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MMD > MMD Exam 2 Lab > Flashcards

MMD Exam 2 Lab Flashcards

1
Q

Variables identifying individuals with cervical radiculopathy

A

+ Spurling’s test
+ Distraction test
+ ULTT
<60 degrees Cx rotation to involved side

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2
Q

Variables identifying individuals with neck pain likely to respond to mechanical Cx traction

A

Age > 55
+ Shoulder abd test
+ ULTT
Symptom peripheralization to lower Cx (C4-C7) with PA motion testing
+ Distraction test

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3
Q

Variables identifying individuals with neck pain likely to respond to thoracic spine manipulation

A

Symptoms < 30 days
No symptoms distal to shoulder
Looking up doesn’t worsen pain
FABQPA (fear avoidance belief questionaire) < 12
Diminished upper thoracic kyphosis
Cx extension ROM < 30

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4
Q

Prior to undergoing physical examination of the cervical region, it is best to ascertain the presence of ______, as well as history of_____

A

dizziness/vertigo, headaches
*positive responses to these symptoms may warrant modifications to examination and further specific testing

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5
Q

How do we screen the shoulder AROM?

A

flexion, abduction, and hand behind back with overpressure (sometimes horizontal flexion)

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6
Q

What are cervical and thoracic spine postures to appreciate on observation?

A

Sagittal plane: FHP, forward shoulders, decreased Cx lordosis, increased/decreased thoracic kyphosis
Frontal plane: protective posture, lateral shift, torticollis, elevated shoulder, scapular retraction/protraction, scoliosis

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7
Q

How do we perform our neurologic motor exam (myotomes)?

A

neck flexion, as needed: C1-2
shoulder shrug: C3-4
shoulder abduction: C5
elbow flexion/wrist extension: C6
elbow extension/wrist flexion: C7
thumb IP extension: C8
finger abduction: T1
*AROM first then overpressure

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8
Q

How do we perform our neurologic sensory exam (dermatomes)?

A

upper traps: C3-4
lateral deltoid: C5
lateral thumb: C6
dorsal middle finger: C7
medial border of hand: C8
medial forearm: T1
medial arm: T2

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9
Q

A test which may reveal the presence of a lesion in the upper motor neuron in the spinal cord. A positive sign occurs when there is a reflexive flexion of the IP joint of the thumb and/or index finger in response to tapping or flicking the nail of the third or fourth finger. Normally, there should be no reaction from the muscles in the thumb or index finger.

A

Hoffman’s

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10
Q

Patient supine with shoe off. Therapist traces a line from lateral heel up lateral foot and across metatarsal heads. Positive if patient’s toes extend and abduct. Indicates and upper motor neuron lesion. Only conduct this test if you suspect cervical myelopathy, upper cervical instability, or an upper motor neuron lesion

A

Babinski reflex

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11
Q

The tendon should be tapped multiple times (__-__) to reveal any fading/fatigue response. This may be indicative of developing nerve root signs. What DTR’s do we test?

A

5-6
Biceps (C5), Brachioradialis (C6), Triceps (C7)

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12
Q

Consider a full cranial nerve exam in upper cervical conditions, presence of:

A

UMN, or atypical cx presentations

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13
Q

What are 5 components of segmental motion testing at the cervical-thoracic spine?

A

Upper cervical: OA extension (protrusion), OA flexion (retraction), AA rotation (completely flex neck then rotate)
Lower cervical: C2-C7 facet joints (passive physiologic intervertebral movements; PPIVMs)
Lateral glides: note amount of side glide and end-feel
Upper rib motions/breathing strategies: excessive upper chest breathing may contribute to C/T symptoms
1st rib mobility: note side-to-side differences in depth of palpation, tenderness, and mobility

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14
Q

Passive Physiologic Intervertebral movements (PPIVMs) can be done in F, E, SB and Rot. Feel for the:

A

initial movement of SP on superior vertebra relative to inferior vertebra SP

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15
Q

Cervical ROM norms

A

Flexion 45-50 deg
Extension 85 deg
SB 40 deg
Rotation 90 deg

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16
Q

Upper/mid-Thoracic ROM norms

A

Flexion 20-45 deg
Extension 25-45 deg
SB 20-40 deg
Rotation 35-50 deg

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17
Q

What are different types of movements you can incorporate into ROM exam as needed per SINSS?

A
  • Repeated Movements (assess centralization/peripheralization)
  • Sustained postures / positions
  • Consider speed of movement
  • Combined motions (Flexion with ROT or SB, Ext with ROT or SB)
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18
Q

Test for presence or absence of cervical radiculopathy
Approx 15 deg SB, apply an axial load ~15 lbs
(+) test: sends pain down the arm

A

Spurling’s

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19
Q

Test for presence of closing dysfunction
Extension, SB, and rotation
(+) test: local neck pain with/out shooting pain

A

Cervical quadrant test

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20
Q

Test for presence of 1st rib hypomobility
Palpate 1st rib, maximally rotate away and add lateral flexion towards the rib being tested
(+) test: lateral flexion is restricted

A

Cervical rotation lateral flexion test (CRLF)

21
Q

Test for transverse ligament instability, perform when suspected cervical instability (RA, Downs, trauma)
Stabilize C2, flight neck flexion, apply AP force to create sliding motion of head
(+) test: clunk, relief of symptoms

A

Sharp-Purser test

22
Q

Test for alar ligament instability
Passive SB and should feel spinous process of C2 “kick out” or rotate opposite the direction of SB
(+) test: no rotation or ipsilateral rotation

