Deck 3 Flashcards
Which of the following is not a high risk factor according to the Canadian C-Spine rules in the evaluation of a patient with cervical pain after an accident?
A. Age > 65
B. Hx of paresthesias in extremities
C. Delayed onset neck pain
D. Fall from height of 6 feet
C. Delayed onset neck pain
You are considering cervical HVLAT on a patient and are reviewing their medical hx. Which pathology is not predisposed to cervical instability or ligamentous laxity?
A. RA
B. Cervical spondylolisthesis
C. Morquio syndrome
D. Marfan syndrome
B. Cervical spondylolisthesis
What is Morquio syndrome?
Bone dysplasia associated with C1-2 subluxation
34 F presents with new onset dizziness. You are concerned for VBI. You passively rotate the cervical spine to end range which reproduces the dizziness. As you hold the position, the intensity decreases. What do your exam findings suggest?
A. Confirm suspicion for VBI
B. Suggest a dx of BPPV
C. Confirm a dx of migraine without aura
D. ID cervical facet dysfunction
B. Suggest a dx of BPPV
35 M with R shoulder pain referral. During exam, you note the pt reports relief of sxs with shoulder abduction. What is the most likely pathology?
A. R RTC strain
B. Cervical radiculopathy
C. R deltoid hypertrophy due to weak RTC musculature
D. TOS
B. Cervical radiculopathy
Shoulder pain reduced with abduction should lead to suspect cervical spine pathology, most likely where?
mid-lower cervical
Shoulder pain reduced with abduction is a (+) ____ sign
+ Bakody sign
40F recreational softball player with dull global L shoulder and neck pain. UA to describe aggs, symptoms intermittent. Inc’d shoulder weakness since starting softball. Also started a new job in HR 4 weeks ago.
PE: 3+/5 L shoulder ER (5/5 on R); L infraspinatus atrophy; limited cervical AROM rot 55˚ B; cervical radiculopathy cluster (-) What is the most likely dx?
A. Nerve entrapment at suprascapular notch
B. C4 radiculopathy
C. Nerve entrapment at spinoglenoid notch
D. C5 radiculopathy
C. Nerve entrapment at spinoglenoid notch
What should you expect when the nerve is entrapped at the suprascapular notch? (atrophy)
atrophy of both supraspinatus and infraspinatus
What should you suspect if the suprascapular nerve is entrapped at the spinoglenoid notch? (atrophy)
infraspinatus atrophy only
45 M with cervical radiculopathy without improvement. MRI of shoulder showed minimal cervical disc disease/degeneration and isolated fatty infiltration of the teres minor. Primary sx’s are shoulder ER and abd weakness and post shoulder pain. What is the most likely dx?
A. Quadrilateral space syndrome
B. C5-6 radiculopathy
C. Suprascapular nerve entrapment
D. Parsonage-Turner syndrome
A. Quadrilateral space syndrome
Characteristics of quadrilateral space syndrome
- fatty infiltration of the teres minor
- compression of the axillary nerve
Classic presentation of Parsonage-Turner syndrome is absence of ___ and presence of ____
absence of pain
presence of weakness
Quadrilateral space syndrome can mimic
cervical radiculopathy
Which nerve root would cause symptoms to the dorsal and lateral neck down to the anterior portion of the clavicle, trapezius, and ACJ?
A. C2-3
B. C3-4
C. C4-5
D. C6-7
B. C3-4
40F referred for cx radiculopathy with paresthesias in digits 1-3. Hx of HTN and smokes 1 ppd. Sx in R arm and hand x 8 mos with no precipitating injury or mechanism. Hypersensitive to light touch of R forearm. Yells in pain from taking BP. She perceives inc temp of forearm and sometimes has swelling. What is the most likely dx?
A. C6-7 radiculopathy
B. Reflex sympathetic dystrophy
C. TOS
D. Central sensitization
B. Reflex sympathetic dystrophy
Why would you think reflex sympathetic dystrophy vs. central sensitization?
temp change
hypersensitivity to light stimuli
Which of the following is not part of the CPR for cervical radiculopathy by Wainner et al in 2003?
A. ULTT IA
B. ULTT IIB
C. Spurlings
D. AROM cervical rot < 60˚
B. ULTT IIB
45M with radicular symptoms (3 of 4 inclusion criteria). flex 70˚ with pain ext 80˚ with sx centralizing to elbow R SB 75˚ with sx centralizing with elbow L SB 55˚ NC in symptoms RR 65˚ NC in symptoms LR 75˚ with PAER
A. Mechanical constant traction
B. Repeated L cervical SB
C. Repeated R cervical SB
D. Nerve tensioners
C. Repeated R cervical SB
According to the 2008 CPG, which intervention has the strongest evidence for a pt with cervical radiculopathy?
A. Median nerve tensioners
B. Mechanical constant traction
C. Repeated cervical extension (at least 10 reps)
D. Mechanical intermittent traction
D. Mechanical intermittent traction
If a patient fails to centralize (neck) during the examination and is very irritable, what should be performed?
intermittent mechanical traction
34 with cervicogenic HA. Inc HA and neck pain at end of workday (secretary). Which is the best tx option?
A. Cervical manipulation
B. Grade III/IV mobilizations and DNF strengthening
C. Cervical mobs G I-IV
D. Thoracic manipulation
B. Grade III/IV mobilizations and DNF strengthening
Which of the following is the best tx option for decreasing the frequency of cervicogenic HA based on current evidence?
