Spine Study Guide Flashcards
Canadian C-Spine Rules
high risk factors (> 65, dangerous mech, paresthesia)
- yes, radiography
NO –> low risk factors that allow for safe assessment for ROM (can sit, ambulatory, absence of midline tender, delayed onset of pain)
- no, radiography
YES –> B rot > 45
- no, radiography
YES - no radiography
C-Spine Fxs
Jefferson/Burst - C1
Odontoid - C2
Hangman’s - C2 (post aspect, usually w/ lysthesis)
Clay Shoveler’s - spinous process of C6-T2 (hyperflex)
C-Spine Dislocation
more frequent than fx
C - violent flex/rot
E - neck tilted toward side of dislocation
Cervical Myelopathy
Hoffman’s, hyperreflex of brachiorad, gait disturbance, Babinski, > 45
Cervical Radic Test Cluster
Positive - cervical distraction test - spurling's - ULTT median < 60 rot to affected side
Dorsal Scapular
C4-C5
rhomboids, LS
Long Thoracic
C5-C7
SA
Suprascap
C5-C6
infra/supra
Lat Pec
C5-C7
pec maj/min
Musculocutaneous
C5-C7
coracobrach, brach, biceps
Upper Subscap
C5-C6
subscap (upper)
Thoracodorsal
C6-C8
lats
Lower Subscap
C5-C6
subscap (lower), TM
Axillary
C5-C6
ant delt, post TM/delt
Radial
C5-T1
triceps, supinator, brachiorad, forearm ext
Med Pec
C8-T1
pec maj/min
Ulna
C8-T1
2 med lumbricals, med digit profund, intrinsics except thenar
C-Spine X-rays
Lateral (initial) - alignment, spacing soft tissues/vertebrae
A/P - alignment, oblique fx
Odontoid - C1-C2 relationship
Swimmer’s - C7-T1
ADI
3-5 instability
> 7 disruptions of transverse ligament
> 9-10 risk of neurologic injury (often needs surgery)
important with trauma, Down syndrome, RA
Stinger/Transient Quadriplegia (CET)
Associated with cervical stenosis, kyphosis, congenital fusion, cervical instability, herniation, vascular/metabolic abnormalities
C - stretch/traction of brachial plexus; ext w/ root compression, direct blow to plexus
E - weakness, “dead” arm, n/t
T - 1st episode - return after resolution; consecutive - MD visit
C1
D - top of head
M - neck flexion
R - none
C2
D - suboccipital
M - neck flexion
R - none
C3
D - side of neck/jaw
M - lat neck flex
R - none
C4
D - top of shoulders
M - sh elevation
R - none
C5
D - lat delt
M - abd
R - biceps
C6
D - tip of thumb
M - elbow flex, wrist ext
R - brachiorad
C7
D - tip of middle finger
M - elbow ext, wrist flex
R - triceps
C8
D - 5th finger
M - finger flex
R - none
T1
D - ulnar side of forearm
M - finger abd
R - none
Modified Sharp Purser (transverse lig)
> 1 mm translation, neurologic symptoms
Alar Ligament
C2 spinous process doesn’t move to opp side
VAT
dizziness, drop attack, diplopia, dysarthria (talk), dysphagia (swallow)
Cervical Flex/Rot Test
identifies movement dysfunction at C1-C2, restricted ROM, firm resistance
Spurling’s Test
reproduction of pain or cervical radic
ULTT
pain, n/t
Cervical Distraction
symptoms dec w/ distraction
Diaphragm
C4
Heart
T3-T4
Esophagus
T4-T5
Stomach
T8
Small Intestine
T10
Colon
T11
Gall Bladder and Liver
T8-T11
Kidney and Testes
T10-T11
Bladder
T11-L1
Murphy’s Sign
gall bladder, T8-T11
lower border of ribs at medial of lowest angle
McBurney’s Point
appendix
midway between ASIS and umbilicus on R side
Thoracic Pain Conditions
breast cancer, osteoporosis, compression fx, spondylodiscitis, visceral disorders, PE
Scoliosis
Functional - muscle spasm or LLD
Structural - idiopathic, irreversible curve
E - Adam’s bend test, Cobb angle
T - surgery if > 45 deg
R may compromise CP function with inc deg
Scheurmann’s (CET)
C - thoracic kyphosis from wedge fx 5 deg or in 3+ consecutive vertebrae
E - kyphosis w/ or w/o pain, pt tender at spinous process
T - prevention, ext exercises, postural edu
gymnastics and swimming most common
L1
D - iliac crest region
M - psoas (hip flex)
R - none
L2
D - ant thigh
M - psoas (hip flex)
R - none
L3
D - ant lower thigh
M - quads (hip/knee ext)
R - pat tendon
L4
D - medial calf, big toe
M - tib and (knee ext, DF)
R - pat tendon
L5
D - lat leg, ant foot
M - ext hall (DF)
R - none
S1
D - lower 1/2 post calf, sole of foot, lat 2 toes
M - flex hall, gastroc (PF, eve)
R - Achilles
S2
D - post thigh, sole and plantar heel
M - HS
R - lat HS
Red Flags
cauda equine, urinary changes, loss of sphincter tone, dec sacral ext, gait disturbance
Stork Test
pain in area of spondylolisthesis
SLR 30
hip/nerve irritation
SLR 30-60
sciatic nerve irritation
SLR 70-90
SIJ involvement
Kernig’s Sign
back pain indicative of nerve root irritation
Brudzinski’s Sign
lumbar disc involvement or nerve irritation
FABER
pain in inguinal region = hip
pain w/ OP = SIJ
Prone Instability Test (PITT)
test for likelihood pt responds positively to spinal stabilization program
SIJ Provocation Tests
distraction, compression, thigh thrust, SIJ thrust, Gaenslen’s
Spondylolysis (CET)
C - repetitive hyperextension, pars interarticularis defect
E - pain w/ ext, oblique X-ray, “scotty dog”
T - activity modification, rest, possible surgery
AS (CET)
C - inflammatory disease that can cause fusing of spine
E - insidious onset, LBP, < 40 onset, worse in AM, improves with exercise
T - ROM, positioning, NSAIDs
Cauda Equina Syndrome (CET)
C - nerve roots compressed shutting off movement and sensation; herniation, tumor, infection
E - bower/bladder changes, sensation changes, LBP, weaknes
T - ROM, positioning NSAIDs
Disc Herniation (CET)
C - forward bending/twisting (wt lifters, collision sports)
E - dec lumbar motion, abnormal gait, weakness, dec reflexes
T - directional preference, possible surgery
Vertebral Osteomyelitis (CET)
C - bacterial infection
E - pain, febrile, loss of lordosis
T - immob, anti-biotics
CPR Spinal Manip
no pain below knee < 16 days < 19 FABQ \+ PA glide > 35 hip IR
Cluster for Stabilization Exercises
< 40
ASLR > 91
+ PITT
aberrant movement present (catch, painful arc, Gower’s sign)
Cluster for Mechanical Traction
< 21 FABQ
no neuro deficit involvement
> 30
non-manual job
Cluster for Spinal Stenosis
B symptoms leg > back symptoms pain during walking/sitting relief with sitting > 48