A

Alar ligament test

23
Q

Patient supine, therapist passively extends head, adding ipsilateral rotation and sidebending. while therapist maintains this position for 30 seconds. The patient would experience 5Ds A 3Ns, or delayed/inconsistent answers to questions if the test were positive. This position occludes the ipsilateral artery, so a positive test indicates occlusion of the contralateral artery
*only necessary if doing rotation maneuvers, be careful

A

Vertebral artery test

24
Q

Patient performs craniocervical nod (chin tuck). Patient then instructed to raise head off the table and hold. If SCM is dominant over DNFs, it will pull the neck out of upper cervical flexion (chin tuck) and into upper cervical extension.
*Average time to be 38.95 seconds on subjects without neck pain and 24 seconds with neck pain

A

Deep Neck Flexor Endurance Test

25
Q

ULTT-A is found to have a high ____ for cervical radiculopathy

A

sensitivity (rules out)

26
Q

List the order of the ULTT-A (median n. bias)

A
  1. Scapular depression
  2. Shoulder abduction
  3. Forearm supination, wrist/finger extension
  4. Shoulder ER
  5. Elbow extension
  6. Contralateral SB (pain confirms nerve tension)
27
Q

Test for presence of cervical radiculopathy
Sustained hold for 5-10 seconds, widens the intervertebral foramen and relieves the pressure of gravity on cervical structures
(+) test: symptoms reduced

A

Cervical distraction test

28
Q

Prone segmental motion exam consists of:

A

Central or unilateral passive accessory intervertebral movements (PAIVMs), perform with neck in slight flexion by dropping face plate ~20 deg
Posterior 1st rib palpation

29
Q

Scalenes stretch

A

Place your hand(s) on your clavicle or sternum, retract chin, extend neck, sidebend neck away, rotate up and toward the involved side.

30
Q

Upper trap stretch

A

Depress shoulder (sit on hand, grab side of table, align hand behind back), retract chin, sidebend away, rotate towards involved side, and flex forward.

31
Q

Levator scapulae stretch

A

Depress shoulder (sit on hand, stabilize hand in front of body), retract chin, sidebend away, rotate away from involved side, and flex forward

32
Q

Pectoralis stretch

A

Stand in open doorway/other, reach arm up to the side (bent at 90 degrees), slowly step forward and/or rotate away until you feel a stretch

33
Q

Commonly used interventions for cervical strain/sprain

A

Physical Agents/Soft Tissue Massage to decrease pain/spasm
Gentle, passive stretching to Cervical Paravertebral muscles,
upper traps, suboccipitals, etc.
Grades I-II Joint mobs to cervical spine and subcranial spine and first rib PRN
Postural stretching and strengthening
Aerobic conditioning (UBE)
Avoid mechanical traction in acute/subacute phases

34
Q

The following structures can be appreciated from which view on radiograph?
Vertebral bodies C3-T2/T3
Spinous processes C3-T2
Transverse process of T1
IV Disc Space
Facet joints
Uncovertebral joints
Costotransverse joint T2-3
Pedicles
Clavicles
1st rib
Uncus (unicate process)

A

AP view

35
Q

The following structures can be appreciated from which view on radiograph?
Arches of C1
Dens of C2
Vertebral bodies C2-7
Intervertebral disc space* (narrowing)
Lower 5 facet joints
Articular pillars
Laminae
Spinous processes
Trachea
Retro-pharyngeal space
Retro-tracheal space

A

lateral view

36
Q

The following structures can be appreciated from which view on radiograph?
Atlas and axis
C1-2 interspace
Dens of C2
C1 and C2 lateral aspects should align.
Note generally symmetric spaces lateral
to dens

A

Open mouth projection

37
Q

The following structures can be appreciated from which view on radiograph?
Vertebral bodies* (narrowing disc space)
Transverse processes
Pedicles
Inter-vertebral foramina* (encroachment/stenosis)
Articular pillars & lamina are superimposed * (facet joint abnormalities)

A

oblique view

38
Q

the most important stabilizer in the functional unit of the thoracic spine is the:

A

intervertebral disc

39
Q

a severely kyphotic mid to upper t-spine caused by anterior wedge compression fractures found in post-menopausal women is termed:

A

dowager’s hump

40
Q

herniated disc in the t-spine are not common however, which area of the t-spine do they tend to occur?

A

lower

41
Q

scheuermann’s disease typically affects:

A

pubescent males or females

42
Q

during R thoracic rotation, the ribs on the ipsilateral (R) side and contralateral (L) side have coupling action:
right ribs rotate ____, left ribs rotate ____

A

posteriorly, anteriorly

43
Q

what vertebral structure is unique to the cervical spine compared to other areas of the spine?

A

uncovertebral joint

44
Q

resisted elbow extension primarily test the myotome of

A

C7

45
Q

all of the following are tets for thoracic outlet syndrome except:
adson’s test, allen’s test, roos test, spurlings test

A

spurlings test

46
Q

in treating a patient with WAD status post MVA, the first muscle-strengthening exercises that should be introduced are:

A

gentle cervical spine isometrics

47
Q

forward head posture is composed of OA ____, lower cervical ____, tight ____ muscles, and stress on the ___ junction

A

extension, flexion, suboccipital, CT

48
Q

list some postural exercises

A

chin tucks
shoulder shrugs
chicken wing
scapular retraction
lat pull down
rowing
I’s, T’s, Y’s

MMD (4 decks)

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