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Semester 3 PM Exam 1 > Clinical Presentation Cervical > Flashcards

Clinical Presentation Cervical Flashcards

1
Q

What percentage of individuals have had neck pain in the past six months

A

54%

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2
Q

What percent of all patients receiving PT are neck pain

A

25%

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3
Q

Of patients with neck pain what percentage will develop chronic symptoms

A

44%

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4
Q

Subjective info

A 
Area
Nature
Type of symptoms
Severity
Behavior
Present hx
Past hx
Special questions
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5
Q

Special questions

A 
Functional/Comparable postures
IF trauma - loss of consciousness, seatbelt, speed and direction
Sleep position or difficulties
Headaches
Strength changes
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6
Q

3 components to irritability

A
  1. Vigor - how much activity it takes to flare up
  2. Severity - how bad is it when flares up
  3. Duration - how long does it take to go back down
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7
Q

Red flags

A 
Constant pain
Night pain/sweats
Inc symptoms with cough or sneeze
Extremity weakness
Bilateral UE symptoms
LE symptoms
Signs and symptoms of VBI
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8
Q

Red flags - also looking for

A

Non musculoskeletal
Vertebrobasilar injury
Craniovertebral ligament injury
Cervical myelopathy (injury to cord)

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9
Q

Vertebrobasilar artery insufficiency - what is it and what can it be caused by

A

Blood flow compromised

Due to stenosis of artery, atherosclerosis (plaque), trauma

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10
Q

Vertebrobasilar artery insufficiency - may lead to

A

brain stem ischemia - decreased bloodflow to the basilar region

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11
Q

Vertebrobasilar artery insufficiency - motions that make it worose and why

A

There is an acute angle in the artery from C1 to the occiput (foramen magnum) so if there is already an issue there, rotation will lengthen or stretch the artery and further occlude it

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12
Q

Vertebrobasilar artery insufficiency - testing

A

Ultrasound doppler is the gold standard

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13
Q

Vertebrobasilar artery insufficiency - things to look for

A

5 Ds And 3 Ns
Dizziness, Diplopia, Dysphagia, Drop attacks, Dysarthria
Ataxia
Nausea, Nystagmus, Numbness

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14
Q

Craniovertebral ligament injuries

A

Alar
Transverse
Tectorial membrane

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15
Q

Craniovertebral ligament injuries - Alar

A

Runs from dens (C2) up to the occiput btw the head and C2

Stabilize at C2 SP and move head

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16
Q

Craniovertebral ligament injuries - Transverse

A

holds dens against C1

Stabilize at C2 SP so that C1 and the head move together

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17
Q

Craniovertebral ligament injuries - tectorial membrane

A

Attaches the head and neck - Keep the head on the neck

Continuation of the anterior longitudinal ligament

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18
Q

Craniovertebral ligament injuries - due to

A

TRAUMA

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19
Q

Craniovertebral ligament injuries - risk to

A

brainstem and upper cord
May require surgical fixation or orthosis
May be associated with dens fracture - need radiograph

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20
Q

Craniovertebral ligament injuries - Signs and symptoms

A

Signs seen with VBI
Mouth/lip numbness
Sensation of having a lump in throat

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21
Q

Cervical Myelopathy - what is it

A

UMN lesion

Injury to the spinal cord

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22
Q

Cervical myelopathy - signs

A

UMN lesion signs - spasticity, hyper-reflexia, visual and balance disturbances, ataxia, bowel/bladder changes
Multi segmental paresthesia

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23
Q

Craniovertebral ligament injuries - tests

A

Babinski, Clonus, Hoffmans test

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24
Q

Impaired posture

A

Muscle imbalances

Seen with neck pain with headache AND neck pain with movement coordination impairments

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25
Q

Muscle imbalances

A

muscle pain
tightness
trigger points

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26
Q

Muscle imbalances - examination

A

Posture
Muscle strength/function testing
Muscle length testing
Palpation

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27
Q

Muscle imbalances - examination - muscle strength/function testing

A

Deep neck flexors
Neck flexor endurance
Scapular stabilizers

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28
Q

Muscle imbalances - examination - muscle length testing

A 
Upper trap
Levator scap
Scalenes
Suboccipital mm
Pec major and minor
Lat dorsi
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29
Q

