Neck and Spine Lecture

Question 1

3 types of joints

Answer 1

• Fibrous (immovable)
• Cartilaginous (minimal movement)
• Synovial (freely moveable)

Question 2

Describe cartilaginous joints

Answer 2

• Minimal movement
• Cartilage b/w bony surfaces
• AC joint, symphysis pubis, vertebral bodies

Question 3

Describe fibrous joints

Answer 3

• Immovable

- Skull sutures

Question 4

Describe synovial joints

Answer 4

• Freely moveable
• Articular cartilage, synovial fluid/joint capsule, ligament
• Ball and socket (hip, shoulder)
• Hinge (fingers, elbow)
• Condylar (knee, TMJ)

Question 5

TMJ - type of joint and description

Answer 5

• Synovial joint

- Busiest joint of the body (talking and chewing)

Question 6

What is the busiest joint of the body?

Answer 6

TMJ (talking and chewing)

Question 7

What is the TMJ formed by

Answer 7

• Fossa/articular tubercle of temporal bone

- Condyle of mandible

Question 8

Inspection of TMJ:

Answer 8

• Redness, swelling, deformity
• Swelling may be just anterior to external auditory meatus
• Check for symmetry bilat

Question 9

Palpation of TMJ:

Answer 9

• Fingers anterior to tragus
• Pt opens mouth
• Should have smooth ROM
• Snap or click w/o pain is ok
• Note swelling/tenderness

Question 10

Primary supporting structure of the trunk?

Answer 10

Spine

Question 11

Vertebral column consists of:

Answer 11

• 24 vertebrae (7 C, 12 T, 5 L)
• 1 fused sacrum and coccyx (vestigial tail)
• Offset by intervertebral discs

Question 12

What are the spinal nerves protected by?

Answer 12

Intervertebral foramen

Question 13

What is the spinal cord protected by?

Answer 13

Posterior vertebral arch

Question 14

Where are the spinal joints slightly moveable?

Answer 14

Between the vertebral bodies and articular facets

Question 15

Define intrinsic muscles

Answer 15

Originates in the limb or part in which it inserts

Question 16

Define extrinsic muscles

Answer 16

Does NOT originate within the part or limb in which it inserts

Question 17

Intrinsic muscles of the back

Answer 17

• Extend from cranium to pelvis
• Maintain posture and move vertebral column
• Divided into superficial, intermediate, deep

Question 18

Extrinsic muscles of the back

Answer 18

• Connect upper extremities to the trunk
• V shaped muscles of upper and mid back
• Lat dorsi, trap, rhomboids, levator scapulae

Question 19

Muscles involved in C-spine motion (flex, ext, rotation, lat bending)

Answer 19

• Flex: SCM, scalene, pre-vertebrals
• Extension: trap, splenius, small intrinsics
• Rotation: SCM, small intrinsics
• Lat bending: scalene, small intrinsics

Question 20

SCM, scalene, pre-vertebrals control what C-spine movement?

Answer 20

Flexion

Question 21

Trap, splenius, small intrinsics control what C-spine movement?

Answer 21

Extension

Question 22

SCM and small intrinsics control what C-spine movement?

Answer 22

Rotation

Question 23

Scalene and small intrinsics controls what C-spine movement?

Answer 23

Lateral bending

Question 24

Inspection of spine from the side:

Answer 24

• Cervical lordosis
• Thoracic kyphosis
• Lumbar lordosis

Question 25

What is a gibbous?

Answer 25

Exaggeration of the thoracic kyphosis (hunchback)

Question 26

What is a Dowager's hump? What causes it?

Answer 26

- Exaggeration of the thoracic kyphosis in post-menopausal women - Caused by osteoporotic wedge fractures

Question 27

Inspection of spine from behind:

Answer 27

- Alignment of shoulders and iliac crests - Gluteal folds - Look for scoliosis

Question 28

Scoliosis of the C-spine is a form of:

Answer 28

Torticollis (or can arise form abnormal muscle spasm)

Question 29

What will scoliosis of the C-spine cause?

