OSCE systems: skin, cervical,spinal Flashcards
Cervical Spine: What is the Canadian C-Spine Rule?
This is a rule for determining if radiography should take place. It says if a patient is over 65, has been involved with a dangerous mechanism, or has paresthesia in the extremities then radiography is a must.
However, Range of Motion can be assessed for simple rear-end collisions, where they can sit at 45 degrees, or they are ambulatory, there is a delayed onset of neck pain or there is an absence of midline C Spine tenderness and active rotation of the neck is 45 degrees on both sides then radiography is not required
Cervical Spine: Describe the Distraction test
The practitioner stands to one side of the seated patient and places one hand under the patient’s chin (with the mouth and teeth closed) and one hand around the occiput.
2) The practitioner slowly lifts the hands to apply a distraction force through the neck by lifting the head.
3) The practitioner then slowly relieves the distracting force.
Cervical Spine: What is the purpose of the Distraction test?
The distraction test is used when the patient has complained of radicular symptoms and these symptoms are present during the consultation. The aim of this test is to alleviate the radicular symptoms by reducing mechanical pressure on the irritated structure.
Cervical Spine: What is a positive finding for the Distraction test?
The test is considered positive if the patient reports a relief or decrease in radicular symptoms when the head is lifted. A positive result may indicate pressure on cervical nerve root(s).
Cervical Spine: Describe the Sharp-Purser test
The practitioner stands beside the patient who is seated at the treatment table.
The practitioner places one hand on the patient’s forehead and the thumb of the other hand over the spinous process of C2.
2) The patient is asked to slowly flex the head. As this is occurring the practitioner presses posteriorly on the forehead.
Cervical Spine: What is the purpose of the Sharp-Purser test?
This test is used to determine if subluxation of the atlas on the axis is present and should therefore be used with caution.
If the transverse ligament of the atlas is torn C1 will be allowed to translate anteriorly on C2 when moving into flexion.
Cervical Spine: What is a positive finding of the Sharp-Purser test?
This test is considered positive if the practitioner feels the head translate posteriorly during the movement (this may be accompanied by an audible ‘clunk’). Translation of the atlas on the axis may indicate rupture or absence of the transverse ligament, resulting in upper cervical instability.
Cervical Spine: Describe the shoulder abduction test
The patient is sitting or lying on the treatment table.
2) The practitioner passively or the patient actively abducts the shoulder and places the hand or forearm on the head.
Cervical Spine: What is the purpose of the shoulder abduction test?
assess for radicular symptoms
Cervical Spine: What is a positive finding of the shoulder abduction test?
This test is considered positive if the patient reports relief or a decrease in symptoms. A positive test may indicate the presence of nerve root compression in the cervical spine (usually C4-C5 or C5-C6).
Cervical Spine: Describe the Spurling test
The patient is sitting on the treatment table.
2) The practitioner applies a downward force on the patient’s head (observe for symptoms).
3) The patient’s head is side-bent toward the non-symptomatic side first, followed by the symptomatic side (observe for symptoms).
4) The practitioner then carefully applies a downward pressure straight down through the head maintaining side-bending (observe for symptoms).
5) Finally, if symptoms have not already been reproduced the patient’s neck is taken into extension with rotation toward the same side as side-bending (observe for symptoms).
Cervical Spine: What is the purpose of the Spurling test?
This test is used to assess for radicular symptoms or radiculopathy. The symptoms may be present at the time of testing, or absent or diminished.
The test is designed to provoke symptoms.
Cervical Spine: What is a positive finding of the Spurling test?
This test is considered positive if the patient reports the production of radicular pain into the upper limb on the side of the neck side-bending and rotation.
This is believed to indicate radiculitis due to pressure on a cervical nerve root. This positioning of the neck reduces the intervertebral foramen.
Observe for a dermatomal pattern to the pain. Localized neck pain without upper limb referral is not a positive test.
Cervical Spine: Describe the First Upper Limb Neurodynamic test for the median nerve (ULNT1)
The patient is lying on the treatment table.
The practitioner stands at the side of the table beside the patient’s trunk facing the head of the table. The patient’s shoulder is abducted to allow the practitioner to stand inside the upper limb.
2) The practitioner depresses the patient’s shoulder girdle using the forearm.
3) The patient’s shoulder is passively abducted to approximately 110° while the elbow is maintained in a flexed position.