Muscle imbalances - interventions

A 
Strengthening exercises
Exercises to lengthen
Trigger point release
Tender point SCS
Postural education
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30
Q

Trap and Levator scap

A

Global muscles that work together for postural stability

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31
Q

Longus Colli and Capitis

A

Local muscles that can lead to stability or stiffness at the segmental level

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32
Q

Suboccipital muscles

A

ATTACHMENTS

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33
Q

If suboccipital muscles are tight what will you see

A

extension at head on neck and compensation with flexion at the lower neck

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34
Q

Scalene mm

A

ATTACHMENTS

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35
Q

Upper crossed syndrome - what is tight

A

Line indicating tightness passes through the levator scap, upper trap, and pec

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36
Q

Upper crossed syndrome - tightness can cause

A

shoulder elevation and scap protraction

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37
Q

Upper crossed syndrome - what is inhibited

A

deep neck flexors and lower scap stabilizers

38
Q

Connective tissue dysfunction includes what

A

Zygo/Facet joint dys
Cervical spondylosis
IV disc
Acute torticollis

39
Q

Zygo - Typical cervical vertebral joints - close packed position

A

Full extension

40
Q

Zygo - Typical cervical vertebral joints - with flexion, the superior segment moves

A

Ant and sup

41
Q

Zygo - Typical cervical vertebral joints - with extension, the superior segment moves

A

Post and inf

42
Q

Zygo - Typical cervical vertebral joints - with LF the superior segment moves so that the

A

ipsilateral side closes and the contralateral side opens

43
Q

Zygo - Typical cervical vertebral joints - Coupled motion Typical

A

LF and Rot is the same

44
Q

Zygo - Typical cervical vertebral joints - Coupled motion Atypical

A

OA - flex/ext are primary motion - LF and Rot are opp

AA - rotation is primary motion (convex on convex, only roll)

45
Q

Zygo - Typical cervical vertebral joints - OA flexion is limited by

A

dens at foramen magnum

46
Q

Zygo - Typical cervical vertebral joints - OA extension is limited by

A

bony approximation

47
Q

Uncinate processes

A

Posterolateral

Form uncovertebral joints or joints of luschka

48
Q

Uncinate processes - development

A

Develop btw ages of 6-9

Degenerate changes due to shear forces that occur with rotation

49
Q

Facet Joint Dysfunction - cause

A

Trauma, degeneration, insidious

50
Q

Facet Joint Dysfunction - Presentation

A

Localized, sharp pain
Pain with ext, ipsilateral SB, quadrant
Can refer pain - diagnostic blocks

51
Q

Facet Joint Dysfunction - presentation - btw shoulder blades

A 
Upper = C5/6
Lower = C6/7
52
Q

Cervical Spondylosis - causes

A

degenerative changes - disc, vertebral bodies, facets, U joints
Nerve root compression, edema, cord compromise

53
Q

Cervical spondylosis - presentation

A

C/O stiffness, diffuse, dulle ache
Painful movement
Accessory motion limitations
Broader and can’t localize as well

54
Q

Capsular pattern - Bilateral OA

A

Equal limitation in ext and LF

55
Q

Capsular pattern - Bilateral Typical

A

Ext and then equal with rot and LF

56
Q

Capsular pattern - Unilateral OA

A

contralateral LF

57
Q

Capsular pattern - unilateral Typical

A

contralateral LF and rot

58
Q

Stenosis - what is it

A

Narrowing - can be lateral of central

59
Q

Stenosis - lateral

A

In IV foramen - degenerative, mechanical, space occupying lesion like tumor or disc herniation

60
Q

Stenosis - central

A

in the spinal canal - usually degenerative

61
Q

Stenosis - presentation

A

Symptoms of nerve or cord compression may result depending on degree of narrowing and if lateral or central

