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OMM M1 CB > E4: Examination of the Neck > Flashcards

E4: Examination of the Neck Flashcards

1
Q

What are the elements of the problem focused history?

A

OPQRST

Onset/Course
Provocation/Palliation
Quality
Radiation
Severity
Timing/Tests
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2
Q

What are the red flags for possible fracture in the patient’s history?

A

Major trauma

Fall from a height

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3
Q

What are the red flags for possible fracture in the PE?

A

Severely restricted Active ROM

*always do active first

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4
Q

What are the red flags for possible infection in the patient’s history?

A

Age over 50 years
Age under 20 years
Fever/chills
Pain worse supine (muscles are relaxed; no longer protecting you from pain)
Recent UTI (travels through blood)
IV drug abuse
Immune suppression (cancer pts, transplant pts)

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5
Q

What are examples of cervical infection?

A

Osteomyelitis

Epidural abscess

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6
Q

What are the red flags for possible infection in the PE?

A

Fever

Spinous process percussive pain: C7 & T1 only

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7
Q

What are the red flags for possible tumor in the patient’s history?

A 
Age over 50
Age under 20
Unexplained weight loss
Pain worse when supine
Severe nocturnal pain
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8
Q

What are the red flags for possible tumor in the PE?

A

Palpable paravertebral edema or deformity

Spinous process percussive pain: C7 & T1

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9
Q

What is a red flag for vertebrobasilar artery compromise in the PE?

A

Have the sitting patient look up, then turn head right and left
Observe for NYSTAGMUS

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10
Q

Which test is not recommended for possible vertebrobasilar artery compromise?

A

DeKleyn test (normal test done passively)

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11
Q

Which age group is at greatest risk for vertebrobasilar artery compromise?

A

20-50

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12
Q

What is the etiology of Wallenberg syndrome?

A

Vertebrobasilar artery occlusion

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13
Q

What are the symptoms of Wallenberg syndrome?

A

Homolateral facial pain (same side as occlusion)
Homolateral paresthesias
Vertigo
Vomiting
Unilateral paralysis of the palate, pharynx, and vocal cords
Dysphagia
“Brassy” dysarthria
Contralateral loss of pain and temperature sensation of the limbs and trunk
Nystagmus
Homolateral dysmetria
Intention tumor

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14
Q

What is dysmetria and what is it a symptom of?

A

A condition in which there is improper measuring of distance in muscular acts (touching fingers to nose)

Wallenberg syndrome

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15
Q

What are the physical findings of Wallenberg syndrome?

A

Ataxia
Positive Romberg test with a tendency to fall toward side of arterial occlusion
Horner syndrome unilaterally (side of arterial occlusion)

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16
Q

What is a red flag for cerebral ischemia?

A

Any sense of acute anxiety or panic on the part of the patient during any part of the examination or treatment

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17
Q

What happens before a routine exam?

A

History and searching for red flags

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18
Q

Etiology of torticollis

A

Spasm of SCM

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19
Q

Physical presentation of torticollis

A

Head is sidebent

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20
Q

What skin markings are you looking for on inspection?

A

Blisters (burns, staph, autoimmune)
Discoloration (ecchymosis, congenital or acquired nevi)
Scars (surgical)

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21
Q

Anterior surgical scars

A

Thyroid

Spinal

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22
Q

Posterior surgical scars

A

Spinal

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23
Q

Level of thyroid cartilage

A

C4/C5

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24
Q

Level of cricoid cartilage

A

C6

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25
Q

Level of carotid tubercle

A

C6

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26
Q

What does unilateral facet joint dislocation result in?

A

Displacement of the upper vertebra forward by <50%

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27
Q

What does bilateral facet joint dislocation result in?

A

Cervical spondylolisthesis

Displacement >50%

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28
Q

What does facet dislocation often result in?

A

Spinal cord compression

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29
Q

Common location of facet osteoarthritis

A

C5/C6

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30
Q

Which muscle is a common cause of stiff neck?

A

Levator scapulae

31
Q

Where would a patient with levator scapulae hyptertonicity be tender?

A

Where the muscle attaches to the scapula

32
Q

What causes levator scapulae hypertonicity?

A

Overloading the muscle from anterior head carriage

33
Q

SCM innervation

A

Spinal accessory nerve

Nerve root levels C1-C8

34
Q

What does carotid bruit/thrill possibly indicate?

A

Vasoocclusive disease

Carotid dissection

35
Q

Where can a vertebral artery bruit be heard?

A

Mastoid processes

36
Q

If you hear bruit in the cervical region, what should you do next?

