Lecture 3: Cervical Medical Screening Flashcards
What is the definition of yellow flag in the C spine?
pain associated with psychological distress that adversely affect outcomes for ms pain, fear of movement
What are some serious pathological neck conditions?
neoplastic, fractures, upper cervical ligament instability, VBI systemic dz, cardiac
What are some indications that neck pain could be neoplastic?
over 50, unexplained weight loss, no relief of sx, night pain, prior history of cancer
What types of cancer most commonly metastasize to the neck/spine?
breast, lung prostate
What is a pan coast tumor?
carcinoma in apex of lung, can present as neck/shoulder pain or C7-T1 palsy
pt likely over 50 and hx of smoking
What are some sx of pan coast?
weakness or atrophy or intrinsic hand muscles, Horner’s syndrome if affecting sympathetic ganglia (constriction of pupil and drooping of eyelid on same side of tumor)
ulnar nerve distribution
When should you be suspicious of a cervical fracture?
major trauma w/o medical clearance or minor trauma in pts with osteoporosis
sx: severe limitation in all neck AROM
What tools are best for determining fx?
- canadian C spine clinical prediction rule (better diagnostic accuracy)
- Nexus
What are risk factors for ligamentous instability?
major trauma, DS, RA, prolonged steroid use, connective tissue disorder
What are sx of ligamentous instability?
severe limitation during neck AROM in all directions, signs of cervical myelopathy, occipital headache and numbness
What are sx of systemic dz?
high temp over 98.6, BP greater than 160/95, resting pulse over 100, RR over 25, excessive fatigue
During exam what medical screening questions should be asked before performing ROM?
any dizziness, arthritis, steroid use, anticoagulants, neuro signs, respiratory hx, imaging
What are 4 self report outcome measures for cervical spine?
- Neck Disability index
- patient specific functional scale
- global rating of change
- Fear avoidance beliefs questionnaire
What are important things to remember about posture assessment?
see static and dynamic
What shoulder motions should be tested for neck exam?
active elevation, Abduction, ABD/ER, Add/IR
What are norms for c spine ROM?
flexion/ext- 45
SB- 45-60
Rotation- 75
What is the dizziness test?
PT holds pts head while pt turns feet with head staying still can help differentiate between vestibular and MS
What are special tests for upper cervical instability?
- alar ligament
- modified sharp purser
- C2 relocation
What is alar ligament test?
SB the occiput only and palpate for immediate motion of SP of C2
Collar and call MD if positive!
What are indications for stability testing?
trauma, feeling of head feeling heavy, sx of tongue numbness, N/V, severe HA, dizziness, lump in throat, signs of SC compression
What is modified sharp purser test?
pt flexes head and reports if they feel any signs or sx if not then stabilize C2 and apply posterior force to head
What is transverse ligament relocation test?
pt supine PT performs a P/A glide of C2, definite capsular end feel should be felt
What is a positive transverse ligament test?
improvement in sx, hearing or feeling clunk, laxity or excess motion
COLLAR and immediate referal
What are special tests for cervical radiculopathy?
spurlings, cervical distraction, compression, neurodynamic testing
What is purpose of neurodynamic testing?
determine the sensitivity of the neural structures or mobility of the strcutures
What is procedure of median nerve test?
shoulder depression, ABD (110), ER (80), supination, wrist/finger extension
Elbow extension done last and slowly
What is procedure for radial nerve?
shoulder depression, ABD and IR, pronation wrist flexion, fingers and thumb flexion
What is procedure for ulnar nerve?
shoulder depression, ABD, elbow flexion (done last) pronation wrist extension
What is a positive result for neurodynamic test?
reproduction of sx and greater than 10 degree diff in elbow side to side
What is also important to see during neurodynamic test?
to see if sx decrease or increase with SB away and towards
What is quadrant or spurlings test?
pt seated and asked to SB and slightly rotate to the painful side and PT provides compression
What are sx of upper motor neuron lesion?
ataxic gait, bilateral weakness numbness/tingling
What is Hoffman’s sign?
flicking of 3rd finger looking to see if thumb and pointer finger flex
What is Lhermitte’s test?
pt flexes neck, positive if feeling of electric shock
What is inverted supinator sign?
PT supports pts forearm in slight pronation and provides series of quick strikes to brachioradialis tendon
pos- finger flexion and slight elbow extension
What are two different types of PAIVMS?
(PA)- central and unilateral
What is neck flexor muscle endurance test?
ability to lift head and neck against gravity
norm- 39 seconds
neck pain - 24 seconds
What is cranial cervical flexion test?
ability to initiate and maintain isolated cranial and cervical flexion (deep neck flexors)
