Exam 5: Cervical Spine (1-4) Flashcards
1
Q
What is the first rule of medicine
A
do no harm
2
Q
True or False:
Acute pain poorly predicts chronic pain
A
False, it is a strong predictor
3
Q
True or False:
Acute pain requires a significant source of nociception and requires a lot of knowledge to treat
A
True
4
Q
Is anatomy more important to discuss with patients in the acute or chronic stages
A
acute
5
Q
In chronic pain patients, what comes first…pain science or test and measures
A
tests and measures
6
Q
There is (no/a ton) of mobility in the cervical spine
A
a ton, extreme mobility
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
8
Q
How many vertebrae and nerve roots are there in the cspine
A
7 vertebrae
8 nerve rotos
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
- Uncovertebral joints
- Disc changes
- Face joint changes
10
Q
What is another name for the uncovertebral joints
A
Joints of Luschka
11
Q
In UV joints, there will be more (stiffness/pain)
A
stiffness
12
Q
True or False:
UV joint sx will not cause referred or neurological sx
A
True
13
Q
UV joint sx will typically have (AM/PM) stiffness
A
morning
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
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
16
Q
True or False:
A patient with a UV joint pathology will show decreased rotation
A
true
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
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
19
Q
By the 70’s or 80’s spontaneous fusion was common at the (upper/lower) cervical spine
A
lower
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
21
Q
What motions of the neck are limited due to fissuring of the cspine
A
extension and side bending
22
Q
True or False:
Fissures are the norm of subjects over 50 years old
A
False, age 35
23
Q
Are upper or lower cspine discs fissured first
A
upper
24
Q
Which vertebral discs are usually spared completely from fissuring
A
C7-T1
25
Explain the different effects of cervical disc fissuring between the upper and lower cspine
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
26
What is the correlation between UVJ and the IV foramen with aging
High incidence of foraminal stenosis because the sclerosis from the UVJ can occlude the foramen
27
What type of treatment do patients with UVJ pathology benefit from
Manual distraction
| Intermittent mechanical traction
28
True or False:
There are no nucleus in the upper 5 cervical discs
False: upper 4
29
True or False:
The only factors related to the progression of degeneration of the cspine is age
true
30
At what age does the nucleus in the upper four cervical discs start to absorb
50
31
What age group has the most spondylosis
early 50's
32
Space in the cervical spine is relatively (small/large), so an isolated disc bulge will cause (little/a lot) of sx
large, little
33
True or False:
Mechanical pressure on a nerve results in pain
False, just numbness or tingling or weakness
34
What pathologies can occur if the cervical discs undergo trauma
annulus tears
endplate injuries
annulus bruising
DRG is chemically irritated
35
True or False:
The majority of the population probably has disc problems that are sx free
true
36
What is a disc extrusion
a bulge that is far enough out that the nucleus comes out a little bit too
37
What percentage of sx free volunteers had a bulging disc
73%
38
What percentage of sx free volunteers had a disc protrusion
50%
39
What percentage of sx free volunteers had a disc extrusion
3%
40
What percentage of sx free volunteers had an annulus tear
37%
41
Why does radiculopathy in the cspine occur
pro-inflammatory mediators and immune compounds remove myelin from adjacent axons causing pain
42
We can use ___ ___ to determine the cervical level causing discogenic pain
clowards points
43
True or False:
Discogenic pathologies result in radicular pain
False, it is referred pain usually in the upper trap and medial scap
44
What are the sx of discogenic pathologies
Cspine can be stiff/sore
Deep burning like a toothache around scapular border and supraspinous fossa
Refers pain to shoulder
45
What is another name for facet joints
zygapopyseal joints
46
What motions occur at the facet joints of the cspine
flexion and extension with a little bit of SB and rot.
