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MMD > MMD Exam 2 Lecture > Flashcards

MMD Exam 2 Lecture Flashcards

1
Q

A patient is referred to physical therapy with subacute neck pain. The therapist suspects neck pain with movement coordination impairments secondary to whiplash-associated disorder (WAD). What is the MOST appropriate examination test to corroborate this diagnosis?
A. Spurling’s test.
B. Cervical mobility testing.
C. Cervical flexor muscle endurance testing.
D. Cervical flexion-rotation test

A

C. Cervical flexor muscle endurance testing

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2
Q

During the patient interview, the therapist learns that the patient has rheumatoid arthritis. What special test is most appropriate to determine if the patient has upper cervical spine instability?
A. Spurling’s test.
B. Sharp Purser test.
C. Quadrant test.
D. Neck flexor muscle endurance test.

A

B. Sharp Purser test

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3
Q

What elements from the patient interview make a diagnosis of cervical radiculopathy most likely?
A. Associated referred pain to the upper extremity.
B. Acute onset of unilateral neck pain.
C. Dermatomal paresthesia or numbness and myotomal muscle weakness.
D. History of headaches associated with neck movements.

A

C. Dermatomal paresthesia or numbness and myotomal muscle weakness

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4
Q

What intervention is the BEST choice for reducing pain
and improving function in Neck Pain with Radiating Pain and a suspected acute cervical radiculopathy?
A. Transcutaneous electrical nerve stimulation (TENS).
B. Cryotherapy.
C. Thoracic manipulation.
D. Cervical mobilizing and stabilizing exercises.

A

D. Cervical mobilizing and stabilizing exercises

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5
Q

A patient is referred to physical therapy with chronic neck pain. What is the MOST appropriate patient outcome tool for this diagnosis?
Choices:
A. Owestry Disability Index.
B. Neck Disability Index.
C. SPADI.
D. DASH.

A

B. Neck Disability Index

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6
Q

What are the subgroups of neck pain classification?

A

Mobility deficits
Movement coordination deficits
Headache
Radiating pain

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7
Q

According to the Canadian C-spine rule, what would be high risk factors that mandate radiography?

A

Age at least 65
Dangerous MOI
Paresthesia in extremities

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8
Q

According to the Canadian C-spine rule, inability to rotate neck to what degree mandates radiography?

A

45 degrees

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9
Q

What are the 5 D’s And 3 N’s of vertebral artery dysfunction?

A

Dizziness
Dysphagia (swallowing)
Dysarthria (speech)
Diplopia
Drop attacks
Ataxia
Nausea
Nystagmus
Numbness

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10
Q

In increasing order of importance, CPG’s help clinicians with decision-making about:

A

Medical screening, neck pain categorization, condition stage/biopsychosocial factors, and interventions

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11
Q

Differential diagnosis is when a PT determines the _______ of physical therapy and need for ____ by performing assessments and utilizing existing imaging studies to determine presence of serious pathology

A

appropriateness, referral

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12
Q

There are numerous causes of neck/upper quarter pain yet, most do not have clearly defined diagnostic criteria.
Therefore, the 2 major jobs of the PT is to:

A

rule out serious medical pathology
identify impairments in an attempt to classify based on clinical characteristics and likely beneficial management strategies

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13
Q

According to the Canadian C-spine rule, what low risk factors allow safe assessment of ROM?

A

Simple rear-end MVA
Sitting position in ER
Ambulatory at any time
Delayed onset of neck pain
Absence of midline c-spine tenderness

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14
Q

Which conditions should we consider testing for cervical instability before performing interventions?

A
  • *Ligamentous instability (Sharp-Purser): post neck trauma, RA
  • Neurological (Distraction, Spurling’s): neck pain, headache, torticollis, other neuro signs
  • *Cervical myelopathy (Hoffman’s, reflexes, clonus)
  • Vertebral artery dysfunction (VAT if doing rotation manouvers)
  • 1st rib mobility
  • Cervical muscle strength (DNF)
  • Cervical spine mobility
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15
Q

Establish baseline for patient’s neck pain, function, and psychosocial matters by administering:

A

validated self reported outcome measures (neck disability index, patient specific functional scale, numeric pain rating scale, global rating scale)

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16
Q

MCID for NDI

A

5-10 points (depending on condition/presence of radiculopathy)

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17
Q

Which neck pain outcome measure asks the patient to rate the following on a scale of 0-5:
pain intensity
personal care (washing, dressing)
lifting
reading
headaches
concentration
work
driving
sleeping
recreation

A

NDI

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18
Q

MCID for patient specific functional scale (PSFS)

A

2 points (average of activities)

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19
Q

Which neck pain outcome measure asks the patient to describe 3 important activities their pain interferes with and rate it on a scale of 0-10?

