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Semester 3 PM Exam 1 > Clinical Presentation of Cervical Spine > Flashcards

Clinical Presentation of Cervical Spine Flashcards

1
Q

Name the 4 categories of neck pain

A
  1. neck pain w/ mobility deficit
  2. w/ headache
  3. w/ movement coordination impairment
  4. w/ radiating pain
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2
Q

If an individual has neck pain with mvmt coordination impairment, in which aspect of the ROM will they have pain?

A

they will have pain throughout the entire ROM

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3
Q

When moving the neck, motion occurs all the way to which thoracic vertebrae?

A

T4 - therefore upper thoracic mobility is important for patients with neck pain

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4
Q

Questions to ask if patient had a trauma

A

loss of consciousness, seatbelt, speed and direction

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5
Q

Special questions

A

functional/comparable postures (have pt demonstrate)
sleep position
headaches
strength changes

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6
Q

What are the 3 components of irritability?

A
  1. vigor
  2. severity
  3. duration
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7
Q

Name the red flags

A 
constant pain
night pain/sweats
increase in symptoms w/ cough/sneeze
extremity weakness
bilateral UE sx
LE sx
signs/sx of VBI
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8
Q

4 categories of red flags

A
  1. non-musculoskeletal
  2. vertebrobasilar injury
  3. cranio-vertebral ligament injury
  4. Cervical myelopathy (cord damage)
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9
Q

Vertebrobasilar Artery Insufficiency (VBI) causes

A

compromised blood flow to the brainstem caused by atherosclerosis, stenosis, or trauma
may result in brain stem ischemia

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10
Q

VBI problem area

A

Acute angle C1 to foramen magnum (between C1 and C2)

rotation to the contralateral side will lengthen the artery and occlude it

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11
Q

VBI most common in:

A

patients with neck pain and history of trauma

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12
Q

Vertebrobasilar artery insufficiency can be diagnosed via:

A

5 D’s and 3 N’s (gold standard = ultrasound doppler)

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13
Q

5 D’s of VBI

A 
dizziness
drop attack
diplopia
dysarthria
dysphagia
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14
Q

3 N’s of VBI

A

numbness
nausea
nystagmus

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15
Q

drop attack

A

patient loses muscular control of legs due to artery occlusion and they fall down but do not lose consciousness

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16
Q

diplopia

A

double vision

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17
Q

dysarthria

A

slurred speech

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18
Q

dysphagia

A

difficulty swallowing

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19
Q

nystagmus

A

eyes drift back and forth

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20
Q

“and” of 5D’s and 3N’s of VBI

A

ataxia (abnormal gait)

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21
Q

Cranio-vertebral ligament injuries are due to what and involve which 3 ligaments?

A

due to trauma or disease process

  1. alar ligament
  2. transverse ligament
  3. tectorial membrane
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22
Q

Alar ligament

A

runs from dens to occiput

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23
Q

transverse ligament

A

holds dens (c2) against C1

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24
Q

Tectorial membrane

A

attaches head to neck, continuation of anterior longitudinal ligament, prevents head from rolling forward

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25
Q

cranio-vertebral ligament injuries

A

risk to brain stem and upper cord, may be associated with dens fracture, may require surgical fixation
require radiographs with mouth open to see dens

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26
Q

signs/symptoms of cranio-vertebral ligament injuries

A

5D’s and 3N’s as well as mouth/lip numbness and feeling of lump in throat

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27
Q

atlanto-axial interval

A

space between dens and atlas

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28
Q

Cervical myelopathy

A

upper motor neuron lesion (injury to spinal cord)

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29
Q

signs/symptoms of Cervical myelopathy

A

UMN signs
spasticity, hyperreflexia, visual/balance disturbances, ataxia, bowel/bladder changes
multi-segmental paresthesia
tests = babinksi, clonus, hoffman’s

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30
Q

4 common clinical presentations (categories from the guide to be used in documentation)

A
  1. impaired posture
  2. connective tissue dysfunction
  3. localized inflammation
  4. referred pain syndromes; peripheral nerve entrapment
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31
Q

Impaired posture

A

muscle imbalances

  • can be neck pain with headache or neck pain with movement coordination impairment
  • check head on neck posture, thoracic posture, shoulder posture, etc
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32
Q

Muscle imbalances

A

muscle pain, tightness, trigger points (treat with SCS!)

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33
Q

examination for muscle imbalances

A

posture
muscle strength
muscle length
palpation

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34
Q

most common impairments (muscle) in the neck are located in which muscle group?

