Exam II Study Guide Flashcards
Localized pain without radiation
Muscle pain
Facet pain
Facet impingement
Radiating pain
Nerve root irritation
History suggesting Cervical Spondylosis (arthritis)
Age >45
Most commonly affected levels C5-6, C6-7
Slow, gradual onset
Unilateral pain
Pain radiates into specific dermatomes
Pain increases with extension and decreases with flexion
History Suggesting cervical Disc Involvement
Age < 60 years
Most commonly effects C5-6
Sudden onset
Unilateral
Symptoms radiate into a dermatome
Tingling present
Pain increases with flexion
History suggesting cervical Instability
Traumatic mechanism of injury
Complaint of nonspecific symptoms that are worse in vertical and better with head support
Vertebral Artery Insufficiency symptoms
Dizziness/Vertigo
Nausea/Vomiting
Inability to stand
Blurred vision/ diplopia
Headache
Facial paresthesia/ facial palsy/ difficulty swallowing
Pain with compression
Disc
Vertebral body fracture
Nerve root irritation (radiating)
Decreased pain with distraction
Disc
Spinal Facet
Nerve root (centralizing)
Spurling’s A
Patient seated
Cervical extension with SB
PT applies compression gently
Positive= radiating symptoms
Test Item Cluster- Radiculopathy
ULTT-A
Spurling’s
Distraction
Cervical rotation < 60 degrees to ipsilateral side
Mobility exam findings
Recent onset
Absence of referred symptoms
Restricted ROM in rotation and/or SB
Restricted cervical and thoracic segmental mobility
Mobility intervention focus
Spinal mobilization/manipulation
Active range of motion exercises
Centralization exam findings
-Radicular/referred symptoms in the upper quarter
-Peripheralization and/or centralization of symptoms with range of motion
-Signs of nerve root compression present
-May have medical diagnosis of cervical
-radiculopathy (see TIC)
centralization intervention focus
Mechanical/manual cervical traction
Repeated movements to centralize symptoms
Manual Therapy
HEP of cervical spine retraction and deep
cervical flexor training
Test item cluster for Improvement with 3 weeks Mechanical Traction
Age greater than 55 years
Positive shoulder ABDuction test
Positive ULTT-A
Symptom peripheralization with central PA testing lower CS (C4-C7)
Positive neck distraction test
Conditioning exam finding
Lower pain and disability scores
Longer duration of symptoms
No signs of nerve root compression
No peripheralization/centralization during range of motion
Conditioning intervention focus
Strengthening and endurance exercises for the muscles of the neck and upper quarter
Aerobic conditioning exercises
Headache exam finding
Unilateral HA with onset preceded by or associated with neck pain
Cervical AROM
Cervical/Thoracic segmental mobility
Cranial Cervical Flexion test
Headache intervention strategy
Spinal manipulation/mobilization
Deep cervical flexor training
Soft Tissue/Muscle trigger point treatment
Postural education and training
Pain Control exam finding
High pain and disability scores
Recent onset of symptoms
Traumatic onset
May have referred pain
Poor tolerance to exam and/or interventions
pain control intervention focus
Gentle AROM as tolerated
ROM for adjacent regions
Modalities prn
Activity modification
Levator Scapulae stretch
-Lie on your back with your knees bent
-Place one hand under your hip
-Rotate your head to the opposite side of the hand that is under your hip
-Place your other hand on back of your head and pull your head and nose toward your armpit
Scalene Stretch Supine
-Lie on your back with your knees bent
-Place one hand under your hip
-Keep your head from rotating by keeping your nose pointed toward the ceiling at all times
-Place your other hand on the side of
Thoracic Spine Mobilization: Towel roll stretch
Roll up a large bath towel
Lay on it crossways, placing it on a stiff spot on your spine
Rest in this position
Thoracic Spine Mobilization: Foam Roller Stretch
Use a 6 inch foam roller for this exercise
Lay on it crossways, placing it on a stiff spot on your spine
Place your hands behind your head for support
Perform the following option if directed by your therapist
□ Perform a small sit up over
the foam roll
□ Lean side to side while
maintaining pressure on
the foam roll
McKenzie Derangement Syndrome
Reducible Derangement
-One direction of repeated movement centralizes symptoms (preferred direction/ directional preference)
-Opposite direction of repeated movement peripheralizes symptoms
ANTERIOR IMPINGMENT SYNDROME RISK FACTORS
History of overhead movements
Progressive
-Stage 1 <25 y/o overhead movements
-Stage II 25-45 y/o overhead movements, decreased inferior glide humerus
-Stage III >40 y/o Overhead movements, arthritis of acromion, loss of biomechanics
