Spine Flashcards
What are the suboccipitals and their actions?
Rectus capitis posterior minor: OA extension
Rectus capitis posterior major extension and ipsilateral rotation
Obliquus capitis inferior: AA ipsilateral rotation
Obliquus capitis superior: extension and lateral flexion
What are the actions of the following anterior neck muscles?
- SCM
- Longus capitis
- Longus Colli
- Anterior scalene
- Middle scalene
- Posterior scalene
- B extension, unilateral lateral flexion and Contralateral rotation
- Flexion and rotation of neck and head
- Flexion and rotation of neck and head
- Elevates 1st rib or ipsilateral lateral flexion and Contralateral rotation of neck if rib is fixed
- Same as anterior scalene
- Elevates 2nd rib or lateral flexion of neck
What are the arthrokinematics of the
- Upper cervical spine
- Lower cervical spine
- In neutral: SB and rotate away; in non-neutral: SB and rotate towards
- Flexion and SB same side
What are the Canadian cervical spine rules?
2+ high risk factors need radiograph
- age>65
- Paresthesia in extremities
- dangerous MOI (fall from >1m or MVA>100kpm or with ejection/rollover, bike collision)
Can ROM be assessed? If not, need radiograph
If rotation <45 in either direction need radiograph
What are the ICF classifications for neck pain?
Neck pain with mobility deficits
Neck pain with headaches
Neck pain with movement coordination deficits
Neck pain with radiating arm pain
What is clinical presentation of patient with neck pain with mobility deficits?
<50 years old
acute
Isolated to neck
Decreased cervical ROM
What symptoms do you get with positive tests of the following:
- Sharp Purser’s
- Alar ligament test
- VBI
- ROS of myelopathic symptoms during flexion or decreased symptoms after push
- Delayed C2 movement during exam
- Perceptual changes, fainting
What are predictors that patients will benefit from HVLA for cervical spine?
NDI <11.5 B involvement Not sedentary at work for >5hr/day Feels better while moving neck Did not feel worse when extensing neck Dx of spondylosis without Radiculopathy (4/6 = 89% success with manipulation)
Another study that predicted 4 attributes of patients that would respond well to HVLA of cervical spine:
- Symptoms <38 days
- positive expectation that thrust will help
- Side to side difference ROM > or equal 10 deg
- pain with PA spring test of middle C/S
What are predictors that patients with neck pain will will benefit from HVLA of thoracic spine?
Sxs <30 days No sxs distal to shoulder Reports looking up doesn't aggravate sxs FABQ <12 Decreased thoracic kyphosis at T3-5 C/S extension >30 (3/6 predicted 86% positive outcome)
What are clinical findings of patients with neck pain with HAs?
Unilateral HA with neck and suboccipitals sxs aggravated by neck movements and positions
Provocateur by cervical myofascial and joints
Restricted cervical segmental mobility and restricted cervical ROM
Restricted upper cervical ROM and mobility and decreased DNF
What cervical ROM contributions does C0-1 and C1-2 make?
C0-1 flexion
C1-2 does 50% of cervical rotation (about 45 deg)
Neck flexor endurance test stops when one of the following happens:
Edge of dawn lines across skin fools no longer approximate each other
Subjects head rested of testers hand >1sec
Subjects head lifts off testers hands
Subject unwilling to continue
What are clinical findings for patient with neck pain with movement coordination deficits?
Long standing neck pin (>12 weeks)
Abnormal CCFT
Abnormal deep neck flexor performance
Coordination, strength, endurance deficits of neck and UQ muscles - Longus Colli, middle/lower trapezius, serratus anterior
Flexibility deficits of UQ muscles - scalene S, upper trapezius levator, pectoralis major/minor
Sxs associated with UQ paint
What are clinical findings for neck pain with radiating pain? What are common diagnoses/
Diagnoses: spondylosis with Radiculopathy or cervical disc disorder
UE symptoms provoked by spurring, ULNTT, and decreased with distraction
Decreased cervical rotation (<60)
Signs of nerve root compression
Success with reducing UE sxs with initial exam
What is considered a positive ULNTT?
ROS or side to side difference of >10 degrees of sensitizing joint
What are predictors for short-term success with multimodal approach of treating patients with neck pain with radiating arm pain?
Age <54 Dominant arm not affected Sxs don't worsen when looking down Multimodal treatment included during 50% of visits (traction,manual, DNF) 4/4 = 90% success 3/4 = 85% success
What is the cervical traction CPR?
Reported peripheralization with lower cervical spine mobility testing
Positive shoulder abduction sign
Age > 55
+ ULNTT
Relief of symptoms with manual distraction test
4/5 = 94% success
What is the rule of 3 in the thoracic spine?
