Neck/Cervical Exam Flashcards
What is compression neuropathy?
- Nerve entrapment by MSK or myofscial tissue
- Produces paresthesias in nerve distribution
- Create sensory dysfunction and pain and decerase muscle strength
- common sites include IV foramen and thoracic outlet
What are 4 tests for central neuropathy?
- Compression test
- Spurlings test
- Neck distraction test
- Valsalva test
How does compression affect central neuropathy?
-compression can cause increasing pain by narrowing the neural IV foramen, put pressure on facets, or intiate muscle spasm
What is the compression test for central neuropathy?
- head and neck in neutral add axial loading force caudally (DOWN)
- look for UE pain parasthesias or numbness
What is Spurlings maneuver for central neuropathy?
- test for nerve root compression/irritation
- doc behind seated patient
- 3 stages (if sx produced in stage dont proceed to next)
1. Compression of head in neutral
2. Compression of head with head extension
3. SB away from affected side and toward affected side and add compression
POSITIVE test= reproduction of sx–> pain neurological sx in nerve root distribution
What is the neck distraction test for central neuropathy?
- can be done seated or supine
- relief of pain wiht dervical distraction (ooposite of compression test)
- 1 hand under pt chin and other hand around occiput
- slowly distract head
POSITIVE test= alleviation of sx indicates a central compression
What is the valsalva test for central neuropathy?
- pt hold bearth and bears down
- increase intrathecal pressure
- if lesion in cervical canal pressure may cause pain in cervical spine and radiation pain to dermontome distribution
POSITIVE test= increase pain/parestheia in nerve root distribution
What is an example of peripheral neutropathy?
- thoracic outlet syndrome!
- 1st rib, T1, manubrium, clavical boundaries
- brachial plexus, subclavian a and v inside
What are the 3 zones of thoracic outlet boundaries?
- scalene triangle
- costoclavicular space
- retropectoralis minor
What is the roos or EAST test for thoracic outlet syndrome?
- EAST= elevated arm stress test
- compression of subclavian a
- abduct shoulder to 90, externally rotate with elbow flexed 90
- pt open adn close fist for 3 min
POSITIVE test= reproduction of sx like increase pain at shoulder and down arm, paresthesia, arm pallor, cyanosis, edema
What is the adson test for thoracic outlet syndrome?
- NV bundle (esp subclavian a) compressed but either tight scalene or 1st rib
- find radial pulse on affected arm and pt breath deeply
- abduct, extend, ext rotate shoulder
- pt extends head and rotate TOWARD affected side= 1st rib etiology
- pt extends head and rotate AWAY from affected side= tight scalene muscles
POSITIVE test= loss or chang ein pulse, reproduction of sx, indicates compression of subclavian a between scalenes or 1st rib
What is the wrights hyperabduction test for thoracic outlet syndrome?
- NV bundle compressed by tight pec minor
- monitor radial pulse on affected side
- abduct pts arm above head with some extension
POSITIVE test= loss or change in pulse, exacerbation or pain/paresthesia indicates NV entrapment by pec minor muscle
What is the costoclavicular test (military/halstead test) for thoracic outlet syndrome?
- extend shoulder with elbow extended and wrist supinated
- apply caudal pressure on shoulder noting change in radial pulse
- NV bundle compressed by clavicle and rib 1
POSITIVE test= decerease radial pulse indicates thoracic outlet syndrome due to decerease space between rib 1 and clavicle
What are other special tests for inflammation in subarachnoid space?
- test for meningitis or subarachnoid hemorrhage
- before make sure no injury to C-spine or cervical cord
- pt supine
- hands behind pt head and flex neck foward until chin touches chest
- normally neck supple and easily bends foward
What is nuchal rigidity?
-flex pt neck chin to chest
POSITIVE test= marked stiffness/resistance to flexion
-found in acute bacterial meningitis and subarachnoid hemorrhage