A

PSFS

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20
Q

MCID for numeric pain rating scale (NPRS)

A

2 points

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21
Q

Which neck pain outcome measure asks the patient to rate their pain on a scale of 0-10?

A

NPRS

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22
Q

MCID for global rating of change (GROC)

A

No change (-1, 0, 1)
Minimal change (+ 2 or 3)
Moderate change (+ 4 or 5) Significant change (+ 6 or 7)

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23
Q

Which neck pain outcome measure asks the patient to rate their overall condition from the time they began treatment until now by checking a box?

A

GROC

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24
Q

What are the 2 strong risk factors of new onset of neck pain? Moderate risk factors?

A

*Female sex, prior hx of neck pain
Older age, high job demands, smoking hx, low social support, prior hx of low back pain

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25
Q

What are the common trajectories of clinical recovery of neck pain?

A

◦ Mild (45%) with rapid recovery
◦ Moderate (40%) with incomplete recovery
◦ Severe (15%) with no recovery

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26
Q

The following are expected findings within which classification of neck pain?
Limited Cx ROM
End-range pain (active & passive)
Mobility restriction
Pain with segmental provocation
Strength and motor control deficits with acute/chronic cases

A

Mobility deficits

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27
Q

The following are expected findings within which classification of neck pain?
+ Cranial Cx flexion test
+ Neck flexor endurance test
+ Pressure algometry (pain sensitivity)
+ Strength and endurance deficits
Mid-range pain, worse with end range
TTP trigger points
Sensorimotor impairment

A

Movement coordination impairments

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28
Q

The following are expected findings within which classification of neck pain?
+ Cx flexion-rotation test
HA with segmental provocation
Limited Cx ROM
Restricted upper Cx segmental mobility
Strength, endurance, and coordination deficits

A

Headache

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29
Q

The following are expected findings within which classification of neck pain?
+ Test cluster: ULTT, Spurling’s, Distraction, limited Cx ROM
UE sensory, strength, or reflex deficits

A

Radiating pain

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30
Q

Physical examination measures useful in classifying mobility deficits and the associated ICD categories of cervicalgia or pain in thoracic spine:

A

◦ Cervical active range of motion
◦ Cervical and thoracic segmental mobility

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31
Q

Physical examination measures useful in classifying neck pain with movement coordination impairments and the associated ICD categories of sprain and strain of cervical spine:

A

◦ Cranial cervical flexion test
◦ Deep neck flexor endurance test
◦ Deep cervical extensors

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32
Q

Physical examination measures useful in classifying headaches and the associated ICD categories of headaches or cervicocranial syndrome:

A

◦ Cervical active range of motion (upper>lower cervical ROM)
◦ Cervical segmental mobility
◦ Cranial cervical flexion test

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33
Q

Physical examination measures useful in classifying neck pain with radiating pain and the associated ICD categories of spondylosis with radiculopathy or cervical disc disorder with radiculopathy:

A

◦ Upper limb tension test
◦ Spurling’s test
◦ Distraction test

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34
Q

Combining cervical manual therapy (mobilization, manipulation with or without thrust) with ____ is more effective for reducing neck pain, headache, and disability than manipulation and mobilization alone

A

exercise

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35
Q

Research shows that most neck pain cases benefit from which manual treatment techniques?

A

Cervical DNF strengthening (100%)
Cervical mobilization (98%)
Thoracic mobilization (81%)

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36
Q

Examination and targeted flexibility exercises used for patients with neck symptoms are focused on which key muscles?

A

Scalenes
Upper trapezius
Levator scapulae
Pectoralis major/minor

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37
Q

Coordination, strengthening, and endurance exercises used to reduce neck pain and headache are focused on which key muscles?

