Lecture 4: Neck and Cervical Spine Exam Flashcards
Articulation between C2 and C3 and rest of cervical joints (C3-C7) is considered?
Typical
What are contraindication for HVLA in the cervical region?
- Rheumatoid Arthritis (weak odontoid ligament)
- Down Syndrome (weak odontoid lig or incomplete/missing odontoid process)
- PVD or risk thereof
- Osteoporosis or risks thereof
- Pt’s on Anticoagulants (shear stress –> intracranial bleed)
The C6 dermatome covers what area?
- Lateral forearm and thumb
What spinal nerves innervate the diaphragm and respiratory paralysis may result from spinal cord injury above which cervical vertebrae?
- C3, C4, C5 “keeps the diaphragm alive”
- Injuries above C5
What are the sensory dermatomes for the neck and clavicle area?
C3-C5
What are the sensory dermatomes for the nipples and umbilicus?
T4 = nipples
T10 = umbilicus
Reflex testing for the: C4-5 disc, C5-6 disc, and C6-7 disc; what root is tested for each and the corresponding muscle?
C4-5 disc = C5 root - Biceps
C5-6 disc = C6 root - Brachioradialis
C6-7 disc = C7 root - Triceps
A sensory exam for C4, C5, C6, C7, C8, and T1 corresponds to which regions?
C4 = lateral neck
C5 = lateral upper arm
C6 = lateral forearm and thumb
C7 = middle finger
C8 = medial wrist/forearm
T1 = medial elbow/upper arm
How do we do strength testing for C1, C2-4, C5, C6, C7, C8, and T1?
C1 = resisted rotation ROM
C2-4 = scapular elevation
C5 = deltoid, should ABduction
C6 = biceps, wrist ext.
C7 = triceps, wrist flex.
C8 = finger flex
T1 = finger ABduction
When do we check ROM in a trauma patient w/ neck pain?
Do NOT check ROM of the neck until you have cleared the neck either clinically or radiographically
What is a very important historical or clinical statement when it comes to the cervical spine; why??
- Neck stiffness (inability or unwillingness) to move the neck is concerning
- Found in majority of cases of acute bacterial meningitis and subarachnoid hemorrhage
Cervical fractures all require what; and what must be determined?
- All require at least neurosurgical consultation
- Must determine if stable or unstable
What are Atraumatic causes of neck pain?
- Cervical strain
- Myofascial injury
- Degenerative (i.e., Spondylolysis)
- Torticollis
- Meningitis
What is the most common cause of acute or chronic neck pain?
Cervical Spondylosis
- Degenerative bony lesions
- Degenerative disc disease
- Osteophyte formation
What is Adult Torticollis?
- Acquired (maybe slept the wrong way)
- Typically result from SCM or Trapezius muscle injury or inflammation
- May be caused by wide variety of conditions due to muscle spasm or cervical nerve irritation
Kernig’s vs. Brudzinski’s sign?
Kerning’s sign: inability or reluctance to allow full ext. of the knee when the hip is flexed 90 degrees
Brudzinski’s sign: spontaneous flexion of the hips during attempted passive flexion of the neck
*Tests for meningitis or sub-arachnoid hemorrhage*
What is it called if pt has normal plain films and CT of the cervical spine but continues to have neurologic signs or symptoms; most commonly seen in?
- Spinal cord injury without radiographic abnormality (SCIWORA)
- More common in peds and geriatric pts
What is the most common cause of atraumatic neck pain?
Degenerative disease
What are Non-spinal causes of Neck pain?
- Thoracic outlet syndrome
- Herpes Zoster
- Diabetic Neuropathy
What is Cervical Radiculopathy; what symptoms seen; most common cause?
- Compression/dysfunction of spinal nerve root
- Pain, weakness, reflex changes, or sensory changes
- Most commonly caused by degenerative changes in spine
What is leading cause of death for young adults worldwide?
MVC’s
What are the Nexus Criteria; what are they used to determine; what are the rules?
- Determine which patients presenting w/ neck pain after trauma need radiographic imaging
- If all criteria are met the patient does not need any imaging
- If all criteria are not met apply a cervical collar and image the patient
When do we apply cervica immobilization?
If you are unable to clear your trauma patient with neck pain clinically, you must immobilize their cervical spine until they can be cleared radiographically
If using a plain film X-ray for imaging after traumatic neck pain what must be seen; practically how is the C-spine typically cleared, radiographically?
- Must have an acceptable view of odontoid
- Must see through the top of T1 on lateral
- Most fractures will be seen on odontoid and lateral views
*Practically, most people clear the C-spine radiographically w/ CT
How to properly perform spinal immobilization?
- Person stabilizing the neck is captain of the team
- Pt should NOT make ANY effort on the rolling process
What are some criteria for performing radiographic imaging in patiens with Non-Traumatic Neck pain?
- Age >50 years w/ new symptoms
- Constitutional symptoms (fevers, chills, unexplained weight loss)
- Moderate-to-severe neck pain lasting more than 6 weeks
- Progressive neurological findings
- Infections risk (i.e., injection drug use, immunosuppression)
- History of malignancy
What should be the first-line imaging study performed in patients with progressive signs or symptoms of neurologic disease?
MRI