SP T1-3 at same level as TP
SP T4-6 1/2 level below TP
SP T7-9 full level below TP
SP T10-12 same level
What is pectoralis major effect on rib cage?
What is serratus anterior effect on rib cage?
Serratus anterior: posterior force on ribs
Pectoralis major: Anterior, lateral,superior force on rib cage
Where can TLJ refer to? Upper T/S?
What is T4-9 called?
What cervical segments can refer to thoracic spine and where?
TLJ refers to hip
Upper thoracic can refer down arms
T4-9 is critical zone
C5-6, C6-7 can refer to upper thoracic spine and inter scapular region
What positions stretch the thoracic sympathetic chain?
Elongated with flexion, Contralateral SB, Contralateral rotation
What are clinical findings of T4 syndrome?
HA, neck pain, UE pain, B stocking glove Paresthesia
What are potential visceral causes of thoracic spine pain?
MI, dissecting thoracic aortic aneurysm, peptic ulcer, acute Cholecystitis, renal colic, acute pyelonephritis
What are clinical findings of thoracic aortic aneurysm?
What are clinical findings of MI?
Thoracic aortic aneurysm: Sudden onset of unrelenting pain not relieved by position
MI: anterior chest pain or heaviness, nausea, pain radiating to back
What is the CPR for coronary artery disease?
Female >/= 65 Male >/=55 Known CVD Pain worse with exercise Pain not producible with Palpation Patient assumes pain is of cardiac origin 3/5 can either rule in or out
What are clinical findings for peptic ulcer?
What are clinical findings for Cholecystitis?
Peptic ulcer: boring, triggered or relieved with eating, prolonged NSAID use
Cholecystitis: R UQ/infra scapular pain, with moderate fever, nausea, vomitting, sxs 1-2 hours after meal
What are predictors of cancer?
> 50 y.o.
History of cancer
Unexplained weight Loss
Failure of conservative therapy
What are predictors of Ankylosing spondylitis?
Stiffness >30 min
Decreased pain with movement, increased pain with rest
Awaken at night during second half of night because of pain
Alternating buttock pain
2 or 3/4
Physical exam shows chest expansion <2.5cm
What are osteoporosis risk factors?
Caucasian History of smoking Early menopause Thin body build Sedentary lifestyle Steroid treatment Excessive caffeine/alcohol consumption
What is normal chest wall ROM?
5cm
What are clinical findings that would suspect presence of infection of disc or vertebrae?
Patient is immunosuppressed
Prolonged fever >100.4
History of IV drug abuse
Hx of recent UTI, cellulitis, pneumonia
What are clinical findings of potential undiagnosed vertebral fracture?
Prolonged use of corticosteroids Mild trauma >50 years Age >70 Know history of osteoporosis Recent major trauma at any age Bruising over spine following trauma
Signs of AAA
Pulsating mass in abdomen
History of atherosclerotic vascular disorder
Throbbing, pulsing back pain at rest or with recumbancy
Age>60
What should patient education include?
- Stay active; avoid bed rest; good pain vs bad pain
- Behavioral education on graded increases in activity
Physiology of pain
What are the layers of meninges?
Dura mater
Arachomater
Pia mater
Treatment based classification for manipulation of lumbar spine:
No sxs distal to the buttock Duration of sxs <16 days Hypo mobility with print test Low FABQ <19 Hip IR >35
Treatment based classification criteria for stabilization
SLR >90 Prone stability test + Age <40 Aberrant movements Increasing episode frequency Hyper mobility with spring test
Treatment based classification for traction
Treatment based classification for specific exercise
Traction: peripheralization of symptoms with no ability to centralize with movement
Specific exercise = directional preference
- centralization with movement in one direction and peripheralization with movements in opposite direction
What are clinical finding with low back pain with mobility deficits?
- pain with movement
- limited mobility
Objective:
Lumbar AROM
Lumbar segment mobility assessment
What are clinical findings with low back pain with related lower extremity pain?
Diagnosis?
Diagnosis: lumbar disk disorder/stenosis LE symptoms related to movement bias (flexion/extension) Objective: Neural screen Side glide/shift assessment if present Lumbar AROM Repeated movement Nerve mobility Lumbar segmental mobility
What are clinical findings of Lumbar paing with radiating LE pain?
Diagnosis?
Diagnosis: lumbar Radiculopathy or radiculitis, HNP LE symptoms not related to a movement Objective: Neural screen Lumbar AROM assessment Nerve mobility assessment Piriformis length and provocation Lumbar segmental mobility
