CT exam and patient history Flashcards
What are descriptors of a musculoskeletal problem?
- sharp
- dull
-aching - numbness
- tingling
-weakness - burning
- shooting
- stabbing
What are descriptors of a non-musculoskeletal issue?
- deep
- boring
- tearing
- pulsating
- itchy
Definition: pain evoked from a dorsal nerve root/ganglion which extends down a limb (inflammation of a nerve)
Radicular pain
What type of pain has a burning/lancinating quality and can be severe/debilitating?
Radicular pain
Pain from an acute disc herniation is an example of ___ pain.
radicular
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
Irritation of the anterior scalene muscle at its insertion site (1st rib) is an example of ___ pain.
nociceptive
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
C5 referring pain to the lateral deltoid is an example of ___ pain.
Somatic referred pain
Somatic referred pain has a _____ feeling.
dull/aching
Definition: noxious stimulation of an organ that produces referred pain into the low back or neck
visceral referred pain
What is the feeling of visceral referred pain?
- dull/aching
- gnawing
- expanding pressure feeling
Definition: left shoulder pain from the spleen
Kehr’s sign
Low back pain can be caused by noxious stimulation of the ___ (visceral referred pain).
kidney
Noxious stimulation of the ___ can result in right scapular pain (Visceral referred pain).
gallbladder
Definition:
- Involves pressure on a nerve or nerve root
- pins and needles, tingling feeling
paresthesia
Lesions of the _____ causes paresthesia.
nervous system
Lesions of the _____ system produces pain.
musculoskeletal
Definition: rounded shoulders and forward head posture
kyphosis
Normative value for cervical FLX
60-80 degrees
Normative value for cervical EXT
60 degrees
Normative value for side bending
45 degrees
Normative value for cervical ROT
90 degrees
What should you assess if a patient’s primary restriction is cervical ROT?
Assess Upper C-spine
___% 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?
- acute lesion (disc herniation)
- pressure on a sensitive structure (formainal stenosis)
- 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?
- referred pain from the joint
- disc herniation
- 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.
80
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.
Anterior
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?
- tectorial membrane stress test
- transverse ligament stress test
- 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)