Deck 4 Flashcards
On the way to injury prevention screen, a patient was involved in an MVA. Which of the following high risk factors would warrant a referral to the ED for radiograph?
A. Pt age 63
B. Cervical rotation 25˚ to R and 60˚ to L
C. Vehicle speed of 58 mph at time of collision
D. Paresthesias in L arm and into 4th/5th finger
D. Paresthesias in L arm and into 4th/5th finger
40F referred with radicular “pins and needles” radiating from R elbow to 4th and 5th fingers. Which of the following would not cause the pt’s symptoms?
A. Entrapment at the ligament of Struthers
B. Entrapment at the arcade of Struthers
C. Entrapment at the arcade of Frohse
D. Lower cervical radiculopathy
C. Entrapment at the arcade of Frohse
Entrapment at the arcade of Struthers and ligament of Struthers would cause paresthesias in what distribution?
ulnar nerve
60F with chronic neck pain and hand weakness. Cervical ROM limited. Normal reflexes/sensation B. Myotomal assessment unremarkable but pt unable to oppose thumb of R hand to tip of 2nd digit. Symptoms are suggestive of which of the following?
A. Spondylosis resulting in radiculopathy
B. Entrapment of anterior interosseous nerve
C. Entrapment of posterior interosseous nerve
D. Entrapment of radial nerve
B. Entrapment of anterior interosseous nerve
Pt presents on 5th visit of POC. You’ve been treating him for mechanical neck pain. Today he reports he is unable to close his mouth completely. What is the most likely cause?
A. Root canal at dentist that was performed the previous day
B. Trauma by tennis ball that hit him on the L aspect of the mandible
C. MVA with WAD
D. Combo of bruxism and increased stress
A. Root canal at dentist that was performed the previous day
It is common after what for pts to not be able to close their mouth all the way
dental procedures
Inability to close the mouth is common with this type of disc displacement
posterior
What is the best tx for a 4 mo old pt with congenital torticollis when the R orbit appears lower in position to the L?
A. DNF strengthening
B. Stretching L SCM
C. Stretching R SCM
D. Sitting on PB with gentle passive rocking by therapist side to side
C. Stretching R SCM
During your eval of a pt with hand weakness, you note a (+) Froment’s sign. What is true of Froment’s sign?
A. Reduction of pt’s symptoms with shoulder abduction
B. Weakness of adductor pollicis and FPB
C. Inability to adduct the 5th finger
D. Weakness of adductor pollicis, FPB, and 1st dorsal interossei
D. Weakness of adductor pollicis, FPB, and 1st dorsal interossei
Weakness of adductor pollicis, FPB, and 1st dorsal interossei is suggestive of what type of neuropathy or entrapment?
ulnar nerve
Alleviation of pain with shoulder abduction is known as
Bakody’s sign
37M presents with flu-like symptoms, malaise, dec AROM lumbar sidebending, and limited chest expansion. What is the most likely dx?
A. Klippel-Feil syndrome
B. Sheurmann’s disease
C. Ankylosing spondylitis
D. Rheumatoid arthritis
C. Ankylosing spondylitis
Klippel-Feil Syndrome involves what?
fusion of the bones in the cervical spine
All of the following are characteristics of Horner’s syndrome except which of the following?
A. Miosis
B. Ptosis
C. Anhidrosis
D. Exophthalmos
D. Exophthalmos
What is exophthalmos?
protrusion of the eye out of its socket
What disease is exophthalmos seen in?
Graves disease
What is enophthalmos?
posterior displacement of the eye within the socket
Horner’s syndrome: (exophthalmos/enophthalmos) is possibly seen, but not always
enophthalmos
Miosis =
constriction of the pupil
Ptosis =
drooping of the eyelid
Anhidrosis =
inability to sweat
All of the nerves in the cervical spine exit above the designated vertebral level except for which of the following?
A. C1
B. C2
C. C7
D. C8
D. C8
The cervical nerves all exit (above/below) their designated spinal level except C8, which exits between C7-T1
above
Which of the following does not have a spinous process?
A. C1
B. C2
C. C6
D. C7
A. C1
52F presents for preop consultation. Failed tx for cervical radiculopathy, no changes in paresthesias and mm weakness down L arm. If surgery is indicated, what is the most likely one to be performed?
