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Ortho (spine) > Lower C-Spine Exam > Flashcards

Lower C-Spine Exam Flashcards

1
Q

What joints make up the lower c-spine?

A

C3-C7

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2
Q

What actions are contraindicated with symptoms of VBI?

A
  • Cervical end range rotation and extension
  • mobilizations
  • Thrust techniques
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3
Q

What is the location of the Vertebral artery proximally?

A

enters foramen transversarium @ C6, anterior to 1st rib and TP of C7

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4
Q

Where is the VA most vulnerable to compression and stretching?

A

at level of C1/C2

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5
Q

how much cerebral blood flow comes from VA?

A

11%

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6
Q

how much cerebral blood flow comes from carotid artery?

A

89%

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7
Q

When you rotate the head, the VA is stressed on what side?

A

opposite side of rotation

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8
Q

What are some risk factors for VBI?

A
  • osteophyte formation or spondylotic changes
  • HTN (esp uncontrolled)
  • visual disturbance
  • h/o TIA
  • neck trauma
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9
Q

What is the aim of the objective exam?

A

determine if there is a mechanical approach to treat

- looking at the contribution of muscles, nerves and joints to sx

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10
Q

What are the Pain assessments?

A
  1. NDI
  2. Superficial palpation (looking for trigger points)
  3. Disability, function, and pain indexes
  4. VAS
  5. Diagrams
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11
Q

What is the MCD for the NDI?

A

5 points

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12
Q

What is the purpose of superficial palpation?

A

to determine: temperature, sweating, trigger points vs. tender points in soft tissue, inspection and mobility of skin/subcutaneous tissue

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13
Q

What is the purpose of observing posture?

A
  1. look for asymmetries
  2. look for abnormal forces and strain on structures that balance & control the head
  3. note habitual postures
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14
Q

If the head is anterior to the COG, what does this lead to?

A

T spine hypomobility

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15
Q

What occurs when the occiput and upper cervical spine are in extension?

A

compensatory flattening of the lower c-spine

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16
Q

what occurs when sub-occipital muscles shorten?

A

cervicogenic headaches

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17
Q

What is likely the cause of lateral asymmetries in the lower c-spine?

A

facet impingement (torticollis, fascial asymmetries)

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18
Q

What movement occurs the c-spine with protraction?

A
  • upper c-spine extension

- lower c-spine flexion

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19
Q

What movement occurs the c-spine with retraction?

A
  • upper c-spine flexion

- lower c-spine extension

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20
Q

What does a change in the symptom severity during a provocation test indicate?

A

mechanical disorder

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21
Q

most c-spine tests aid in the diagnosis of what condition?

A

cervical spine radiculopathy

22
Q

What is the purpose of the ROM Quadrant test?

A
  1. elicit sx when AROM and overpressure are WNL

2. reproduce sx by mechanically stressing tissues

23
Q

What are the special tests in the lower c-spine?

A
  1. Cervical compression
  2. Cervical distraction
  3. Shoulder ABD
24
Q

What is the purpose of the cervical compression test?

A
  • assess vertical irritability & patency of IV foramen
25
Q

What does a positive cervical compression test indicate?

A

Possible:

  • disc problem
  • end plate or vertebral fx
  • acute inflammation of facet
  • nerve root irritation
26
Q

What does an increase in symptoms with cervical distraction test indicate?

A

possible:

  • tear of spinal ligament
  • tear of inflammation of annulus
  • irritated dura
  • large herniation
27
Q

What does the shoulder ABD test screen for?

A

-nerve root irritation at C4/C5 and C5/C6

28
Q

What are the muscle function test positions?

A
  1. supine (neck flexion)
  2. prone (neck extension)
  3. SL (neck side flexion and rotation)
29
Q

What can you do to test the sensory integrity of the patient?

A

Dermatomes

30
Q

What can you do to test the reflex integrity of the patient?

