Lecture 2B: Cervical Spine Exam And Eval Flashcards
In the C spine what other pain is common
Neck and UE
Does c spine have a high or low potential for serious injury
Hig
T/f: we need to examine the c spine w caution bc exam may be harmful , especially w hx of trauma
True
When doing a c spine exam what do we need to make sure is intact
Vertebral artery ,
Transverse ligament
Alar ligament
If we find reduced AROM of c spine what 2 paths can we go down and what do we think
Capsular pattern —> suspect arthritis
Noncapsular pattern—> assess glides , if reduced then mobilize (WD40) if normal then do MET
If we asses AROM of c spine and it is normal so then we assess combined motions and it is normal what can we suspect ?? And then what do we do
Suspect hypermobility —> do stress test —> can be negative which means hypermobility or can be positive which means instability but u would do stabilization exercises for both
When does c spine pain usually start (age)
3rd decade of life
If a patient comes in w c spine pain and they have a MOI of trauma what are we automatically on high alert for
Transverse lig
Alar leg
VBI
What are the 5D’s and 3N’s
D: diplopia , dysphagia , dysarthria , drop attack , dizziness
N : nausea, numbness in face , nystagmus
How do the neurologic symptoms present with patient history of C spine pain
Paresthesias
Dizziness
Tinnitus
Visual disturbances
LOC
Paitnet w C spine pain can also have pain where else
Neck or arm or both
What does the pateint health questionnarie ask
- Over the past 2 weeks, how often
have you had little interest or
pleasure in doing things? - Over the past 2 weeks, how often
have you felt down, depressed or
hopeless?
What 3 domains of psychological distress foes the OSPRO-YF assess
• Negative mood
• Fear-avoidance
• Negative affect/coping
C spine dysfucntion = ___ poteiental for ___ injury
High
Serious
When doing a C spine examination it it’s important to DDx __ pain … and how
Neck
• Mobility deficits
• Movement coordination impairments
• Headaches
• Radiating pain
• Serious injury/pathology
Basically all the buckets for neck
How should u sequence your exam when doing a c spine exam
• Patient safety**
• Efficient data collection
• Effective clinical decision-making
Hx of recent trauma in the last ___ ___ demands cautious approach
6 weeks
Presence of yellow flags can ___ complexity of symptoms and __ pt outcomes
Increased
Decrease
What is the purpose of the Canadian C spine test
Determine whether radiograpthy is necessary prior to initiating PT treatment
When are the Canadian C spine rules not applicable (8)
• Non-trauma cases
• Glasgow coma scale <15
• Unstable vital signs
• Age <16
• Acute paralysis
• Known vertebral disease
• Previous c-spine surgery
• Pregnant
Describe how to do the CanadianC spine rules
- Any high risk factors that mandated radiography
- age 65 or older or dangerous mechanism or paresthesiasa in extremities
If yes then get radiography if no then go on to 2
- simple rearened MVC
Or - sitting position in ED
Or - ambulatory at any time
Or - delayed onset of neck pain
Or
-absence of midline C spine tenderness
If ANY ARE NO then go get radiography … if all yes then go on to 3
- Can the patient actively rotate neck 45° L and R if no then go get pics
What is considered a dangerous mechanism for Canadian C spine rules
- fall from elevated > 3 feet/ 5 stairs
-axial load to head (diving) - MVC high speed (> 100)
- motorized recreational vehicles
- bike crash
What does the simple rearend MVC excludefor teh Canadian c spine
-pushed into oncoming traffic
- hit by the bus
- rollover
- hit by a high speed vehicle
What are the 5 cervical conditions that must be ruled out
• Ligamentous instability
• Myelopathy
• Malignancy
• Spinal fx’s
• Vascular pathologies (ie. VBI)
What are the 2 evaluation and interventional schools of thought
Structures based (Cyriax)
Impairment/treatment based (McKenzie and Maitland)
The selective tissue tension test for the structures based eval and interventions does what 2 things
Identified pathologic strucutre
Stage of pathology
What is the intervention based on for the Strucutres based (cyriax) school of thought
Based on treating pathologic strucutre
- connective tissue healing model
Which school of thought for eval and intervention seldom seek to identify pathological structures
Impairment/Treatment-Based
(McKenzie and Maitland)
What is the intervention of the Impairment/Treatment-Based (McKenzie and Maitland) based on
Based on response to tissue loading an SYMTOMS response
What is the ultimate goal for the 2 schools of thoughts for Eval and intervention
Self management by the pt
pathoanatomic diagnoses are ___ based