A

Deep neck flexors
Deep cervical extensors

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38
Q

Whiplash associated disorder (WAD) falls into which category? What is a key intervention?

A

Movement coordination impairments
Educate patient that early return to normal, non-provocative pre-accident activities is important; provide reassurance that prognosis is good and full recovery commonly occurs

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39
Q

Centralization is driven by change in ____ of symptoms with repeated movement (ex. chin tucks)

A

location

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40
Q

____ ______ is when the location of pain doesn’t change but symptoms improve

A

Directional preference

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41
Q

Neck pain is the second most prominently treated (and worker’s comp-ed) complaint by PTs behind ___, which is most prevalent

A

LBP

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42
Q

Indicators of poor short-term prognosis for neck pain

A

Older age >40
Concomitant LBP and HA

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43
Q

Indicators of poor long-term prognosis for neck pain

A

Older age >40
Concomitant LBP and HA
Traumatic onset
Duration of sxs >13 weeks
Stable neck pain >2 weeks
Previous episodes of neck pain

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44
Q

Consequences of forward head posture includes:
____ cervical extensors, suboccipitals, upper traps, levator scapulae
____ cervical flexors, rhomboids, middle and lower traps

A

tight, weak

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45
Q

Consequences of increased thoracic kyphosis includes:
____ thoracic extensors, middle and lower trapezius muscles, rhomboids,
and posterior ligaments
_____ anterior longitudinal ligament, upper abdominal, pectoralis, and
anterior chest muscles
_____ of discs anteriorly and fractures of vertebral bodies

A

weak, tight, compression

46
Q

“Cross-syndrome” describes

A

forward head posture combined with thoracic kyphosis; weakness and tightness on opposite create a criss-cross

47
Q

____ is the characteristic tilting of head to one side (congenital, acquired, or idiopathic)

A

Torticollis (cervical dystonia)

48
Q

___ ____ _____ is an acute painful joint disorder, facet “locking” (stuck in Cx rotation and SB away from pain)
MOA: unexpected/sudden movement, lying for long time period in prone with head rotated, synovial meniscoid blocks gliding movement, capsular/synovial inflammation (painful movement)

A

facet joint dysfunction
source of symptoms typically involve disc and facet joint (~41% of cases)

49
Q

the following are symptoms of ____ ____ ____:
onset of sharp pain & protective deformity at same time (w/o trauma)
unilateral, local mid-cervical pain
most common at C2-3, C3-4, C4-5
AGG: neck movements or attempting to correct deformity
EASE: rest, avoids aggravating movement

A

facet joint dysfunction

50
Q

what are the signs of facet joint dysfunction acutely vs chronicly?

A

acute: deformity, locking
chronic: pain and limited ROM, closing/opening restriction
no neuro signs unless nerve root affected by hypertrophic joints

51
Q

pain and LROM with EXT and SB/ROT to the painful side

A

closing dysfunction

52
Q

pain and LROM with FLEX and SB/ROT away from painful side

A

opening dysfunction

53
Q

the following are symptoms of ____ ____ ____:
SB may be primary restriction
typically associated with spondylosis
neuro findings: none unless nerve root affected by hypertrophic joints
not distinguishable from facet syndrome

A

uncovertebral joint dysfunction

54
Q

the following describes ____ ____/____:
acute pain arising from injured soft tissues of the neck
acceleration-deceleration mechanism (MVAs)
MOI complex: head/neck acceleration lag when struck (energy stored), then head/neck thrust forward (energy release)

A

cervical sprain/strain

55
Q

the following are symptoms of ____ ____/____:
non-radiating neck pain
neck stiffness, fatigue, and worsening symptoms with cervical motion
symptoms may extend into the trapezius/interscapular region
HA common, originating in occiput region and radiating frontally
increased irritability and sleep disturbances
other: paresthesias, radiating arm pain, dysphagia, visual or auditory symptoms, dizziness

A

cervical sprain/strain

56
Q

what are 5 signs of cervical sprain/strain?