A. Posterior microendoscopic fusion
B. ACDF
C. Artificial disc replacement
D. Laminectomy
B. ACDF
ACDF =
Anterior Cervical Discectomy & Fusion
Why is an ACDF advantageous to a posterior approach?
can remove compressive lesion without having to retract the spinal cord
From anterior to posterior, select the correct order of structures in the mid-lower cervical spine
A. ALL, IV disc, SC, PLL, ligamentum flavum
B. ALL, IV disc, ligamentum flavum, PLL, SC
C. ALL, IV disc, PLL, SC, ligamentum flavum
D. ALL, ligamentum flavum, IV disc, PLL, SC
C. ALL, IV disc, PLL, SC, ligamentum flavum
Pt presents with new onset HA localized to orbit after MVA 3 weeks ago. HA frequency 4x per week that progressively worsen through day. PROM LR increased intensity of HA. Inc’d suboccipital soreness with PROM cervical retraction. Pt with co-complaint of neck pain. Also reports increase in frequency and intensity of dizziness. What dx would best fit this pt?
A. BPPV
B. Tension HA
C. Migraine HA
D. Cervicogenic HA
D. Cervicogenic HA
What is the best test to confirm a cervicogenic HA?
A. Cervical flexion rotation test
B. Palpation of suboccipital region
C. Pt subjective hx
D. Inc in HA with sustained cervical protrusion
A. Cervical flexion rotation test
What type of fx involves the pedicles of the axis?
A. Jefferson fx
B. Tear drop fx
C. Hangman’s fx
D. Clay shoveler’s fx
C. Hangman’s fx
A hangman’s fx involves which vertebra?
axis
A Jefferson’s fracture involves which vertebra?
Atlas
A teardrop fx typically affects what part of the cervical spine?
middle to lower cervical spine
Where does a Clay Shoveler fx occur?
lower cervical spine
After birth, the baby appears to have motor weakness of the arm 2/2 traction injury of the brachial plexus. Presents w/ R arm hanging limp, internally rotated, extended, and pronated. Classic presentation is characteristic of what pathology?
A. Shoulder subluxation
B. Erbs-Duchenne palsy
C. Klippel-feil syndrome
D. Klumpke’s palsy
B. Erbs-Duchenne palsy
Erb’s palsy involves traction or avulsion injury to
Upper roots of C5/6 of the brachial plexus
Klumpke’s palsy is a brachial plexus injury affecting what levels?
C8-T1
What is Klippel-feil syndrome?
congenital fusion of two cervical vertebrae
Which of the following is the least likely patient to have upper cervical instability?
A. Pt diagnosed with RA
B. Pt with dizziness and a HA after MVA
C. Pt diagnosed with JRA
D. Pt with Down’s syndrome
B. Pt with dizziness and a HA after MVA
Bicycle race. Racer rides by booth and the front tire of the bike collapses, rider flips forward over the handlebars and hits his head in a flexed cervical position. The racer denies paresthesias down arm and cervical AROM WNL. What is the best management for this racer?
A. Help the rider with a spare front tire
B. Ask event physician to assess the racer
C. Have ambulance transport to the ED
D. Have the rider discontinue the rest of the race
C. Have ambulance transport to the ED
Assessing alar ligament stability of a pt who was referred for neck pain after MVA. The PT rotates the pt’s head to the R and does not feel the C2 spinous process move in the CL direction. What is the best answer choice below?
A. The test is negative; continue with exam
B. The test is positive; continue with exam
C. The R alar ligament is compromised
D. The L alar ligament is compromised
D. The L alar ligament is compromised
Rotation to the R tests which alar ligament?
L
For a normal alar ligament test, the therapist would feel the spinous process move where with passive rotation to the right
to the left
A pt involved in MVA 2 weeks ago. Pain is 8/10 at rest and with activity. NDI = 65. Pt is limited to 50˚ AROM rotation B. What is the best treatment for this pt?
A. Grade I/II central AP mobs to cervical spine
B. Grade I central AP mobilization and education for increased bed rest until pain decreases to 5/10
C. Grade I central AP mobs and education to return to normal activities without exacerbation of pain and education of good prognosis of recovery
D. Grade III/IV central AP mobs to the cervical spine
C. Grade I central AP mobs and education to return to normal activities without exacerbation of pain and education of good prognosis of recovery
Despite importance of return to normal activity, this may be indicated initially after an MVA, but should be avoided as the pt progresses from the injury
bed rest
54F referred for neck pain with radicular symptoms just proximal to elbow. Dx of DDD and cervical spondylolisthesis (lateral radiographs only). Mechanical traction recommended as principal intervention. Pt has increased pain sleeping on L side. Pain reproduced with AP GH joint mobilizations. (+) anterior apprehension test. MMT of L shoulder ER 4/5*. The pt can actively rotate her head > 60˚ B, Spurling (-), ULTTA (-). What is the best treatment for this pt?
A. Chin tucks
B. RTC and shoulder girdle strengthening
C. Mechanical cervical IMT
D. Cervical mobilization
B. RTC and shoulder girdle strengthening
What is the CPR for intermittent mechanical cervical traction?
