Student Questions: Cervical ME and CS Flashcards
A 42 year old male presents to your clinic with neck pain for the past 4 weeks. He says that he has worked at a desk all day for the past 15 years. Patient tests positive for a red reflex and tenderness in the cervical spine. He tests negative for the Spurling maneuver on both sides and denies any recent trauma directed to his neck. When checking his cervical range of motion, the patient has no restriction in any plane in the middle and lower neck but you note restriction in flexion of the head. Between what two structures is this patient’s dysfunction?
A. C1 and C2
B. Occipital condyles and C1
C. C3 and C4
D. C6 and C7
E. C4 and C5
A 20 year old male presents to your office at the student health clinic with complaint of neck pain that has been worsening over the past three weeks. He is a new college student and says that he has a big exam coming up and has been studying late, to the point that he has been falling asleep on his textbooks at the library. He does not drink and is not taking any prescribed medications. He does admit to using Adderall “occasionally.” He does not have any history of back or neck injuries and he has never had previous OMT treatment. You assess TART criteria and find that there is a persistent red reflex on the right side, and also note that the patient has difficulty rotating his head to the left. Upon inspection you find that C4 has a hard end feel when translating the lateral edge of the left articular pillar to the right. Motion does not improve in flexion or extension. When treating with post-isometric muscle energy, what is the starting treatment position?
A). C4 NSLRL
B). C4 FSLRL
C). C4 ESLRL
D). C4 NSRRR
E). C4 NSLRR
Over the weekend, a 34 y/o female worked as a chair umpire for several Wimbledon matches. She presents to your primary care office now with significantly reduced range of motion continuing over the last 3 days and points to the base of her skull when describing the pain while denying any numbness, tingling or weakness in her extremities. She states it is similar to a headache without radiation and occurs primarily when rotated to the left. The pain only gets better when she is resting or takes NSAIDs. During the matches, she says there was no impact/trauma to her head, just a lot of ball watching. During the physical exam, the physician notices in the patient a decreased range of motion of 20-30º when patient rotates head to the left with no indications of trauma with no neurological deficits in vision or sensation. What is her diagnosis and what is the proper post-isometric muscle energy technique?
A. OA NSRRR, OA NSLRL
B. AARR, AARR
C. OA ESLRR, OA ESLRR
D. AARR, AARL
E. C6 ESRRL, C6 ESLRR
A 20 year old female presents to your family practice clinic with a complaint of neck pain that started about a week ago. She says the pain began as a slight pinching on her left neck that only lasted a few hours, over the last 2 days the pain has become much more intense and feels like it is shooting onto her left shoulder. The patient denies any trauma or illness, the patient also says she is on her phone most of the time during the day, for her work as a social media influencer. You decide to perform a test for nerve root compression in the cervical spine. You first start by putting the patient into neutral compression. What would be the most appropriate next step(s) for conducting this test?
A.) Along with axial compression: flexion, side bend right, side bend left
B.) Along with axial compression: flexion, side bend left, side bend right
C.) Along with axial traction: flexion, side bend left, side bend right
D.) Along with axial traction: extension, side bent left, side bend right
E.) Along with axial compression: extension, side bent right, side bend left
F.) Along with axial compression: extension, side bent left, side bend right
A 23-year-old male presents to your primary care clinic with complaints of neck pain. He states that the pain began after he was involved in a motor vehicle accident approximately 2 weeks ago. Initial screening at the ED ruled out possible fractures or nerve damage. During examination, you notice that the patient’s C3 vertebra is restricted when translating from left to right. This restriction is alleviated when the patient is placed into flexion. What is the somatic dysfunction for this patient?
A. C3 FRRSR
B. C3 ERLSL
C. C3 NRRSR
D. C3 FSRRL
E. C3 FSLRR
A 25-year-old male presents to the walk-in clinic with a complaint of a sore neck. He states that he woke up with sore neck 2 days ago after a spending time at the gym powerlifting. This pain has been constant and he only gets mild relief with ibuprofen. Upon physical examination, you find that there is a hard end feel when translating from left to right at C3. Translation from left to right improves with extension. What is your diagnosis at C3?
A. NRrSr
B. ERlSl
C. ERrSr
D. FRrSr
E. FRlSl
A 25 year-old male comes in to your family practice clinic complaining of neck stiffness for the past week. He states the stiffness began after he spent 8 hours gaming with his new virtual reality headset. He denies any other symptoms besides the neck stiffness. After inspection of the area of complaint and assessing for any TART criteria, you test the motion of the neck and determine: There is a hard-end feel when you translate the lateral borders of the articular pillars of C6 from right to left. This hard-end feel improves in flexion. In what position would you place the patient to begin Muscle Energy treatment?