A

deformity - protective posture
decreased/painful ROM
spasms - scalenes, SCM, paraspinal, trapezius, levator
tenderness
normal neuro signs - unless nerve compromised by guarding/spasm

57
Q

describe the 4 classifications of WAD

A

WAD I: neck c/o; stiff/tender; no physical
signs trauma
WAD II: neck c/o; stiff/tender; (+) physical
signs injury (point tender or pain w/ ROM)
WAD III: neck c/o; stiff/tender; (+) neuro signs
(reflexes or weakness)
WAD IV: neck c/o; fracture or dislocation

58
Q

the following are symptoms of ____ ____:
Unilateral head pain begins in the occipital region
and spreads to the ipsilateral temporal region or
forehead (ram’s horn distribution)
-may be bilateral (“unilaterality” on two sides)
- may cross midline during severe or prolonged attacks
Deep, pressing soreness in the head
May develop a throbbing or pulsatile nature given the right aggravating factor
May experience diffuse, vague ipsilateral arm pain

A

cervicogenic headache

59
Q

structures innervated by __-__ nerves are potential pain generators for cervicogenic headache

A

C1-3:
OA joints and ligaments
Medial and lateral AA
C2-3 facet joints
Suboccipital, upper prevertebral, trapezius, and
sternocleidomastoid muscles
C2-3 intervertebral disc
Spinal dura mater
Vertebral artery

60
Q

diagnostic cluster of CGH

A

palpably painful upper Cx joints
restricted Cx ROM
impaired muscle function on the cranio-cervical flexion test
migraine features may be present (nausea, vomiting, photophobia)
evidence of CGH: HA developed in relation to Cx disorder, HA improved with Cx disorder improvement, CROM improves HA/provocative movements worsens HA

61
Q

common impairments seen with CGH

A

Joint dysfunctions in OA, AA or C2-3 facets
Restricted cervical ROM (Cervical Flexion Lateral Rotation….same test as we’ll do for C1 on C2)
Muscle tightness in the upper trapezius, levator scapulae, scalene, and suboccipital extensors
Decreased strength in cervical flexor and/or extensor muscle groups
Altered motor control of deep neck flexors (Craniocervical flexion test:CCFT) with activation of SCM

62
Q

cervical spondylosis is aka ____
most commonly affects which levels of the Cx spine?
radiographically associated with _____

A

arthritis, C5-6/C6-7, instability

63
Q

what are the 3 symptom complexes associated with Cx spondylosis?

A

axial spine pain
radicular pain (herniated disc, neuroforaminal stenosis, facet hypertrophy)
myelopathy (central stenosis leading to cord compression)

64
Q

the following are symptoms of ___ _____
Symptoms usually begin at age 30-50 years
C/o neck pain, stiffness with loss of motion in one or more planes, and paraspinal muscle spasm.
(+/-) Occipital headache (i.e. CGH)
(+/-) Cervical radiculopathy symptoms: arm pain, weakness, clumsiness, paresthesia, or hypesthesia may be present
(+/-) Pain in the trapezius, paraspinal, and interscapular areas
Morning/immobility stiffness – eased with ~ 30 min movement
DJD (facet symptoms) + DDD (disc symptoms)

A

cervical spondylosis

65
Q

cloward’s sign represents ______ ____

A

discogenic pain (C3-T1) referred to upper back

66
Q

describe reliable referral patterns of discogenic neck pain

A

C2/3 - head
C3/4 - head and upper neck
C4/5 - neck, cap of shoulder, and upper back
C5/6 - neck, shoulder, and upper back
C6/7 - neck, shoulder, upper back, down arm

67
Q

pathophysiology of Cx radiculopathy

A

nerve root disorder
- mechanical compression (herniated disc, osteophytes, thickened soft tissue, foraminal stenosis, neoplasm)
- chronic edema
- DRG (chemical mediators, local response)
- no definitive Dx criteria

68
Q

the following are symptoms of ___ _______
Patient uncomfortable
Neck and predominant sharp, radiating pain in the
UE – dermatomal pattern
Distal symptoms often worse than proximal (acute)
Pain may refer into the shoulder, interscapular, or suboccipital regions
N/T commonly noted in distal dermatome
AGG: Neck motion; cough/valsalva maneuvers
Weakness or inability to perform certain ADLs
Pain often worse at night; sleep disturbances

