Medical Screening For Cervicothoracic (2) Flashcards
What are the risk factors that indicate imaging in a cervical fracture?
Age>65
Dangerous mechanism
Upper extremity paresthesia
What type of test are the high risk factors for cervical fracture?
High sensitivity (good at ruling out)
What are the mechanical causes of cervical myelopathy?
Trauma
Spinal cord compression
Degenerative changes
Bulging disc
RA
What are the 5 tests to see if cervical myelopathy is present?
Gait deviation
+Hoffmanns test
Inverter supinator sign
+ babinski test
Age >45
When can you rule in cervical myelopathy using the 5 tests?
If 3 out of 5 are positive you can rule in cervical myelopathy
What is upper cervical ligamentous laxity?
Problems with the transverse and alar ligaments
What are symptoms of upper cervical ligamentous laxity?
Occipital headaches and numbness
Severe limitation during neck AROM
Signs of cervical myelopathy
What are causes of upper cervical ligamentous laxity?
Trauma
RA/Down syndrome
Os odontoideum
Odontoid fracture
What are some key signs of spinal infection?
Pain worse at night and does not change with position
Fever, chills, fatigue
Redness, swelling, warmth
Local tenderness
Spinal percussion painful
What do you do if you suspect a spinal infection?
Refer for imaging
What is used to treat a spinal infection?
Antibiotic therapy or surgical decompression
What are the symptoms of a possible cardiovascular event?
Chest pain
Abdominal pain
Shortness of breath
Heart palpitations
Dizziness, nausea
Peripheral edema
Syncope
What are the musculoskeletal complaints associated with a cardiovascular event?
Jaw, neck, shoulder, arm, and back pain (poor exercise tolerance)
What are the symptoms of cervical arterial dysfunction?
(5 D’s and 3 N’s)
Dizziness
Drop attacks
Dysphagia
Dysarthria
Diplopia
Ataxia
Nausea
Numbness
Nystagmus
What are the pain descriptors of a pulmonary event?
Sharp and localized pain
Aggravated by breathing, coughing, sneezing, or laughing
Better in upright
Better with autosplinting
What is pneumothorax?
Collapsing of the lung
What are symptoms of pneumothorax?
Shortness of breath
Sharp pain in chest
Ipsilateral shoulder/upper trap referred pain
Drop in BP
Better in sitting/worse in recumbent positions
What is pulmonary embolism?
Blockage of a pulmonary artery
How do you determine if pulmonary embolism is present?
Use predictor variables (wells)
What are symptoms of stomach, duodenal, or pancreatic conditions?
Sudden weight loss, nausea, vomiting, or fever
Pain waves related to eating or drinking
Heartburn
What are causes of stomach, duodenal, or pancreatic conditions?
Gastric, pyloric, or duodenal ulcers and stomach cancer
What is the most common site for metastases?
Skeleton
Where do metastases occur?
60% thoracic and 40% lumbosacral
What are the main signs to look for in cancer?
Prior history of cancer
Age>50
Unexplained weight loss
Failure to improve after 1 month
Where does the alar ligament attach to?
Dens to skull
Where does the transverse ligament attach to?
Around the dens
How does neck being brought to end range (trauma) cause a stroke?
Causes artery to tear on inside and when healing process occurs inflammation can block artery leading to stroke
What are some signs to rule out cervical arterial dysfunction?
Ipsilateral neck pain and headache
Horners syndrome
Pulsatile tinnitus
CN palsies (CN 9-12)
Trauma in past 72 hours
Headache of new feeling
What is Horner’s syndrome?
Ptosis (drooping of eyelids)
Anhidrosis (lack of sweat on one side of face)
Miosis (shrinking of pupil)
What are the signs that someone has a cervical fracture?
Age>65
Dangerous mechanism
Parasthesisias in extremities any time since trauma
Acute cervical trauma
Patient unable to rotate neck 45° both ways
What are considered dangerous mechanisms?
Fall from > 1 m or 5 stairs
Axial load to head (diving)
High speed MVA
Bicycle collision
What are the buckets for cervical injury?
Neck pain with mobility deficits
Neck pain with radiating pain (radicular)
Neck pain with headache (cervicogenic)
Neck pain with movement coordination impairments
What are treatments for neck pain with mobility deficits?
Thoracic manipulation
Cervical mob/manipulation
ROM/stretching/strengthening
What are treatments for neck pain with radiating pain?
Traction
Centralizing exercises
Strength exercises
CT mob/manipulation
What are interventions for neck pain with headache?
C1-2 self-SNAG
CT mob/manipulation
ROM/stretching/strengthening
What are interventions for neck pain with movement coordination impairments?
Education
Minimize collar use
AROM/strength exercises
Proprioceptive exercises
Cervical mobs
Ice/heat/TENS
