Exam 2: UQS Flashcards
The “Fundamental Four”
Present Illness (Chief complaint)
Past Health History
Family Health History**
Personal/Social History**
The “Sacred Seven”
Setting or Onset
Location/Radiation
Severity
Quality
Chronology/Timing
Associated Symptoms/Modifying Factors
Current Medical Management
location of pain
Local; Referred; Radicular; Regional
Canadian Cervical Spine Rules - high risk factors
age > 65
dangerous MOI
parathesia in the extremities
Red FlagsSpinal Neoplasm
Medical history is (+) for cancer, even if cleared or thought to be in remission
Night pain and other atypical pain manifestations
Worsening Pain
Unexplained weight loss
Fatigue, malaise, unwellness
No response to conservative management
Red Flags(Fractures/Dislocation)
Trauma, sufficient energy exchange
MVA, Falls, Direct blow or impact
Severe limitations of motion all planes
Muscular spasm; unwillingness to move
Deformity may be present
Must be ruled-out by diagnositc imaging
Canadian Cervical Spine Rules - low risk factors
safe to assess ROM
simple rear end motor vechile accident
normal sitting posture in ER
amb at anytime during injury
delayed onset of neck pain and absence of midline tenderness
Red FlagsInflammatory/Systemic Disease
Body Temperature > 100 F
Blood pressure > 160/95 mmHg
Resting pulse > 100 bpm
Resting respiration > 25
Redness, warmth, swelling
Discoloration (eg. Jaundice)
Fatigue, malaise, unwellness
Red FlagsReferred Pain: Visceral Cardiac Considerations
Chest, neck and arm pain
Jaw, posterior thorax, epigastrium
Classically, left sided, C8
angina
Associated symptoms:
Dyspnea, lower extremity edema, SOB, fatigued, syncope
Dysarthria
where you have difficulty speaking because the muscles you use for speech are weak
Dysphagia
hard time swallowing
Referred Pain: Visceral gall bladder
Recurrent, right thoracic/lower rib region, right scapular region
Increased intensity following meals
Fatty, greasy foods tend to worsen symptoms
At risk:
Obese, women, in their 40’s
Associated symptoms:
Nausea/heartburn, vomiting/diarrhea, difficulty swallowing, jaundiced, rectal bleeding/stool changes
Referred Pain: Visceral lungs and associated structures
Thoracic and chest regions
Possibly cervical region or shoulders
Pancost Tumors
Pulmonary Disease
Rarely manifests purely as pain
Infections, pleurisy, cancer
Difficulty with respiration, cough
Hoarseness, sore throat, wheezing
is Multi-segmental weakness
a red flag
yes
is double vision normal
no this is abnomral
what is Myelopathic Involvement
the result of compression of the spinal cord and nerve roots caused by inflammation, arthritis, bone spurs and spinal degeneration due to aging
Myelopathic Involvement presentation
More common in the cervical region than the thoracic region
Gait and balance disturbances, generalized weakness
May not be associated with any radiating pain
Bilateral P/N Arms and/or legs
May have local radicular involvement
Myelopathic Involvement positive test
(+) Signs of UMN involvement
Hoffman’s, Hyper-reflexic DTR’s, Clonus
Shoulder Component
Symptoms are primarily affected by movements of the shoulder joint
Stiff shoulder; Weakened shoulder; Unstable shoulder
Symptoms are essentially unaffected by head movements/positions
Thoracic Component
Symptoms may be diffuse and hard to localize without direct palpation
Thoracic Dermatome: Circumferential
Rib Involvement: Unilateral radiation
Symptoms may be affected by breathing
Vertebrobasilar insufficiency (VBI)
is defined by inadequate blood flow through the posterior circulation of the brain, supplied by the 2 vertebral arteries that merge to form the basilar artery.
