Msk- Cervical And thoracic Flashcards
What is Vertebrobasilar insufficiency (VBI)?
Compression of the vertebro-artery causing decreased blood flow
What are the 5D’s and 3N’s for signs/symptoms of Vertebrobasilar insufficiency?
5D:
Dizziness
Diplopia(double/blurred vision)
Drop attacks (loss of power or consciousness)
Dysphagia (difficulty swallowing)
Dysarthria (difficulty speaking)
3N:
Nystagmus (eye flickering)
Nausea or vomiting
Other neurological symptoms
What is torticollis?
Unilateral shortened sternocleidomastoid causing ipsilateral side flexion and contralateral rotation of the c spine
What is the treatment for torticollis?
Stretch the affected side SCM
Strengthening exercises to improve balance between both sides
Positioning/handling to stimulate symmetry
Torticollis Right
Side flexion of neck to …side
Cervical rotate to….side
Which side has decreased ROM and PROM?
Side flexion to the right side
Cervical rotate to the left
Decreased AROM and PROM to the LEFT side
What are the 5 special tests for cervical instability?
Anterior shear/ sagital stress test
Lateral flexion alar ligament stress test
Lateral(transverse) shear test
Sharp-purser test
Cervical flexion rotation test
What does the anterior shear or sagital stress test indicates?
Test the integrity of supporting ANTERIOR ligaments and capsular tissues
What does the lateral flexion alar ligament stress test indicates?
Integrity of contralateral alarm ligament
What does the lateral( transverse) shear test indicates?
Integrity of lateral ligaments and capsular tissues
What does the Sharp Purser test indicates?
Determine subluxation of C1on C2
What does the flexion-rotation test indicates?
Indicates C1 and C2 dysfunction
What is the special test for cervical spine muscular control?
Craniocervical flexion test ( pressure biofeedback test)
How is the craniocervical flexion test ( pressure biodeedback) performed?
Pt supine in crook lying w c spine in neutral ( place towels under head)
Place infatable pressure sensor (BP cuff) under the upper c spine
Inflate pressure cuff to a base level of 20mmHG
Instruct pt to perform c spine flexion slowly in order to get 22mmHG and hold for 10 secs
Repeat 22-24-26-28-30mmhG
Positive: pt unable to increase pressure to at least 26mmhg
Unable to maintain 10secs
Inability to raise small pressure 2mmhg
Use compensatory patterns
What is the characteristics of round back?
Thoracic kyphosis
Forward head and rounded shoulders( scapular protraction)
Pt entire spine seems like a C
Posterior pelvic tilt
What is the characteristics of Scheuermann’s disease?
Common in teenagers
typically seen at T10-L2
Uneaven growth of the vertebrae resulting in a excessive wedge shape leading into kyphosis
What is the characteristics of Hump back?
Gibbus in thoracic spine
What is the characteristics of flat back?
Decreased pelvic inclination ~20degrees
Thoracic spine is mobile
What is the characteristics of Dowager’s hump?
Increased kyphosis typically seen in older women w postmenopausal osteoporosis
Typically occurs in upper to middle thoracic spine
Contributes to decrease height
What are some interventions for thoracic deformities?
Postural education **
Extension approach
Stabilization exercs
Stretching as needed
Mobilization as needed
Contraindications: joint mobilization in Scheuermann disease and Dowager’s hump
What are some interventions for compression fracture? And some contraindications?
Posture education *** teach pt to be in a extended position
WEIGHT BEARING exercs (walk,jogging/running)
Extension approach
Stabilization exercises
Scapular stabilization exercs
Light mobilization as needed (w precaution )
Contraindications: joint manipulation amd aggressive mobilization, trunk flexion exercs
How are the scoliosis labeled?
The curve patterns are labeled in the direction of the CONVEXITY of the curve.
What is considered “major” and “minor” on scoliosis?
If there is more than one curve, the greater of two curves is labeled “major “ and the lesser of the two curves is labeled “minor”
What is the Cobb angle on scoliosis?
Cobb angle is the angle of inclination of the curve.
More than 10degrees: scoliose
Less than 10 degrees: not scoliosis
What is the Cobb angle on a treatable scoliosis w exercs?
15 degrees or less
What Cobb angle is considered a “severe scoliose that will need surgery?
40 degrees
What Cobb angle may result in a compromised Cardioresp system?
60 degrees
What test can help identify scoliosis?
Adam’s test
What is a non structural scoliosis?
The curve disappears w forward flexion.
Can be due to poor posture, inflammation, leg length discrepancy
What is a structural scoliosis?
Structural changes in bone.
Curve does not disappear w forward flexion
Vertebral bodies rotates to the side of the CONVEXITY
What is a rib hump?
