L9 CT Conditions

Question 1

Cervical Spine Motions

Answer 1

• Flexion causes spinal canal widening
• Extension causes narrowing of spinal canal
• Ipsilateral rotation causes larger narrowing of the lateral foramen then contralateral rotation

Question 2

Systemic S/S

Answer 2

• disturbs sleep
• deep aching or throbbing
• reduced by pressure
• constant or waves of pain/spasm
• not aggravated by mechanical stress
• associated with fatigue, weight loss, rash, fever, etc

Question 3

Mechanical S/S

Answer 3

• generally lessens at night
• sharp or superficial ache
• usually decreases with cessation of activity
• aggravated by mechanical stress

Question 4

Cervicothoracic Spine Cancer RF

Answer 4

• age >50 years
• hx of cancer
• unexplained weight loss
• failure of conservative therapy

Question 5

Cervical Primary tumors

Answer 5

lumbar and thoracic are more common than cervical

Question 6

Cervical Metastatic Tumors

Answer 6

only 8-20% will appear within cervical tumors

Question 7

Pancoast Tumors

Answer 7

• most common s/s is sharp posterior shoulder pain as tumor invades brachial plexus and upper ribs
• usually men in 6th decade

Question 8

Peptic Ulcer

Answer 8

• boring pain from epigastric area to middle thoracic spine
• history of NSAID use
• perforated ulcer can refer pain to shoulder with irritation of diaphragm

Question 9

Cholecystitis

Answer 9

• right upper quadrant and scapular pain
• fever, nausea, vomiting 1-2 hours after fatty meal

Question 10

Renal Infection

Answer 10

• renal colic/flank pain
• fever, nausea, vomiting
• increased risk for kidney infection with ongoing UTI

Question 11

Systemic/Infection S/S

Answer 11

• temperature >100°
• BP >160/95
• resting pulse > 100 bpm
• resting respiration > 25 bpm
• fatigue

Question 12

Imaging for Cervical Fracture

Answer 12

• High risk = age >65, dangerous MOI, UE paresthesia
• low risk = simple rear end, ambulatory at any time, delayed onset of neck pain, absence of midline tenderness
• able to rotate neck 45°

Question 13

Cervical Myelopathy

Answer 13

• s/s = imbalanced altered gait, progressive stiffening of spine, clumsiness with hands
• altered sensations, impaired reflexes, B/B changes
• refer for consult and imaging, surgery is often indicated

Question 14

Cook’s myelopathy cluster

Answer 14

1. gait deviation
2. positive hoffman’s
3. inverted supinator sign
4. positive babinski
5. age > 45 yo

more than 3 have a high likelihood of having myelopahty

Question 15

Inverted Supinator Sign

Answer 15

• pt is seated, therapist supports pronated forearm
• PT applies a series quick strikes near styloid process

normal response: slight elbow flexion

positive: finger flexion, elbow extension

indicates UMN lesion and myelopathy

Question 16

Cervical Myelopathy Grading

Answer 16

• four different categories include upper limb motor, lower limb motor, upper limb sensory, and sphincter (B/B)
• a lower score indicates higher levels of disability

Question 17

Conservative management for cervical myelopathy

Answer 17

• neck bracing
• bed rest
• PT
• pharmacology
• traction

no RCTs that show effects of specific conservative treatment

Question 18

Surgical mgmt for Cervical Myelopathy

Answer 18

• anterior decompression and fusion
• posterior laminectomy with or without fusion
• improvements in disability and function seen in majority of pts after surgery

Question 19

Factors associated with poor surgical mgmt outcomes

Answer 19

age >50
s/s longer than 12 mo
multi-level involvement
hx of smoking

Question 19

Cervical Arterial Dysfunction

Answer 19

• umbrella term for vascular pathologies in neck
• including carotid artery and vertebro-basilar
• can be atherosclerotic, ischemic, hemorrhagic
• dissection vs no dissection events

Question 20

CAD Screening (5 Ds and Ns)

Answer 20

Diplopia
Dizziness
Drop Attack
Dysarthria
Dysphagia
Ataxia
Nystagmus
Nausea
Numbness

Question 21

Physical Exam for CAD

Answer 21

• history/subjective exam will help PT to decide if they should continue with physical exam. HISTORY not exam will increase suspicion of vascular issues in neck
• neuro exam of cranial and pn
• sustained end range rotation for >10 s
• BP
• auscultation

Question 22

VBI and SMT

Answer 22

• rotation, specifically EOR, has been connected with vertebra-basilar artery dissection
• most common direction of thrust in manipulative therapy
• adverse vascular events usually follow chiropractors and other HCPs, PTs have the least amount of adverse events

Question 23

Refer when…

Answer 23

• suspicious of fx
• suspicious of infection
• appearance of stenosis–UMN signs, gait, balance, LE s/s

Question 24

Cervical Manual Treatment recommendations

Answer 24

• avoid cervical manipulation during first week, with recent onset of head and neck pain
• treat with thoracic manip and cervical ROM during first week
• manip of upper cervical spine should be rarely used, if at all
• only low force traction for cervical
• pre-manip hold has to be performed prior to thrust

Question 25

Regional Interdependence

Answer 25

• primary thoracic mechanical dysfunction and pain
• neck pain due to thoracic impairments
• shoulder pain due to thoracic impairments
• neck pain due to shoulder impairments
• shoulder pain due to cervical impairments

–> limited thoracic or cervical can cause pain in the other. Improving one can improve the other