
How would you know if the transverse ligament test is positive?
Abormal pupil response Eye twitching/nystagmus Soft end feel Muscle spasm Dizziness Nausea Paresthesia of lips, face, limb Lump sensation in throat
What are 3 positive findings of the cervical flexion-rotation test?
- Firm resistance on one side
- Pain provocation
- Limited ROM
Which 4 muscles are assessed by the neck flexor endurance test? What is a normal finding for women? For men?
- Rectus capitus anterior
- Rectus capitus lateralis
- Longus capitus
- Longus colli
Women: 29.4s
Men: 38.9s
Which orthopedic test can be used to assess just longus capitus and longus colli?
Craniocervical flexion test
What is the modified ashworth scale?
Tool for grading spasticity:
0 = no increase in muscle tone
1 = slight increase in tone with catch/release at end range
2 = More marked increase in muscle tone through most of ROM but affected part(s) easily flexed
3 = Considerable increase in tone, passive movement difficult
4 = affected part rigid in flexion or extension
In older patients, Spinal cord neuropraxia (SCN) tends to be associated with _________________ and _______________ whereas in younger patients it tends to be associated with ____________________
Spondylosis; stenosis; hypermobility
True or false: in pediatric populations, spinal cord injuries can be present without radiographic abnormalities
True - called SCIWORA
4 Predisposing factors for spinal cord injury
- Age (20-29 and >70)
- C/S spondylosis
- OA
- Congenital anomalies which narrow spinal canal
2 MC causes of spinal cord injury
Unintentional falls (43.2%) MVA (42.8%)
All of the following are clinical features of SCI. Which 6 are considered red flags?
Breathing difficulties Sexual dysfunction (impotence) Loss of bladder/bowel control, constipation Urinary frequency/urgency Spinal cord shock Paraplegia, quadriplegia
5 types of spinal cord injuries
Contusion Concussion Compression Laceration Ischemia
What is spinal shock?
Flaccid paralysis with loss of autonomic reflexes, and bowel and bladder dysfunction
How long does spinal shock take to resolve?
Days, weeks, or months
What is autonomic hyperreflexia? Which type of injury will cause it?
Systemic symptoms (eg. Hypertension, tachycardia, flushing, sweating, HA) following stimulation of the ANS
High spinal injury (above T6)
S&S of central syringomyelia
Bilateral loss of pain and temperature with varying motor affects depending on size of lesion
Damage to the dorsal spinal cord will lead to which motor and sensory changes?
Bilateral loss of motor (varies with size of lesion)
Bilateral sensory loss of position and vibratory sense
Damage to the ventral spinal cord will lead to which motor and sensory changes?
Complete motor loss
Loss of pain and temperature below the level of the lesion
Varying proprioception, vibratory sense, and touch
Which surgery is commonly associated with anterior spinal cord syndromes?
Kidney
What is Brown-Sequard syndrome?
Hemi-cord lesion - causes IL loss of motor, position, and vibratory sense + CL loss of pain and temperature
Transverse syndrome is considered a _____________ lesion while all other spinal cord syndromes are considered ______________ lesion
Complete; incomplete
Damage to which level of the spinal cord can resul in loss of respiratory function?
C1-C4
Damage to C6/C7 of the spinal cord will result in quadriplegia with sparing of which 2 muscles?
Biceps
Diaphragm
Damage to C7/8 of the spinal cord will result in quadriplegia with sparing of which 3 muscles?
Biceps
Triceps
Diaphragm
Still no function of intrinsic hand muscles
A lesion below which spinal cord level is called cauda equina syndrome?
L2
What is the definition of WAD according to the quebec task force?
Acceleration-deceleration mechanism of energy transfer to the neck which may result from rear-end or side impact, predominantly in MVAs
According to one study by Kaneoka et al, what speed of impact was found to lead to WAD?
8km/h
What are the 5 “dangerous mechanisms” from C-spine rules?
Fall from elevation of >3ft/5 stairs Axial load to head MVA at high speed (>100km/h), rollover or ejection Motorized recrational vehicle Bike struck
What are 4 conditions which would exclude an MVA from being considered “simple”?
Pushed into oncoming traffic
HIt by bus/large truck
Rollover
Hit by high speed vehicle
Describe the classications of WAD grade 0 to 4
0 = no neck complaints, no physical signs, minor interference 1 = neck complaints of pain, stiffness, or tenderness but no physical signs 2 = neck complaint and MSK signs (decreased ROM, point tenderness) 3 = neck complaint and neuro signs 4 = neck complaint and fx/dx
What are 3 WAD presentations requiring referral?
- Sudden, sharp neck/occipital pain unlike any previous pain
- Sudden, severe, persistent headache unlike any other
- S&S of neurovascular impairment
