CT exam and patient history Flashcards by Colleen Caribardi

What are descriptors of a musculoskeletal problem?

sharp
dull
-aching
numbness
tingling
-weakness
burning
shooting
stabbing

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What are descriptors of a non-musculoskeletal issue?

deep
boring
tearing
pulsating
itchy

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Definition: pain evoked from a dorsal nerve root/ganglion which extends down a limb (inflammation of a nerve)

Radicular pain

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What type of pain has a burning/lancinating quality and can be severe/debilitating?

Radicular pain

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Pain from an acute disc herniation is an example of ___ pain.

radicular

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Definition: pain evoked by a noxious stimulation of structures in the cervical spine that DOES NOT radiate and is very local to the site of irritation

Nociceptive pain

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Irritation of the anterior scalene muscle at its insertion site (1st rib) is an example of ___ pain.

nociceptive

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Definition: Noxious stimulation to structures in the cervical spine can produce referred pain into the UE/mid-back in addition to pain localized in the neck

Somatic referred pain

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C5 referring pain to the lateral deltoid is an example of ___ pain.

Somatic referred pain

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Somatic referred pain has a _____ feeling.

dull/aching

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Definition: noxious stimulation of an organ that produces referred pain into the low back or neck

visceral referred pain

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What is the feeling of visceral referred pain?

dull/aching
gnawing
expanding pressure feeling

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Definition: left shoulder pain from the spleen

Kehr’s sign

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Low back pain can be caused by noxious stimulation of the ___ (visceral referred pain).

kidney

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Noxious stimulation of the ___ can result in right scapular pain (Visceral referred pain).

gallbladder

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Definition:
- Involves pressure on a nerve or nerve root
- pins and needles, tingling feeling

paresthesia

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Lesions of the _____ causes paresthesia.

nervous system

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Lesions of the _____ system produces pain.

musculoskeletal

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Definition: rounded shoulders and forward head posture

kyphosis

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Normative value for cervical FLX

60-80 degrees

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Normative value for cervical EXT

60 degrees

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Normative value for side bending

45 degrees

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Normative value for cervical ROT

90 degrees

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What should you assess if a patient’s primary restriction is cervical ROT?

Assess Upper C-spine

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___% of cervical rotation comes from the AO and AA joints of the neck

50%

What should you assess if a patient's primary restriction is in cervical side bending?

Assess mid-lower C-spine and upper ribs

The C2-C3 segments are often limited in ____ which can mimic trigeminal symptoms and cause headaches

extension

What are the possible findings of the cervical compression test?

1. acute lesion (disc herniation) 2. pressure on a sensitive structure (formainal stenosis) 3. Fracture w/ elicit pain

What is considered as a (+) test for cervical compression test and Spurling's compression test?

Reproduction of neck or UE symptoms

What does it mean if a Spurling's compression test produces neck pain?

The pain can be from joint tissue

What does it mean if there is reproduction of UE symptoms when performing a Spurling's compression test?

1. referred pain from the joint 2. disc herniation 3. foraminal stenosis

What are you looking for when performing a cervical distraction test?

Decrease in neck and UE symptoms

What is a quick and very effective screening test to help determine if the UE symptoms are coming from the C-Spine?

Cervical Distraction test with UE activity

When performing DTR tests, you want to see ___ stretch reflexes that are involuntary and give information about the health of a particular spinal segment

monosynaptic

With a LMN lesion, the issue is somewhere between the ___ and ____.

spinal nerve root, innervated muscle

What is the most common site of a LMN lesion?

spinal nerve root (Formainal stenosis, disc herniation, etc)

Myotomal testing should consist of at least __ trials with a minimum of ___ second holds.

3, 5

With myotomal testing, you (should/should not) gradually increase resistance with each trial.

should

If fatigable weakness is present during myotomal testing, that means ___% of the motor unit is affected.

The C5 myotome can be tested via what muscles?

deltoid, biceps, RTC muscles

The C6 myotome can be tested via what muscles?

brachioradialis (wrist EXT)

The C7 myotome can be tested via what muscles?

triceps, FCR (elbow extension, wrist flexion)

The C8 myotome can be tested via what muscles?

EPL, PIP joint FLX

During Upper limb tension tests, you should (gradually, rapidly) increase the tension on the nerve roots and nerves by passively moving the UE.

gradually

Describe the ULTT1 (Median).

