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