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Musculoskeletal Conditions 2 > Exam 1: C-spine > Flashcards

Exam 1: C-spine Flashcards

1
Q

What motions occur at the A-O joint?

A

flexion/extension

lateral flexion

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2
Q

What motions occur at the A-A joint?

A

rotation

flexion/extension

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3
Q

What is the facet orientation in the C-spine, and what motions does this orientation allow?

A

between vertical and horizontal planes; allows rotation, flexion/extension, and lateral flexion

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4
Q

Describe the joints of Luschka.

A

Uncinate process and the adjacent part of the superior vertebae; limits lateral flexion, guides flex/extension; provides stability

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5
Q

What is the effect of cervical motion on intervertebral foraminal size?

A

Flexion increases

Extension decreases

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6
Q

Describe intervertebral discs in the C-spine.

A

provide shock absorption and movement
no AA or AO discs
nucleus pulposus, annulus fibrosis on the outside
discontinuous rings and thickened anteriorly compared to other places in the spine

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7
Q

How does the disc:body ratio compare in the C-spine with other areas of the spine?

A

greatest ratio in cervical and lumbar spines, least in thoracic (bigger ratio=more movement)

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8
Q

What motions are coupled in the C-spine?

A

axial rotation and lateral flexion

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9
Q

BRAIN BREAK! Don’t forget to look in the C-spine review sheets you made for ligaments and muscles. Review dermatomes & myotomes please.

A

this was a brain break brought to you by Anna White

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10
Q

Mobility and stability in the cervical spine

A

C-spine is most mobile region of the spine; stability is critical for protecting nerves, BVs, etc
together-use mobility to position sense organs, then use stability to keep still so senses aren’t distracted by motion

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11
Q

Where does half of rotational movement of the C-spine come from?

A

A-A, O-A joints (upper cervical spine)

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12
Q

What is acute pain, and what is chronic pain?

A

acute 3 months

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13
Q

What are demographic risk factors of neck pain?

A

female, 45-49 years old

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14
Q

What are occupational/physical work risk factors of neck pain?

A

Heavy labor occupations, office and computer workers, health care (dentists, nurses), unemployed, sedentary work, repetitive work, working with neck flexed, working with arms at or above shoulder height

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15
Q

What hobby is a risk factor for neck pain?

A

cycling

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16
Q

What factors are negative for PT, and what are positive for PT?

A

People with neck pain who see PT’s have more severe pain, functional problems, worsening health status. Positive indicators for seeking PT: higher education, worker’s comp, and being in litigation.
Negative indicators: age, male

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17
Q

pain characteristics of non-MS neck pain

A

deep, nonspecific location

constant, not related to movement, night occurence

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18
Q

BRAIN BREAK!! review red flag symptoms on page 4 of C-spine hand out

A

Go ahead, Mark would want you to.

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19
Q

Tracheobronchial referral: conditions and symptoms

A

conditions: inflammation, infection (viral or bacterial), tumor
potential symptoms: neck pain, dyspnea, dysphagia, persistent cough, fever/chills, hemoptysis

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20
Q

bone tumors

A

benign: osteochondromas/blastomas, chondromas, hemangiomas, giant cell tumor
malignant: osteo/chondrosarcoma, multiple myeloma

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21
Q

symptoms of tumors in head/neck

A

neck pain, sore throat, dysphagia, growing mass, UMN signs (if SC involvement)

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22
Q

Pancoast’s tumor: pathology

A

lung cancer in upper lobe that invades lower brachial plexus

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23
Q

Pancoast’s tumor: symptoms

A

extrapulmonary: pain in shoulder/scapula, referred down arm; more common than
pulmonary: cough (isn’t typical initially), chest pain
Horner’s syndrome
mimics radiculopathy

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24
Q

Horner’s syndrome

A 
if the tumor invades the sympathetic chain
enopthalamos (protuding eye)
ptosis
miosis
anhidrosis (dry eye)
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25
Q

Osteomyelitis in the neck

A

Staph and strep most common

Sx: neck pain, night pain, stiffness, may have a fever

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26
Q

Discitis

A

Osteomyelitis of vertebral body
Can be infectious
Sx: neck pain, stiffness, may have a fever
See disc space narrowing on imaging
In later stages, might have myelo- or radiculo- pathic signs