4) With the forearm supinated the wrist and fingers are taken into extension.
5) The patient’s elbow is then taken toward extension while the shoulder remains depressed, and the wrist and hand are maintained in extension.
6) Note the production or worsening of symptoms and the degree of elbow flexion they occur.
7) If symptoms are produced ask the patient to actively side-bend away from the side of symptoms (this may exaggerate the symptoms). Then have the patient side-bend the neck toward the side of symptoms (this may reduce symptoms). The ipsilateral neck side-bending is referred to as a ‘sensitizing’ movement
Cervical Spine: What is the purpose of the First Upper Limb Neurodynamic test for the median nerve (ULNT1)?
The upper limb neurodynamic tests are designed to place stress on the neurological structures in the upper limb by placing them under tension.
Cervical Spine: What is a positive finding of the First Upper Limb Neurodynamic test for the median nerve (ULNT1)?
This test is considered positive if the patient reports the reproduction of radicular symptoms in the upper limb.
It is important to note that the test can also cause aggravation of pain in inert and contractile tissues. The character and familiarity of the symptoms reproduced or aggravated should be noted.
Cervical Spine: Describe the Second Upper Limb Neurodynamic test for the radial nerve (ULNT2)
The patient is lying on the treatment table. The practitioner stands at the side of the table beside the patient’s head.
The practitioner then uses their hip/thigh to depress the patient’s shoulder on the affected side.
2) The patient’s hand and wrist are taken into full flexion, with the forearm in pronation.
3) The practitioner abducts the patient’s shoulder to approximately 40° and extends it to 25°.
4) While maintaining the shoulder in abduction and the wrist and hand in flexion the patient’s elbow is taken toward extension until symptoms are reproduced.
5) If symptoms are produced ask the patient to actively side-bend away from the side of symptoms (this may exaggerate the symptoms).
Then have the patient side-bend the neck toward the side of symptoms (this may reduce symptoms). The ipsilateral neck side-bending is referred to as a ‘sensitising’ movement.
Cervical spine: What is the purpose of the second Upper Limb Neurodynamic test for the radial nerve (ULNT2)?
The upper limb neurodynamic tests are designed to place stress on the neurological structures in the upper limb by placing them under tension
Cervical spine: What is a positive finding of the second Upper Limb Neurodynamic test for the radial nerve (ULNT2)?
This test is considered positive if the patient reports the reproduction of radicular symptoms in the upper limb.
Cervical Spine: Describe the Third Upper Limb Neurodynamic test for the ulna nerve (ULNT3)
1) The patient is lying on the treatment table. The practitioner stands at the side of the table beside the patient’s trunk facing the head of the table. The patient’s shoulder is abducted to allow the practitioner to stand inside the upper limb.
2) The patient’s shoulder girdle is depressed using the forearm or hand, and the shoulder is taken into 90° abduction.
3) The patient’s forearm is pronated and the wrist and fingers are extended.
4) The shoulder is then passively taken into further shoulder abduction and elbow flexion while maintaining the wrist and finger position. Stop when symptoms are reproduced or worsened.
5) If symptoms are produced ask the patient to actively side-bend away from the side of symptoms (this may exaggerate the symptoms). Then have the patient side-bend the neck toward the side of symptoms (this may reduce symptoms). The ipsilateral neck side-bending is referred to as a ‘sensitizing’ movement.
Cervical spine: What is the purpose of the third Upper Limb Neurodynamic test for the ulna nerve (ULNT3)?
The upper limb neurodynamic tests are designed to place stress on the neurological structures in the upper limb by placing them under tension
Cervical spine: What is a positive finding of the third Upper Limb Neurodynamic test for the ulna nerve (ULNT3)?
This test is considered positive if the patient reports the reproduction of radicular symptoms in the upper limb.
Thoracic Spine: Describe the Adson Manoeuver
1) The practitioner locates the radial pulse on the side to be tested.
2) The patient is asked to rotate the neck over the shoulder on the test side and move the neck into extension (chin up).
3) The practitioner extends the shoulder on the side to be tested and externally rotates the shoulder while continuing to palpate the radial pulse.
4) Finally, the patient is asked to take a deep breath and hold it (no time specified).
Thoracic Spine: What is the purpose of the Adson Manoeuver
This test is used to assess for potential thoracic outlet syndrome.
