Lecture 3: Cervical Medical Screening

Question 1

What is the definition of yellow flag in the C spine?

Answer 1

pain associated with psychological distress that adversely affect outcomes for ms pain, fear of movement

Question 2

What are some serious pathological neck conditions?

Answer 2

neoplastic, fractures, upper cervical ligament instability, VBI systemic dz, cardiac

Question 3

What are some indications that neck pain could be neoplastic?

Answer 3

over 50, unexplained weight loss, no relief of sx, night pain, prior history of cancer

Question 4

What types of cancer most commonly metastasize to the neck/spine?

Answer 4

breast, lung prostate

Question 5

What is a pan coast tumor?

Answer 5

carcinoma in apex of lung, can present as neck/shoulder pain or C7-T1 palsy

pt likely over 50 and hx of smoking

Question 6

What are some sx of pan coast?

Answer 6

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

Question 7

When should you be suspicious of a cervical fracture?

Answer 7

major trauma w/o medical clearance or minor trauma in pts with osteoporosis

sx: severe limitation in all neck AROM

Question 8

What tools are best for determining fx?

Answer 8

1. canadian C spine clinical prediction rule (better diagnostic accuracy)
2. Nexus

Question 9

What are risk factors for ligamentous instability?

Answer 9

major trauma, DS, RA, prolonged steroid use, connective tissue disorder

Question 10

What are sx of ligamentous instability?

Answer 10

severe limitation during neck AROM in all directions, signs of cervical myelopathy, occipital headache and numbness

Question 11

What are sx of systemic dz?

Answer 11

high temp over 98.6, BP greater than 160/95, resting pulse over 100, RR over 25, excessive fatigue

Question 12

During exam what medical screening questions should be asked before performing ROM?

Answer 12

any dizziness, arthritis, steroid use, anticoagulants, neuro signs, respiratory hx, imaging

Question 13

What are 4 self report outcome measures for cervical spine?

Answer 13

1. Neck Disability index
2. patient specific functional scale
3. global rating of change
4. Fear avoidance beliefs questionnaire

Question 14

What are important things to remember about posture assessment?

Answer 14

see static and dynamic

Question 15

What shoulder motions should be tested for neck exam?

Answer 15

active elevation, Abduction, ABD/ER, Add/IR

Question 16

What are norms for c spine ROM?

Answer 16

flexion/ext- 45
SB- 45-60
Rotation- 75

Question 17

What is the dizziness test?

Answer 17

PT holds pts head while pt turns feet with head staying still can help differentiate between vestibular and MS

Question 18

What are special tests for upper cervical instability?

Answer 18

1. alar ligament
2. modified sharp purser
3. C2 relocation

Question 19

What is alar ligament test?

Answer 19

SB the occiput only and palpate for immediate motion of SP of C2

Collar and call MD if positive!

Question 20

What are indications for stability testing?

Answer 20

trauma, feeling of head feeling heavy, sx of tongue numbness, N/V, severe HA, dizziness, lump in throat, signs of SC compression

Question 21

What is modified sharp purser test?

Answer 21

pt flexes head and reports if they feel any signs or sx if not then stabilize C2 and apply posterior force to head

Question 22

What is transverse ligament relocation test?

Answer 22

pt supine PT performs a P/A glide of C2, definite capsular end feel should be felt

Question 23

What is a positive transverse ligament test?

Answer 23

improvement in sx, hearing or feeling clunk, laxity or excess motion

COLLAR and immediate referal

Question 24

What are special tests for cervical radiculopathy?

Answer 24

spurlings, cervical distraction, compression, neurodynamic testing

Question 25

What is purpose of neurodynamic testing?

Answer 25

determine the sensitivity of the neural structures or mobility of the strcutures

Question 26

What is procedure of median nerve test?

Answer 26

shoulder depression, ABD (110), ER (80), supination, wrist/finger extension

Elbow extension done last and slowly

Question 27

What is procedure for radial nerve?

Answer 27

shoulder depression, ABD and IR, pronation wrist flexion, fingers and thumb flexion

Question 28

What is procedure for ulnar nerve?

Answer 28

shoulder depression, ABD, elbow flexion (done last) pronation wrist extension

Question 29

What is a positive result for neurodynamic test?

Answer 29

reproduction of sx and greater than 10 degree diff in elbow side to side

Question 30

What is also important to see during neurodynamic test?

Answer 30

to see if sx decrease or increase with SB away and towards

Question 31

What is quadrant or spurlings test?

Answer 31

pt seated and asked to SB and slightly rotate to the painful side and PT provides compression

Question 32

What are sx of upper motor neuron lesion?

Answer 32

ataxic gait, bilateral weakness numbness/tingling

Question 33

What is Hoffman’s sign?

Answer 33

flicking of 3rd finger looking to see if thumb and pointer finger flex

Question 34

What is Lhermitte’s test?

Answer 34

pt flexes neck, positive if feeling of electric shock

Question 35

What is inverted supinator sign?

Answer 35

PT supports pts forearm in slight pronation and provides series of quick strikes to brachioradialis tendon

pos- finger flexion and slight elbow extension

Question 36

What are two different types of PAIVMS?

Answer 36

(PA)- central and unilateral

Question 37

What is neck flexor muscle endurance test?

Answer 37

ability to lift head and neck against gravity

norm- 39 seconds
neck pain - 24 seconds

Question 38

What is cranial cervical flexion test?

Answer 38

ability to initiate and maintain isolated cranial and cervical flexion (deep neck flexors)