Lecture 1 Flashcards
Is Cervical Myelopathy Easily diagnosed?
No
What age group typically gets cervical myelopathy?
Older (50+)
What does myel mean?
Spinal cord
What is Cervical Myelopathy?
Compression of the spinal cord
What causes Myelopathy? (GDP)
Anything that compresses the spinal cord
Stenosis of the spinal canal / herniated disc / Bone spurs /hypertrophy of ligaments
Is cervical myelopathy common?
No
How do we treat mild myelopathy?
Surgery or supervised trial of structured rehab
- If rehab and either failure to improve or worsening, then surgery is indicated
How do we treat moderate to severe cervical myelopathy?
Surgery recommended
How many Signs/Symptoms do we need ro rule in cervical myelopathy?
3+
What are the 5 cervical myelopathy signs and symptoms to rule it in?
1) Age > 45
2) Unstready gait
3) Positive Hoffman reflex
4) Inverted supinator sign
5) Positive Bbinski sign
Need at least 3 to rule in
What are some common diseases that go along with upper cervical instability (make it more likely)
Ehlers-Danlos syndrome
Down syndrome
Marfan syndrome
Trauma
RA
When you start seeing these diseases your first thought should be upper cervical instability - I need ot rule this out
What is the highest risk factor for cancer?
Previous history of cancer
Aside from a previous history of cancer, what is another very strong indicator of cancer?
Define how much it is
Unexplained weight loss
(loss of 5-10% of body weight over 3-6 months)
Why might no relief when lying flat indicate cancer?
Joints / muscles typically calm down when lying flat - however, if theres cancer that pressure will remain
What are the two high level of evidence to indicate cancer?
1) Previous history of cancer
2) Unexplained weight loss
Do you have a higher risk of cervical arterial disection with exercise or cervical manipulation?
Exercise (cervical manipulation is sage)
What is a large indicators for systemic (whole body) or inflammatory disease?
These symptoms plus what would start to clue us in to this?
There are 5
Elevated or decreased BP not consistent w/ the activity being done
Increased resting pulse (or higher than normal) > 90bpm
Increased respiration> 20 bpm
Fatigue or malaise (generally unwell)
Temperature
These symptoms plus a recent surgery would start to clue us in. - even going in to do a spinal tap could cause this.
What are the 5D’s and 3N’s related too?
Cervical Artery Dysfunction (vertebral artery)
What are the 5 D’s?
What are they related too?
1) Diplopia
2) Dizziness
3) Dysphasia (hard time swollowing)
4) Dysarthria (hard time speaking due to weak muscles)
5) Drop attacks
Cervical artery dysfunction
What are the 3N’s?
What are they related too?
1) Nausea
2) Numbness
3) Nystagmus (shaking of eyes)
Cervical Artery Dysfunction
How do we assess Cervical Artery Dysfunction?
Patient seated w/ feet on growned - lean forward w/ elbows on thighs head turned to side. Have them talk to you
What are the 3 most common symptoms of vertebral artery dissection (cervical artery dysfunction)
Dizziness/vertigo
Headache
Neck pain
What is the difference between a disecting stroke and non disecting stroke?
Disecting = some type of trauma has ruptured the artery
Non = some type of claduication or impeding of blood flow is present
60% of patient with vertebral artery dysfunction present with what kind of pain where?
Do they get this before or after 5 D’s and 3 N’s?
Dull Pain / posterior ipsilateral neck pain (note it presents as musckuloskeletal because it comes w/ turning neck)
Get this before 5 D’s and 3 N’s
Whats more important to cervical artery disease - patient demographics or our tests
Patient demographics
What 3 symptoms come with horners syndrome
Ptosis - eyelid drooping
Miosis - pupillary constriction
Anhydrosis - Lack of facial sweating
Internal Carotid Artery dysfunction / dissection causes what 8 signs and symptoms
1) Ipsilateral head or neck pain
2) Horners syndrome (ptosis)
3) Pulsatile tinnitus (coming and going)
4) Five D’s Three N’s
5) Cranial nerve palsies (nerve loss of function) (blood flow)
6) Transient ischemic attack sx’s (temporary loos of blood flow to the brain)
7) Ischemic stroke sx’s (insufficent blood flow to the brain)
8) Visula changes (not enough BF to eyes)
NOTE: Horners syndrome is caused when there is a disturbance to the sympathetic nerves (that cause it). basically w/ internal carotid dysfunction blood flow is kept from these nerves presenting w/ horners syndrome
Tinnitus because of the reduced bloood flow to the ear and the nerves dying
Ischemic defintion
No enough blood flow to a particular organ
Two charts that i need to learn that i skipped
What causes migrains?
Vascular changes
What are the 9 risk factors for dissecting vascular events?
