Examination of the Cervical Spine Flashcards
As you are taking the patients history who has a cervical spine injury or pain, often times it is helpful to know if there was a specific episode of trauma or some specific event that happened that started this or is it more just an insidious onset? Like that just started bothering me and got worse over time.
The thing you wanna think about here if it is truly due to some trauma like a car accident or falling off their bike, hit in the head, we worry much more about fractures and stuff like that in this case. So often times the follow up question that I have in my history is after this happened, what was your course of treatment? Did you just go back home, go to the emergency room (did they do tests and rule out fractures?), etc? We know in the cervical spine there are some bad fractures that can happen in the cervical spine that we want to know about.
If it is more insidious onset then I worry much less about it being a fracture, I more so think is it overuse, bad positioning, and things like that. If someone has no history of trauma I suspect more of the basic things like tightness, positioning, etc.
Got it
In the spine we can get symptoms that are local (directly in the spine) and we can get symptoms that are remote from the primary site. In the cervical spine we may get those symptoms in one arm or both arms.
Got it
The symptoms a patient may have can vary in the cervical spine, can be pain, pain with tingling down the arm, pins and needles sensation down the arm, all good information for us to know.
Got it
Radicular pain is typically what we see more commonly, things like numbness, tingling, and that sort of thing, is typically due to irritation of a nerve and that irritation can be at the very nerve root or it could be anywhere along the course of the nerve itself. It can be a mechanical irritation of it, so you have some tissue or bone or whatever that is pressing on it or it could be an inflammatory process that is going on so we refer to that as chemical irritation, we have all these chemical irritants in that area and that is what is creating the irritation, pain, or tingling, and that sort of thing.
Got it
Radicular symptoms/Pain:
Travels in anatomic path: usually if you have an irritation of a specific nerve, you are normally going to see the radicular symptoms travel in the path of that nerve / dermatome patterns. Perfect example: If you hit your funny bone (the ulnar nerve), you get symptoms down the medial aspect of your forearm, your fifth finger, and often times the path of your fourth finger because this is the distribution of your ulnar nerve (C7-T1 ;)). Another example: Carpal tunnel.
Got it
Radicular symptoms/Pain:
Extremity pain > spine pain: A lot of patients will come in and complain of shoulder pain and elbow pain and their neck pain feels perfectly fine. As you do your screening exam and you start moving their neck, low and behold I can start changing their symptoms and you found your culprit.
Got it
Referred pain is similar to radicular pain in that the person feels pain or other symptoms at a site that is remote from the primary cause of the pain but the mechanism that causes referred pain is entirely different. A classic example is an individual is getting angina, so the source of that discomfort is heart tissue, and the person may not even have chest pain at all, they may have left arm pain, jaw pain, shoulder pain, and that sort of thing. That is referred pain so the mechanism for that is the nerves that innervate the heart share the same space in the spinal cord as does the left arm, the jaw, and shoulder region.
Got it
It is much more common for us to see people with (radicular/referred) pain.
radicular
When you are talking about someone who has symptoms from the spine, irritation of a nerve, compression of a nerve, and that sort of thing, (radicular/referred) pain is the term that you really use to describe that.
radicular
In any joint that we treat there are some common referred pain things that can happen. For example, in the cervical spine we can get referred pain that people will describe as diaphragm or upper belly pain, anterior cervical pain, or even pain associated with their liver. Those are common areas where we might get people that are complaining of pain.
Got it
If I examine someone and they say they have pain, I should be able to manipulate their neck around and do something to make it hurt. I should be able to do that with most musculoskeletal pain. If I go and examine someone who has normal motion, I do all sorts of special tests, I position them in different places, and if I can’t reproduce their pain at all that is when I start thinking about these typical referred symptom pain. Or I at least start thinking I’m not sure their pain is musculoskeletal in origin, they might need to go somewhere else for therapy. If you can reproduce the pain then you do not have to be worried about the associated referred symptoms/pain.
Got it
Pain that is generated from the diaphragm, the heart or the liver can sometimes mimic itself as cervical spine pain. Similar to the heart attack being left arm pain.
Got it
A RED flag in taking someone’s history is if someone complains of (unilateral/BILATERAL) symptoms, they come in and say I may or may not have neck pain, I have numbness and tingling or pain down BOTH of my arms, generally that is considered a red flag because that is an indication that they have some sort of spinal cord compression. It is pretty common for an individual to have compression or irritation of one of those nerve roots on one particular side, it is pretty rare for a person to have it on both sides. Often times they need decompressive surgery to alleviate those symptoms.
BILATERAL
Spondylosis (sometimes referred to as Degenerative Joint Disease (DJD)) is arthritic changes in the spine. We see these changes in individuals as young as _.
25
When patients ask if they should get a diagnostic test. Two things that are important to remember: 1) Are the results of that test going to change your _treatment__ ? 2) Those diagnostic tests really should be used to help confirm clinical exams. The clinical exams should be the thing that is helping decide what you are going to do with patients as far as treatment.
Got it