A

cervical radiculopathy

68
Q

the following are symptoms of ___ _______
Patient uncomfortable
Neck and predominant sharp, radiating pain in the
UE – dermatomal pattern
Distal symptoms often worse than proximal (acute)
Pain may refer into the shoulder, interscapular, or suboccipital regions
N/T commonly noted in distal dermatome
AGG: Neck motion; cough/valsalva maneuvers
Weakness or inability to perform certain ADLs
Pain often worse at night; sleep disturbances

A

cervical radiculopathy

69
Q

the following are signs of ___ _______
Observations:
- Lower cx roots (C7-8): may hold forearm for support
- Upper cx roots (C5-6): may hold arm above head (to ease)
Movement severely limited (EXT, ROT/SB to
symptomatic side)
(+) upper limb tension tests (ULTT1)
Objective neuro findings with radiculopathy:
- Diminished DTRs
- Myotomal muscle weakness
- Anesthesia in dermatomal pattern

A

cervical radiculopathy

70
Q

diagnostic test cluster for Cx radiculopathy

A

+ spurlings
+ distraction
+ ULTT
< 60 rotation to involved side

71
Q

acute vs chronic Cx radiculopathy

A

acute: N/T symptoms worse distally, minimal Cx symptoms, moderately severe cloward referral

chronic: distal symptoms not dominant, pain is deep/achy and hard to localize, rarely functionally limiting, often referred to PT with primary shoulder, elbow or wrist diagnosis

72
Q

central vs lateral stenosis

A

central involves compression of spinal cord; sxs consistent with cervical spondylotic myelopathy (CSM), LMN and UMN signs

lateral involves compression of nerve root canals or neuro foramina; sxs consistent with cervical radiculopathy, LMN signs depending on severity

both: seen in pts over 50, (+,-) axial neck pain and/or stiffness due to IVD degeneration and facet joint arthritis

73
Q

The following describes ___ ____ ____
Most common spinal cord disease affecting middle-aged and elderly patients
Clinical presentation varies depending on severity of stenosis & portion of cord involved
Gradual evolution of subtle symptoms for years
Can progress rapidly (i.e. acute quadriparesis over hours)
May result in significant and permanent disability
Requires high degree of suspicion for diagnosis

A

cervical spondylotic myelopathy

74
Q

The following are symptoms of _____ ____ _____
Variable with level and extent of involvement
CC: weakness, clumsiness, balance difficulties, pain not typically present
cord signs: weakness (UE>LE), decreased manual dexterity, ataxic broad gait, sensory changes, spasticity, urinary retention

A

cervical spondylotic myelopathy

75
Q

The following are signs of _____ _____ _____
Extent of cord ± root involvement
UMN lesion signs BELOW level:
- Hyperreflexia,
- Hoffmann’s sign, inverted radial reflex, clonus, Babinski’s sign, spasticity
LMN lesion signs (coexisting radiculopathy) AT level:
Lhermitte’s phenomenon (radiating lightning like sensation down the back with neck flexion)
Decreased ROM, preferred position is flexion

A

cervical spondylotic myelopathy

76
Q

syrinx are _____ cavities in the spinal cord which are often caused by Chiari malformation

A

longitudinal

77
Q

the following are sxs of ______
Bilateral hand weakness/numbness
Other extremity weakness/numbness
Bowel/bladder problems
Upper motor neuron signs
Headaches
Caused by: Chiari malformation, spinal trauma, tumors
Anterior horn cells commonly affected & sensory pathways

A

syringomyelia

78
Q

The following describes ____ ______
Osteochondrosis of the thoracic spine
Abnormal cartilage with deficient bone growth under areas of abnormal growth plates causing wedge-shaped
deformities and rigid kyphotic spinal deformity
Schmorl’s nodes common: vertical herniation of nucleus into vertebral body
Sharp angular deformity present with forward-bending
Adolescents: 13-17 yrs
Prevalence: males = females
Misdiagnosed as “poor posture”
Etiology: probable genetic defect
Minimum of 3 levels involved, schmorl nodes anteriorly, end plate sclerosis, wedge deformity, loss of disc height

A

Scheuermann’s disease (juvenile osteochondrosis/kyphosis)

79
Q

The following are signs of ____ ____
Deformities:
- Rigid thoracic or thoracolumbar kyphosis; does not correct in hyperextension (angles > 75 degrees usually require surgical intervention_
- Flexible lumbar hyperlordosis and cervical forward head posture
- Limited ROM: Thoracic extension; Sharp kyphotic angulation noted in flexion
- Tightness: Anterior shoulder musculature, hamstrings, and iliopsoas muscles
- Neurologic signs can occur: due to severe kyphosis, dural cysts, or thoracic disc herniation

A

Scheuermann’s disease (juvenile osteochondrosis/kyphosis)

80
Q

Dowagers hump is related to what type of fracture?