Answer 29

Uneven shoulder height

Question 30

Uneven shoulder height could be a sign of:

Answer 30

C-spine scoliosis

Question 31

Palpation of the spine:

Answer 31

- Spinous processes (C7 most prominent, note any tenderness) - SI joint - Paravertebral muscles - Sciatic notch

Question 32

Tenderness at C1-C2 in patients with RA can indicate?

Answer 32

Impending high cervical subluxation

Question 33

How to palpate sciatic nerve?

Answer 33

-In sciatic notch -Pt lies on opposite side, hip flexed -Just lateral to ischial tuberosity (or standing w/hip and knee flexed)

Question 34

Percussion of the spine:

Answer 34

Gentle thumping w/ulnar aspect of fist

Question 35

Most motion in the spine is in the:

Answer 35

C-spine

Question 36

ROM testing for C-spine:

Answer 36

- Flexion (chin to chest) - Extension (look up) - Rotation (look over shoulder) - Lat bending (tilt head toward shoulder)

Question 37

T and L spine ROM

Answer 37

- Flexion (pt bend over) - Extension (place hand on small back and ask them to bend backwards) - Rotation - Lat bending

Question 38

Patient w/cervical radiculopathy may have:

Answer 38

Neuro deficits in UE

Question 39

Patient w/cervical myelopathy may have:

Answer 39

Neuro deficits in UE OR LE

Question 40

Special tests for C-spine:

Answer 40

Distraction, compression, Valsalva, swallowing, Adson's/Wright's

Question 41

What is distraction test and how to do it?

Answer 41

- Special test of C spine - Place open palm of dominant hand under pts chin, other hand over occiput, gently lift head to distract spine - Is pain relieved?

Question 42

Mechanism of distraction test

Answer 42

C spine can sometimes relieve pain due to narrowing of neural foramen or by decreasing pressure on capsules around facet joint

Question 43

What is the compression test?

Answer 43

- Special test of C spine - Opposite of distraction test - May provoke symptoms of cervical or radicular pain - Press down on pts head and see if this provokes pain

Question 44

What is the Valsalva test?

Answer 44

- Special test of C spine - Hold breath and bear down, pain anywhere? - Intra-abdominal pressure increases thereby increasing intrathecal pressure (CNS) - Pain my be provoked in a dermatome

Question 45

What is the swallowing test?

Answer 45

- Special test of C spine - Pts w/anterior cervical disk herniation or bony osteophytes can have difficulty swallowing if disk/osteophyte is pressing against esophagus

Question 46

When is Adson's test performed?

Answer 46

Only in patients with positional shoulder pain

Question 47

Adson's vs. Wright's test

Answer 47

- Adson's turn head to same side | - Wright's turn head to opposite side

Question 48

Inspection of lumbar spine:

Answer 48

- Redness, cafe-au-lait spots, lipomas | - Evaluate posture, check for scoliosis

Question 49

Lipomas in lumbar spine area may be a sign of:

Answer 49

Spina bifida

Question 50

Palpation of lumbar spine

Answer 50

- Sit on stool behind pt - Fingers over iliac crests, thumbs rest over L4-L5 - Palpate spinous processes moving up then back down

Question 51

Lumbar spine special tests:

Answer 51

- SLR - Crossed SLR - Hoover test

Question 52

What is the straight leg raise test designed to do?

Answer 52

Stretch sciatic nerve and reproduce back or leg pain

Question 53

With HNP, pain during the SLR test occurs at what angle?

Answer 53

30-70 degrees

Question 54

During SLR, sciatic nerve is stretched between what angles?

Answer 54

30-70 degrees

Question 55

SLR technique

Answer 55

- Lift leg supporting heel and knee - Note angle at which pt feels pain and location (back vs leg) - Lower leg until pain resolves then dorsiflex foot - If NO pain, then prob hamstring tightness

Question 56

What is the crossed SLR test?

Answer 56

SLR on the uninvolved side

Question 57

What is the Hoover test?

Answer 57

- To determine malingering - Cup hands under each heel - Tell pt to lift good leg first (try to feel downward pressure of "bad" leg) - If they are actually weak, you should NOT feel this