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MS II > Exam 5: Cervical Spine (1-4) > Flashcards

Exam 5: Cervical Spine (1-4) Flashcards

1
Q

What is the first rule of medicine

A

do no harm

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2
Q

True or False:

Acute pain poorly predicts chronic pain

A

False, it is a strong predictor

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3
Q

True or False:

Acute pain requires a significant source of nociception and requires a lot of knowledge to treat

A

True

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4
Q

Is anatomy more important to discuss with patients in the acute or chronic stages

A

acute

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5
Q

In chronic pain patients, what comes first…pain science or test and measures

A

tests and measures

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6
Q

There is (no/a ton) of mobility in the cervical spine

A

a ton, extreme mobility

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7
Q

True or False:

The functions of the IVD and ZPJ are the same in the lumbar spine as they are in the cervical spine

A

false, they are different

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8
Q

How many vertebrae and nerve roots are there in the cspine

A

7 vertebrae

8 nerve rotos

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9
Q

Pathology of the cspine could be a result of either aging or trauma. What are the three categories that fall under aging

A
  1. Uncovertebral joints
  2. Disc changes
  3. Face joint changes
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10
Q

What is another name for the uncovertebral joints

A

Joints of Luschka

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11
Q

In UV joints, there will be more (stiffness/pain)

A

stiffness

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12
Q

True or False:

UV joint sx will not cause referred or neurological sx

A

True

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13
Q

UV joint sx will typically have (AM/PM) stiffness

A

morning

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14
Q

What are the symptoms of a UV joint pathology

A

very little pain, maybe vague discomfort
more stiffness than pain
AM stiffness
No referred or neuro sx

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15
Q

UV joint signs will show a loss of (flexion/extension) causing the neck to be in a ___ ___ position.
In addition, there will be limited _____ in flexion, neutral, or extension.

A

extension; forward flexed; side bending

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16
Q

True or False:

A patient with a UV joint pathology will show decreased rotation

A

true

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17
Q

What are the signs of a UV joint pathology

A 
Loss of extension
Decreased rotation
Neck in a forward flexed position
Limited side bending
Crepitus or grinding
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18
Q

Are there more disc problems in the lumbar or cervical spine. Why?

A

Lumbar because the discs basically dissolve or are absorbed in the top four spine

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19
Q

By the 70’s or 80’s spontaneous fusion was common at the (upper/lower) cervical spine

A

lower

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20
Q

What is the result of decreased disc height in the Cspine

A

UV osteophytes and hard posterior disc protrusions form which can encroach on the spinal canal

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21
Q

What motions of the neck are limited due to fissuring of the cspine

A

extension and side bending

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22
Q

True or False:

Fissures are the norm of subjects over 50 years old

A

False, age 35

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23
Q

Are upper or lower cspine discs fissured first

A

upper

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24
Q

Which vertebral discs are usually spared completely from fissuring

A

C7-T1

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25
Q

Explain the different effects of cervical disc fissuring between the upper and lower cspine

A

The upper cspine has no nucleus so there is no inflammatory mediated chemicals to irritate the nerve root, unlike the lower cspine. Therefore, there are more cspine disc injuries and radiculopathy is the lower cspine

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26
Q

What is the correlation between UVJ and the IV foramen with aging

A

High incidence of foraminal stenosis because the sclerosis from the UVJ can occlude the foramen

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27
Q

What type of treatment do patients with UVJ pathology benefit from

A

Manual distraction

Intermittent mechanical traction

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28
Q

True or False:

There are no nucleus in the upper 5 cervical discs

A

False: upper 4

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29
Q

True or False:

The only factors related to the progression of degeneration of the cspine is age

A

true

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30
Q

At what age does the nucleus in the upper four cervical discs start to absorb

A

50

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31
Q

What age group has the most spondylosis

A

early 50’s

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32
Q

Space in the cervical spine is relatively (small/large), so an isolated disc bulge will cause (little/a lot) of sx

A

large, little

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33
Q

True or False:

Mechanical pressure on a nerve results in pain

A

False, just numbness or tingling or weakness

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34
Q

What pathologies can occur if the cervical discs undergo trauma

A

annulus tears
endplate injuries
annulus bruising
DRG is chemically irritated

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35
Q

True or False:

The majority of the population probably has disc problems that are sx free

A

true

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36
Q

What is a disc extrusion

A

a bulge that is far enough out that the nucleus comes out a little bit too

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37
Q

What percentage of sx free volunteers had a bulging disc

A

73%

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38
Q

What percentage of sx free volunteers had a disc protrusion

A

50%

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39
Q

What percentage of sx free volunteers had a disc extrusion

A

3%

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40
Q

What percentage of sx free volunteers had an annulus tear

A

37%

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41
Q

Why does radiculopathy in the cspine occur

A

pro-inflammatory mediators and immune compounds remove myelin from adjacent axons causing pain

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42
Q

We can use ___ ___ to determine the cervical level causing discogenic pain

A

clowards points

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43
Q

True or False:

Discogenic pathologies result in radicular pain

A

False, it is referred pain usually in the upper trap and medial scap

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44
Q

What are the sx of discogenic pathologies

A

Cspine can be stiff/sore
Deep burning like a toothache around scapular border and supraspinous fossa
Refers pain to shoulder

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45
Q

What is another name for facet joints

A

zygapopyseal joints

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46
Q

What motions occur at the facet joints of the cspine

A

flexion and extension with a little bit of SB and rot.