A. FRRSR
B. ERRSL
C. ERRSR
D. FRLSR
E. NRRSR
Cervical Diagnosis and Muscle Energy: A 23 year old female presents to your OMT clinic with complaints of right neck pain. She claims that the pain is due to constant studying for medical school. This started at the beginning of the school’s cardiovascular block, approximately 1 week ago, when she “slept wrong atop her books”. The patient denies loss of consciousness, nausea, vomiting, numbness, or tingling. The patient does not have a previous history of neck pain or injuries. During physical exam, you note a hard end feel when translating the left lateral articular pillars of C3 from left to right. This hard-end feel does not improve or worsen in flexion or extension. Based on cervical diagnosis principles, how would you position this patient for cervical muscle energy?
A. F RRSL
B. N RRSR
C. N RLSL
D. E RLSR
E. N RRSL
Cervical Diagnosis and Muscle Energy: A 23 year old female presents to your OMT clinic with complaints of right neck pain. She claims that the pain is due to constant studying for medical school. This started at the beginning of the school’s cardiovascular block, approximately 1 week ago, when she “slept wrong atop her books”. The patient denies loss of consciousness, nausea, vomiting, numbness, or tingling. The patient does not have a previous history of neck pain or injuries. During physical exam, you note a hard end feel when translating the left lateral articular pillars of C3 from left to right. This hard-end feel does not improve or worsen in flexion or extension. Based on cervical diagnosis principles, how would you position this patient for cervical muscle energy?
A. F RRSL
B. N RRSR
C. N RLSL
D. E RLSR
E. N RRSL
A 25-year-old male medical student presents to your family practice clinic with complaints of a headache at the “back of his head” and intermittent “ringing in his ears”. He states the pain began after staying up all night last night studying for his OPP practical slouched over his desk. Patient denies any neck or head injuries or history of tension headaches. Physical examination reveals normal range of motion in rotation, but limited flexion/extension and side bending to the left. Patient does not have a fever, there is no bulging of the tympanic membrane, and oropharynx examination is unremarkable. Osteopathic exam reveals tenderness on the inferior aspect of the spinous process at C2. Which of the following describes the correct tender point diagnosis and treatment position.
A. AC2; ESARA
B. PC2; ESARA
C. PC3; FSARA
D. AC2; FSARA
E. PC3; FSTRA
A 24 year old female patient presents to clinic for her annual wellness exam. She complains of right-sided neck pain which began a week ago. Her pain worsens with flexion and left head rotation. Patient states that she is reading more often due to an increased workload at school and has been experiencing higher stress levels as a result. Upon physical exam, you elicit tenderness at the posterosuperior surface of the right clavicle. How would you position the patient’s head and neck for treatment of her tenderpoint?
A. Extension, Side-bent away, Rotated away
B. Flexion, Side-bent away, Rotated away
C. Rotated away
D. Flexion, Side-bent toward, Rotated away
E. Extension
A 22 year-old female presents to the family practice clinic with complaints of neck pain when looking down at her phone for the past month. She denies numbness, weakness, or tingling in her arms. Upon physical examination, range of motion of the neck is normal and there is tension in the right paraspinal muscles. The physician elicits a tender point at the right inferior lateral border of the C2 spinous process. What is the treatment position for this somatic dysfunction?
A.) Flexed, sidebent left, rotated left
B.) Extended, sidebent left, rotated left
C.) Extended, sidebent right, rotated left
D.) Extension
E.) Flexed, sidebent right, rotated left
A 24 year old female presents to your family medicine clinic with complaints of neck pain, mainly on the right side. She states that the pain began after she was in a car accident two weeks ago, where a car slammed into the back of her and she recalls her head jerking forward and hitting her ejected air bag. She states the pain is sharp and has been consistent over the past two weeks and has not been alleviated with ice, heat, or ibuprofen. Right after the accident she went to the emergency room and it was confirmed with an X-Ray and CT scan that there were no cervical fractures, as well as no cervical dislocations. It was also confirmed by MRI that there was no nerve damage. After obtaining a full history and performing TART criteria, the anterior and posterior tender points on both the right and the left side of the neck were assessed in the clinic, and with verbalization from the patient using a 0/10 pain scale with 10 being the most painful, the most tender point was found on the right side of inferolateral aspect of the C2 spinous process. What position would the physician position the patient in to treat this tender point?
