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Orthopedics II - Cervical > Cook Pragmatic > Flashcards

Cook Pragmatic Flashcards

1
Q

What are some signs and symptoms of cord compressive myelopathy (CCM)?

A
  1. sensory and ataxic changes of LE’s
  2. Poorly coordinated gait
  3. weakness
  4. tetraspasticity
  5. clumsiness
  6. spasticity
  7. hyperreflexia
  8. presence of primitive reflexes
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2
Q

What are some historical tests used to screen for CCM? Why are these tests not so great for determining of one has CCM?

A
  1. Hoffman’s sign
  2. clonus
  3. Lhermitte sign
  4. grip-and-release test
  5. finger escape sign
  6. Babinski test
  7. inverted supinator sign
    These tests have low sensitivity, leading to many false negatives.
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3
Q

True/False. Radiculopathy is considered a LMN lesion and myelopathy is considered an UMN lesion.

A

True

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4
Q

What is myelopathy (in a short one-sentence description)?

A

A UMN lesion resulting from sagittal narrowing of the spinal cord.

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5
Q

What percentage of people have CCM by their 7th decade of life?

A

70%

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6
Q

What type of CCM (cervical, thoracic or lumbar) is the most common spinal cord dysfunction found in people over the age of 55 years?

A

cervical

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7
Q

True/False. Individuals with MS will often exhibit abnormal cranial nerve testing while individuals with CCM will not.

A

True

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8
Q

A test with low ____________ will often lead to the tester determining the patient to be normal when the test comes up negative while in fact the patient has a pathology.

A

sensitivity

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9
Q

What percentage of primary care physicians typically screen for conditions such as CCM in an initial screen?

A

5%

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10
Q

What can the compression associated with CCM lead to? What can that in turn lead to?

A

Compression can lead to spinal cord ischemia leading to histopathological changes of the spinal cord (myelomalacia).

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11
Q

What is the initial symptom often seen with mild cervical CCM?

A

hand clumsiness or numbness. (less sensory more motor).

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12
Q

What comes first in cervical CCM, pain/bowel/bladder symptoms or weakness/stiffness in extremities?

A

weakness/stiffness

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13
Q

What is the most common contributor to CCM?

A

disk herniations

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14
Q

In CCM, are the signs/symptoms usually consistent in their progression or do they fluctuate?

A

fluctuate

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15
Q

Is it important to distinguish between lumbar CCM or cauda equina syndrome? why or why not?

A

no, because signs/symptoms tend to be very similar and both are considered serious red flag findings.

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16
Q

What are the 2 main ways spinal cord abnormalities are found?

A

MRI

dedicated clinical testing procedures

17
Q

True/False. MRI’s have high sensitivity but low specificity

A

False. MRI’s have high sensitivity AND specificity.

18
Q

Why is an MRI alone not good enough for screening for CCM specifically?

A

Because of false positives caused by spinal cord compression not directly equating with clinical signs/symptoms.

19
Q

What can an EMG distinguish between?

A

EMG’s can differentiate between cervical CCM and peripheral nerve issues such as carpal tunnel syndrome. (normal EMG’s in 100% pts with dx of cervical CCM have been found in study by Kang and Fan).

20
Q

What type of stimulus has better sensitivity, motor or sensory evoked potentials?

A

sensory (according to Kang and Fan).

21
Q

How do you test and what is a positive finger escape sign? sensitivity of this test?

A

hold adducted fingers statically.

positive: involuntary flex and abd. within 1 minute.
sensitivity: 55%

22
Q

What is the inverted supinator reflex?

A

positive test of finger flex or triceps extension upon brachioradialis reflex testing. Considered a sign of LMN lesion AT the spinal level of reflex testing and of an UMN lesion (like CCM) below spinal level of testing.

23
Q

Which of the following babinski sign studies was the strongest (most internal and external validity)? Which one found the highest sensitivity? Which found the lowest sensitivity?

  1. de Freitas and Andre
  2. Berger and Fannin
  3. Ghosh and Pradhan
  4. Hindfelt et al
A

Strongest: Ghosh and Pradhan
highest sensitivity: Berger and Fannin
lowest sensitivity: de Freitas and Andre (0%???)

24
Q

What is the crossed upgoing toe sign and are it’s sensitivity and specificity levels high or low?

A

resisted flexion of hip with knee in full extension. Positive is upgoing toe in the contralateral foot.

sensitivity: low (31%)
specificity: high (96%)

25
Q

True/False: The Allen-Cleckley sign is a moderately sensitive test.

A

true.

26
Q

Glaser et al found the Hoffmann sign to be more sensitive or specific?

A

specific (both in blinded and unblinded trials)

27
Q

What is the Lhermitte Sign and what is the main problem with it?

A

standing or sitting cervical flexion with electical (pins and needles) sensation near the end range of flexion. The main problem is that studies have reported very low sensitivity (as low as 3%) for this test.

28
Q

What is the main problem with almost all of the clinical tests for CCM?

A

low sensitivity. Not good for ruling out CCM.

29
Q

What are the main problems seen with the studies used for sensitivity testing of these clinical tests?

A

spectrum bias
examiner bias
lack of methods that differentiate between other neuro dysfunctions such as cerebral hemispheric damage.

30
Q

What are the 3 examination guidelines that Cook suggested that could reduce the risk of exam error?

A
  1. Perform comprehensive pt history
  2. Rule out analogous symptoms associated with CES so that PT exam, eval, and intervention can begin (If symptoms found, IMMEDIATE medical referral necessary).
  3. Use a full battery of tests to improve sensitivity with full recognition that a negative finding may be false.
31
Q

What is the main causes of thoracic CCM? lumbar CCM?

A

thoracic: trauma, metastasis or tuberculosis
lumbar: herniated disk

32
Q

What is the general recommendation that Cook says is good for any positive or unclear finding upon clinical testing?

A

Get MRI or other imaging method so that intervention can happen soon if there is an issue. Better to be thorough and stay safe than miss a diagnosis.

Orthopedics II - Cervical (6 decks)

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