Shoulder: stabilized superiorly, ABD 90-120 degrees, ER Elbow: EXT Forearm: SUP wrist, fingers, and thumb: EXT

Describe the ULTT2 (Median).

Shoulder: depressed, ABD 10 degrees, ER Elbow: EXT Forearm: SUP wrist, fingers, and thumb: EXT

Describe the ULTT3 (radial).

Shoulder: depressed and ABD 10 degrees, IR Elbow: EXT Forearm: PRON wrist: FLX and UD fingers, and thumb: FLX

Describe the ULTT4 (ulnar).

Shoulder: depressed and ABD 10-90 degrees, ER Elbow: FLX Forearm: PRON wrist: EXT and RD fingers, and thumb: EXT

What is a (+) response for upper limb tension tests?

reproduction of pain, numbness, tingling, or burning sensation in the UE

definition: When he tip of the odontoid becomes separated from the remainder of the vertebra, which can lead to spinal instability.

os odontoideum

What are the primary movements that occur at the AO joint?

FLX/EXT

What is the primary movement at the AA joint?

ROT

What ligament attaches C2 to the occiput?

tectorial membrane

What ligament is an important restraint to excessive craniovertebral FLX?

tectorial membrane

definition: connects the superior part of the dens to the occipital condyles (can also attach to the lateral messes of the atlas.

Alar ligaments

What ligament resists excessive Craniovertebral FLX, contralateral SB, and contralateral ROT?

alar ligaments

The major role of the transverse ligament is to counteract ____ translation of the atlas relative to the axis, thus maintaining the correct position of the dens on the anterior arch of the atlas.

What is the action of the sub-occipital musculature?

EXT and ROT of the head

What artery and nerve are found in the sub-occipital triangle?

vertebral artery sub-occipital nerve

The Rectus capitis posterior major runs from the ___ to the ___.

C2 spinous process, inferior nuchal line

What is the action of the rectus capitus posterior major?

EXT, ipsilateral ROT

The rectus capitus posterior minor runs from the ____ to the ____.

posterior tubercle of C1, inferior nuchal line

What is the action of the rectus capitis posterior minor?

EXT of the head

The superior oblique muscle runs from the ___ to the __.

C1 transverse process, medial portion of the occiput

What are the actions of the superior oblique muscle?

EXT and contralateral ROT

The inferior oblique runs from the ___ to the ____.

C2 SP, C1 TP

What is the action of the inferior oblique muscle?

ipsilateral ROT

definition/test: Assesses the integrity of passive ligamentous structures and look for cardinal signs or symptoms (5 D’s And 3 N’s)

Upper C-spine ligamentous assessment

What are the 5 D's?

dizziness diplopia dysphagia dysarthria drop attacks

What are the 3 N's?

numbness nystagmus nausea

definition: seeing two images due to an ocular misalignment

diplopia

definition: difficulty swallowing

dysphagia

definition: difficulty speaking

dysarthria

What are the 3 tests of the upper cervical spine ligamentous assessment?

1. tectorial membrane stress test 2. transverse ligament stress test 3. alar ligament stress test

Side bending and ROT in the UPPER C-spine occur in (opposite/same) directions when they are combined.

opposite

Side bending and ROT in the MID to LOWER C-spine occur in (opposite/same) directions when they are combined.

same

If cervical ROT is limited to one side, SB to the the contralateral side and rotate once more... if there is still a limitation, what part of the spine is most likely affected?

Upper C-spine

If cervical ROT is limited to one side, SB to the the contralateral side and rotate once more... if there is no longer a limitation, what part of the spine is most likely affected?

middle/lower C-spine

The upper C-spine movement assessment involves testing neck ____, ___, and ___.

neutral ROT, FLX w/ ROT, and EXT w/ ROT

If rotation in the Upper C-spine is equally limited in the neutral, flexion, and extension positions, that means that the ___ joint is most likely the cause of the limitation.

AA joint

If rotation in the Upper C-spine is more restricted in EITHER FLX or EXT, that means that the ___ joint is most likely the cause of the limitation.

AO joint

(true/false) After the Upper C-spine movement assessment, intervention will be performed on both sides of the neck

true

What are the common symptoms of upper C-spine dysfunction?

headaches, local muscle soreness and spasm, trigeminal nerve symptoms (tongue sensitivity, paresthesia of face/hand/tongue)