A

compression
causes: osteoporosis, trauma, tumors/radiation

81
Q

intercostal neuralgia or myelopathy may be related to ___ ____ disease due to disc protrusion or trauma

A

thoracic disc

82
Q

_____ _____ _____ symptoms:
Thoracic or Lumbar presentation
LMN – pain at level, decreased sensation at root level
UMN signs and symptoms below level of lesion (variable; poss B)
▪ Postural (i.e. Rhomberg) and gait disturbance (i.e. wide-based) disturbances
▪ Leg parasthesias
▪ Pathologic reflexes: hyperreflexia, Babinski, clonus
▪ Spastic paraparesis

A

Thoracic compressive myelopathy

83
Q

Painful joint disorder at the facet,
costotransverse or costovertebral joint –
“locking”

A

thoracic joint dysfunciton

84
Q

the following are signs of ____ _____ ____:
Deformity position: may assume postural position away
from pain
Limited ROM into restrictive barriers:
- “closing restriction” – pain and LROM with EXT and SB into the restriction
- “opening restriction” – pain and LROM with FLEX and SB away from the restriction
Pain and/or stiffness with passive accessory or physiologic mobility testing
No neuro signs
Radicular nerve symptoms with advanced spondylosis/arthrosis affecting nerve

A

thoracic joint dysfunctions

85
Q

symptoms of thoracic outlet syndrome

A

Neurological Symptoms (differentiate from nerve root
or various B.P. entrapments)
- neurogenic pain and referral (C8-T1)
- motor weakness
- paraesthesias
- arm fatigue
Vascular Symptoms – more of a whole hand/arm sxs
prsentation
- swelling in hand
- arm fatigue
- discoloration
- deep, boring pain

86
Q

Non-dermatomal paresthesia in one or both
extremities with or without neck/head symptoms.
Often mistaken for Thoracic Outlet Syndrome
Occasionally diagnosed as bilateral CTS, or radiculopathy, spondylosis, malingering
Woman more affected than men (3:1)

A

T4 syndrome - sympathetic referral

87
Q

the following describes symptoms of ____ _____ ______
Unilateral pain over costovertebral joint or subscapular
May refer pain into posterior shoulder
AGG:
▪ Thoracic or shoulder movements into the joint restriction
▪ Deep breathing into restriction
EASE: positions or motions away from joint restrictions

A

costovertebral joint dysfunciton

88
Q

the following are symptoms of ____/_____ ______
Unilateral pain posteriorly over costotransverse joint,
anteriorly over costochondral or chondrosternal joints,
and anywhere along course of rib
May complain of chest pain!
May have Dx of “costochondritis”
Hx of trauma / sports injury? Seatbelt?
AGG:
▪ Thoracic or shoulder movements
▪ Deep breathing, coughing, sneezing

A

costochondral/chondrosternal dysfunction

89
Q

rib movements:
____ (Inhalation) anterior ribs move up and posterior ribs move down
______ (Exhalation) posterior ribs move up and anterior ribs move down

A

Extension, Flexion

90
Q

EXCESSIVE KYPHOSIS = emphasize movement of T/S into extension with _____.
LOSS OF KYPHOSIS = emphasize movement of T/S into flexion with _____

A

inhalation, exhalation

91
Q

EXCESSIVE KYPHOSIS = emphasize movement of T/S into extension with _____.
LOSS OF KYPHOSIS = emphasize movement of T/S into flexion with _____

A

inhalation, exhalation

92
Q

1st rib syndrome is typically thought of as an “elevated” 1st rib, with or without ____ tightness
Sometimes residual sx following cervical radiculopathy perhaps due to decreased mobility
Could be associated with trauma (skiing accident, fall on shoulder in sports)