47
True or False:
Facet joints gradually change position over time
true
48
What innervated the facet joints
The medial branch of the primary dorsal raus
49
What type of pain is felt in facet joint issues
sharp and localized
50
Is facet joint pain unilateral of bilateral
unilateral
51
There will be greater (UE/neck) pain in pathologies involving facet joints
neck
52
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
False, the pain doesn't go past the shoulders.
53
In regards to orthopedics, why do muscles spasm occasionally
it is a protective mechanism to tell the body to relax
54
What are the symptoms of facet joint pathologies
Sharp localized pain that is unilateral
Neck pain more than UE pain but can refer into UE
Spasms
55
What are the signs of a facet joint pathology
Limited extension
| Limited SB and rotation to the same side
56
```
The facets (open/close) during extension.
What is result of this
```
They close which can squeeze on menisci and cause pain
57
True or False:
Facet joints follow type I mechanics
False, they follow type II since SB and rotation occur to the same side
58
True or False:
Sleeping can cause unwanted facet joint loading
true
59
Why are VBs like tiles on a roof
They overlap on each other and can move together during bulges or other movements
60
Explain the difference between the clinical presentation of UVJ and Facet joints
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
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
nerve roots
spinal cord
vertebral artery
62
True or False:
LMN signs and sx will occur with encroachment/stenosis of the spinal cord
False, UMN signs will occur like hyperreflexia
63
Cervical myelopathy can occur as a result of aging in the cspine. Before treatment begins, what should a PT do
Test other UMN things like babinski
64
Vertebral artery insufficiency can occur as a result of aging in the cspine. What will the signs and sx of that look like
gait deviations
| bilateral sx
65
True or False:
Cervical radiculopathy dermatomal mapping may be inaccurate when compared to sensory deficit dermatomal maps
true
66
Cervical radiculopathy sx are (unilateral/bilateral)
unilateral
67
True or False:
Cervical radiculopathy will cause more proximal pain than distal
False, more distal than proximal
68
What are the cervical radiculopathy sypmtoms
Unilateral dermatomal pain
Deep ache, numbness, pins and needles
Weakness
Distal pain more than proximal
69
What are the cervical radiculopathy signs
```
protective deformities
neurodynamic testing
spurling's test
distraction
sensation
motor function
```
70
Describe the protect deformities and their location of cervical radiculopathy
C5 if arm above head is better
C7 if arm at their side is better
Forward head
71
What are the 4 signs of threatening nerve root pain
1. Dermatomal pain with distal pain greater than proximal
2. Severe pain, latency
3. Slight movement cause pain
4. Protective deformities
72
Why would a patient with cervical radiculopathy have their head slightly tilted to the side
it will open the facet joints and relieve pain
73
What are the clinical prediction rules for cervical radiculopathy
ipsilateral rotation of less than 60 degrees
positive ULNT 1a test (median)
positive distraction
positive spurlings test
74
What is the hallmark sign someone has cervical radiculopathy
distal sx greater than prox that follow a dermatomal pattern
75
Explain the specificity and sensitivity of the ULNT 1 for a patient with cervical radiculopathy
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
True or False:
ULNT 1a is used for screening and not diagnosing cervical radiculopathy
true
77
myelopathy signs will always be (unilateral/bilateral)
bilateral
78
What are the signs for cervical myelopathy
gait abnormality
| UMN signs like hyperreflexia, Babinski, Hoffman's sign and clonus
79
True or False:
At C1 the vertebral artery make two 90 degree turns while traveling from foramina to formaina
true
80
True or False:
Arthritis of the cspine can cause encroachment leading to VA sx
true
81
Cervical rotation will cause (VA/ICA) insufficiency
VA
82
Cervical rotation with extension will cause (VA/ICA) insufficiency
ICA
83
Extension of the neck will cause (VA/ICA) insufficiency
ICA
84
True or False:
VBI occurs to the same side that is being rotated towards
False, if I rotate my head to the right, the left VBI will be occluded
85
True or False:
Occlusion is normal with rotation
True, it becomes abnormal if sx arise
86
Should we be more worried about the VA or ICA more
VA
87
What is the acronym to remember in regards to VA sx
5 D's And 3 N's
88
What does the 5D's And 3N's stand for and what does it help with
It is for VA sx
Dizziness, diplopia, dysphagia, drop attacks, dysarthria
ataxia
Nystagmus
Numbness
Nausea
89
If a patient has VA sx and they are feeling numb, where would the numbness be felt at
the back of the neck/suboccipital
90
True or False:
Testing for VA insufficiency has good reliability
false, it is poor
91
True or False:
Rotation will reduce BF contralaterally in healthy individuals
true
92
True or False:
PT's can treat VBI
False, notify a physician
93
How can RA lead to VA insufficiency
RA can lead to hypermobility that allows greater ROM at the neck that can occlude the artery
94
If VBI testing has poor reliability, then why do we do it
to document that we tested for it to cover ourselves if anything were to happen
95
Is C1 on C2 convex on convex or concave on concave
convex on convex
96
The skull on C1 is (convex/concave) on (convex/concave)
convex on concave
97
What can the AA joints cause problems with
The fat pads by them are highly vascularized and can get crushed
98
Which muscle has been linked to headaches and why
rectus capitis posterior minor because it attaches to the dura
99
As always, (sensory/motor) relies on (sensory/motor)
motor relies on sensory
100
True or False:
The suboccipital muscles are some of the mostly dens of spindle fibers in the body
true
101
The rectus capitis posterior minor keeps the dura tight when the neck is (flexed/extended).
How is this so
extended, because that muscle has a small tendon that inserts into the posterior dura
102
Patients with CTTH will have atrophy of what muscle
rectus capitis posterior muscles
103
What can the atrophy of the rectus capitis posterior muscles in patients with CTTH be accounted for
a reduction of proprioceptive output from those muscles that could also explain the perpetuation to pain
104
What is the clinical presentation of sub occipital pathologies
OA on the left
| C1-2 on the right
105
What do the Alar ligaments do
they are passive restraints to excessive rotation and SB
106
Which ligament is the primary passive restraint of C1 displacement in the sagittal plane
Transverse ligament
107
True or False:
The dens is fx more than its surrounding ligaments
true
108
True or False:
Joint hypermobility, specifically the cspine, can be a predisposing factor for headaches
true
109
What can happen if the cervical spine muscles are too tight
In anterior cspine neck muscles can pull the clavicle up, pinching the first rib sending sx down the arm
110
What type of mobs should be done with UVJ issues
central PAs for extension
111
What is the best pt position when performing central PAs on the elderly
on their side
112
What type of mob would be performed to create a sponging effect for cervical discs
Central PAs
113
What does the sponging effect do
aids in the transfer of fluids
114
Why would you perform unilateral PAs or PAs in rotation for cervical disc pathologies
Lateral fissures or Cloward referral patterns
115
When performing mobs for facet joints, should you start in extension or flexion
flexion and progress towards more extension
116
(traction/rotation) is best with UVJ issues
traction
117
(traction/rotation) is best with facet joint issues
rotation
118
If your patient has foraminal stenosis and they need more space, what treatments can you do
lateral glide, longitudinal cephalad
119
If your patient has foraminal stenosis and they need more movement, what treatment can you do
neural mobs
120
True or False:
PT's can treat cervical myelopathy
True, but ONLY if medically cleared
121
If you are treating a patient with cervical myelopathy, should you treat in flexion or extension
flexion, avoid extension
122
When treating cervical radiculopathy, is intermittent or static traction better
intermittent
123
(cervical/lumbar) issues less are more common
lumbar
124
What percentage of the area around the spinal cord can be reduced and the cord will still be fine`
16%
125
True or False:
Encroachment on the spinal cord will always cause sx
False
126
What nerve supplies the discs at the same level and level above
sinuvertebral nerves
127
What nerve supplies the lateral discs in the cspine
branches of the vertebral nerve