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27
Q

CV pain referral: Acute MI, carotodynia

A

MI: males-neck and jaw, females, back and neck
carotodynia: painful carotid artery; pain in front of neck, inflammation in arterial wall

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28
Q

GI referral

A 
esophageal conditions (infection, tumor, varices (pouches that develop in esophagus)
sx: anterior neck pain, dysphagia
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29
Q

disease conditions that can affect neck pain

A

Lyme disease, RA, ankylosing spondylitis, fibromyalgia, Klippel-Feil syndrome (congential fusion of cervical vertebrae), hypo- and hyper- thyroid

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30
Q

A-A joint ligaments

A

Alar, cruciform (includes transverse leg), apical, anterior atlanto-dental ligament, ALL/PLL, accessory A-A ligament

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31
Q

signs/symptoms of AA instability

A

suboccipital pain (C2), bilateral UE/LE paresthesias, nystagmus, UMN signs, headaches, blurry vision

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32
Q

causes of AA instability

A

congenital bony malformation, Down’s Syndrome (ligamentous laxity); inflammatory-RA, PA, ankylosing spondylitis, osteomyelitis; trauma; chronic corticosteroid use

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33
Q

radiculopathy

A

impingement of a nerve root; sensory and motor changes

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34
Q

myelopathy

A

impingement of the SC; UMN signs/sx

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35
Q

What’s the only outcome measurement for the C-spine?

A

Neck Disability Index

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36
Q

scoring of the NDI

A

least disabled=0, most disabled=5; higher number=greater disability
MCID=7pts (8.5)
0-4 no disability; 5-14 mild; 15-24 moderate; 25-34 severe; 35 and up complete disability

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37
Q

What do we do clearing exams?

A

To figure out if the neck pain is referred from somewhere else or not. Test other joints to see how that changes the neck paint (TMJ, shoulder)

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38
Q

symptoms of VBI

A

Dizziness, diplopia, dysarthria, dysphagia, drop attacks, nauseua & vomiting, sensory changes

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39
Q

What is the vertebral artery test for?

A

clearing test for VBI before doing upper c-spine manual therapy; can probably rule it, but not rule out

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40
Q

Wainner’s radiculopathy cluster

A

ULNT (median)
cervical rotation less than 60
Spurling’s test
cervical distraction test

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41
Q

BRAIN BREAK: page 12 has a summary of evidence

A

it’s probably important

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42
Q

standard series for radigraphs for C-spine

A

anterior-posterior
lateral
AP open mouth (odontoid)

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43
Q

other plain film views for C-spine

A

oblique

flexion-extension stress view

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44
Q

ABC’s of c-spine films

A

Adequacy: 7 vertebrae
Alignment: all 4 lines (anterior bodies, posterior bodies, spinolaminar line, SP line)
Bone: body and SP uniformity
Catilage: disc space
Soft tissue: prevertebral soft tissues C2 <22mm

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45
Q

CT

A

shows relationship of bones to neural canal in transverse plane

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46
Q

MRI

A

visualization of SC and soft tissues

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47
Q

myelogram

A

contrast solution into subarachnoid space; visualization of SC and nerve roots

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48
Q

discogram

A

injection of contrast material into discs

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49
Q

Child’s Neck Pain Clinical Practice Guidelines

A

Neck pain with mobility deficits
Neck pain with headaches
Neck pain with movement coordination impairments
Neck pain with radiating pain

50
Q

Neck pain with mobility deficits

A
  • younger individual (< 3 months)
  • symptoms isolated to neck with no neuro-related pain patterns (may have trigger point)
  • restricted cervical ROM, associated restricted segmental mobility
51
Q

Neck pain with headaches

A
  • unilateral HA associated with symptoms in neck/suboccipital area
  • HA produced or aggravated with provocation of the ipsilateral posterior cervical myofasia & jts
  • restricted cervical ROM & cervical segmental mobility
  • abnormal/substandard performance on the cranial cervical flexion test (typically have weak deep flexors)
  • acute or chronic
52
Q

Neck pain with movement coordination impairments

A
  • chronic pain
  • abnormal cranical cervical flexion test
  • abnormal deep flexor endurance test
  • coordination, strength, and endurance deficits of neck and upper quarter muscles
  • flexibility deficits of upper quarter muscles
  • ergonomic inefficiencies with performing repetitive activities
53
Q