A

scalene

93
Q

the following are symptoms of __ ____ ______
upper pectoral pain/mammary pain
mid to low scapular pain, dull ache
can extend to axillary region
dull, nagging ache/burn over upper trap
occas. numb U/E, arm heavy but may need to consider TOS, low cervical radic with extremity pain / parasthesia
overhead lifting, cervical motions usually aggravating activities

A

1st rib syndrome

94
Q

the following are signs of __ ___ ______
restricted shoulder elevation at end range
restricted cervical “closing” movement (esp SB)
neural tension signs common
palpatory tenderness and restricted mobility of 1st / 2nd ribs
(+) Cervical Rotation Lateral Flexion (CRLF) test

A

1st rib syndrome

95
Q

what are the 6 red flag conditions that may require medical referral?

A

spinal fracture
cervical myelopathy
neoplasm (cancer)
upper cervical ligamentous instability
vertebral artery insufficiency
inflammatory or systemic disease

96
Q

yellow flags are attitudes, beliefs, and behaviors indicating heightened _____-____ beliefs

A

fear-avoidance

97
Q

red flags for headache

A

worst HA ever that wakes up pt or is present upon waking
HA with documented elevated BP
insidious/new onset(<6 months)
HA with neurologic signs
HA with consitutional signs or stiff neck
blacking out with HA
sudden severe HA with flue like sxs, muscle aches, jaw pain with eating, visual changes
no previous history of migraines

98
Q

referred pain patterns of MI

A
  • common combination: midchest, neck, and jaw
  • larger area of chest, neck, jaw, and inside arms
  • lower center neck to both sides of upper neck; jaw from ear to ear
  • between shoulder blades
99
Q

what are absolute contraindications for cervical manipulation?

A

athlerosclerosis, can lead to MI
history of high cholesterol, taking statins or BP meds
acute fracture
acute soft tissue injury

100
Q

risk factors associated with increased risk of internal carotid or vertebrobasilar artery pathology

A

prior hx of trauma to Cx spine/vessels
hx of migraines
HTN
hypercholesterolemia, hyperlipidemia
cardiac/vascular disease, TIA, CVA hx
DM
blood clotting disorders
long term use of steroids
hx of smoking
recent infection
immediately post partum
trivial head/neck trauma
absence of plausible mechanical explanation for sxs

101
Q

triad symptoms of meningitis

A

sudden fever, severe HA, stiff neck

102
Q

___ tumor is a malignant tumor in upper apices of lung often missed; presents as shoulder pain or cervical disc problem in men with smoking hx

A

pancoast

103
Q

cervical myelopathy sxs

A

wide based spastic gait
clumsy hands
intrinsic muscle wasting of hands
hyperreflexia
+ babinski, hoffmans, lhermitte (shooting pain with neck movement), clonus
urinary retention followed by overflow incontinence

104
Q

o Complaints vary – pain, dizziness, numbness, headaches, vertigo, visual, etc.
o Severe limitation during neck AROM in all directions
o Signs of cervical myelopathy
o Abnormal Atlanto-dental interval (> 3.0 mm is considered abnormal)

A

upper cervical instability

105
Q

sudden occlusal change in TMJ is generally caused by ___ ____ muscle holding condyle in a partially translated position

A

lateral pterygoid (due to ms spasm or TMJ arthralgia)

106
Q

what are the muscles of mastication likely to become hypertonic?

A

temporalis, masseter, and medial pterygoid (closers)
lateral pterygoid and digastric (openers)

107
Q

what is the strongest muscle of mastication?

A

masseter

108
Q

TMJ motion: upper joint _____ while the lower joint _____

A

translates, rotates

109
Q

a condition associated with joint noises and blocked mouth opening without locking?

A

disk displacement with reduction

110
Q

what are the thoughts behind the functional linkage of the cervical spine and TMJ?

A

Forward head posture
Increased cranial rotation
Reduced cervical lordosis
Increased translation at TMJ
Reduced condylar rotation
Dysfunctional opening
TMJ pain and degeneration

111
Q

average DNF endurance time to be ___ seconds on
subjects without neck pain and ___ seconds with neck pain.

A

38.95, 24

MMD (4 decks)

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