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figures and tables Flashcards

1
Q

Describe how to perform the numeric pain rating scale

A
  1. Average of current, best and worse in the past 24 hours

2. MDC is 2.1

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2
Q

What is the MDC for NDI and PSFS

A
  1. NDI - 7

2. FSFS - 2

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3
Q

What is the ICF and its goals

A

International classification of functioning, disability and health guideline

  1. provide scientific basis for consequence of health conditions
  2. establish common language
  3. permit comparisons across countries and professions
  4. provide systematic coding
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4
Q

What are the ICFs for cervical dysfunction

A
  1. neck pain with mobility impairments
  2. neck pain with headaches
  3. neck pain with movement coordination
  4. neck pain with radiating pain
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5
Q

Describe sharp purser test

A

The patient is seated. The examiner places the palm of one hand on the patient’s forehead, and the index finger or thumb of the other hand on the tip of the spinous process of the axis (C2). The patient is asked to slowly flex the head performing a slight cervical nod, at the same time the examiner presses posteriorly on the patient’s forehead.

A sliding motion of the head in relation to the axis indicates atlantoaxial instability.[1] A positive result may also be accompanied by a reduction in symptoms[3], a “clunk” sensation, or patient reports of a “click” or “clunk” felt in the roof of their mouth. It is thought that this technique reduces atlantoaxial subluxation caused by forward flexion of an unstable cervical spine.

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6
Q

Common findings for neck pain with mobility impairments ICF

A
  1. age less than 50
  2. acute onset (less than 12 weeks)
  3. symptoms isolated to the neck
  4. restricted cervical ROM
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7
Q

Describe the alar ligament special test

A

In performing this test, the spinous process and lamina of the axis are stabilized by the therapist to prevent both side bending and rotation of the segment. Slight compression is applied through the crown of the head to facilitate atlanto-occipital side bending. Passive side bending then is applied using pressure through the patient’s head; in effect, directing the patient’s ear toward the opposite side of the neck.

If fixation of the axis is adequate, the normal coupled movement will not be permitted to occur. Hence, no lateral flexion should occur. Testing is recommended to be performed in 3 planes (neutral, flexion, and extension) to account for variation in alar ligament orientation[7]. For a side-bending stress test to be considered positive for an alar ligament lesion, excessive movement in all 3 planes of testing should be evident[8][7]

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8
Q

What are some historical and clinical features of vertebral artery dissection

A
  1. head and neck pain, unilateral and subocciptal
  2. No history of pain
  3. acute onset
    4, pain is distinct but nonspecific features
  4. sensation of stiff neck with no ROM loss
  5. Upper motor neuron and ataxia
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9
Q

What current theory is used to explain the benefit of spinal manipulation?

A

neurophysiologic - there is an influence on central pain control by stimulating descending inhibitory pain mechanisms, particularly the periaqueducatal gray

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10
Q

Dunning’s 2012 study of upper cerivcal manipulation versus mobilization demonstrated what key findings?

A

The manipulation group had better pain reduction, NDI, ROM and DNF coordination following intervention

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11
Q

What findings would indicate a strong likelihood of a neck pain patient benefiting from cervical manipulation

A

Tsang 2007
(1) NDI<11.5 (2) (B) involvement (3) active lifestyle (3) improved symptoms with movement (4) no increase in symptoms with extension (5) spondylosis without radiculopathy
Puentedura 2012
(1) less than 38 days onset (2) positive expectation from manipulation (3) side to side difference in rotation 10 deg (4) pain with P/A spring test mid cervical spine

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12
Q

What finding would suggest a neck pain patient would benefit from a thoracic manipulation?

A

Cleland

  1. less than 30 days of symptoms
  2. no symptoms past shoulder
  3. extension does not increase symptoms
  4. FAQ less than 12
  5. decreased thoracic kyphosis
  6. Cervical extension less than 30 degree
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13
Q

What is a normal cranial cervical flexion test score

A
  1. no use of superficial neck flexors
  2. hold each pressure for 10 seconds
  3. incrementally increase to between 6 and 10 mmHg
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14
Q

What is a normal score for neck flexor endurance test?

