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EIM OCS Prep > Neck and Thoracic > Flashcards

Neck and Thoracic Flashcards

1
Q

Cervical mobility limitation treatments

A

Thoracic thrust manip helps all acuity/chronicity levels regardless of CPR for cervical thrust manip
Emphasis of ex and empowering patient
CPR exists for cervical manip

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2
Q

Cervical manipulation CPR

A

Symptoms < 38 days
Positive expectation manipulation will help
Cervical rotation ROM asymmetry > 10deg
Pain with PA testing mid-cervical spine

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3
Q

Neck pain classification

A

Cervicalgia + mobility deficit
Cervicalgia movement control deficits/WAD
Cervical radiculopathy
Cervicogenic headache

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4
Q

Cervical radiculopathy
Clinical presentation

A

Peripheralization/centralization of symptoms
Diminished myotomes, dermatomes, and/or reflexes
Pain with cervical rotation (< 60deg)
Adverse neurodynamics

Most often seen individuals 40s or 50s

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5
Q

CPR cervical myelopathy

A

+Hoffman
+Babinski
Inverted supinator sign
Gait deviation
Age > 45 years

Post test probability with 3/5 positive tests 94%, 4/5 is 99%

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6
Q

Cervical radiculopathy treatment

A

Upper quarter and nerve mobilization, traction, Thoracic manip or manual therapy

Mechanical traction +ex retained benefits more than ex alone or mechanical traction alone

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7
Q

Cervicogenic headache presentation

A

Primarily occipital headache, radiating into head and face. Tends to be unilateral without side shift
Affected by cervical movements or posture

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8
Q

Trigeminal nucleus

A

Receives afferents from cn V and spinal nerves 1-3
Nuclei of head, throat, and neck afferents

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9
Q

Migraine presentation

A

Multiple triggers, usually not neck movement
Often unilateral with side shift
Located frontal, periorbital, or temporal
Throbbing or pulsating
Can be associated with nausea, vomiting, phonophobia, photophobia

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10
Q

Tension headache presentation

A

Location: diffuse, bilateral
Characterization: dull
Triggers: multiple, not typically associated with neck movement
Associated symptoms: decreased appetite, phonophobia, photophobia

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11
Q

Headache red flags
Possible signs intracranial pathology

A

Sudden onset severe HA with increasing intensity
Persistently unilateral or focal HA
Headache that wakes patient up
Generalized stiff neck or s/s meningitis
Systemic symptoms
Focal neurologic symptoms

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12
Q

5 Ds And 3 Ns

A

Dizziness
Drop attack
Diploplia
Dysarthria
Dysphagia

Ataxia

Nausea
Numbness
Nystagmus

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13
Q

Cervicogenic headache treatment

A

Diagnostic block of occipital nerve

Neck coordination, strength, endurance ex, cervical manual therapy, stretching.
Effective for short and long term relief of chronic symptoms. MT+ex > either one alone
Scapular stabilizers should include serratus anterior and lower traps

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14
Q

Cervicogenic headache special testing

A

+ cervical flexion-rotation test (< 32 degrees)

Poor deep cervical endurance:
+ cranial cervical flexion test (ccft) (unable to generate 26-30mmHg for 10 seconds)
Neck flexor endurance test < 38 seconds

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15
Q

Diagnostic cluster cervicogenic headache

A

Very high specificity and sensitivity
Decreased cervical extension AROM
Limited cervical endurance on CCFT
Palpably tender OA to mid-cervical region

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16
Q

Primary symptoms of cervical arterial dissection

A

80% present with head and neck pain, particularly ipsilateral

Vertebral artery:
5Ds And 3Ns
May be affected by cervical rotation

Internal carotid artery:
May be affected by cervical extension
Horner’s syndrome
Miosis+ptosis+anhidrosis

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17
Q

Emergency procedure if you suspect cervical arterial dissection

A

Call 911
Rescue and recovery position
Record vitals
Do not give pt anything to eat/drink
Record time

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18
Q

Cardiovascular disease risk factors
(8 items)

A

Age (women > 55, men > 45)
Family history (MI and sudden death of direct relative before age 55)
Cigarette smoking
Sedentary lifestyle
Obesity (bmi > 30)
Hypertension
High LDL and low HDL. (High HDL is a negative risk factor)
Diabetic or pre-diabetic

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19
Q

Unstable angina

A

Unpredictable chest pain or pressure
Does not alleviate with rest
Does not alleviate with nitroglycerin
S/s consistent with MI
Episodes last > 30min

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20
Q

Pulmonary embolism
Signs and symptoms

A

0.97 sensitivity, 0.3 -LR of:
Sudden onset dypsnea
Chest pain

Tachypnea
Wheezing
Hypotension
Pulmonary referral pattern (chest and LUE)

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21
Q

Wells criteria

A

> 6 high probability of DVT or PE
4.5 - 6 moderate probability
< 4 low probability

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22
Q

Revised Geneva score

A

> = 11 high probability of PE
4-10 moderate
=< 3 low probability

23
Q

PERC rule

A

Sensitive test to rule out PE in patients with LOW risk of PE (if all of the below are negative)

