PT 608

Question 1

What are the 6 Red Flags to screen for with cervical pain patients?

Answer 1

1. Cervical Fracture
2. Upper cervical Instability
3. Vertebral Artery Insufficiency
4. Neoplastic conditions (cancer)
5. Systemic infectious disease (meningitis)
   6 Cervical myelopathy

Question 2

A typical neurological screening exam consists of which 2 types of tests?

Answer 2

1) Nerve conduction tests

2) Provocation/Alleviation tests

Question 3

What 3 components make up nerve conduction tests?1

Answer 3

1. Motor (myotomal)
2. Sensory (dermatomal)
3. Reflexes (spinal cord)

Question 4

What is considered an orange flag for the purposes of 608?

Answer 4

Neck pain with radiculopathy

Important to monitor patient’s symptoms over time

Question 5

What is the difference between radiculopathy and myelopathy?

Answer 5

Radiculopathy = S&S are qualitatively similar to other PNS disorders with segmental distribution of symptoms

Myelopathy = S&S are qualitatively similar to other CNS disorders wth extra-segmental, and often bilateral, distribution below the level of the spinal cord compression

Question 6

Common causes of radiculopathy?

Answer 6

Osteophytes (@ facet joint or uncovertebral joint)
Disc protrusion
Spondylosis

Question 7

Common causes of cervical myelopathy?

Answer 7

Osteophytes
Disc protrusion
Ligamentous buckling
Spondylosis

Question 8

5 test cluster for cervical myelopathy?

Answer 8

1. Age > 45
2. Hoffman’s Reflex (+)
3. Babinski Reflex (+)
4. Inverted supinator reflex (+)
5. Clumsy gait

Question 9

How can you use examination data to tell the difference between radiculopathy and radiculitis?

Answer 9

Radiculopathy presents with impaired nerve conduction (>1 conduction test is + )

Radiculitis presents withOUT impaired nerve conduction and (>1 provocation/alleviation test is + )

Question 10

How can we confirm radiculopathy from nerve conduction testing? Justify using sensitivity and specificity data

Answer 10

If 2 or more conduction tests are (+) we can confirm radiculopathy
Sensation + Reflexes, Sp = 0.96
Sensation + Weakness, Sp = 0.91
Weakness + Reflexes, Sp = 0.98

Question 11

What test, when negative, can we have the most confidence in ruling out cervical radiculopathy?

Answer 11

Upper limb neural tension test A (sensitivity = 0.97)

Question 12

4 test cluster for cervical radiculopathy?

Answer 12

1. AROM rotation <60 deg to involved side
2. Spurling Compression Test A (+)
3. Neck distraction test (+)
4. Upper limb neural tension test A (+)

Question 13

What is the specificity for the cervical radiculopathy test cluster?

Answer 13

4 tests (+), sp = 0.99
3 tests (+), sp = 0.94
2 tests (+), sp = 0.56

Question 14

Based on the 2016 CPG update, what treatment-based classification would be appropriate for a patient who we can confirm radiculopathy?

Answer 14

Neck pain with radiating symptoms

Question 15

Clinical Prediction Rule to identify patients with neck pain likely to benefit from cervical traction and exercise?

Answer 15

1. Age >55
2. (+) Neck distraction test
3. (+) Shoulder abduction test
4. (+) Upper limb tension test A
5. Peripheralization with PA at C4-7