A

deep neck flexors

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35
Q

local vs global muscles

A

local muscles act on segments (segmental control) while global muscles do not have segmental control

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36
Q

Trap and SCM working together =

A

head on neck stability

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37
Q

if the trap dominates, what force occurs on the neck?

A

anterior shear

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38
Q

SCM and trap

A

global muscles; neither has segmental control on neck

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39
Q

longus capitis and longus colli

A

local muscles, provide stability for neck at the segmental level

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40
Q

suboccipital muscles

A

tight = neck will be extended

compensation for this is lower cervical spine will flex

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41
Q

Upper crossed syndrome

A

line of weakness and tightness
tight pecs, traps, levator scap
weak neck flexors, rhomboids, serratus anterior

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42
Q

upper crossed syndrome

A

tightness causes shoulder elevation and scapula protraction

inhibited deep neck flexors and lower scap stabilizers

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43
Q

Connective tissue dysfunction includes which 4 things?

A
  1. zygapophysial/facet joint dysfunction
  2. cervical spondylosis
  3. IV disc
  4. acute torticollis
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44
Q

Zygapophysial facet joints: typical cervical vertebral joints

A

close packed position = extension
facet glide during cervical ROM
disc compression/distraction
if facet issue, will have pain with extension

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45
Q

Motion of typical cervical vertebral joints: flexion

A

superior segment moves anteriorly and superiorly

46
Q

Motion of typical cervical vertebral joints: extension

A

superior segment moves posteriorly and inferiorly

47
Q

Motion of typical cervical vertebral joints: side bending (lateral flexion)

A

ipsilateral side closes and contralateral side opens

48
Q

Motion of typical cervical vertebral joints: rotation

A

depends

49
Q

retraction/protraction

A

don’t use as strengthening exercise!

50
Q

coupled motion of typical cervical vertebrae

A

side bending (LF) and rotation occur in the SAME direction, regardless of the position

51
Q

Atypical cervical vertebrae

A

OA joint

52
Q

what motion occurs at OA joint?

A

flexion/extension

53
Q

flexion at the OA joint is limited by what structre?

A

dens at foramen magnum

54
Q

extension at the OA joint is limited by what structure?

A

bony approximation

55
Q

what is the coupled motion at the OA joint? (atypical vertebrae)

A

side bending (LF) and rotation occur in OPPOSITE directions

56
Q

OA =

A

occiput and C1

57
Q

motion at AA joint (c1/c2)

A

rotation!

58
Q

what is the reason for the rotation at the AA joint?

A

convex on convex movemnt (bi-convex)

roll without glide!

59
Q

Uncinate Processes

A

posterolateral
from uncovertebral joints or joints of Luschka
develop between age 6-9
degenerate early due to shear forces from rotation

60
Q

neck pain with mobility deficit =

A

joint hypomobility

61
Q

Facet joint dysfunction can be due to what 3 things?

A

trauma, degeneration, or insidious onset

62
Q

Facet joint dysfunction

A

can refer pain - diagnostic blocks
pain is sharp and localized but can also be diffuse
pain between shoulder blades could be C4,5,6,7

63
Q

Cervical Spondylosis

A

degenerative changes of disc, vertebrae, facets, or uncinate processes

nerve root compression, edema, cord compromise

64
Q

cord compromise in cervical spondylosis occurs because of what?

A

facet hypertrophy which causes stenosis and therefore cord compression

65
Q

Presentation of cervical spondylosis

A

stiffness, diffuse pain, dull ache, pain with movement, accessory motion limitations

66
Q

Capsular Pattern : Bilateral at OA joint

A

equal limitation in extension and LF

67
Q

capsular pattern: bilateral at typical vertebrae:

A

extension is most limited, follwed by equal limitations in rotation and LF

68
Q

capsular pattern: unilateral at OA joint

A

contralateral LF is limited

69
Q

capsular pattern: unilateral at typical vertebrae

A

contralateral LF and rotation are limited

70
Q

capsular pattern

A

a pattern of limitation in those with degenerative changes

71
Q

Central stenosis

A

cord compromise

degenerative!

72
Q

lateral stenosis

A

nerve compromise

73
Q

Stenosis

A

narrowing laterally in IV foramen where nerve exits

centrally in spinal canal

74
Q

presentation of stenosis

A

sx of nerve/cord compression depending on degree of narrowing

75
Q

stenosis can be caused by:

A

tumor, degeneration, or disc herniation (herniation is usually lateral)

76
Q

68 yr old with neck stiffness and ache. gradual onset over past 3 months, AROM limited and painful into extension and rotation bilaterally

A

spondylosis! due to age, stiffness and ache

77
Q

IV Discs

A

gelatinous nucleus pulposus becomes fibrous early

peripheral annulus fibrosus; concentric rings alternate direction

78
Q

IV discs make up what % of the height in the c spine?