A. Rotation Away
B. ESARA
C. Extension
D. FSARA
E. FSTRA
F. Flexion
A 35 y.o. caucasian male presents to your family practice clinic six weeks s/p MVA with complaints of neck pain likely from whiplash during his car accident. He states his head was jolted anterior to posterior during impact. His pain shortly began after the incident and has continued since. He also reports difficulty sleeping due to discomfort on his left side. He denies weakness, numbness or paresthesias of the upper and lower extremities. Motion testing of the neck during physical examination reveals pain during active rotation to the left and flexion. Upon palpation the patient is tender with pressure applied to the infero-lateral portion of the spinous process of C3. XR imaging reveals no acute boney abnormalities. Which of the following treatment positions will you place the patient in for counterstrain treatment of this tenderpoint?
A. ESARA
B. FSARA
C. FSTRA
D. Marked Rotation Away
E. Counterstrain is contraindicated for this patient
A 25 y.o. female presents to your family practice clinic complaining of pain in the back of her neck that started approximately 1 week ago. She states that she recently moved into her apartment and the mattress delivery was delayed so she’s been sleeping on the floor on an air mattress while using a blanket as a makeshift pillow. She denies any pain, weakness, or numbness in her shoulders, back, and upper and lower extremities. You assess her neck musculature using TART criteria and notice several hypertonic areas. Further testing reveals that the patient has pain radiating down her neck when palpating the lateral aspect of the transverse process of C1 and tenderness without radiation when palpating the anterolateral aspect of the anterior tubercle of the transverse process of C2. Physical examination of the heart, lungs, and abdomen are normal. What counterstrain tender point is this and what is the classic treatment position?
A. AC 1 Lateral, RA
B. AC 1 Lateral, FSARA
C. AC 2, ESARA
D. AC 2, FSARA
E. PC2, ESARA
A 47 year-old female presents to your clinic for her annual physical. Upon updating her health history, she states that her desk job has been giving her a, “pain in the neck,” for the past three months. When asked specifically where the pain is felt in the neck, she points under her earlobe on her left. She has no numbness or tingling, and she doesn’t note any alleviating factors though the area is aggravated when touched or working at her desk. Upon palpation during your physical exam, a tenderpoint is found at the location to which the patient originally pointed, with force applied in lateral to medial direction. In what treatment position would you place the patient for a counterstrain technique used in such a setting?
A. Rotation right with slight fine tuning of flexion
B. Flexion, sidebending left, rotate left
C. Extension, sidebending right, rotate right
D. Rotation left
E. Sidebending right with slight fine tuning
A 32-year-old male comes into your clinic complaining of neck pain with onset following a motor vehicle accident two weeks ago, where he was rear-ended by another car. He denies any radiating symptoms into his arms, to include numbness, pain, tingling or weakness. He notes that he has tried Ibuprofen, with little relief of symptoms as well as alternating heat and ice. He states he feels only temporary relief with heat. He notes that he has been holding his neck more stiffly because it hurts to “turn or move his head”. Upon examination, you notice significant red reflex bilaterally from C2-C7, though to palpation, the patient is most tender over C3. Motion testing reveals ease of motion in cervical rotation to the right side. You notice restricted motion at C3 when you palpate the lateral articular pillars and induce left to right translation at that segment. You notice this movement at C3 improves with extension of the neck. What is the appropriate treatment position for this patient in order to treat with cervical muscle energy?
A. C3 ERrSr
B. C3 FRrSr
C. C3 FRlSl
D. C3 ERlSl
E. C3 FRlSr
A 28 year old male medical student is seen in the primary care clinic for his annual wellness check. The patient reports mild, but intermittent atraumatic neck pain that began last night. He believes the pain could be related to studying hard for his OPP class for 6 hours the previous day out of fear of disappointing Dr. Rau. He denies fever, sore throat, cough, recent illness or sick contacts, decrease in ROM or neck stiffness, rash, headache, chest or abdominal pain, or recent travel. He has no numbness, tingling, or weakness in his extremities and no contraindications for OMT. His physical exam reveals a well appearing male with a normal HEENT and neurological exam without deficits, a supple neck without lymphadenopathy or mass, and no tenderness along his neck except an anterior cervical tender point at C4. Where did the physician palpate to elicit tenderness and which of the following treatment positions is most appropriate?
A. In the prone patient, palpate the posterior medial aspect of the anterior tubercle of the transverse process at C4. Position the patient in FSARA.
B. In the prone patient, palpate the anterior lateral aspect of the anterior tubercle of the transverse process at C5. Position the patient in FSTRT.
C. In the supine patient, palpate the anterior lateral aspect of the anterior tubercle of the transverse process at C4. Position the patient in FSARA
D. In the supine patient, palpate the anterior lateral aspect of the anterior tubercle of the transverse process at C4. Position the patient in FSTRT.
E. In the supine patient, palpate the anterior lateral aspect of the anterior tubercle of the transverse process at C5. Position the patient in ESARA.