ANTERIOR IMPINGMENT SYNDROME CLINICAL MANIFESTATIONS
- Pain with overhead movements from acromion to lateral shoulder into deltoid region
-Difficulty reaching up back
-Stage I: intermittent, mild pain with overhead movements
Stage II: Intermittent mild to moderate pain with overhead movements
Stage III: Pain with rest and activities, night pain, weakness
ANTERIOR IMPINGMENT SYNDROME SPECIAL TESTS
-Hawkins and Kennedy
-Painful arc sign
-Infraspinatus test
-Neer test
RCT (SUPRASPINATUS TEAR) RISK FACTORS
Age >40 y
History of overhead sports or occupations
RCT (SUPRASPINATUS TEAR) CLINICAL MANIFESTATIONS
-Deep ache in shoulder and along deltoid region
-Night pain
-Pain reaching up back
-, weakness in ABD and ER, Loss of AROM
RCT (SUPRASPINATUS TEAR) SPECIAL TESTS
-Drop arm
-Painful arc
-Infraspinatus muscle test
-Dropsign
-Empty and full can
-Scapular retraction test
-ER lag sign
-Subacromial grind test
GH INSTABILITY RISK FACTORS
-Congenital laxity of capsule
-Progressive laxity of capsule with overhead athletes
GH INSTABILITY CLINICAL MANIFESTATIONS
-Popping and/or feeling of instability with movements of shoulder into elevation
-Can usually self reduce
GH INSTABILITY SPECIAL TESTS
-Sulcus sign
-Load and shift
-Apprehension/ relocation/release
GH DISLOCATION RISK FACTORS
Traumatic dislocation,
Can be associated with Bankart lesion (see labral tear) and Hills Sachs lesions (compression impaction fracture)
GH DISLOCATION CLINICAL MANIFESTATIONS
Apprehension with shoulder ABD and ER
GH DISLOCATION SPECIAL TESTS
-Sulcus sign
-Load and shift
-Apprehension/ relocation/release
LABRAL TEAR RISK FACTORS
-trauma FOOSH
-degeneration with age-overhead activities or heavy lifting
LABRAL TEAR CLINICAL MANIFESTATIONS
-Aching pain, vague location
-Clunking with overhead movements
-Feeling of weakness in shoulder
LABRAL TEAR SPECIAL TESTS
- Anterior slide test
-Crank test
-Compression Rotation test
-Active Compression test
-Bicep load test
-Kim test
ADHESIVE CAPULITIS (FROZEN SHOULDER) RISK FACTORS
-Gradual onset of loss of ROM in a capsular pattern (ER>ABD>IR)
-May be accompanied with a history of shoulder pain however generally idiopathic
ADHESIVE CAPULITIS (FROZEN SHOULDER) CLINICAL MANIFESTATIONS
-Pain with all movement
-Pain when sleeping on involved side
-Difficulty with ADLs
ADHESIVE CAPULITIS (FROZEN SHOULDER) SPECIAL TESTS
-Loss of AROM and PROM (ER>ABD>IR)
-Decreased capsular mobility
AC JOINT SPRAIN RISK FACTORS
-Result from a fall on the acromion (direct force) or FOOSH
-First-degree, grade I A-C joint sprain: minimal loss of function
-Second-degree, grade II A-C sprain: moderate pain, some dysfunction
-Third-degree, grade III A-C ligament injury, may have significant dysfunction
AC JOINT SPRAIN CLINICAL MANIFESTATIONS
-Localized pain, swelling over AC joint
-Cradling arm decreases pain
AC JOINT SPRAIN SPECIAL TESTS
-Horizontal ADD painful
-Positive active compression test
C1/ C2 Rotation testing
Patient is seated
C2 is stabilized and C1 is rotated
C2/C3 Lateral flexion testing
Patient seated or supine
Passive SB to C2/3
Cervical Spine: Foramina Degeneration symptoms
Dermatomal pattern
Can just be sensory without
motor component
Reproduced with closure of foramina
Cervical Spine: Disc symptoms
Dermatomal pattern – usually limited to 1
Usually a pattern across neurological tests (sensory, motor and reflexes)
Foraminal closure can reproduce symptoms but repetitive opening may increase symptoms
Thoracic Outlet Syndrome
Anatomical structures compressing the brachial plexus
Thoracic outlet: brachial plexus, ant and med scalene, clavicle
Sternocostovertebral Space impingement
Roots have just left the spine and trunks have not formed.
Pancoast tumor
Costoclavicular syndrome symptoms
Posterior, lateral and medial cord sensory and motor patterns
Pathology in Costoclavicular space
Soldiers with heavy backpacks
Test exaggerated military posture with inspiration
Posterior cord branches
STAR – subscapular, thoracodorsal, axillary, radial
Lateral Cord Branches
LLM “Lucy Loves Me” –lateral Pectoral, lateral root of the median nerve, musculocutaneous
Medial Cord Branches
MMMUM “Most Medical Men Use Morphine” –medial pectoral, medial cutaneous nerve of the arm, medial cutaneous nerve of the forearm, ulnar, medial root of the median nerve
Cords: Lateral, Posterior, Medial
Lateral= C5-C7 (LLM)
Medial= C8-T1 (MMMUM)
Posterior= C5-T1 (STAR)
Causative pathology within pectoralis minor space
Increased tension in pect minor
Overuse as accessory respiratory muscle
Postural kyphosis
Direct trauma to muscle
Upper thoracic spinal dysfunction
Costal lesions
Facilitated segment of CT segment