A

check cervical nerve root pathology C5, C6, C7

31
Q

What is the purpose of neurodynamic tests?

A

determine if neural tissue is responsible for the production of pt’s sx

32
Q

What is the purpose of testing the level of reactivity?

A

describes the relationship of pain provocation as it relates to sense of tissue resistance during passive motion (PA or PIVM) testing

33
Q

What does a high reactivity level mean?

A

pain is reported before detection of resistance to passive motion

34
Q

what does moderate reactivity level mean?

A

pain is reported synchronous to detection of resistance to passive motion

35
Q

what does a low reactivity level mean?

A

pain is reported after detection of resistance to passive motion (only with OP)

36
Q

in a hypermobile segment, if the irritable range appears “normal” but with a spasm, what is going on?

A

reflex muscle contraction is preventing motion into abnormal painful range

37
Q

in a hypermobile segment, if the non-irritable range is increased, and the end feel is excessive what happens?

A

stability needs to be assessed

38
Q

What are some exam findings for a patient with cervical hypomobility

A
  • restricted AROM
  • Restricted PIVM testing in cervical and upper t-spine
  • no UE radicular sx
39
Q

What are some proposed interventions for cervical hypomobility?

A
  • AROM exercises
  • Cervical and thoracic mobilization/manipulation isometrics or thrust manipulation techniques
  • non-thrust manipulation
40
Q

What are some exam findings for a patient with cervical radiculopathy

A
  1. sudden or gradual onset
  2. (+) spurling’s A
  3. (+) neck distraction test
  4. (+) ULNT
41
Q

What are some proposed interventions for cervical radiculopathy?

A
  1. Cervical traction
  2. AROM
  3. T-spine manipulation
  4. postural exercises
42
Q

What are some exam findings for a patient with clinical instability?

A
  1. remote h/o trauma
  2. sx provoked with sustained WB
  3. sx decreased with NWB
  4. hypermobility with loose end feel of mid cervical segments
  5. poor strength (2/5) of multifidus, longus colli, and longus capitis
  6. aberrant motion with cervical AROM
  7. greater AROM in NWB than in WB
43
Q

What are some proposed interventions for clinical instability?

A
  1. postural re-ed
  2. cervical stabilization exercise program
  3. mobilization/manipulation above and below hypermobilities
  4. ergonomic corrections
44
Q

What are some exam findings for a patient with acute pain (whiplash)?

A
  1. high pain and disability scores
  2. recent h/o of trauma
  3. referred symptoms into upper quarter
  4. poor tolerance to examination & most interventions
45
Q

What are some proposed interventions for acute pain (whiplash)?

A
  1. gentle AROM within tolerance
  2. activity modification to control pain
  3. relative rest
  4. physical modalities
  5. intermittent use of cervical collar
  6. gentle manual therapy and exercises
46
Q

What are some exam findings for a patient with cervicogenic headaches?

A
  1. UL headache with onset preceded by neck pain
  2. headache pain triggered by neck movement or positions
  3. headache pain elicited by pressure on posterior neck, especially at 1/3 upper cervical joints
47
Q

What are some proposed interventions for a patient with cervicogenic headaches?

A
  1. c and t-spine mobilization/manipulation
  2. strengthening neck and postural muscles
  3. postural education
48
Q

Describe posture cervical hypomobility

A
  • not associated with trauma
  • pain occurs due to compensation of forward head
  • normal motion in poor posture
  • muscles cause pain–> restricts motion
49
Q

Describe zygapophyseal joint hypomobility: cervical hypomobility

A
  • 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
50
Q

Describe symptoms that occur with disc conditions in the c-spine

A
  1. head list away from side on injury
  2. AROM limited in extension, ROT and lateral flexion to side of lesion
  3. radicular sx develop
51
Q

What age is the peak incidence of disc issues?

A

45-54 years

52
Q

what is the most common segment of disc issues?

A

C5/C6 followed by C6/C7

Ortho (spine) (4 decks)

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