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47
Q

True or False:

Facet joints gradually change position over time

A

true

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48
Q

What innervated the facet joints

A

The medial branch of the primary dorsal raus

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49
Q

What type of pain is felt in facet joint issues

A

sharp and localized

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50
Q

Is facet joint pain unilateral of bilateral

A

unilateral

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51
Q

There will be greater (UE/neck) pain in pathologies involving facet joints

A

neck

52
Q

True or False:

If a patient has unilateral pain that goes from the neck down to the elbow, a facet joint problem should be considered

A

False, the pain doesn’t go past the shoulders.

53
Q

In regards to orthopedics, why do muscles spasm occasionally

A

it is a protective mechanism to tell the body to relax

54
Q

What are the symptoms of facet joint pathologies

A

Sharp localized pain that is unilateral
Neck pain more than UE pain but can refer into UE
Spasms

55
Q

What are the signs of a facet joint pathology

A

Limited extension

Limited SB and rotation to the same side

56
Q 
The facets (open/close) during extension. 
What is result of this
A

They close which can squeeze on menisci and cause pain

57
Q

True or False:

Facet joints follow type I mechanics

A

False, they follow type II since SB and rotation occur to the same side

58
Q

True or False:

Sleeping can cause unwanted facet joint loading

A

true

59
Q

Why are VBs like tiles on a roof

A

They overlap on each other and can move together during bulges or other movements

60
Q

Explain the difference between the clinical presentation of UVJ and Facet joints

A

They both limit lateral glides in neutral and in flexion. However the facet joint is LESS restricting in flexion which means if a lateral shift is limited and I further flex the neck, and then the shift is more fluid, it is probably a facet joint issue

61
Q

As we age UVJ, Facet joints, and IV discs can cause “the perfect storm.” As a result what are the three things that could be damaged in the cspine

A

nerve roots
spinal cord
vertebral artery

62
Q

True or False:

LMN signs and sx will occur with encroachment/stenosis of the spinal cord

A

False, UMN signs will occur like hyperreflexia

63
Q

Cervical myelopathy can occur as a result of aging in the cspine. Before treatment begins, what should a PT do

A

Test other UMN things like babinski

64
Q

Vertebral artery insufficiency can occur as a result of aging in the cspine. What will the signs and sx of that look like

A

gait deviations

bilateral sx

65
Q

True or False:

Cervical radiculopathy dermatomal mapping may be inaccurate when compared to sensory deficit dermatomal maps

A

true

66
Q

Cervical radiculopathy sx are (unilateral/bilateral)

A

unilateral

67
Q

True or False:

Cervical radiculopathy will cause more proximal pain than distal

A

False, more distal than proximal

68
Q

What are the cervical radiculopathy sypmtoms

A

Unilateral dermatomal pain
Deep ache, numbness, pins and needles
Weakness
Distal pain more than proximal

69
Q

What are the cervical radiculopathy signs

A 
protective deformities 
neurodynamic testing
spurling's test
distraction
sensation
motor function
70
Q

Describe the protect deformities and their location of cervical radiculopathy

A

C5 if arm above head is better
C7 if arm at their side is better
Forward head

71
Q

What are the 4 signs of threatening nerve root pain

A
  1. Dermatomal pain with distal pain greater than proximal
  2. Severe pain, latency
  3. Slight movement cause pain
  4. Protective deformities
72
Q

Why would a patient with cervical radiculopathy have their head slightly tilted to the side

A

it will open the facet joints and relieve pain

73
Q

What are the clinical prediction rules for cervical radiculopathy

A

ipsilateral rotation of less than 60 degrees
positive ULNT 1a test (median)
positive distraction
positive spurlings test

74
Q

What is the hallmark sign someone has cervical radiculopathy

A

distal sx greater than prox that follow a dermatomal pattern

75
Q

Explain the specificity and sensitivity of the ULNT 1 for a patient with cervical radiculopathy

A

The UNLT has a great sensitivity which means if it is negative, then the pt probably doesn’t have radiculopathy. But it doesn’t have great specificity so it that is positive, it doesnt mean they will have radiculopathy

76
Q

True or False:

ULNT 1a is used for screening and not diagnosing cervical radiculopathy

A

true

77
Q

myelopathy signs will always be (unilateral/bilateral)

A

bilateral

78
Q

What are the signs for cervical myelopathy

A

gait abnormality

UMN signs like hyperreflexia, Babinski, Hoffman’s sign and clonus

79
Q

True or False:

At C1 the vertebral artery make two 90 degree turns while traveling from foramina to formaina

A

true

80
Q

True or False:

Arthritis of the cspine can cause encroachment leading to VA sx

A

true

81
Q

Cervical rotation will cause (VA/ICA) insufficiency

A

VA

82
Q

Cervical rotation with extension will cause (VA/ICA) insufficiency

A

ICA

83
Q

Extension of the neck will cause (VA/ICA) insufficiency

A

ICA

84
Q

True or False:

VBI occurs to the same side that is being rotated towards

A

False, if I rotate my head to the right, the left VBI will be occluded

85
Q

True or False:

Occlusion is normal with rotation

A

True, it becomes abnormal if sx arise

86
Q

Should we be more worried about the VA or ICA more

A

VA

87
Q

What is the acronym to remember in regards to VA sx

A

5 D’s And 3 N’s

88
Q

What does the 5D’s And 3N’s stand for and what does it help with

A

It is for VA sx

Dizziness, diplopia, dysphagia, drop attacks, dysarthria

ataxia

Nystagmus
Numbness
Nausea

89
Q

If a patient has VA sx and they are feeling numb, where would the numbness be felt at

A

the back of the neck/suboccipital

90
Q

True or False:

Testing for VA insufficiency has good reliability

A

false, it is poor

91
Q

True or False:

Rotation will reduce BF contralaterally in healthy individuals

A

true

92
Q

True or False:

PT’s can treat VBI

A

False, notify a physician

93
Q

How can RA lead to VA insufficiency

A

RA can lead to hypermobility that allows greater ROM at the neck that can occlude the artery

94
Q

If VBI testing has poor reliability, then why do we do it

A

to document that we tested for it to cover ourselves if anything were to happen

95
Q

Is C1 on C2 convex on convex or concave on concave

A

convex on convex

96
Q

The skull on C1 is (convex/concave) on (convex/concave)

A

convex on concave

97
Q

What can the AA joints cause problems with

A

The fat pads by them are highly vascularized and can get crushed

98
Q

Which muscle has been linked to headaches and why

A

rectus capitis posterior minor because it attaches to the dura

99
Q

As always, (sensory/motor) relies on (sensory/motor)

A

motor relies on sensory

100
Q

True or False:

The suboccipital muscles are some of the mostly dens of spindle fibers in the body

A

true

101
Q

The rectus capitis posterior minor keeps the dura tight when the neck is (flexed/extended).
How is this so

A

extended, because that muscle has a small tendon that inserts into the posterior dura

102
Q

Patients with CTTH will have atrophy of what muscle

A

rectus capitis posterior muscles

103
Q

What can the atrophy of the rectus capitis posterior muscles in patients with CTTH be accounted for

A

a reduction of proprioceptive output from those muscles that could also explain the perpetuation to pain

104
Q

What is the clinical presentation of sub occipital pathologies

A

OA on the left

C1-2 on the right

105
Q

What do the Alar ligaments do

A

they are passive restraints to excessive rotation and SB

106
Q

Which ligament is the primary passive restraint of C1 displacement in the sagittal plane

A

Transverse ligament

107
Q

True or False:

The dens is fx more than its surrounding ligaments

A

true

108
Q

True or False:

Joint hypermobility, specifically the cspine, can be a predisposing factor for headaches

A

true

109
Q

What can happen if the cervical spine muscles are too tight

A

In anterior cspine neck muscles can pull the clavicle up, pinching the first rib sending sx down the arm

110
Q

What type of mobs should be done with UVJ issues

A

central PAs for extension

111
Q

What is the best pt position when performing central PAs on the elderly

A

on their side

112
Q

What type of mob would be performed to create a sponging effect for cervical discs

A

Central PAs

113
Q

What does the sponging effect do

A

aids in the transfer of fluids

114
Q

Why would you perform unilateral PAs or PAs in rotation for cervical disc pathologies

A

Lateral fissures or Cloward referral patterns

115
Q

When performing mobs for facet joints, should you start in extension or flexion

A

flexion and progress towards more extension

116
Q

(traction/rotation) is best with UVJ issues

A

traction

117
Q

(traction/rotation) is best with facet joint issues

A

rotation

118
Q

If your patient has foraminal stenosis and they need more space, what treatments can you do

A

lateral glide, longitudinal cephalad

119
Q

If your patient has foraminal stenosis and they need more movement, what treatment can you do

A

neural mobs

120
Q

True or False:

PT’s can treat cervical myelopathy

A

True, but ONLY if medically cleared

121
Q

If you are treating a patient with cervical myelopathy, should you treat in flexion or extension

A

flexion, avoid extension

122
Q

When treating cervical radiculopathy, is intermittent or static traction better

A

intermittent

123
Q

(cervical/lumbar) issues less are more common

A

lumbar

124
Q

What percentage of the area around the spinal cord can be reduced and the cord will still be fine`

A

16%

125
Q

True or False:

Encroachment on the spinal cord will always cause sx

A

False

126
Q

What nerve supplies the discs at the same level and level above

A

sinuvertebral nerves

127
Q

What nerve supplies the lateral discs in the cspine

A

branches of the vertebral nerve

MS II (14 decks)

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