1) recent trauma
2) Known vascular anomaly
3) Current or past smoker
4) History of migraine-type headache (vascular issue)
5) Hypercholesterolemia
6) Recent infection
7) Hypertension
8) Oral contraception
9) Family history of stroke
NOTE: Absence of risk factors does not rule out neuro-vascular event
What are the 9 risk factors for non-dissecting vascular events
1) Current or past smoker
2) Hypertension
3) Hypercholestermia
4) History of migraine type headache
5) Known vascular anaomly
6) Family history of stroke
7) Oral contraception
8) Recent infection
9) Recent trauma
KNOW: Subjective is king for vascular events in the cervical spine (dissecting / non)
Is vertebral artery testing a good test?
Not that great (get patient to do it their self)
When screening for cervical arterial dysfunction what should we do? (4)
Blood pressure examination (vitals)
Cranial nerve examination (part of neuro screen)
Pulse palpation / ausculation of carotid arteries (put finger on carotid)
Proprioceptive tests (romberg; tandem gait)
Learn referral pattern chart
What is a positive sharp-purser test?
What does it feel like (2 things)
Perception of excessive posterior glide of the cranium on C2 (lax ligament make it go back easily)
Relief of pain with manual gliding
(remember - this ligament runs behind the dens so pushing posteriorly will cause it to become more lax [moving closer to its insertions])
Tests the transverse ligament
How do you position a patient for the Alar ligament Stress test? / where is the therpaist
What are the 3 positions we test it in
What is the expected negative response?
What does a positive test indicate?
Patient is supine with head on pillow - top of head even with table edge
Therapist is standing at the patient’s head
- Hand under head - pinch grip on spinous process/laminae / articular pillars of C2
- Hand on top of head used to side bend atlantoaxial joint (bending neck sideways)
Tested in craniovertebral neurtal / flexion / extension (note we are side bending in these positions)
Expected negative response: Ipsilatearl rotation of C2 with minimal side bend movement (SP moves contralaterally)
Positive test = excessive movement without or before C2 SP movement
What position is the patient / therapist in for the anterior shear test?
How does the therapist move the head
What is a positive anterior shear test?
* What is the potential posititve
How long should therapist hold this position?
Does this test give us good information on Sp/Sn?
Patient = supine with head and c-spine supported by therapist
Therapist: standing at patients head
- Support occiput
- Index fingers under C1 transverse process
Therapist moves the head anteriorly (which essentially stretches the transverse ligament because it goes over the dens [and starts behind the dens) this movement moves the dens forward (further away of the transvese ligament origin) stretching it out
Positive test = increase in motion / empty end feel or reproduction of symptoms of ligamentous instability OR production of lateral nystagmus or nausea
Potential positive = feeling lump in throat
Hold for up to 10 seconds
No good infor
How is a shoulder abduction test performed?
This is one of the special tests for neck radiating pain
Hand of symptomatic side placed on head while patient is sitting
Positive = symptoms reduced or alieveated
* this puts the nerve on slack, and takes pressure of muscles that could be pulling.
How is Spurling’s Test A done?
What is a positive test?
This is a neck radiating pain special test
Patients head put in side bending and provide compressive force - I am not further side pressing it but pressing down through the axis
Radicular symptoms reproduced (symptoms come back)
NOTE: A better than B
How is the distraction test for neck pain w/ radiating pain performed?
What is a positive test?
Patient in supine. Place patients neck into slight flexion and apply distraction force
Positive = symptoms alleviated (NOT JUST THE NECK PAIN FEELING BETTER –> IT MUST ALLIEVAITE DISTAL SYMPTOMS)
How many neurodynamic tests are there? Name them in order.
What is a positive
NOTE: This is part of the special tests for neck pain w/ radiating pain
3
Upper Limb Tension Test 1 = Median nerve (most important) - for this test item cluster were really just looking at median
Upper Limb Tension Test 2 = Radial nerve
Upper Limb Tension Test 3 = Ulnar nerve
(alphabetical order)
Positive = Radiular symptoms reproduced or > 10 deg difference contraltarelly
Picture specifically for radial nerve (which is what we care about)
There are three parts that mark up neurodynamic testing or adverse neural dynamics (AND). what are they (ON TEST)
- On practicals / Tests
one of the special tests for neck pain w/ radiating pain
1) Reproduces patients compreable pain (what they came in with) - not just that its really tight but that it reproduces that neural numbness / pain
2) Needs to be a side to side difference greater than or = to 10 degrees. Normally measured at elbow flexion extension (could be at wrist but normally stuck at elbow)
3) You’re able to change their symptoms based on proximal or distal segment changes. Meaning I can tension the nerve and bring on their wrist pain by moving their head or relaxing their shoulder. I can bring on or take away symptoms by changing something else along the change
NOTE: If we bring on some pain but its not the same pain thats still a negative they need to have all 3 for it to be considered neuraldynamic positive