- hypomobility of lower cervical spine
- age > 55
- (+) ULTT
- (+) shoulder abduction sign
- relief of symptoms with distraction
Pt presents 6 wks s/p benign tumor removal from R upper trunk of brachial plexus within the posterior triangle of the neck. You notice the pt is unable to actively shrug the shoulder and has asymmetrical winging of the R scapula. What is the most likely nerve injured?
A. Suprascapular nerve
B. Long thoracic nerve
C. Spinal accessory nerve
D. Axillary nerve
C. Spinal accessory nerve
This nerve runs superficially through the posterior triangle of the neck
spinal accessory nerve
The spinal accessory nerve innervates which muscles?
- SCM
- trapezius
When trauma occurs to spinal accessory nerve, what might you notice clinically?
- drooping of shoulder
- wasting of trapezius
- weak shoulder abduction
If the lesion to the spinal accessory nerve is distal, which muscle is spared and which is affected?
SCM spared
trapezius affected
Scapular winging can occur due to damage of which nerves?
- spinal accessory nerve
- long thoracic nerve
55F with lumbar radiculopathy. B pins and needles from lower buttock to knees. Pins and needles sensation started > 1 year ago. Recently, reports B anterior thigh numbness. Sx only noticeable while sitting for prolonged periods. What body region needs to be screened prior to initiating tx?
A. Cervical spine
B. Thoracic spine
C. Lumbar spine
D. Visceral organs
A. Cervical spine
B radicular symptoms in extremities should make you suspicious for
cervical myelopathy
19M college pitcher presents with paresthesia along anterior radial aspect of the forearm. Just started training sessions with the baseball team and has increased volume/intensity of throwing. Cervical ROM WNL. Spurling (-). ULTT median (+). Paresthesia unchanged with manual cervical distraction. Based on the limited info, what is the most likely dx?
A. Radial nerve entrapment
B. C6 radiculopathy
C. Bassett’s lesion
D. Musculocutaneous nerve entrapment
C. Bassett’s lesion
Bassett’s lesion is an entrapment of what nerve?
lateral antebrachial cutaneous nerve
Bassett’s lesion affects (sensation/motor)
sensation only
Bassett’s lesion is most common in which groups
OH athletes
Bassett’s lesion is reproduced with what motions at the elbow?
- extension
- pronation
Which of the following is not a sign of cervical myelopathy?
A. Gait disturbance
B. Grade 1+ biceps tendon reflex
C. + Babinski
D. + Inverted supinator sign
B. Grade 1+ biceps tendon reflex
A pt presents to PT with pain between shoulder blades and neck with radiculopathy into L hand with a stocking glove pattern. What is the most likely dx?
A. DM
B. T4 syndrome
C. Diabetes insipidis
D. C8-T1 cervical radiculopathy
B. T4 syndrome
The pattern for T4 syndrome can mimic this condition
DM
Which muscle is not innervated by the anterior interosseous nerve branch?
A. Radial half of FDP
B. Pronator teres
C. FPL
D. Pronator quadratus
B. Pronator teres
The anterior interosseous nerve is a (sensory/motor) branch of the median nerve
motor
Where does the anterior interosseous nerve branch off from the median nerve?
after it passes through pronator teres muscle
You are going to perform cervical manipulation on a patient. Before proceeding, you let the pt know the risks/complications that can occur with cervical manipulation. Which of the following choices is most accurate?
A. Strong association with cervical manipulation and stroke
B. Moderate association with cervical manipulation and stroke
C. Low association with cervical manipulation and stroke
D. Complications with cervical manipulation are common, but with screening is safe
C. Low association with cervical manipulation and stroke
20M college wrestler referred by PCM for R arm cellulitis and arm pain. Pt reports with 2 wk hx of erythematous painful swelling of R elbow and forearm. He noticed acute swelling and redness after one of his matches. What is the most likely dx?
A. Olecranon bursitis
B. Paget-Schroetter syndrome
C. Cellulitis
D. Parsonage-Turner syndrome
B. Paget-Schroetter syndrome
What is Paget-Schroetter syndrome?
DVT of one of the veins in the UEs
Paget-Schroetter syndrome: common in what groups?
young active males involved in sports that require repetitive UE movement overhead
Which muscle is the primary cause of mandible depression and contributes to protrusion and medial/lateral deviation of the jaw?
A. Temporalis
B. Medial pterygoids
C. Lateral pterygoids
D. Masseter
C. Lateral pterygoids
Primary mandible depressor
lateral pterygoid
Temporalis, masseter, and medial pterygoids all are primary (openers/closers) of the jaw
closers
Pt presents with TMD and myalgia of the masseter appears to be a primary contributor to concordant pain. Which of the following interventions would be inappropriate for this pt?
A. Trigger point DN
B. STM
C. Joint mobilization
D. None of the above
D. None of the above