A

Listen to the heart to determine if the sound is coming from an artery in the neck or from a valvular problem in the heart

37
Q

Where can ophthalmic artery bruit be heard?

A

Over closed eyes

38
Q

What are you looking for when palpating the supraclavicular fossa?

A

Cervical ribs

39
Q

Cervical ribs often result in ______

A

Thoracic outlet syndrome

due to impingement of lower cervical nerves

40
Q

Possible findings on palpation of supraclavicular fossa

A

Lumps:
Lymph nodes
Apical Lung Tumor

Swelling:
Clavicular fracture
Lymphatic obstruction

Bone:
Cervical rib

41
Q

Which muscle is often injured in cervical flexion traumas?

A

Trapezius

42
Q

What are you looking for when palpating trapezius?

A

Tenderness
Spasm
Defects

43
Q

Lymphadenopathy of the upper trapezius can occur due to:

A

Infection
Lymphoma
Metastatic scalp tumor

44
Q

Which nerves will be inflamed after whiplash injury?

A

Greater occipital nerves

45
Q

Significant range of motion loss can indicate:

A

Fracture
Sprain & Strain
Disc herniation
Congenital anomalies (Klippel-Feil / Block Vertebrae)

46
Q

Which joint accounts for half of rotation in the neck?

A

C1 (Atlanto-Axial joints)

47
Q

Significant loss of rotation indicates a problem in one of three ways:

A
  1. Motion loss at C1 on C2
    - -Somatic dysfunction
    - -Levator scapulae
  2. Hypertonicity of the long muscles of the neck
    - -SCM
    - -Scalenes
  3. Motion loss at C3-C7 as a group
48
Q

What does neuro evaluation consist of?

A

Deep tendon reflexes
Muscle strength
Skin sensation
Special tests

49
Q

C5 motor and sensory innervation

A

Motor: Deltoid abduction, bicep flexion
Sensory: Shoulder

50
Q

C6 motor and sensory innervation

v important

A

Motor: Bicep flexion, wrist extensors
Sensory: First two fingers, lateral aspect of forearm

51
Q

C7 motor and sensory innervation

A

Motor: Tricep extension, wrist flexion, finger extension
Sensory: Middle finger

52
Q

Most commonly herniated disc

A

C5/C6

53
Q

C8 motor and sensory innervation

A

Motor: Finger flexors, intrinsic muscles of the hand
Sensory: 4th and 5th fingers

54
Q

C5 reflex

A

Biceps

55
Q

C6 reflex

A

Biceps, brachioradialis

56
Q

C7 reflex

A

Triceps

57
Q

C8 reflex

A

None

58
Q

T1 motor and sensory innervation

A

Motor: Intrinsic muscles of the hand
Sensory: Inner elbow

59
Q

T1 reflex

A

None

60
Q

Distraction test decreases pain for which conditions?

A

Joint/Disc/Nerve problem:
Disc herniation
Neuroforaminal compromise
Facet joint

61
Q

Distraction test increases pain for which condition?

A

Muscle/Ligament problem

62
Q

Compression test increases pain for which conditions?

A

Joint/Disc/Nerve problem

63
Q

Compression test decreases pain for which conditions?

A

None

64
Q

Spurling test

A

Sidebend and rotate head to same side; then add compression

Tests for foraminal compromise

65
Q

What do you do after a negative compression test?

A

Spurling test

66
Q

Lhermitte Sign

A

Passively flex the neck as far as possible

Numbness/tingling indicates spinal problem (meningitis/multiple sclerosis/etc)

67
Q

Swallowing test may indicate which conditions?

A 
Bony protuberances
Bony osteophytes
Hematoma
Abscess
Tumor
68
Q

Adson test

A

Reproduces symptoms and often diminishes radial pulse

Tests for Thoracic Outlet Syndrome

69
Q

What are the borders of the thoracic outlet?

A

Medial: First rib
Anterior: Clavicle
Posterior: Trapezius
Medial wall: Scalenes

70
Q

Adson test technique

A

Step One:
Anatomic position
Restrain patient’s shoulder
Palpate radial pulse

Step Two:
Hyperabduct and extend shoulder
Have patient turn toward side of symptoms
Bend chin to chest

Step Three:
Have patient turn their head as far as possible to the opposite side and attempt to tilt head backward

71
Q

Adson test positives

A

Loss of radial pulse

Reproduction of symptoms (even if pulse remains normal)

72
Q

Positive Adson test indicates:

A

The presence of neurovascular compression

73
Q

Which cervical level is most prone to spinous process avulsion fractures due to whiplash type injuries?

A

C2

OMM M1 CB (6 decks)

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