A

25 %

79
Q

IV discs

A

no disc at OA joint
smaller than discs in vertebral bodies
thicker anteriorly than posteriorly!
contact uncinate processes laterally

80
Q

IV discs are stressed via

A

rotation

81
Q

IV disc dysfunction is caused by which 3 things/causes which 3 things?

A
  1. disc herniation
  2. disc degeneration
  3. rim lesions
82
Q

the cervical spine is built for:

A

mobility (this is why IVD are not as large as in lumbar spine)
degenerate sooner than in lumbar spine

83
Q

Disc herniation subjective findings

A

scapular, paraspinal sx with or w/o neck pain

pain increases w/ sustained postures and is better with activity

84
Q

disc herniation examination findigns

A

relief with traction
pain with compression
pain with repeated flexion
possible neuro signs

85
Q

most common location of disc herniation in cervical spine

A

C5/C6 because it is a common spot for hypermobility, causing shear forces in this area

86
Q

Disc herniation pain

A

discs can refer pain - if disc herniates and compresses nerve, referral pattern will follow nerve not disc

87
Q

DDD (disc degeneration)

A

spondylosis
in youth, proteoglycans and H2O are abundant
nucleus begins to resemble annulus and loses height

88
Q

Disc herniation treatment

A

traction, posture, muscle imbalance

eval = neuro, flexibility, strength

89
Q

goal of treatment for DDD

A

unload disc and increase mobility

same interventions as disc herniation

90
Q

Rim Lesion

A

horizontal annular tear at anterior vertebral rim, w/o tearing the anterior longitudinal ligament
often a multisegmental injury
poor prognosis

91
Q

rim lesions most often occur due to

A

hyperextension trauma - whiplash = most common

92
Q

Predisposing factors to rim lesions

A

extension trauma
MVA hit from behind/poor headrest position
forward head posture

93
Q

S/S of rim lesion

A

fear of movement
immediate pain after impact
highly irritable neck
same sx with compression and distraction!
difficulty lifting head off pillow (flexion)

94
Q

Rim lesion xray

A

xray will appear normal, MRI must be done

95
Q

rim lesion: avoid __?

A

extension

96
Q

treatment for rim lesion

A

start with eye mvmts, isometrics, neurodynamics, leg/arm movemnts

97
Q

Acute torticollis

A

contracture of SCM

98
Q

Localized inflammation

A

whiplash-associated disorders (WAD) = an acceleration-deceleration mechanism of energy transfer to the neck

99
Q

Prognosis in WAD

A

higher initial NDI score = higher likelihood of developing chronic neck pain

100
Q

higher NDI score at 2-3 yrs post- injury is associated with what 4 things in those with WAD?

A
  1. higher initial NDI score
  2. older age
  3. cold hyperalgesia
  4. higher post-traumatic stress symptoms
101
Q

what to exam for acute vs chronic

A 
cranio-vertebral ligaments
vascular structures
soft tissue
joints
IVD
nerves
102
Q

Referred pain syndroms: peripheral nerve entrapment includes what 2 things?

A
  1. radiculopathy

2. thoracic outlet syndrome

103
Q

Referred pain syndroms: peripheral nerve entrapment

A

pain relieved with distraction
examine ROM, sidebending, extension
treatment = traction and nerve mobs
classification = neck pain with radiating pain

104
Q

Cervical nerve roots

A

exit laterally from spinal canal

IV foramen widens w/ flexion and narrows with extension!

105
Q

Cervical radiculopathy

A

irritation of sensory nerve root causing pain and or paresthesia in the distal part of the dermatome

106
Q

cervical radiculopathy clinical presentation

A

unilateral symptoms
neck/shoulder/arm/hand symptoms
worse with movements that narrow foramen (compress nerve)
examine sensory, motor, reflex changes

107
Q

intervention for cervical radiculopathy

A

unload nerve, ROM to open forament

108
Q

cervical radiculopathy sx are worse with

A

ipsilateral side bending and extension

109
Q

Radiculopathy is present if these 4 s/s are present (tests are positive)

A
  1. nerodynamics

2. cervical rotation towards painful side is limited to

110
Q

Spurling test

A

compression test – positive = pain increases with compression (closing lateral foramen)

111
Q

Distraction test

A

positive = nerve pain in arm decreases with distraction

Semester 3 PM Exam 1 (1 decks)

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