A. Cervical manipulation
B. Low level laser
C. Shoulder girdle strengthening
D. All of the above
A. Cervical manipulation
Strong support for low level laser and shoulder girdle strengthening for cervicogenic HA?
no
What best describes an Arnold-Chiari malformation?
A. Excessive buildup of CSF
B. Displacement of cerebellar and brain stem tissue into foramen magnum
C. Hydrocephaly
D. Brain aneurysm
B. Displacement of cerebellar and brain stem tissue into foramen magnum
This condition may result from Arnold-Chiari malformation
Hydrocephalus
This condition may result from brain aneurysm
hydrocephalus
35M with thoracic SCI with R anterolateral shoulder pain. R shoulder weakness and dec performance in WC basketball games.
PE: teres minor and deltoid atrophy, 3+/5 strength with MMT
What is the most likely pathology?
A. anterior interosseous nerve entrapment
B. TOS
C. Posterior interosseous nerve entrapment
D. Quadrilateral space syndrome
D. Quadrilateral space syndrome
With quadrilateral space syndrome, this nerve is frequently involved
axillary nerve
Quadrilateral space syndrome most commonly seen in what groups?
- OH athletes
- individuals with SCI - repetitive strain from WC propulsion
35M with thoracic SCI with R anterolateral shoulder pain. R shoulder weakness and dec performance in WC basketball games.
PE: teres minor and deltoid atrophy, 3+/5 strength with MMT
Which nerve is most likely affected in this case?
A. Axillary
B. Musculocutaneous
C. Radial
D. Ulnar
A. Axillary
Which of the following is not part of the quadrilateral space in the shoulder?
A. Humeral shaft
B. Posterior head of the deltoid
C. Teres major
D. Long head of triceps
B. Posterior head of the deltoid
What artery passes through the quadrangular space in the shoulder?
posterior circumflex humeral artery
Which cervical nerve roots innervate the teres minor and deltoid?
A. Axillary
B. C5-6
C. C4-5
D. C6-7
B. C5-6
Compression of the axillary nerve results in atrophy and weakness of which muscles?
- teres minor
- deltoid
Compression of the axillary nerve results in pain referral where?
lateral shoulder
Quadrilateral space: superior border
teres minor
Quadrilateral space: inferior border
teres major
Quadrilateral space: medial border
long head of triceps
Quadrilateral space: lateral border
humeral shaft
The posterior circumflex humeral artery follows this nerve through the quadrilateral space and encircles the humeral head
axillary nerve
Which nerve roots provides innervation to deltoid and teres minor
C5-6
55 yo with rapid onset severe neck, UE, radial forearm pain. Pt had influenza vaccine 2 weeks prior. Weakness with AROM shoulder abd/ER. Was treated for mechanical neck pain. Over time, the neck pain resolved, but weakness progressed. EMG revealed supraspinatus P waves and fibrillations. What is the most likely dx?
A. RTC tear
B. Parsonage-Turner Syndrome
C. Cervical radiculopathy
D. Amyotrophic lateral sclerosis
B. Parsonage-Turner Syndrome
What age is Parsonage-Turner syndrome commonly seen?
5th decade of life
Parsonage-Turner syndrome has been associated with recent…
illness or vaccinations
Parsonage-Turner syndrome: NCV testing will be
normal
Parsonage-Turner syndrome: trademark s/s
- severe pain at onset which resolves
- muscle weakness as it progresses
33M security guard referred for R cervical radiculopathy. C/o radicular sx into 4th and 5th fingers x 3 weeks. Developed after practicing hammer punch (hit pad with ulnar side of hand in a pronated position as the elbow extends). Can only produce radicular symptoms with OH lifting.
What is the most likely dx?
A. R lateral stenosis of C6-7 causing radiculopathy
B. R posterolateral disc bulge causing radiculopathy at C6-7
C. R anteroinferior shoulder instability
D. Parsonage-Turner syndrome of ulnar nerve
C. R anteroinferior shoulder instability
Parsonage-Turner syndrome typically presents after what age?
50
33M security guard referred for R cervical radiculopathy. C/o radicular sx into 4th and 5th fingers x 3 weeks. Developed after practicing hammer punch (hit pad with ulnar side of hand in a pronated position as the elbow extends). Can only produce radicular symptoms with OH lifting.
What is the best treatment option for this pt?
A. Mechanical intermittent traction
B. Repeated cervical retraction with pt OP
C. RTC strengthening
D. Referral to physician if sx’s do not resolve
C. RTC strengthening
Wartenberg sign is indicative of entrapment affecting which nerve?
ulnar nerve
Wartenberg sign: weakness of
palmar interossei
Wartenberg sign: weakness of palmar interossei leads to
abduction of 5th digit in hand
Pt presents after FOOSH when slipping on ice. Radiographs showed middle ⅓ of humerus fx. What nerve most likely to be compromised?
radial
35M with TMD pain. Already being treated for mechanical neck pain. Only able to open his mouth 2 finger widths. Pt states he used to hear a click with mouth opening but hasn’t heard in a few weeks. Symptoms suggestive of what pathology?
A. Anterior DDWR
B. Anterior DDWOR
C. Posterior DDWR
D> Posterior DDWOR
B. Anterior DDWOR
When is it common to see posterior disc displacement?
dental procedures where the pt is required to keep the mouth open for an extended time.
With (anterior/posterior) disc displacement, the pt may not be able to close the mouth
posterior
