L11 C spine Examination Flashcards
if pt reports trauma or you suspect cervical instability/vascular disease, what exam(s) should be performed?
vasculogenic screen: pulses, VAI
- refer to specialist
upper cervical screen
- refer to urgent care or ED
s/s of dissecting stroke from trauma
can be caused by trauma, vascular disease
headache
neck pain
visual disturbance
paresthesia
dizziness/drowsiness/confusion
unsteadiness
prosis
weakness
facial palsy
speech/swallowing impairment
LOC
s/s of non dissecting stroke
can be caused in older adults from CV risk factors like smoking, HTN, hi cholesterol
headache
neck pain
visual disturbance
paresthesia
dizziness
weakness
speech/swallowing difficulty
ptosis
facial palsy
BASICALLY SAME AS DISSECTING
steps to determining if patient is appropriate for cervical exam
- clinical suspicion of vascular causes from hx
- trauma causing dissecting stroke
- vascular disease causing occlusion: palpate/auscultate carotid - clinical suspicion of instability from hx
- trauma
- in addition to risk factors like Marfan’s, down syndrome, EDS - Precautions or contraindications to physical examination
- if vascular or instability is suspected, should be referred out before performing cervical exam - Perform appropriate physical exam elements to further rule these out if not conraindicated:
- neuro exam of CN and PN
- coordination, gait
- BP
- audcultation
canadian c spine rule
to be used on GCS 15 patients only when c spine injury is a concern
1. high risk factors mandating xrays
- 65+, dangerous mechanism, extremity paresthesia
2. low risk factor allowing safe assessment include: rearend, seated in ED, ambulatory, delayed onset neck pain, no midline c spine tenderness (if not, need xray)
3. if pt can rotate neck 45 degrees BL, don’t need xrays
if rotation is the patient’s primary ROM limitation, which cervical exam should be performed?
proceed with upper cervical biomechanical exam
after ruling out VBI, ligamentous, fracture
if sidebending is primary limitation in ROM, which cervical exam should be performed?
traditional cervical exam
after ruling out VBI, ligamentous, fracture
when should an upper cervical screening be performed?
first clear:
1. xrays for fracture
2. Canadian c spine rules if no imaging
3. rotation > 45 degrees BL
do not perform if these are positive, immediate referral
continue with upper cervical screening if suspicion of VBI or instability
assess vasculogenic risk factors and physical exam
continue if negative to upper cervical/ligament exam
5Ds And 3Ns
Dizziness
Diplopia
Drop attacks
Dysarthria
Dysphagia
Ataxia
Nystagmus
Numbness
Nausea/vomiting
special questions relating to the neck
- Any 5Ds And 3Ns?
- BL N/T in extremities, gait disturbances
- General health/recent weight loss
- Medications
- Imaging
Cloward’s Areas
areas in interscapular region that can correspond to anterior disc pathology
3-4: clavicle
4-5: scapular spine
5-6: medial to infraspinatus
6-7: inferior angle
purpose/use of upper cervical spine screening exam
hands off way to:
screen for serious pathology
assess neuro status
assess vascular risk
determine areas needing further biomechanical assessment
upper cervical spine screen includes:
- active rotation
- ipsilateral first
- contralateral second - active sidebend
- active flexion
- sharp purser
- compression in neutral - Neuro screen
- vasculogenic screen
- craniovertebral ligament stress tests
AROM rotation under 45 degrees could indicate:
osseous, ligamentous, or vascular issues depending on presentation
splinting indicating fracture
signs of radiculopathy in the hands
loss of soft tissue contous
atrophy/wasting
swelling
How should cervical AROM be performed?
in seated, assess movement against gravity without assistance
perform OP only if no pain has been reproduced, none into extension
provide resistance once ROM cleared
order of traditional C spine exam
- observation/inspection/posture
- AROM shoulders
3, AROM c/s with OP and resisted isometrics as appropriate
- Quadrant - Neuro exam
- PROM with eyes open
- DNF strength assessment as indicated
- Palpation always
- Special tests
cervical radiculopathy CPR
- positive ULTTA - median
- involved side rotation AROM<60
- distraction
- Spurling’s