A
  1. normal time is 39 seconds
  2. Impairment is less than 24 seconds
    - men typical can hold longer
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15
Q

What findings would you expect to seen for the neck pain with movement coordination impairment IFC

A
  1. long standing neck pain of greater than 12 weeks
  2. Impairment CCFT and/or deep flexor entrance test
  3. muscular impairment of neck and upper body
  4. flexibility deficits of the upper body and neck
  5. ergonomic impairments
  6. pain with UE movement and
  7. mid-to-outer range cervical ROM pain
  8. cervical hypermobility
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16
Q

What findings would you expect to seen with the neck pain with radiating pain IFC

A
  1. upper extremity symptoms
  2. decreased cervical rotation (less than 60 degrees) toward the involved side
  3. sings of nerve root compression and centralization of symptoms
  4. production of radicular symptoms with cervical testing
  5. decreased symptoms with distraction
  6. neuro findings on the involved side
17
Q

Key findings for C5 involvement?

A
  1. deltoid
  2. lateral forearm symptoms
  3. biceps DTR
18
Q

Key finds for C6 involvement?

A
  1. biceps and ECRL/B
  2. distal thumb
  3. brachioradilais DTR
19
Q

Key findings for C7 involvement?

A
  1. triceps and FCU
  2. distal middle finger
  3. ticep
20
Q

Key findings for C8

A
  1. APB
  2. distal fifth finger
  3. No reflex
21
Q

Key findings for T1 involvement?

A
  1. first dorsal interossei
  2. medial forearm
  3. No reflex
22
Q

What variable would suggest the greatest likelihood of success when treating someone with neck pain with radicular symptoms?

A
  1. age less than 54
  2. non-dominant involvement
  3. looking down does not increase symptoms
  4. treatment involving manual therapy, traction, DNF strengthening
23
Q

What findings would suggest a neck pain patient could benefit from traction?

A
  1. peripheralization of symptoms with mobility testing of C4-C7
  2. positive shoulder abduction sign
  3. age less than 55
  4. passive ULTT-1
  5. relief of symptoms with manual distraction
24
Q

What findings would you expect to see with the neck pain with headaches IFC?

A
  1. unilateral headache associated with neck area symptoms and head movement
  2. symptoms increase with posterior cervical myofascial points
  3. decreased cerivcal ROM
  4. decreased cervical segmental mobility
  5. impaired CCFT
25
Q

what are IFC mobility, movement coordination and muscle power impairments

A
  1. mobility - muofascia, joint, nerve mobility impairment
  2. movement coordination - postural alignment
  3. power - strength and endurance
26
Q

What is the purpose and target population of the the Canadian C-spine rule

A
  1. The Canadian C-Spine Rule (CCR) is a decision making tool used to determine when radiography should be utilized in patients following trauma.
  2. The Canadian C-Spine Rule is applicable to patients who are in an alert (Glasgow Coma Scale score of 15) and stable condition following trauma where cervical spine injury is a concern.
  3. It is not applicable in non-trauma cases, if the patient has unstable vital signs, acute paralysis, known vertebral disease or previous history of Cervical Spine surgery and age <16 years.
27
Q

What are the three key questions of the Canadian C-spine rule?

A
  1. where there any high risk factors? yes-radiograph
  2. where there any low risk factors that allow safe assessment of ROM? No-radiograph
  3. Are they able to rotate the neck greater than 45 degree? No-radiograph
28
Q

What are the Canadian c-spine rule high risk factors?

A
  1. greater than 65
  2. paresthesia in extremities
  3. dangerous mechanism (1) pushed into oncoming traffic (2) hit by bus or large truck (3) rollover (4) high speed MVA
29
Q

What are the Canadian c-spine rule low risk factors that allow for safe assessment of ROM?

A
  1. simple MVA
  2. able to sit in the waiting room
  3. ambulatory at any time
  4. delayed onset of neck pain
  5. absence of midline tenderness

cervical (6 decks)

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