Neck pain with radiating pain

A
  • UE symptoms produced or aggravated with Spurling’s, ULT tests, and reduced with neck distraction test
  • decreased cervical rotation (<60) toward involved side
  • signs of nerve root compression
  • success with reducing UE symptoms with initial exam and intervention procedures
  • acute or chronic
54
Q

Principles of Classification -McKenzie system

A

pain behavior
loss of ROM
presence of referred pain
effect of repeated movement

55
Q

Postural Syndrome

A

caused by mechanical deformation or vascular insufficiency of normal tissue as a result of prolonged positioning

56
Q

characteristics of postural syndrome

A

full painfree cervical AROM
no arm pain
neck pain with sustained end range positions
gradaul onset, dull, symmetric pain

57
Q

dysfunction syndrome

A

caused by mechanical deformation or vascular insufficiency of abnormal tissue (shortened, fibrosed, lengthened)

58
Q

characteristics of dysfunction syndrome

A

loss of cervical AROM
intermittent neck pain
neck pain at end range
no arm pain

59
Q

derangement syndrome

A

caused by internal disruption or displacement of tissues

-thought to be disc related

60
Q

characteristics of derangement syndrome

A

loss of cervical AROM
constant neck pain
pain radiates into UE
neck/arm pain affected by repeated movement

61
Q

What’s the most common postural impairment?

A

forward head

62
Q

What’s the effect of forward head on the c-spine?

A

increased facet loading, extension of upper c-spine

63
Q

What’s the effect of forward head on muscle activity?

A

increased posterior cervical muscle activity

64
Q

Upper crossed syndrome

A

Hyperactivity and shortness of levator, upper trap, pec major and minor
Hypoactivity and lengthening of deep neck flexors, middle and lower traps

65
Q

deep cervical flexors

A

longus colli and capitis, rectus capitis anterior and lateralis

66
Q

FHP and cervical mobility

A

variable, depends on when they present

67
Q

Where do trigger points usually present in upper crossed syndrome

A

short and hyperactive muscles

-upper trap, SCM/scalenes, levator scapulae, masseter, temporalis

68
Q

Child’s and McKenzie classifications of FHP

A

Childs: mobility deficits maybe, headaches maybe, movement coordination impairments maybe
McKenzie: postural syndrome, dysfunction syndrome

69
Q

disc height/body ratio

A

2:5

70
Q

cervical vs. lumbar discs

A

annulus: discontinuous, thickened anterior, posterior support is PLL, no alternating lamellae fiber directions
NP: 25% of disc (vs 50%), fibrosis an desiccation with age

71
Q

4 classifications of disc pathology

A

annular tears
disc protrusion (contained)
disc extrusion (prolapse)
disc sequestration

72
Q

Where do the most disc problems occur?

A

in general: lumbar, then cervical, thoracic

in C spine- C6/7

73
Q

Cloward’s areas

A

interscapular pain due to anterior disc irritation

74
Q

Bakody’s sign

A

put arm on the top of their head and it relieves their symptoms

75
Q

comfort posture for disc problems

A

may be sidebent or rotated away from the painful side

76
Q

Childs and McKenzie classifications for disc problems

A

Childs: with radiating pain
McKenzie: derangement syndrome

77
Q

disc tx

A

McKenzie repeated motion for centralization;

traction, though it’s not supported by evidence; mobes and manips, including T-spine; nerve gliding

78
Q

Cervical spondylosis

A

degenerative spinal changes-OA

79
Q

Radiographic hallmark signs of C spondylosis

A

decreased disc height (DDD), osteophytes (DJD) (jts of Lushka, facet hypertrophy)

80
Q

common areas for c spondylosis

A

C5-6, C 6-7

81
Q

unique exam findings

A

morning stiffness, neck crepitation; generally can’t centralize any nerve pain with bone pushing on the nerves; motion typically reduced in all directions; positive Spurling’s

82
Q

Cervical Spondylitic Myelopathy

A

UMN signs (B neuro sx UE and LE, gait clumsiness, loss of hand dexterity, B&B changes)

83
Q

test cluster for CSM

A

Babinski, inverted supinator sign, Hoffman’s, reflex testing (hyperreflexive)

84
Q

Childs and McKenzie classifications for cervical sponylosis

A

Childs: movement coordination impairment or radiating pain
McKenzie: maybe dysfuction or derangement, but this really isn’t meant for disc pts

