CT division Flashcards
Common S/S of CAD
headaches/migraines
men 35-50
Carotidynia
Ptosis
Ptosis definition
Dropping of the eyelid
Carotidynia definition
Mid - upper cervical pain
Pain around ear and jaw
Cranial nerve Mnemonic
Oh oh oh to touch and feel very good velvet, ah heaven
Cranial nerve 1
olfactory nerve
sense of smell
Cranial nerve 2
Optic nerve
Ability to see
Cranial nerve 3
Oculomotor nerve
Ability to move and blink your eyes
Cranial nerve 4
Trochlear nerve
Ability to move your eyes up and down or back and forth
Cranial nerve 5
Trigeminal nerve
Sensations in your face and cheeks, taste and jaw movements
Cranial nerve 6
Abducens nerve
Ability to move your eyes
Cranial nerve 7
Facial nerve
Facial expressions and sense of taste
Cranial nerve 8
Auditory/vestibular nerve
Sense of hearing and balance
Cranial nerve 9
Glossopharyngeal nerve
Ability to taste and swallow
Cranial nerve 10
Vagus nerve
Digestion and heart rate
Cranial nerve 11
Accessory nerve or spinal accessory nerve
Shoulder and neck muscle movement
Cranial nerve 12
Hypoglossal nerve
Ability to move your tongue
Cervical myelopathy demographics
males
> 50 y/o
C5-6 more commonly
Cervical myelopathy signs
Hyperreflexia DTRs
UMN signs
Unsteadiness
UMN signs
Sensory loss with multi-dermatomal pattern
Neuromuscular exam of upper and lower extremities
Spasticity
Clonus
Ms wasting of UE and LE
Finger escape sign
Seated, pt flexes both elbow to 90
PT pronates and ADD fingers
(+) if 5th finger cannot maintain adduction
Ulnar nerve neuropathy
(+) Wartenberg sign
Paresthesias on 4th and 5th finger
Posterior interosseus nerve
Radial Nerve branch and is motor only seen w/ supinator syndrome
Median nerve entrapment
Cause paresthesias on the volar aspect of the band and the fingertips of 1,2,3 & lateral 4th
Parsonage - Turner’s syndrome
Neuritis involving the brachial plexus (involves the upper trunk)
Mckenzie dysfunction results
Pain at end range
Best intervention is to progress into their limitation w/ dysfunction criteria
Cervical myelopathy CPG
Gait deviation
(+) Babinski’s test
(+) Hoffman test
(+) Supinator sign
Hyperreflexia of Brachioradialis
3+ or greater w/ ms stretch reflex testing
T4 syndrome
Stocking glove pattern and symptoms in their upper thoracic spine
Common mimic of diabetes and radiculopathy
Pronator teres innervated
Median Nerve
Radiculopathy and stenosis have what in common?
Dermatomal loss at specific lvls
Morquio syndrome
Bone dysplasia associated w/ C1-2 subluxation
VBI vs BPPV
VBI at end range cervical rotation will increase dizziness
BPPV at end range cervical rotation will decrease dizziness over time after it is increased w/ position change
Bakody sign (abduction test)
P or AROM shld ABD to place hand on head
(+) if symptom reduction
(-) for symptom magnification and potential for scalene issue/involvement
Spinoglenoid notch
Entrapment in this area could lead to suprascapular nerve involvement and atrophy of infraspinatus
Quadrilateral space syndrome
Fatty infiltration of the teres minor and compression of the axillary nerve
Cause cervical radiculopathy symptoms and posterior shld pain
Parsonage - turner syndrome
Brachial neuritis w/ pain initially but no pain and only muscle weakness
Common w/ recent illness or vaccinations, 5th decade of life
Reflex sympathetic dystrophy
Similar to CRPS
S/s of burning pain, increased skin sensitivity, changes in skin temp, swelling and stiffness in joints, changes in skin color
Cervical mechanical Tx is done when?
If no centralization of symptoms
Cervicogenic headaches w/ increased symptoms past work will benefit from?
Grade III/IV mobs and DNF training
Arnold Chiari malformation
Displacement of cerebellar tonsils and brain stem tissue into the foramen magnum.