62
Q

IVD - C spine make up

A

25% of the height in c spine
No disc at OA
Smaller than vertebral bodies

63
Q

IVD - C spine thicker

A

thicker ant than post

64
Q

IVD - C spine Contact

A

uncinate processes laterally

65
Q

IVD - C spine stressed by

A

rotation

66
Q

IVD - C spine

A

Gelatinous nucleus pulposs becomes fibrous early

Peripheral annulus fbrosus, concentric rings alternate direction

67
Q

Intervertebral disc dysfunction includes

A

Dis herniation
Degeneration
Rim lesion

68
Q

Disc herniation - subjective

A

C/O scapular, paraspinal sx with or w/o neck pain

Inc with sustained posture and better with activity (move fluid)

69
Q

Disc herniation - examination

A 
Relief with traction 
Pain with compression
Pain with rx flexion
Most common at C6
Possible neurological signs and symptoms
70
Q

Disc herniation - intervention

A

Traction to unload disc

Treat reason it is aggravated - maybe postural impairment

71
Q

Disc Degeneration

A

Spondylosis
In youth - proteoglycans and H20 are abundant
Nucleus begins to resemble the annulus
Lose height

72
Q

Disc degeneration - Examination

A

All same - neuro eval too though is symptoms

73
Q

Disc degeneration - Intervention

A

same - unload the disc

heat feels good too

74
Q

Rim lesion

A

Horizontal annular tear at anterior vertebral rim, without tearing anterior longitudinal ligament
Often multilevel injury
Poor prognosis cuz not good circulation
Can be caused by whiplash injury

75
Q

Rim lesion - predisposing factors

A

Extension trauma
MVA hit from behind/poor headrest position
Forward head posture

76
Q

Rim lesion - signs and symptoms

A 
Immediate pain upon impact
Highly irritable neck
SAME symptoms with comp and distrac (both painful)
Difficulty lifting head off pillow
XR appear normal - MRI would show
77
Q

Rim lesion - intervention

A

Rest, immobilization, education, distal intervention

78
Q

Acute torticollis

A

SCM contracture

Congenital, traumatic, spasmodic

79
Q

Localized inflammation

A

Whiplash associated disorders (WAD)

80
Q

Definition of WAD

A

An acceleration - deceleration mechanism of energy transfer to the neck

81
Q

Causes of WAD

A

MVA, Diving, Other bony or soft tissue injuries

82
Q

Prognosis in WAD - Higher NDI score at 2-3 yrs post injury is associated with

A

Higher initial NDI score
Older age
Cold hyperalgesia
Higher PTSD symptoms

83
Q

Acute vs Chronic WAD - history

A

History - mechanism, head position, amount and direction of force

84
Q

Acute vs Chronic WAD - examination

A 
Cranio vertebral ligaments
Vascular structures
Soft tissue (muscles, ligaments)
Joint and joint capsule
IVD
Central or peripheral neurologic symptoms
85
Q

Referred pain syndromes - peripheral nerve entrapment

A

Radiculopathy

Thoracic outlet syndrome

86
Q

Cervical nerve roots exit

A

laterally from the spinal cord

87
Q

Intervertebral foramen does what with flexion and what with extension

A

Widens with flexion

Narrows with extension

88
Q

Dermatome pattern

A

ADD MORE
C6 - thumb
C7 - index and middle
C8 - ring and pinky

89
Q

Cervical radiculopathy - clinical presentation

A

Unilateral
C/O neck/shoulder/arm/hand symptoms
Worse with movements that narrow foramen

90
Q

Cervical radiculopahty - examination

A

sensory, motor, reflex changes

91
Q

Cervical radiculopathy - intervention

A

unload the nerve
open the area
correct any mm imbalances
neurodynamics

92
Q

Cervical radiculopathy - clinical exam - best variables to diagnose

A

Neurodynamics
Cervical rotation toward painful side less than 60 degrees
Distraction test pos (pain dec with distraction)
Spurling test pos (comp inc their pain)

Semester 3 PM Exam 1 (2 decks)

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