Lab 2: C Spine Exam Flashcards
If the have pain w coughing and/or sneezing what do we think
Disc path
What are 3 mandatory questions for pts w neck pain
- Any dizziness (vertigo) , black outs , or drop attacks (5 D’s and 3 N’s)
- Any hx of RA , other inflammatory arthritis or treatment w systemic steroids
- Any neurological symptoms int he legs
What ligament connects the dens to the atlas (C1)
Transverse lig
When u are clearing the spine what do u do if 1 ligament in the neck is (+)
Send them to urgent care , it is not emergent in an ambulance
What do u do in the neck before u decide if ur gonna scan or not scan
Clear the C spine (trasnver , alar and VBI)
What is the modified sharp purser (primary test) testing
Assess integrity of transverse ligament and AA joint stability (C1-C2)
What kind of force is the PT giving at the forehead during the modified sharp purser test and what is a (++) sign
Postieor
(+) S&S are reduced (relocation test)
Immediate referral to physician
What is the supine lift off test assessing (2° test to confirm as needed) and what is a (+) test
Assess integrity of transverse ligament and AA joint stability
(+)= excessive upper cervical mobility suggesting ligamentous laxity or damage
Immediate referral
What kind of test is the Alar ligament test and what joint is it assessing
Mobility test
OA joint
What is a (+) test for the alar ligament test
Immediate movement of C2 SP into PTs fingers NOT felt suggesting ligamtous laxity
Immediate referral
How do u perform the Alar ligament test
Pt is supine and PT places 1 hand on C2 SP and other hand on top of head and performs passive CV L and R SB ( can use L and R rotation also) and movement of C2 SP should be felt immediately
How do u test the VBI screen and what is a positive test
Pt is seated or supine and PT is holding pt head and passively extendes it and to count down from 10 w their eyes open and then PT passively rotated Pt head to the other side and doing it again .. if no SYMTOMS in the cardinal planes then do it w combine motions (extend w R rotation/ L rotation)
(+) presence of 5 D’s and 3 N’s , emergent call ambulance if neurological signs are increasing
DO u over pressure if patient has pain with AROM
No
in what postion is the cervical mm strength (MMT) tested in
In neutral position no lengthened
What key mm is flexion MMT testing
C1-C2 and CN XI (asscesory n)
What key mm is L/R SB MMT testing
C3 and X1
What key mm is L/R rotation MMT testing
C2
How do u test the mm length of the upper traps
Max flexion and contagion SB and ispilateral rotation
Then depress ipsilateral shoulder
What is normal mm length of upper traps
45° of soft tissue end range
Decreased is <45 and hard end range
How do u test the mm length of levator scapular
- PT maximally flexes pt’s head, then
contralaterally rotates w/ contralateral SB - PT then depresses ipsilateral shoulder
What is the normal and decreased mm length for levator scapulae
Normal= 45° of rotation w soft tissue end range
Decrease= TTP at mm insertion or < 45°
How do u test mm length of SCM
extens , contra SB , ipsi rotation and stabilizes ipsi shoulder
What is the normal mm length and decreased fro SCM
Normal= equal bilaterally
Decreased= unequal ROM bilateral w or w/o TTP and hypertonicity
How do u test mm length of scalences
• PT extends and contralaterally SBs pt’s neck
while stabilizing shoulder
• PT then stabilizes ipsilateral shoulder
What is normla and decreased mm length for scalences
• Normal mm. length = ~45º of SB ROM
• ↓ mm. length = <45º of SB ROM w/ or w/o
TTP and hypertonicity
When would u do a CN testing
If asymmetry in face , head trauma or speech
Pertaining to OA joint mobitity how do u check opening on the R and L
- Opening on R- PT performs CV flexion w/ L to R sideglide
- Opening on L- PT performs CV flexion w/ R to L sideglide
Pertaining to OA joint mobitity how do u check closing on the R and L
• Closing on R= PT performs CV extension w/ R to L sideglide
•Closing on L= PT performs CV extension w/ L to R sideglide
How do u check AA joint mobility
L/R rotation
PT flexes mid lower c spine to take up the slack and then rotates to L —> R
What is the spurling test assessing
Compressing foramina to test for cervical radic
How do u perform the spurling test and what is postive test
Pt is seated and PT is behind them and ask pt to SB head and then applies an inferior force (toward floor) for 5-8 seconds and repeat on opposite side
(+)- reproduction of SYMTOMS into ipsilateral UE
testing for cervical radic
What is the cervical radiculopathy CPR
- C-spine rotation to painful
side <60 deg - (+) Spurling test
- (+) ULLT #1
- (+) cervical distraction test
(ie. relieves symptoms)
What test is assesses activation and enrudance of deep cervical neck flexors
Cranio cervical flexion test
How do u perfomr the cranio cervical flexion test
Pt in hooklying position and biofeedback BP cuff is placed under lortodtic curve of C spine and then is inflated to 20 mmHG and to is asked to gently nod head for 10 econds in a sufficient amount to increase pressure to 22 mmHG and then they rest for 10 seconds and repeats 4 more times adding 2 mmHG each time (last rep should be 30) w 10 sec of rest in between
What is a (+) test of men and women for the neck flexor endurance test
• (+) test for men = <38.9 sec
• (+) test for women = <29.4 sec
How much does teh pt need to lift head off of table for neck flexor endurance test
2.5 cm - 1 inch and maintain chin tuck
What is the cervical flexion rotation test assessing
Pretense of cervicogenic HA
How do u perform the cervical flexion rotation test and what is (+)
Pt is supine and asked to maximally flex ther head and hold position and then PT applies pressure thru out full rotation to other sides and notes any SYMTOMS
(+)= rotation ROM loss to 1 side >10° compares to other side and/or reproduction of symptoms
What is the most common outcome measure for the c spine
Neck disability index (NDI)
What are the other outcome measures for the neck
• Northwick Park Neck Pain
Questionnaire
• Copenhagen Functional Disability Scale (CNFDS)
• Neck Pain and Disability Scale (NPDS)
• Whiplash Disability Questionnaire (WDQ)
• Core Outcome Measures Index for
Neck Pain (COMI – neck)
• Neck Bournemouth Questionnaire
(NBQ