Neck pain and HA symptoms
Quadrilateral space syndrome
Created by the lateral head of the triceps, teres minor, teres major and medial border of the humerus
Hold the axillary nerve and posterior circumflex humeral artery
What does the C5 innervate?
Axillary nerve root and innervates the deltoid, teres minor
sensation to lateral shoulder
Wartenberg sign
Slightly greater ABD of the 5th digit due to weakness of the palmar interosseous ms unopposed action to the radial innervated extensor ms (digiti minimi, digitorum communis)
Wartenberg’s syndrome
Entrapment of the superficial branch of the radial nerve w/ only sensory manifestations and no motor deficits
Middle 1/3 humeral Fx results in?
Radial N injury
Radial nerve supplies motor
Triceps
Anconeus
Brachioradialis
Extensor bundle
Abductor pollicis and extensor indices
TMJ w/ reduction
Opening click where disc shifts anteriorly and returns posteriorly w/ closing
TMJ w/o reduction
Smaller ability to open the jaw due
Posterior displacement results in decreased ability to close jaw
Thoracodorsal Nerve innervates
Latissimus dorsi
Thoracodorsal nerve is from what nerve root
C6-8
Lower subscapular nerve innervates
Teres Major
Lower subscapular nerve is from what nerve root
C5-6
Upper subscapular nerve innervates
Subscapularis
Upper subscapular nerve is from what nerve root
C5-7
Musculocutaneous Nerve innervates
Coracobrachialis
Brachialis
and is the lateral cutaneous nerve of the forearm
Musculocutaneous nerve is from what nerve root
C5-7
Axillary Nerve innervates
Deltoid
Teres minor
Axillary nerve is from what nerve root
C5-6
Radial nerve is from what nerve root
C5-T1
Dorsal scapular nerve innervates
Rhomboid
Levator
Dorsal scapular nerve is from what nerve root
C4-5
Long thoracic nerve innervates
Serratus anterior
Long thoracic nerve is from what nerve root
C5-7
Nerve to the subclavius innervates
Subclavis ms
Nerve to the subclavius is from what nerve root
C5-6
Suprascapular nerve innervates
Supraspinatus
Infraspinatus
Suprascapular nerve is from what nerve root
C5-6
Lateral Pectoral nerve innervates
Pec minor and major
Lateral pectoral nerve is from what nerve root
C5-7
Ulnar nerve innervates
Flexor carpi ulnaris
Medial 2 bellies of flexor digitorum profundus
Intrinsic hand ms
Thenar ms
2 most lateral lumbricals
Ulnar nerve is from what nerve root
C8-T1
OA CPG treatment
Flexibility, endurance, and strengthening exercises and manual is A evidence
Canadian C-spine rules
≥ 65 y/o
Dangerous mechanism
Paresthesias in extremities
Rotate L & R 45 degrees (Unable)
C-spine rule dangerous mechanism
Fall of ≥ 3ft or 5 stairs
Axial load to head
> 100km/hr
Arcade of Froshe
Commonly traps the posterior interosseous Nerve branch of radial Nerve
Ligament of struthers and arcade of struthers and lower c-spine radiculopathy cause?
Increased pain for ulnar nerve
How to reduce right orbit lower than left in congenital torticollis
R SCM stretching to reduce tightness and eye issues
Froment’s sign
Weakness of ADD pollicis, flexor pollicis brevis and first dorsal interosseous ms
Suggestive of ulnar neuropathy or entrapment
Klippel - Feil syndrome
2 or more vertebra are fused in the C/s from birth
Scheuermann disease
Juvenile kyphosis
Vertebral bodies are discs of the spine identified by anterior wedging of greater than or equal to 5 degrees or 3 or more adjacent vertebral bodies & > 40 degrees
What is a characteristic of Grave’s disease?
Enophtalmos or posterior displacement of the eye within the socket
Anterior cervical discectomy and fusion (ACDF)
Most widely used surgeries for cervical radiculopathy
Can remove compression w/o retraction of spinal cord
Hangman’s Fx
Fx of the axis (C2) at the pedicles
Jefferson Fx
C1 Fx
Extension Tear drop Fx
Middle or lower c/s Fx due to forced et w/ avulsion of anterior inferior corner of the vertebral body
Tx for tear drop Fx
Immobilization
Clay shoveler’s Fx
Lower C/s
Avulsion type spinous process Fx of lower C/s or upper T/s
Erbs - Duchenne palsy
Traction or avulsion injury to the upper roots of C5-6
Results in waiter’s tip of the UE
Klumpke’s palsy
Involves C8-T1
Upper cervical instability is seen with?