Age > 50
Hemoptysis
SpO2 > 94%
HR >= 100bpm
Previous DVT or PE
Recent surgery or trauma in last 4 weeks
Unilateral leg swelling
Estrogen use

24
Q

Murphy’s sign

A

Sharp pain with sudden stop of inspiration with palpation to right costal margin with deep inspiration

Suggestive of cholescystitis

25
Q

Canadian c/s rules
High risk factors

A

Age > 65
Dangerous mechanism (fell > 3 ft or 5 steps, axial load, MVA > 60mph, rollover, ejection, bike collision, , motorized rec vehicle accident)
Upper extremity paresthesia

Warrants radiograph or CT

26
Q

Canadian c/s rules
Low risk factors allowing ROM assessment

A

Simple rear-end MVA
Able to sit in Emergency Room
Ambulatory at any time after injury
Delayed onset of neck pain (no immediate pain at time of injury)
Absence of midline c/s tenderness upon palpation

If no to any of the above, needs radiograph. If yes to all of the above, proceed to checking ROM

No –> radiograph
Yes –> c/s ROM assessment

27
Q

Canadian c/s rules

A

If no high risk factors, or have low risk factors but able to rotate c/s > 45 degrees both ways, pt very unlikely to have fracture
Sensitivity 94%

28
Q

Cervical spine instability special testing

A

Alar ligament stress test
Transverse ligament shear test (anterior shear test)
Sharp purser test*

*Recommend to test sharp purser first bc it’s not provocative

29
Q

Alar ligament stress test

A

Positive if no capsular/firm endfeel is noted

C2 spinous process moves with head during cervical motion. If head is rotated, c2 will move immediately (in contralateral direction)

30
Q

Transverse ligament stress test
AKA Anterior shear test

A

Positive test elicits bilateral lower extremity paresthesias

31
Q

Sharp purser test

A

Positive test is relief of symptoms, particular lower extremity paresthesias; excessive motion; clunk noted

32
Q

Olecranon manubrium percussion

A

Special test for olecranon fracture. Positive if symptomatic side percussion is duller in intensity and pitch

Warrants urgent MD referral

33
Q

Pericarditis clinical signs

A

Chest pain, pressure, or shortness of breath

Exacerbated with lying down, coughing, deep breath
Alleviated with bending forward or holding breath

34
Q

VBAI test

A

Passively rotate pt for 10 seconds for pre manipulative hold to help rule out VBAI
*note 2020 IFOMPT cervical framework no longer recommends premanip holds. Focus on cardiovascular risk factors

35
Q

Risk factors for chronic neck pain

A

Weakness in hands

36
Q

Parsonage-Turner syndrome

A

Neuritis of brachial plexus. Can present like a c8 radiculopathy

37
Q

Flexion-rotation test

A

Strong sensitivity and specificity test for ruling in and ruling out cervicogenic headache

Sn=0.86
Sp=1.0

38
Q

c1-c2 PA assessment

A

Sn = 0.62
Sp = 0.87
Differentiation to find guilty segment for cervicogenic headache

39
Q

Cervical rotation lateral flexion

A

Assesses for elevated first rib contralateral to the side that is rotated, then laterally flexed. Must perform bilaterally to compare

40
Q

Upper limb tension test (median nerve bias)

A

Sens=0.97, -LR=0.14
Extremely sensitive test to rule out cervical radiculopathy

41
Q

Cervical distraction test

A

Good specificity test to rule in cervical radiculopathy

42
Q

Spurling’s test

A

High specificity test to rule in cervical radiculopathy
Sp=0.92
LR+ = 4.87

43
Q

Cervical Mechanical traction cpr

A

Peripheralization with lower c/s mobility testing
+ shoulder abduction test
Age >= 55
+ distraction test
+ ULTT A

44
Q

Thoracic Vertebral compression fracture clinical cluster to diagnose fracture

A

Extremely good specificity with 3/4 positives:

Female
Age > 70 years old
Significant trauma
Prolonged use of corticosteroids

45
Q

Thoracic Vertebral compression fracture clinical cluster for r/o fracture

A

Sn = 0.95, -LR = 0.16 with < 2 positives:

Age > 52
No leg pain
BMI =< 22
does not exercise regularly
female

46
Q

Adam’s flexion test

A

high sensitivity test for thoracic scoliosis

47
Q

Neck pain with movement coordination deficits.
Treatment strategies

A

Patient education/ counseling, stretching** coordination, strengthening and endurance exercises for neck

48
Q

Cervicalgia and mobility deficits
Treatment

A

Cervical and thoracic manual therapy, stretching exercise
Neck coordination, strength, endurance exercises

49
Q

Hangman’s fracture

A

Fracture of posterior elements of C2, resulting in spondylolisthesis of C2 on C3

50
Q

Jefferson fracture

A

Fracture of anterior and posterior arches of C1

51
Q

Clay-shoveler fracture

A

Fractures of spinous process of lower cervical vertebra

52
Q

Scheurman’s disease
Clinical features

A

Results in significant kyphosis due to anterior wedging of vertebral bodies. Juvenile discogenic disease.

53
Q

Thoracic disc herniation
Clinical features

A

Most common in patients between 30 to 50 years old

EIM OCS Prep (11 decks)

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