Lower C-Spine Exam Flashcards
What joints make up the lower c-spine?
C3-C7
What actions are contraindicated with symptoms of VBI?
- Cervical end range rotation and extension
- mobilizations
- Thrust techniques
What is the location of the Vertebral artery proximally?
enters foramen transversarium @ C6, anterior to 1st rib and TP of C7
Where is the VA most vulnerable to compression and stretching?
at level of C1/C2
how much cerebral blood flow comes from VA?
11%
how much cerebral blood flow comes from carotid artery?
89%
When you rotate the head, the VA is stressed on what side?
opposite side of rotation
What are some risk factors for VBI?
- osteophyte formation or spondylotic changes
- HTN (esp uncontrolled)
- visual disturbance
- h/o TIA
- neck trauma
What is the aim of the objective exam?
determine if there is a mechanical approach to treat
- looking at the contribution of muscles, nerves and joints to sx
What are the Pain assessments?
- NDI
- Superficial palpation (looking for trigger points)
- Disability, function, and pain indexes
- VAS
- Diagrams
What is the MCD for the NDI?
5 points
What is the purpose of superficial palpation?
to determine: temperature, sweating, trigger points vs. tender points in soft tissue, inspection and mobility of skin/subcutaneous tissue
What is the purpose of observing posture?
- look for asymmetries
- look for abnormal forces and strain on structures that balance & control the head
- note habitual postures
If the head is anterior to the COG, what does this lead to?
T spine hypomobility
What occurs when the occiput and upper cervical spine are in extension?
compensatory flattening of the lower c-spine
what occurs when sub-occipital muscles shorten?
cervicogenic headaches
What is likely the cause of lateral asymmetries in the lower c-spine?
facet impingement (torticollis, fascial asymmetries)
What movement occurs the c-spine with protraction?
- upper c-spine extension
- lower c-spine flexion
What movement occurs the c-spine with retraction?
- upper c-spine flexion
- lower c-spine extension
What does a change in the symptom severity during a provocation test indicate?
mechanical disorder
most c-spine tests aid in the diagnosis of what condition?
cervical spine radiculopathy
What is the purpose of the ROM Quadrant test?
- elicit sx when AROM and overpressure are WNL
2. reproduce sx by mechanically stressing tissues
What are the special tests in the lower c-spine?
- Cervical compression
- Cervical distraction
- Shoulder ABD
What is the purpose of the cervical compression test?
- assess vertical irritability & patency of IV foramen
What does a positive cervical compression test indicate?
Possible:
- disc problem
- end plate or vertebral fx
- acute inflammation of facet
- nerve root irritation
What does an increase in symptoms with cervical distraction test indicate?
possible:
- tear of spinal ligament
- tear of inflammation of annulus
- irritated dura
- large herniation
What does the shoulder ABD test screen for?
-nerve root irritation at C4/C5 and C5/C6
What are the muscle function test positions?
- supine (neck flexion)
- prone (neck extension)
- SL (neck side flexion and rotation)
What can you do to test the sensory integrity of the patient?
Dermatomes
What can you do to test the reflex integrity of the patient?
check cervical nerve root pathology C5, C6, C7
What is the purpose of neurodynamic tests?
determine if neural tissue is responsible for the production of pt’s sx
What is the purpose of testing the level of reactivity?
describes the relationship of pain provocation as it relates to sense of tissue resistance during passive motion (PA or PIVM) testing
What does a high reactivity level mean?
pain is reported before detection of resistance to passive motion
what does moderate reactivity level mean?
pain is reported synchronous to detection of resistance to passive motion
what does a low reactivity level mean?
pain is reported after detection of resistance to passive motion (only with OP)
in a hypermobile segment, if the irritable range appears “normal” but with a spasm, what is going on?
reflex muscle contraction is preventing motion into abnormal painful range
in a hypermobile segment, if the non-irritable range is increased, and the end feel is excessive what happens?
stability needs to be assessed
What are some exam findings for a patient with cervical hypomobility
- restricted AROM
- Restricted PIVM testing in cervical and upper t-spine
- no UE radicular sx
What are some proposed interventions for cervical hypomobility?
- AROM exercises
- Cervical and thoracic mobilization/manipulation isometrics or thrust manipulation techniques
- non-thrust manipulation
What are some exam findings for a patient with cervical radiculopathy
- sudden or gradual onset
- (+) spurling’s A
- (+) neck distraction test
- (+) ULNT
What are some proposed interventions for cervical radiculopathy?
- Cervical traction
- AROM
- T-spine manipulation
- postural exercises
What are some exam findings for a patient with clinical instability?
- remote h/o trauma
- sx provoked with sustained WB
- sx decreased with NWB
- hypermobility with loose end feel of mid cervical segments
- poor strength (2/5) of multifidus, longus colli, and longus capitis
- aberrant motion with cervical AROM
- greater AROM in NWB than in WB
What are some proposed interventions for clinical instability?
- postural re-ed
- cervical stabilization exercise program
- mobilization/manipulation above and below hypermobilities
- ergonomic corrections
What are some exam findings for a patient with acute pain (whiplash)?
- high pain and disability scores
- recent h/o of trauma
- referred symptoms into upper quarter
- poor tolerance to examination & most interventions
What are some proposed interventions for acute pain (whiplash)?
- gentle AROM within tolerance
- activity modification to control pain
- relative rest
- physical modalities
- intermittent use of cervical collar
- gentle manual therapy and exercises
What are some exam findings for a patient with cervicogenic headaches?
- UL headache with onset preceded by neck pain
- headache pain triggered by neck movement or positions
- headache pain elicited by pressure on posterior neck, especially at 1/3 upper cervical joints
What are some proposed interventions for a patient with cervicogenic headaches?
- c and t-spine mobilization/manipulation
- strengthening neck and postural muscles
- postural education
Describe posture cervical hypomobility
- not associated with trauma
- pain occurs due to compensation of forward head
- normal motion in poor posture
- muscles cause pain–> restricts motion
Describe zygapophyseal joint hypomobility: cervical hypomobility
- referral zones overlap myofascial & dermatomal pain patterns
- UL dull ache
- referred into craniovertebral or interscapular regions
- motion testing corresponds to injured facet joint
- soft tissue changes occur
Describe symptoms that occur with disc conditions in the c-spine
- head list away from side on injury
- AROM limited in extension, ROT and lateral flexion to side of lesion
- radicular sx develop
What age is the peak incidence of disc issues?
45-54 years
what is the most common segment of disc issues?
C5/C6 followed by C6/C7
