Competency 2: Cervical Spine Examination Flashcards
Where do cervical nerve roots exit in relation to the numbered vertebra?
Exits above the numbered vertebra
The Atlas (C1) and Axis (C2) are considered atypical why?
- Atlas lacks a vertebral body and rotates around dens of C2
- Body of axis extends superiorly to form odontoid process
Upper cervical facets align in a plane pointing where; lower cervical facets point to?
- Upper cervical facets align in a plan pointing toward the eye
- Lower cervical facets point to opposite ASIS
What is the facet joint; type; where is it found?
- Zygapophyseal joint
- Synovial joint between articular processes
Biomechanics of the OA joint, AA joint, and C2-C7?
OA joint: flexion and extension primarily, minor SB and rotation Occiput rotates and SB to opposite sides (Type I like)
AA joint: primary motion is rotation. Atlast rotates around dens of C2
C2-C7: Rotation and SB typically occur to the same side (Type II like)
What do we observe and palpate for during cervical spine examination?
- Trauma, scars, masses, goiter
- Carrying angle
- Increased or decreased lordosis
- Distended external jugular vein (JVP): elevate head of bed 30°
- Tracheal deviation
- Masses in the neck, mediastinal mass, atelectasis, large pneumothorax
What makes up the Anterior and Posterior Triangle?
Anterior: mandible, SCM, midline
Posterior: SCM, trapezius, clavicle
- Omohyoid cross lower portion
What lymph nodes can we palpate for?
- Superficial and posterior cervical chain
- Occipital
- Pre/post-auricular
- Submandibular
- Submental
- Tonsillar
- Supraclavicular
Where is the Carotid pulse felt and what is the rule for feeling this pulse; what can we assess here with stethoscope?
- Medial to the SCM. Inferior to the corner of the jaw. Repeat on opposite side
- DO NOT assess BOTH pulses simultaneosuly. Could lead to fainting due to hypotensive reflex caused by baroreceptors
- Assess for thrills and bruits w/ bell of stethoscope
What does Jugular Venous Pressure assess and what is normal?
- Right atrial pressure, right internal jugular vein is in direct line w/ the SVC, assessment of the right IJV
- < 3-4 cm above the sternal angle = normal
Proper setup for assessing Jugular Venous Pressure?
- Place pillow under patients head to relax SCM’s
- Raise head of exam table to 30° and turn pt’s head slightly away from the side you are examining
- Identify the IJV using tangenitial lighting.
- Identify the highest point of pulsation. Extend object horizontally from teh apex. Place a ruler vertical from sternal angle ot create a right angle w/ the horizontal object
- Distance in cm above the sternal angle (right atrium) is the JVP
How is Low JVP’s vs High JVP’s best seen?
Low JVP is best seen in near supine position (hypovolemic pt)
High JVP is best seen sitting upright (hypervolemic pt)
Trachea should be where and what spaces are used as identification landmarks? Lateral displacement of trachea can occur with?
- Should be midline, use spaces between thyroid and SCMs as landmarks
- Lateral displacement of trachea can occur in tension pneumothorax
For thyroid palpation how do we locate, what do we have the patient do, where do we palpate?
- Isthmus overlies 2nd-4th tracheal rings
- Have patient flex neck slightly to relax SCMs
- Place fingers of both hands on pt’s neck so that index fingers lie just below cricoid cartilage. Have the pt swallow so thyroid rises up under finger pads.
- Observe for contour and symmetry
- Displace trachea to right and palpate right lobes. Repeat on left. Anterior surace of a lateral lobe is approximately the size of the distal phalanx of thumb and feels somewhat rubbery
When may a bruit be heard when listenings over lateral lobes of thyroid?
Hyperthyroidism
What is the normal ROM for flexion, extension, rotation, and sidebending of cervical spine; muscles involved with each movement?
Flexion: 45-90° (SCM, scalenes, paravertebral muscles)
Extension: 70-90° (Splenius capitus, cervicis, intrinsic spinal ms.)
Rotation: 70-90° (SCM, intrinsic spinal ms.)
Sidebending: 20-45° (Scalenes, intrinsic spinal ms.)