Posterior prominence caused by the ribs on the convex side.
Visible w forward flexion
What are some interventions for scolioses?
Posture education
Stretch side of concavity
Strengthen side of convexity
Stabilization exercs
Mobilization as needed
Bracing as needed
Surgey as needed in severe cases
What are the three braces for scoliosis?
Boston brace: type of thoracic-lumbar-sacral orthosis (TLSO) or CTLSO for a high thoracic curvature.
This one closes on the back
The brace apply corrective pressure on the convex side of the curvature and leave open the concave side.
Milwaukee brace: the original CTLSO brace. Rarely used anymore
Wilmington brace: similar to Boston brace. This one closes in the front.
What is the presentation for Herpes zoster ?
Skin rash follows typical dermatomal pattern
In the thoracic spine presents in stripe on one side of the body
May have a fever
What are the muscles involved on upper crossed syndrome?
Weak: crevical flexors and low fibers of trapezio , serratus anterior and romboides
Tight: pectoralis, elevator os scapula and upper trapezius’s
Compression fractures are typically secondary to
Osteoporosis
Which spinal segment compromise the cervical plexus?
C1-c4
Which spinal segment compromise the brachial plexus?
C5-t1
Which spinal segment compromise the lumbar plexus?
T12-l4
Which spinal segment compromise the sacral plexus?
L4-s4
Which spinal segment is affected in Klumkes palsy?
C8-t1
Which spinal segment is affected in Erb s palsy?
C5-c6
Which spinal segment is affected in median nerve palsy?
C5-t1
Which spinal segment is affected in waiters tip position?
C5-6
Which spinal segment is affected in claw hand?
C8-t1
Which of the following would indicate a positive test when performing the Lateral Shear Test?
a) Excessive motion
b) Symptoms of spinal cord pathology
c) Symptoms of vascular pathology
d) All of the above
D
As a part of your examination, you perform a pressure biofeedback test to determine if the patient would benefit from deep neck flexor training. Which of the following would result in a positive test?
a) Patient is unable to lift head off of blood pressure cuff
b) Patient is unable to rapidly raise pressure by 10mmHg
c) Patient is unable to hold contraction at a given pressure for 10 seconds
d) Patient cannot perform a retraction
C
No teste o pt tem q fazer uma cerv flex e hold 10secs
A patient with a forward head/rounded shoulders posture is being examined by a physical therapist. The therapist notes that the patient’s scapulae will not retract, even during passive range of motion testing. Which of the following is the MOST likely cause of the patient’s poor posture?
- Tight pectoralis minor
- Weak scapular retractors
- Tight posterior scalene muscle
- Weak rotator cuff musculature
- This is the correct answer. The pectoralis minor attaches to the scapula and prevents retraction if the muscle is tight.
A physical therapist is testing reflexes in the upper extremity. Which of the following spinal nerve roots is BEST tested with the brachioradialis reflex?
- C4
- C5
- С6
- C7
3
A patient is being evaluated for a chief complaint of mid-thoracic back pain. Your patient is an athlete who often participates in vigorous exercise. The patient reports in the history that the back pain began several months ago and is relieved primarily by antacids.
Which of the following actions would be the most appropriate next step?
a. Perform a physical examination of the mid-thoracic and lumbar spine.
b. Refer the patient to the primary care provider for a gastrointestinal evaluation.
c. Initiate core strengthening exercises with a focus on transversus abdominis activation.
d. Provide pain relieving modalities to the mid-thoracic spine, including moist heat and TENS.
A
Which of the following effects of forward head posture would you likely not see in this patient?
a. Cranium extended on upper cervical spine
b. First and second ribs elevated
c. Tongue raised to top of mouth
d. Scalenes are shortened
C
You perform orthopedic testing to determine if there is radial nerve involvement. Which of the following is the correct method to evaluate upper limb tension in the radial nerve?
a. Depression and abduction of shoulder to 10 degrees, elbow extension, forearm pronation, and wrist flexion and ulnar deviation.
b. Depression and abduction of shoulder to 10 degrees, elbow extension, forearm supination, and wrist flexion and radial deviation.
c. Depression and abduction of shoulder to 10 degrees, elbow extension, forearm pronation and wrist extension and ulnar deviation.
d. Depression and abduction of shoulder to 10 degrees, elbow extension, forearm supination and wrist extension and radial deviation.
A
Upper limb tension testing of the radial nerve reveals a positive test. Which of the following would not indicate a positive test?
a. Contralateral side flexion reproduces patients symptoms.
b. Ipsilateral side flexion decreases patients symptoms.
c. There is a side to side difference in the amount of elbow extension tolerated.
d. Symptoms worsen when performed in a slumped position.
D