symptoms of VBI
headache nausea redness of the face
how do you test VBI
hautards test
Tromner sign position
- Patient is sitting with head in a neutral position
- Set the hand mid-way between pronation and supination
tromner sign procedure
flick the finger up
positiove tromner sign
Flexion of the IP in the thumb
- Localized cervical and higher
what can hautards test tell you
upper body proprioception, positional provocative testing, VBI
angle of seating and injury
the greater the seat angle the greater the impact
rim lesion
an avulsion of the disc from the end plate
the ant longitudinal ligament is also torn
neck the healing process
3 weeks - rest
3 weeks - 3 months: therapy
after 3 months there is not much we can do
what is the def of a concussion
trauma induced change in mental status that may or may not involve a LOC
caused by a jolt to the head that disrupts the function o the brains
how long do concussion symptoms last
varibles
MOI of concussion
blow to the head or the body - direct contact is not necessary
acc/dec
disrupts the neuro-metabolism in the brain results in a energy crisis
no anatomical changes: MRI/CT are normal
freq. LOC
concussion staff noticed sym
LOC
forgets prior events
forgets events after the hit
appears dazed or confused
is confused about assignment
forgets play
is unsure of game, score or opponent
moves clusmily
ans questions slowly
shows behavior or personlity chnages
concussion pt noticed syms
feels foggy or groggy
chnage in sleep
feels fatigued
headache
nausea
balance problems or dizziness
double or fuzzy/blurry vision
sensitive to light or noise
feels sluggish or slowed down
conccentration or memory issues
the sharps pursors test is looking at what ligament and boney structure
transverse
AA joint (dens)
the kick test is testing what ligmant
alar ligament
what is the shear test looking at
the movement of the atlas in the frontal plane
what is the Tectorial membrane of the cervical spine
provides for a second line of defense, preventing the odontoid process from compressing the spinal cord
hautard’s cervogenic issue
alteration in the cervical afferent input
hautard’s vestibular issue
status stabilizes as the head position is stabilized
hautrad’s vascular issue
VBI
development of neighborhood signs
status worsens with sustained head position
Neighborhood signs
used to help distinguish a central from a peripheral origin of a patients vertigo.
jaw jerk is looking at what segments
C5 and above
what is the neck torsion test differentiating between
cervical and vestibular
morphlogical difference between c spine and lumbar spine
vert art
spinal cord
in the llumbar spine how much compression do the disc bear
85% of the axial compressive load
15% is borne by the facets
c spine axial loading - % borne
disc and posterior facets bear the same amount
facet orientation and movement in the lumbar spine
resistance to flexion and rot
stopping forward translation
c spine facet orientation
promote movement in the sagittal plane
translation in the horizontal plane will occur
nucleus in the c spine compared to lumbar
25% nucleus - c spine
50% nucleus - lumbar spine
nucleus of the discs in the c spine are only there briefly - only gel like for a little
where do cervical disc hernation occur compared to the lumbar spine
posterior laterally
lumbar - lateral disc herniations
soft discc herniations
small well contained herniations of nuclear material
hard disc herniations
actual fragmentation of nuclear material
what does cerviogenic means
sym that are associated with movements of the head and neck region
C5 radiating pain mimics what
shoulder pain
referred pain in cerviogenic presentation
medial border of the scapula
what vert make up the articular column
C2-C7
what runs through the transverse foreman
vertrbral art
what is the orientation of sup facet of C1 - atlas
sup and medial
what is the orientation of inf facet of C1 - atlas
inf and medial
C2 SP
large and bifid
inf facet orientation for c spine
down and forwards
is there a disc between AA and AO
no
movement seen at the AO joints
nodding and side bending
tranverse axis - nodding
A/P axis - slight lateral flexion
what is the function of the transverse ligamaent
retains den in contact with the anterior arch of the atlas during movement
movement and joints seen at the AA joint
rotation and slight flexion and extension
medial - dens and the atlas, rot
lateral - facet joint of A and A, supports the weight of the head and flexion and ext
range of rot seen t the dens
45-degrees
what is the tectorial membrane
extension of the posterior long lig
axis body to occiput
alar ligamnet
2 lig that run from the side of the dens to the condyles of the occciput
what is the alar ligament a primary restraint for
contralateral rotation and SB
what is the scalene ant attached to
1st rib
what is the scalene meduis attached to
1st rib
what is the scalene post attached to
2nd
what is in the suboccciptal triangle
vert art and C1 DPR
the vert art travels through what seegments
C1 - C6 transverse canal
what is the most mobile spinal segment
AO
