Neck and C Spine Exam Flashcards

1
Q

anterior triangle

A

mandible SCM midline

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2
Q

posterior triangle

A

SCM trapezius clavicle omohyoid crosses lower portion

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3
Q

flexion - chin to chest

A

45‐90°

SCM, scalene, prevertebral muscles

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4
Q

extension

A

70‐90°

Splenius capitus, splenius cervicis, intrinsic spinal muscles

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5
Q

rotation

A

70‐90°

SCM, intrinsic spinal muscles

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6
Q

SB

A

20‐45°

Scalenes, intrinsics

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7
Q

thyroid exam

A
  1. To locate, use cues from visual inspection. Isthmus overlies
    2nd‐4th tracheal rings. Have pt flex neck slightly to relax SCMs.
    Place fingers of both hands on pt’s neck so that index fingers
    just below cricoid cartilage. Have pt swallow so thyroid rises
    up under finger pads.
  2. Displace trachea to right and palpate right lobe. Repeat for
    left lobe. Anterior surface of a lateral lobe is approx. the size
    of the distal phalanx of thumb and feels somewhat rubbery.
  3. If enlarged, listen over lateral lobes to detect bruit which may
    be heard in hyperthyroidism.
  4. Findings:
    a. Goiters‐Simple (non‐nodular) or multinodular
    b. Graves’ disease – soft
    c. Hashimoto’s thyroiditis and malignancy – firm
    d. Thyroiditis‐tenderness
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8
Q

mm strength C1

A

resisted R ROM

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9
Q

mm strength C2-4

A

scapular elevation

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10
Q

mm strength C5

A

shoulder AB deltoid m

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11
Q

mm strength C6

A

elbow flexion (biceps) wrist extension

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12
Q

mm strength C7

A

elbow extension (triceps) wrist flexion

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13
Q

mm strength C8

A

finger flexion

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14
Q

mm strength T1

A

finger AB

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15
Q

C1-C4

A

lesser occipital
greater auricular
cervical cutaneous

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16
Q

C4

A

superior shoulder/lateral neck

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17
Q

C5

A

Lateral upper arm (over deltoid)

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18
Q

C6

A

lateral forearm

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19
Q

C7

A

middle finger

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20
Q

C8

A

Right/little finger, medial wrist and forearm

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21
Q

T1

A

Medial elbow and upper arm

22
Q

biceps reflex

23
Q

brachioradialis

24
Q

triceps

25
Compression test & Spurling’s | maneuver – Seated or supine
Compression can cause increased pain by narrowing the neural (intervertebral) foramen, pressure on the facets, or initiating muscle spasm Compression test – with head and neck in neutral position add an axial loading force caudally looking for upper extremity pain, paresthesias, or numbness Spurling’s – Tests nerve root compression/irritation. Tested with axial force in neutral, then extension, then SB/rotation toward; test of high specificity (+) test = Reproduction of symptoms (pain/neurological symptoms in distribution of nerve root)
26
Neck Distraction Test - Seated or | supine
Relief of pain with cervical distraction, opposite of compression test Doctor places one hand under the patient’s chin & places the other hand around the occiput.  The doctor slowly distracts the head. (+) test= alleviation of symptoms indicating central compression or central neuropathy
27
valsalva test
Pt. holds breath and bears down. (+) test = increased pain/paresthesia, especially in nerve root distribution. Valsalva ↑ intrathecal pressure. In presence of space occupying lesion in cervical canal, this pressure may cause pain in cervical spine as well as radiation of pain to dermatomal distribution.
28
thoracic outlet boundaries
Boundaries = 1st ribs, 1st thoracic vertebra, manubrium   Thoracic duct passes through fascial diaphragm twice (left side); Rt lymphatic duct drains body’s right upper quadrant Broken into vasculogenic & neurogenic Structures: brachial plexus, subclavian v, subclavian a   Best thought of as 3 possible zones: scalene triangle, costoclavicular space, retropectoralis minor
29
Roos or EAST Test
Compression of subclavian a. Abduct shoulder to 90° & externally rotate with elbow flexed to 90°; Doc instructs pt to open & close fist for up to 3 minutes (+) = reproduction of symptoms (incr pain at shoulder & down arm, paresthesia, arm pallor, cyanosis and swelling)
30
Adson Test
Neurovascular bundle (specifically subclavian artery) compressed by tight scalene muscles or 1st rib Locate radial pulse on affected arm. Pt breathes deeply. Doc abducts, extends & ext rotates the shoulder while palpating the radial pulse. Head is extended & rotated toward affected side.   (Looking towards dysfunctional side‐ 1st rib etiology) Then the pt’s head is extended & rotated away from affected side.   (looking away from dysfunctional side‐ tight scalene muscles). (+)= loss or change in pulse, reproduction of symptoms (+) test indicates compression of subclavian artery between scalenes, cervical rib, or 1st rib
31
Wright's Hyperabduction Test
NV bundle compressed by tight pectoralis minor   Doc locates and monitors the radial pulse on the affected side.  The patient is seated. Stand behind the patient and palpate the radial pulse with one hand. Abduct the patient's arm above his or her head with some extension. (+)= loss or change in pulse; exacerbation of pain/paresthesia (reproduction of symptoms) (+) test indicates neurovascular entrapment by pectoralis minor muscle
32
Costoclavicular Test
Extend shoulder and caudal pressure on shoulder noting change in radial pulse – NV bundle compressed by clavicle and rib 1 Pt seated with Doc behind pt.  Contact the ipsilateral wrist at the radial pulse, extend the shoulder, with elbow extended and wrist supinated and apply caudal pressure on the shoulder (+)= decrease in radial pulse (+) test indicates thoracic outlet synd due to decrease space between rib 1 & clavicle  
33
nuchal rigidity
(+) test = Marked neck stiffness/resistance to flexion Found in 57‐92% cases of acute bacterial meningitis, and 21‐86% of subarachnoid hemorrhage
34
brudzinski's
(+) test = flexion in both hips and knees | Low sensitivity, specificity data limited.
35
subluxation
w/o fracture
36
dislocation
w/ or w/o neurologic injury
37
fracture
w/ or w/o neurologic injury
38
flexion injury
anterior subluxation wedge tx
39
extension injury
C1, hangaman's fx (C2) teardrops fx
40
axial compression injury
jefferson fx (C1)
41
motor vehicle accident
C1 most common, also C5, C6, C7
42
falls and sports injuries
C5, C6, C7
43
clay shovelers'
C6 and C7
44
jefferson fracture
C1 burst fracture (axial compression injury)
45
Dens fracture
C2 odontoid fracture at junction of process & body | Often requires surgery
46
hangman's fracture
Hyperextension | Bilateral arch fracture, unstable
47
spinous process fracture
Hyperextension or avulsion force from muscle contraction | Clay Shovelers’ fx – C6 or C7
48
teardrop fracture
Fracture & dislocation Flexion & compression injury Anterior‐inferior teardrop fragment: unstable
49
wedge fracture
Compression, flexion loading force  
50
burst fracture
Comminuted (ex. Diving injury)   | Can result in severe spinal cord injury
51
anterior subluxation
facet dislocation without fracture Flexion injury Unilateral or bilateral facet dislocation