Examination - Cervicothoracic Spine

Question 1

What are some examples of easing factors?

Answer 1

Positions/motions of comfort, ice/heat, self-manipulation, medications

Question 2

How can aggravating and easing factors change?

Answer 2

They can change over time, so it’s important to reassess them periodically.

Question 3

What are the general guidelines for observation and screening?

Answer 3

Be confident, explain procedures well, watch for non-verbal cues

Question 4

What should you observe in the waiting room?

Answer 4

General posture, any visible discomfort, gait

Question 5

What are the Canadian C-Spine Rules used for?

Answer 5

Screening for cervical spine fractures in traumatic situations

Question 6

What are the key signs of cervical artery dysfunction?

Answer 6

Unilateral head and neck pain, dizziness, diplopia, dysarthria, dysphagia, drop attacks

Question 7

What is the difference between non-ischemic and ischemic signs of cervical artery dysfunction?

Answer 7

Non-ischemic signs include unfamiliar unilateral head/neck pain, ischemic signs include dizziness, diplopia, dysarthria, etc.

Question 8

How is the vertebrobasilar insufficiency test performed?

Answer 8

Prolonged rotation of the neck for a minimum of 10 seconds

Question 9

What should you look for during range of motion testing?

Answer 9

Quantity, quality, willingness, and provocation of movement

Question 10

What are the movements tested in lower cervical range of motion?

Answer 10

Flexion, extension, side-bend, rotation, chin-tuck

Question 11

How is upper cervical range of motion tested?

Answer 11

Perform standing or sitting, look for quantity, quality, willingness, and provocation

Question 12

What should you look for in thoracic range of motion?

Answer 12

Flexion, extension, side-bend, rotation

Question 13

What is the purpose of resisted testing?

Answer 13

To assess strength and provocation of symptoms

Question 14

What movements are tested in resisted testing?

Answer 14

Cervical flexion, cervical side-bend, scapular elevation, GH abduction, elbow flexion, elbow extension, thumb extension, 5th digit abduction

Question 15

Which nerve root is tested with biceps reflex?

Answer 15

C5

Question 16

Which nerve root is tested with brachioradialis reflex?

Answer 16

C6

Question 17

Which nerve root is tested with triceps reflex?

Answer 17

C7

Question 18

What is the purpose of sensory testing?

Answer 18

To assess the sensory function of different nerve roots

Question 19

What is passive physiologic segmental mobility?

Answer 19

Assessing the movement between individual spinal segments

Question 20

What is passive accessory segmental mobility?

Answer 20

Assessing the accessory movements (e.g., glide) of spinal segments

Question 21

How is passive physiologic segmental mobility tested in the thoracic spine?

Answer 21

Palpate the tips of each spinous process from T1-T4 for general motion, assist with maximum cervical rotation

Question 22

What are the key characteristics of local cervical syndrome?

Answer 22

Facet joint issues, uncovertebral joint issues, internal disc disruption, C4 nerve root involvement, vertebral or carotid artery involvement

Question 23

What are the indicators of spondylosis?

Answer 23

Facet arthritis, end-range ROM limits, pain worse with 3D motions, pain with PA segmental mobility

Question 24

What is Wainner’s Clinical Prediction Rule for cervical radiculopathy?

Answer 24

Rotation less than 60 degrees, 2+ positive tests has a specificity of 56%, 3+ positive tests has a specificity of 94%, 4+ positive tests has a specificity of 99%

Question 25

What is the radial neural tension test used for?

Answer 25

Assessing the radial nerve’s mobility and provocation

Question 26

What is the ulnar neural tension test used for?

Answer 26

Assessing the ulnar nerve’s mobility and provocation

Question 27

What is a cervicogenic headache?

Answer 27

Headache caused by issues in the cervical spine, often requires thorough examination of upper cervical mobility

Question 28

What is the cervical flexor endurance test?

Answer 28

A test to bias the deep neck flexors by having the eyes look down and mouth slightly open

Question 29

How is rib mobility tested?

Answer 29

Spring testing of ribs 2-10, patient prone with head neutral, pressure applied towards the anterior aspect of the armpit

Question 30

What is the purpose of thoracic disc testing?

Answer 30

To assess the mobility and provocation of thoracic discs, performed with seated progressive thoracic rotation

Question 31

How is 1st rib testing performed?

Answer 31

Assessment of the mobility of the 1st rib

Question 32

What are the key signs of thoracic outlet syndrome?

Answer 32

Pain, numbness, tingling in the arm and hand, often worsened by certain positions

Question 33

What is the closed-fist percussion sign?

Answer 33

A test for thoracic compression fractures, involves tapping the spine with a closed fist

Question 34

What is Lhermitte’s sign?

Answer 34

A sudden sensation resembling an electric shock that passes down the back of your neck and into your spine when you bend your neck forward

Question 35

What is the TMJ range of motion with auscultation?

Answer 35

Assessing the range of motion of the temporomandibular joint while listening for any sounds

Question 36

What is TMJ joint play testing?

Answer 36

Assessing the movement and function of the temporomandibular joint in various directions

Question 37

What is the Krogh-Poulsen dental stick bite test?

Answer 37

A test to differentiate between joint compression and myalgia in the TMJ by biting and holding on different sides