Neck Flashcards
What are the steps of the neck PE?
- Inspect
- Movements
- Scapular movements
- Arm tests
- Adjunctive tests
- Palpation
- SD eval
What are the four things you are assessing for with movements of the neck?
- RROM
- Weakness
- Pain
- Location of pain
If the neck movements are clearly disturbed, then the problem is most likely what?
In the neck itself
If there is neck pain but there is no RROM, then what is the etiology of the pain?
- Referred pain
- Non-mechanical
If there is pain in shoulder girdle, what are the four joints that should be assessed?
- Sterno-clavicular
- Acromio-clavicular
- costo-scapular
- 1st costo-transverse
What are the neck problems that can lead to arm pain?
Spinal cord/cervical root lesion
What does rotation of the neck check?
Stretches elements on either side of the neck
What does sidebending of the neck test for?
facets on either side
Is there limitation to flexion with flexion of the neck with capsular pain?
No
Which is worse with capsular neck pain: side bendings or rotation
Both equally bad
Is there limitation to flexion with extension of the neck with capsular pain?
Can be
Painful capsular pattern of RROM indicates what?
Fracture or RA
What are the physiologic types of end feel?
Hard
Elastic
Tissue approx
What are the pathologic type of end feel?
Guarding
Muscle spasm
What is elastic end feel?
At the end of ROM, the examiner feels resistance, but further stretching over a few degrees is possible, typical of a normal joint capsule
What do muscle spasms indicate?
restricted ROM–severe disorder
What are the two end-feels that contraindicate OMM?
Guarding
Muscle
Pain on active and passive stretching in one direction, but also on isometric testing in the opposite direction indicates what?
Musculotendinous lesion,
Pain with elevation of the scapula indicates what?
The need for a shoulder girdle exam
Resisted elevation of the shoulder tests which spinal levels? What nerve is this?
C3-C5 + CN XI
If there is painful limitation of movement without weakness with elevation of the arm, this indicates what?
Local lesion in the arm
Hyperreflexia is an UMN or LMN sign?
UMN
Hyporeflexia is an UMN or LMN sign?
LMN
Biceps reflex tests which spinal level?
C5/6
Brachioradialis reflex tests which spinal level?
C5/6
Triceps reflex tests which spinal level?
C7
Patellar reflex tests which spinal level?
L4
Achilles reflex tests which spinal level?
S1
Shoulder adduction = which spinal level?
C5/6
Elbow flexion = which spinal level?
C5/6
Wrist extension = which spinal level?
C6
Elbow extension = which spinal level?
C7
Long finger flexion = which spinal level?
C8-T1
Abduction of the 5th digit = which spinal level?
C8-T1
What does Spurling’s test look for?
Nerve root compression
What is the procedure for Spurling’s test?
Add rotation, sidebending and axial compression
What is the distraction maneuver for spurling’s? What is a positive test? What does this indicate?
Dural stretch.
Positive = decrease in radicular pain
Indicates radiculopathy
When should you do x-rays before doing ROM of the neck? (3)
- Suspect fracture
- Severe neurological complaints
- Intoxication
What are the five things that you should decide after a neck PE?
- Need to examine further
- further testing?
- Consult?
- OMM?
- Other treatments?
True or false: capsular pattern is an indication for x-ray
True
True or false: neurological findings are an indication for an x-ray
True
What should you examine if the patient gets dizzy looking up?
Auscultate the carotids
How, generally,do you assess joint surfaces? Ligaments? Muscles?
joint surfaces = squish
Ligaments = pull apart
Muscles = have them contract
True or false: anticoagulation is a relative contraindication to OMM
True
What are the four neck problems that should be assessed for with inspection of the neck?
- Abnormal head position
- Abnormal Shape
- Masses
- Scoliosis reaching the neck
If there is dizziness when looking up, what imaging should you get?
- Flexion/extension cervical spine x-rays
- Carotid and vertebral US
What are the characteristics of the capsular pattern of the neck in terms of:
- Flexion
- Side bending/rotation
- Extension
- No limitation of flexion
- Equal degree of limitation of side bending and rotation
- Some or great limitation of extension
What are the likely etiologies of the capsular pattern of the neck?
Fracture or tumor.
True or false: Capsular pattern is a contraindication to OMM
True
What are the three things you are looking for with passive movement of the neck?
Restriction
Pain
End feel
What are the two things you are looking for with resisted movement of the neck?
Pain
Weakness