RA, DS and juvenile RA
Alar ligament test
Prom to the left or right upper c/s rotation
Left rotation spinous process moves right
No feeling of the spinous process moving then the contralateral side alar ligament is compromised
Cervical myelopathy when a patient is sitting may cause
Paresthesia and anterior thigh pain
Bassett’s lesion is?
Entrapment of the lateral ante-brachial cutaneous Nerve
Common with OH athletes
T4 syndrome is?
Bilateral stocking glove paresthesias and upper T/S pain
Pain behind the shoulder blade & pain in the neck
Nondermatomal pattern
Hypo-mobility of lower c/s and upper t/s
Paget - schmetter syndrome is?
DVT of the upper extremities
Seen in young active males with repetitive OH activities
What is the primary jaw depressor?
Lateral Ptreygoid
Rule of 3s
T1-3 = SP & TP same lvl
T4-6 = SP is 1/2 lv below TP
T7-9 = SP is 1 lvl below TP
T10-12 = SP is at the same lvl as the vertebra they are attached to
Acute cholecysitis referral pain
Pain of right upper quadrant/ infrascapular and pain post eating
Pancreatitis pain referral pattern
Epigastric pain and radiation of thoracolumbar pain
Pyelonephritis referral pain
Costovertebral &/or flank pain
Ankylosing spondylitis s/s
Morning pain and decreased AROM of T/s
< 45 y/o
Wakes up in the 2nd half of the night
Weather pain
Crohn’s disease gene and elevated blood value
HLA - B27 gene expression
Elevated c-reation protein
Pancoast tumor
Smoker
> 50 y/o
Arm paresthesias
Enthesitis characteristics
Inflammation at the sit of ligament or tendon attachment
Common with Synovitis, Psoritic arthritis, ankylosing spondylitis
Thoracic disc herniations occur in?
30 - 50 y/o males and females
What is the periaqueductal gray
Supra-spinal structures that can be stimulated w/ manual for analgesia
Sympathetic nervous system is able to?
Can change skin conductance and temperature past joint mobilizations due to stimulation of the dorsal peri-aqueductal matter of the mid brain
Elevated first rib right or left mechanics
Suspect a cervical rotation to the right and lateral flexion to the left to assess left first rib
opposite for right rib
Lhermitte’s sign “Barber sign”
Indicated of cervical myelopathy
Cervical flexion occurs and electrical stimulation is felt down the back
Froment’s sign/test
Key grip with paper inbetween
Thumb should stay flat showing ADD pollicis is firing and the ulnar nerve is firing
(+) if thumb flexes to engage FPL
Hoffmans signs is?
Upper motor neuron sign when pressure is applied to the nail of the 3rd digit and is flicked
Kernig’s sign is?
Limitation of straightening the knee when hip is flexed to 90 degrees
Characteristic of meningitis
Dorsal scapular nerve innervates?
Levator scapula
Rhomboid minor and major
Paraspinals Lateral to medial
Iliocostalis, longissimus, spinalis
I love spaghetti
Brown sequard syndrome is?
Hemisection of the spinal cord
Loss of proprioception and motor function of the side of the lesion
Inability to sense pain or temperature on the contralateral side
12 ribs and the truth and false
7 true ribs
5 false ribs
Kehr’s sign
Ruptured spleen where there is acute left shoulder pain at the tip
Inferior Vena Cava enters?
Diaphragm at T8
Esophagus enters the diaphragm at?
T10
ta enters the diaphragm at?
T12
What happens if the inferior vena cava gets compressed?
Hypotension
Occurs in later pregnancy
What happens past 120 degrees of shoulder elevation?
Lower trap and serratus anterior facilitate further mvmt
Prone double straight leg raise test purpose
Best test for LBP
Best SN and SP
Marathon runners commonly develop?
A-fib
What will you see with a long thoracic nerve injury?
Increased distance from T4 to the medial border of the scapula on the same side as the injury