strucutred
what are teh 3 deficitis associated w forward head posture
- cervical hyperlordosis
- shoulder protraction
- CT hyperkyphosis
what is associated w cervical hyperlordosis
- TMJ ___
- ____ compression
- CV ___
- OA ___ ___
- AA ___ ___
- ___ extension HYPERmobile
- CV instability
- Mid-cervical ____
overcloses
posterior
hyperextension
flexion hypo
roation hypo
OA
hyperextedned
what is 3 things are assocaited w CT hyperkyphosis assocaited w forward head posture
- T-spine extension HYPOmobile
- Shoulder complex HYPOmobile
- RC tendinopathy
there is a diangostic label when neck pain is NOT cuases by what 3 things
- Trauma (ie. MVA)
- Cervical radiculopathy
- Non-MSK cause
what is the percent of poeple who experience mechanical neck pain symptoms during lifespace
20-50°
when is mechanical neck pain more prevalent (age)
4th adn 5th decade of ilfe
mehcanical neck pain can transition to what
chronic neck pain if symptoms are severe
Acute disc herniation is uncommon in what age and most common in what age
< 30
~50
what is disc degeneration
end plat damaged followed by distruptive changes in the disc resultis in decreased height
does the disc have a limtied ability to self repair? yes or why not
yes bc of restricited blood supply
what corresponds w disc level in 80% of people with disc degeneration
neurologic deficit’s
what is cervicla radiculopathy
compression of spinal nerve root by space occupying lesin
what kind of MOI is common for cervical radicu
hyperextension injuruies especially when combined w roation and SB
what nerve root is between these levels
C4-C5
C5-C6
C6-C7
C7-T1
T1-T2
5
6
7
8
1
what are the motor deficits if somoen has a C5 nerve root impingment
deltoid and biceps
what are the motor deficits if somoen has a C6 nerve root impingment
wrist extensors
biceps
what are the motor deficits if somoen has a C7 nerve root impingment
wrist flexors
tricpes
finger extesnors
what are the motor deficits if somoen has a C8 nerve root impingment
finger flexors
hand intrinscis
what are the motor deficits if somoen has a T1 nerve root impingment
hand intrinscics
where are disc hernication rare
C2-C3
where will pain for C 4 spinal nerver root compression be
posterior neck/medial scapular border pain
what spine nerve would affect breathing w physical activity which means diaphragm invovlment
C3-C5
what spinal nerve root would u think is compressed if a patient has numbness on superior aspects of shoulders
C5
where will pain refer if there is a impingement at C6
radiating pain from neck to lateral aspect of upper arm , forearm and hand
where would C7 nerve root refer pain if impinged
radiating pain from posterior neck to scpaula , posterior upper arm, forearm, and hand
what is the most common site for cervical radiculopathy
C 7
what nerve would be ivovled if a patient had radiating pain from neck to medial aspect of upper arm , forearm anf hand
C8
what is a chronic degenetative condition affected content of spinal canal ( spinal cord and spnal nerve roots)
cervical spondylosis
cervical spondylosis can be related to bony changes and can causes what 2 things
cervical myelopathy —> spinal cord compression
foraminla stenosis —> radiculopathy
t/f: cervical spondylosis can stay asymtomatic for a long time
true
in cervical spondylosis the IVD and facet joints are affects by degenrative changees .. what are the 3 things
• Osteophyte formation
• Hypertrophy of ligamentous structures
• Result in chronic inflammatory response
does cervical spine instability damage spina cord , nerve roots or surrounding strucutres
no .. basically u cant control the motion u have
cervical spine instability can occur secondary to what (4 things)
trauma
sx
systemic disaese
degenerative changes
what is the gold standard for diagnosing mild c spine insatbility
non
what are teh S/S w mild c spine insatbility
- Hx of major ___
- Reports of ___, __, ___
___ - ____ of symptoms
- Subjective reports of neck ____ (ie. head feels heavy)
- Altered ROM
- Neck pain w/ or w/o ___ spasms
- Reports of ___
- Hx of major trauma
- Reports of catching, locking, giving
way - Unpredictability of symptoms
- Subjective reports of neck weakness (ie. head feels heavy)
- Altered ROM
- Neck pain w/ or w/o muscle spasms
- Reports of HAs
what does whiplash associated disorder result in
motor control deficits and pain
what are the 4 types of HA
-miagraine (whole side of head)
- tension ( band above the eyes)
- cluster (1 spot behind eye)
-cervicogenic ( rams horn)
What are the 4 neck pain classification categories (buckets)
• Neck Pain w/ Mobility Deficits
• Neck Pain w/ Movement Coordination Impairments (WAD)
• Neck Pain w/ HAs
• Neck Pain w/ Radiating Pain