Thoracic Spine: What is a positive finding of the Adson Manoeuver?
The test is considered positive if the pulse disappears and/or symptoms are reproduced in the upper limb.
Thoracic Spine: Describe the Costoclavicular (Miltary Brace) Test
1) The practitioner locates the radial pulse on the side to be tested.
2) The practitioner then takes the patient’s upper limb into extension and depresses the shoulder girdle, while maintaining contact over the radial pulse for observation.
Thoracic Spine: What is the purpose of the Costoclavicular (Miltary Brace) Test?
This test is used to assess for potential thoracic outlet syndrome
Thoracic Spine: What is a positive finding for the Costoclavicular (Miltary Brace) Test?
This test is considered positive if the pulse disappears and/or the patient reports a reproduction of the upper limb symptoms
Thoracic Spine: Describe the Wright Test
1) The practitioner locates the radial pulse on the side to be tested.
2) The practitioner then takes the patient’s upper limb into abduction to 90 degrees, horizontal extension/abduction, and flexion of the elbow to 90 degrees.
3) In some texts the patient is asked to rotate the neck to the contralateral side (observe for symptom reproduction and/or loss of pulse.
4) For the original Wright test the shoulder is taken into full elevation.
Thoracic Spine: What is the purpose of the Wright Test?
This test is used to assess for potential thoracic outlet syndrome
Thoracic Spine: What is a positive finding for the Wright Test?
This test is considered positive if the pulse disappears and/or the patient reports a reproduction of the upper limb symptoms.
Thoracic Spine: Describe the Roos (Aka: The elevated Arm Stress) Test
1) The patient stands and abducts the shoulders to 90 degrees, laterally rotates the shoulders and flexes the elbows to 90 degrees (surrender position)
2) The patient is asked to open and close the hands repetitively for up to 3 minutes or until symptoms are reproduced/exacerbated.
Thoracic Spine: What is the purpose of the Roos (Aka: The elevated Arm Stress) Test
This test is used to assess for potential thoracic outlet syndrome
Thoracic Spine: What is a positive finding of the Roos (Aka: The elevated Arm Stress) Test
This test is considered positive if the patient is unable to hold this position for 3 minutes, suffers ‘ischaemic’ pain, heaviness, or profound weakness of the arm, or numbness and tingling of the hand(s).
Thoracic Spine: Describe the Reflex Hammer Test
1) The patient is seated on the treatment table
2) The practitioner taps over the spinous process at the level of interest with the reflex hammer.
Thoracic Spine: What is the purpose of the Reflex Hammer Test
This test is used to assess for potential vertebral fracture
Thoracic Spine: What is a positive finding of the Reflex Hammer Test
Localized pain with the tapping of the vertebra may indicate a potential fracture of the vertebra. Further imaging may be advised to help rule out vertebral fractures.
Thoracic Spine: Describe the Rib Spring Test
1) The patient is lying prone on the treatment table
2) The practitioner places the extended thumb and adjacent finger along the angle/shaft of the rib to be tested and applies a posterior-anterior force through the rib.
3) The practitioner then places the ulnar surface of the other hand over the region of the transverse process on the other side of the spine to ‘prevent rotation’ of the vertebra, attempting to block rotation of the segment.
4) The springing motion is then repeated while this pressure is maintained on the other side of the spine.
Thoracic Spine: What is the purpose of the Rib Spring Test
This test is used to assess for a potential costotransverse or costovertebral contribution to the patient’s thoracic pain.
Thoracic Spine: What is a positive finding of the Rib Spring Test
If the second springing motion (providing blocking of movement) is painful but the first is not this may suggest a costotransverse or costovertebral source of pain
Skin: what are the six descriptors for describing a lesion
Number Colour Size Shape(&otherdescriptors) Arrangement Distribution
Skin: lesions; name Non-palpable lesions:
<1cm are macules >1m patch
Skin: lesions; name palpable elevated lesions:
Papule <1cm
Plaque >1cm
Nodule >1cm and has depth
Tumor solid mass>1cm
Wheal superficial localized oedema
Vesicle fluidfilled,<1cm
Bulla fluid filled, >1cm
Pustule pus filled
Skin: lesions; name depressed skin lesions
Erosion loss of superficial dermis
Excoriation erosion from scratch
Fissure linear crack
Ulcer deeper loss epidermis & dermis
Atrophy thinning, loss of bulk