Lower Cervical Spine Flashcards
If a pt has ANY symptoms of insufficiency, what is contraindicated?
cervical end-range rotation & extension, mobilizations and/or thrust techniques
where does the vertebral artery enter the foramen?
enters @ C6, anterior to 1st rib & TP of C7
from C2-C6, what is the vertebral artery encased in?
encased in a sheath adherent to the periosteum of TP & Uncinate process (decr motion)
what percentage of the cerebral blood flow comes from the vertebral artery?
11%
what artery contribute the majority of the cerebral blood flow?
carotid arter (89%)
what motion compresses the vertebral artery?
cervical hyperextension, also contralateral rotation (i.e. rotation toward R stresses L vertebral artery)
If your pt has HTN, hypercholesterolemia, hyperlipidemia, DM, smoker, h/o TIA, neck trauma OR family hx of MI, TIA, CVA, PVD, osteophytes, visual disturbances …
vascular occlusion with high velocity thrust is very risky
combinations of ext & rotation of the head & neck stress..
–IF this is a positive test
vertebrobasilar artery
–contraindicates thrurst techniques and end range techniques
signs of vertebral artery insufficiency - 5D’s and 3 Ns
Dizziness related to neck mvmt Drop attacks, loss of consciousness Diplopia, other visual disturbances Dysarthria Dysarthria Ataxia Nausea, vomiting Numbness on one side of the face or body Nystagmus
PLUS impaired sensation of the face, altered taste, acute anxiety/pain
DO NOT PERFORM VBI
what is the potential result if a position is maintained
cerebral ischemia, CVA, vertebral artery occlusion
QUICK vertebral artery assessment
sitting, patient raises arms out front with palms up
with eyes CLOSED< extends and rotates head to one side; repeats on opp side
POSITIVE TEST: drifting of arms, vertigo, blurred vision, nausea, syncope, and nystagmus
INDICATES: vertebral, basilar, or carotid artery stenosis or compression
what position should you test in for VBI?
in the position of treatment
you should specifically ask if there is pain or numbness where?
in or about your face
what follow up questions should be asked when asking about headaches?
HA..
- w neck pain?
- throbbing, irregular & unrelated to activity
- blurred vision or nausea
- aura
what are 3 special tests you can do to follow up a VBI
- compression/distraction
- Thoracic Outlet tests
- ULTT
what (subjective) outcome measure is used with neck patients?
NDI (Neck disability index)
what’s a minimally clinically relevant change for hte NDI?
5 pt change
a change of — pts on the NDI indicates a 90% sure clinicaly relevant change has occurred?
change of 6 pts
red flags for the cervical myelopathy (4)
- HANDS : sensory disturbance, ms wasting
- Unsteady gait; Hoffman’s reflex; hyperreflexia
- Bowel & bladder disturbances
- Multisegmental weakness OR sensory changes
Neoplastic conditions RED FLAGS (5)
- > 50 y.o.
- hx of CA
- unexplained wt loss
- constant pain; no relief w bed rest
- night pain
RED FLAGS of inflammatory or systemic disease
- temp >37 deg C
- BP >160/95 mmHg
- resting pulse >100 bpm
- resting respiration >25 bpm
- fatigue
with a FWD head posture, disc pressure is concentrated at –
L5-S1
when the occiput and upper C spine are ext there is compensatory..
flattening of lower C spine
What do the signs of hyperreflexia, Hoffmann’s reflex and ms wasting of intrinsic hand ms indicate? What should you do?
Indicative of cervical myelopathy - RED FLAG for the cervical spine
What are the vital signs correlated with inflammatory or systemic disease
temp >37 deg C BP >260/95 mmHg RHR >100bpm RR >25 br per min fatigue RED FLAG FOR CERVICAL SPINE
If a patient presents with CN signs and dysphasia/dysarthria/diplopia , what does this indicate? What would you do?
Indicative of vertebral artery insufficiency; RED FLAG for the Cervical spine
for every INCH that the head is FWD, wt of the head is added to load and increases disc pressure WHERE?
L5/S1
typically overstretched, weak muscles of the upper quarter
rhomboids, lower trap, serratus ant, short ant neck flexors
Hypertonic - adaptively shortened ms of upper quarter
suboccipitals upper trap lev scap pecs SCM scalenes
“Protraction” of the cervical spine
upper C spine ext
lower C spine flex
Cervical compression assesses for …
disc problem
end plate/vert body fx
acute inflammation of facet
IF cervical distraction elicits sx, indicative of..
tear of spinal ligament
tear or inflammation of annulus
irritated dura
Quadrant testing - foraminal closure
-a + test elicits sx, indicating..
space occupying lesion (herniated disc or edema)
OR localized capsular restrictions
Spurling’s Test A & B are indicative of ..
closing restrictions – restricted (LOM) in ext, SB & rotation to same side
what is shoulder abduction/resting hand on head used for in screening the cervical spine?
It screens for nerve root irritation
– if sx alleviated wwhen hand of symptomatic UE placed on head, positive test for nerve root irritation
How do you determine neck flexion strength?
lift head, keeping chin tucked 6-8 reps
FUNCTIONAL = 3-5 reps
how do you determine neck extension strength?
lift head backward while in prone
-FUNCTIONAL: hold 20-25 seconds
SAME FOR NECK ROTATION & SIDE FLEXION!!! (20-25 sec functional)
testing C1 nerve root with isometric movement:
cervical rotation
what nerve roots determine ms performance of shoulder elevation?
C2-C4
C-spine facet pain is typically what kin of pain?
unilateral dull ache; can be referred into craniovertebral or interscapular regions
What are the FOUR FINDINGS associated with Cervical Radiculopathy?
- Sudden OR gradual onset.. either one..
- Positive Spurling’s A Test (SB toward symptomatic side)
- Positive neck distraction test (alleviates sx)
- (+) ULNTT <60 deg ipsilateral neck rotation
PT Interventions for Cervical Radiculopathy - ? (4)
- Cervical Traction ULNT I
- AROM
- Thoracic spine manipulation
- Postural exercises
If a patient has.. AROM limited into ext, rotation to the R & lat flex to the R weakness in the C5 myotome and is 45-54 y.o. primary diagnostic hypotheis:
degenerative disc disease
If a patient has incr sx with sustained WBing postures, hypermobility with LOOSE end feel of mid cervical segments & POOR STRENGTH (2/5) of cervical spine multifidi, longus colli & longus capitus along with shaking/poorly controlled motion with C-spine AROM, you PRIMARILY SUSPECT:
- and what would you do??
clinical instability
Interventions:
- postural ed
- C-spine stabilization exercise program
- Mobilization/manip above & below HYPERmobilities
- Ergonomic corrections
for ACUTE PAIN in the C-spine (incl whip lash), where would you expect ot see referred symptoms?
upper quarter
What are interventions for ACUTE CERVICAL PAIN (incl whiplash)
- Gentle AROM within tolerance
- Activity modif
- Relative rest
- Phys modalities (i.e. e-stim, TENS)
- Intermittent use of cervical collar
- Gentle manual therapy & exercises (DO NOT INDUCE FURTHER PAIN)
If a patient has unilateral HA w onset preceded by neck pain, along with HA pain triggered by neck mvmts & positions, what would you look for as your FINAL FINDING to confirm cervicogenic HA?
-put P on post neck esp at 1 of 3 upper cervical jts – HA pain would be elicited
If you suspect a cervicogenic HA, what interventions would you implement? (3)
- Cervical & thoracic mobilization/manipulation
- strengthening neck and postural ms
- postural ed