85
Q

cervical spondylosis tx

A

FHP correction; traction; heat can help

86
Q

facet dysfunction

A

crick in the neck

87
Q

pain source from facet dysfunction

A

unknown; maybe synovial entrapment in facet, segmental muscle spasm maybe

88
Q

Classifications of facet dysfunction

A

Childs: mobility deficits
McKenzie: dysfunction

89
Q

Whiplash-associated disorder: common adverse prognosis predictors

A

female, severe pain, low professional status/low level of education

90
Q

WAD classification table

Grade 0

A

no complaint about neck, no physical signs

91
Q

WAD classification table

Grade I

A

Neck pain, stiffness, or tenderness only; no physical signs

92
Q

WAD classification

Grade II

A

neck complaint and MS signs

93
Q

WAD classification

Grade III

A

neck complaint AND neuro signs

94
Q

WAD classification

Grade IV

A

neck complaint and fx or dislocation

95
Q

exam findings

A

know details of accident, LOC; upper cervical instability assessment is critical; myelopathic signs are red flag

96
Q

WAD classifications

A

Childs: mobility deficits if acute, could be radiating pain, chronic=movement coordiation impairments, could be headaches or radiating pain
McKenzie: acute in all directions=non-mechanical, after that dysfunction or derangement

97
Q

WAD intervention

A

soft collar for 2&3, 72 hours; controlled rest 1-4 days for 2&3; stretching non-appropriate with pain

98
Q

Myofascial Pain Syndrome

A

trigger points not inflammatory, not systemic; acute onset-trauma, stress, fatigue, posture, hormones; dully aching pain pattern; upper crossed syndrome

99
Q

MPS trigger points

A

hyperirritable spot, taut and palpable band, local pain with compression, referred pain, twitch response with snapping palpation

100
Q

MPS classification

A

Childs: maybe headaches, movement coordination impairments, NOT radiating pain
McKenzie: maybe dysfunction

101
Q

MPS intervention

A

ischemic compression, myofascial release, spray n stretch

102
Q

Jefferson fx

A

C1 fx from axial load

103
Q

Hangman’s fx

A

C2 pedicle fx from sudden hyperextension

104
Q

Odontoid

A

dens fx where it attaches to C2 body; from combined hyperextension/rotation

105
Q

Clay Shoveler’s

A

lower c-spine SP fx from forced hyperflexion; typically C4 and below

106
Q

Ferguson-Allen classification of c-spine fx

A 
compresssion-flexion
compression extension
vertical compression
distraction-flexion
distraction-extension
distraction
107
Q

Do people with ORIF in their spine ever have normal range?

A

Nope. Sagittal and frontal motion are limited, can have about 50% rotation

108
Q

fx classification

A

Doesn’t really fit any of them. Childs might be mobility deficits, movement coordination impairment.

109
Q

general post-surgical rehab guidelines

A

collar 4-6 weeks, walking program, ROM at tolerance at 6 weeks, muscle strengthening at 8-10 weeks (isometrics->isotonics)

110
Q

cervicogenic headaches-NM causes

A

cervical muscle tension, trigger points, greater occipital nerve impingement, convergence of C1-C4 afferents and trigeminal afferents

111
Q

location of cervicogenic headaches

A

tend to be unilateral; occiput to forehead, orbits, temples, ears

112
Q

BRAIN BREAK! page 21 of part 2: dx criteria

A

learn it. love it. know it.

113
Q

CGHA exam findings

A

weak deep cervical flexors, scapular stabilizers; tight cervical extensors, suboccipitals; suboccipital region trigger points

114
Q

CGHA classifications

A

Childs: neck pain with headaches
McKenzie: postural if range isn’t restricted, then its dysfunction; could be derangement

115
Q

Congenital muscular torticollis

A

unilateral shortening of SCM muscles

116
Q

potential causes of torticollis

A

muscle injury during fetal development, birth trauma, intrauterine malposition

117
Q

JRA

A

persistent arthritis lasting more than 6 weeks in 1 or more joints in a child under 16

118
Q

types of JRA

A

systemic, polyarticular (5 jts or more), pauciarticular (4 joints or less)

119
Q

How is the c-spine usually involved in JRA?

A

loss of extension, rotation, lateral flexion; AA subluxation risk

120
Q

one last BRAIN BREAK

A

read EBP section (23-24 of part 2)

Musculoskeletal Conditions 2 (4 decks)

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