The Cervical Spine Flashcards by Salma Elsayed

In addition to the usual items, what else should the PT ask a patient experiencing cervical spine pain? (6)

How many and what type of PILLOWS does the patient use when sleeping?
What POSITIONS does the patient adopt when sleeping?
Does the patient experience DIZZINESS with cervical movements?
Does the patient have HEADACHES?
Does the patient have symptoms in the area of the shoulders or TMJ?
Does the patient have any numbness or tingling in the hands or feet?

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The pillow should support the cervical spine in the _____ position.

NEUTRAL

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True or False: Pts. with normal spinal curves should sleep with no pillow or a flat pillow in supine but have more support from a pillow in side lying.

TRUE

The neck should be kept in a neutral position

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Patients with an increase in their _____ curve need to use a _____ pillow when lying supine.

Kyphotic

2. Thicker

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What 2 sleeping positions are not advisable for patients with cervical spine pain? Why?

Prone lying: forces neck into rotation for prolonged periods of time
Lying in fetal position: positions spine into too much flexion

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What 2 diagnoses may a patient that reports dizziness with cervical movements present with?

Cervical artery insufficiency

2. Middle ear/vestibular problem

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How can a PT differentiate between cervical artery insufficiency vs a middle ear/vestibular problem?

Instruct the patient to rotate the trunk while keeping the head forward in standing position
No reproduction of symptoms = middle ear problem (fluid in semicircular canal not changing)
Symptoms reproduced = vertebral artery problem (neck is moving into rotation)

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A problem with C1 can refer pain to the ____ , C2 to the _____, and C3 to the _____.

C1 = top of the head 
C2 = temporal area
C3 = occiput

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Neck problems commonly refer pain to the _____.

SHOULDERS

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Regional interdependence exists between the neck, ____, and ___.

Shoulders

TMJ

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What diagnosis may be indicated by numbness and tingling in the hands?

Space-occupying lesion in the intervertebral foramen

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What diagnosis may be indicated by numbness and tingling in the feet?

Spinal cord lesion

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In addition to the usual items, what 5 things should be observed in patients with cervical spine pain?

Forward head posture
Protracted scapulae
Increased/decreased cervical lordosis
Breathing Pattern
Antalgic gait

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What may walking with a wide base of support and heavy footed gait indicate the loss of? (2)

Loss of proprioception

2. Loss of sensation/motor control due to a lesion of the spinal cord

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List 5 signs/sxs associated with cervical myelopathy.

At least 3 of the following are present:

Antalgic gait, gait with wide base of support
Positive Babinski
Positive Hoffman’s
Inverted brachioradialis reflex = inverted supinator sign: present when the brachioradialis reflex elicits finger flexion and not elbow flexion
Age > 45

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List 4 things to check for when assessing cervical AROM in sitting.

Quality/smoothness of movement
Segmental location of an increase/decrease in motion
Symmetry of motion into side bending/rotation
Deviations to left/right with forward bending

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How is AROM of the upper cervical spine assessed in sitting?

Instruct the patient to poke the chin out (backward bending) and pull the chin in (forward bending = axial extension)

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What position must the patient be in when assessing PROM of the cervical muscles? Why?

SUPINE

The joints are not weight bearing in supine.

How is PROM of the upper cervical spine assessed in supine? Why?

Rotation by forward bending the entire cervical spine to the end range, and then rotating the neck, comparing left rotation to right rotation
Forward bending the neck locks the lower cervical joints, thus most of the motion into rotation occurs at the upper cervical spine.

One half of cervical spine rotation occurs at the____ cervical spine, so the patient should rotate about ____ degrees in each direction.

Upper

2. 45 degrees

What are the 4 accessory motions at the cervical spine?

Forward bending
Backward bending
Left Rotation
Right Rotation

What 2 things are examined to evaluate if facet joint hypomobility is present?

2. Accessory Motion

Motion in the____ cervical spine is BELIEVED to be coupled such that _____ and _____ occur to an equal extent to the same side

Lower
Side bending
Rotation

What ROM limitation should one expect to see if there is unilateral hypomobility at the left facet joints that restrict upward and forward gliding?

Decrease ROM into forward bending, right rotation and right side bending, with deviation to the left with forward bending.

What ROM limitation should one expect to see if there is unilateral hypomobility at the left facet joints that restrict downward and backward gliding?

Decrease ROM into backward bending, left rotation and left side bending, with deviation to the right with backward bending.

What 4 signs and symptoms make up the clinical prediction rule for diagnosing cervical radiculopathy/nerve root irritation?

1. Positive Spurlings Test 2. Decrease in symptoms with cervical distraction (up to 30 pounds) 3. Ipsilateral cervical spine rotation less than 60° 4. Positive Upper Limb Tension Test (ULTT 2A) (neural tension test (shoulder abduction and lateral rotation, elbow extension, wrist and finger extension, neck side bending)

What 5 things make up the Canadian C-Spine Rules for acute cervical fractures?

Indicated with patients with an ACUTE cervical spine injury who demonstrate 1 or more of the following signs or symptoms: 1. Not cognitively intact or have neurological symptoms 2. Aged 65 or older 3. Fearful of moving the head on command 4. Involved in a distraction-based injury 5. Midline neck pain

List 3 surgical procedures that can be performed at the spine.

1. Laminectomy 2. Discectomy 3. Fusion

True or False: Manipulation effects are specific to a particular joint, leading to a change in alignment and long term changes in joint mobility.

FALSE 1. Manipulation effects are not specific to a particular joint 2. There is no change in alignment after a spinal manipulation 3. Most likely, there is no long-term change in joint mobility

What are 2 non specific effects of spinal manipulation that may explain successful treatment effects?

1. Placebo | 2. Patient expectation

How can PTs explain the effects of manipulation to their patients?

Explain that stimulation introduced to the CNS by manipulation therapy may help the brain ‘down regulate’ the perceived threat of current stimuli and thus decrease the pain by means of descending inhibition and other peripheral and central mechanisms

What impairment can occur, although RARE, as a result of cervical spine manipulation?

Cervical arterial dissection

What is cervical arterial dissection?

Tear in the wall of one of the blood vessels in the neck.

Cervical arterial dissection is a major cause of _____ in young adults (<45)

Ischemic stroke

What 2 arteries are typically affected by cervical arterial dissection?

1. Internal carotid (ICAD) | 2. Vertebral (VAD) artery

What is the incidence of cervical arterial dissection as a result of cervical manipulations?

~ 1.3 per 100,000

What percentage of cerebral blood flow is supplied by the vertebral artery?

11%

What area of circulation is the vertebral artery responsible for supplying? How can you stress the vertebral artery?

1. Posterior cranial circulation | 2. Greater stress with upper cervical rotation

What percentage of cerebral blood flow is supplied by the carotid artery?

89%

What area of circulation is the carotid artery responsible for supplying? How can you stress the carotid artery?

1. Anterior cranial circulation | 2. Greater stress with mid cervical extension

List 10 risk factors for cervical artery dissection.

1. Age 30 – 45 2. Atherosclerosis 3. Diabetes 4. Recent infection 5. Migraine 6. Hypertension 7. Hypercholesterolemia / hyperlipidemia 8. Oral contraceptive use 9. Trauma 10. Genetic (connective tissue diseases such as Ehler’s Danlos Syndrome)

List 6 screening guidelines for cervical artery dissection.

1. Identify potential risk factors 2. Proceed with ROM testing if not signs/sxs for dissection present 3. Apply incrementally greater movements and loads during PT exam 4. Monitor pts signs/sxs during and after manipulation/treatment procedures 5. Avoid cervical manipulation during the first week of therapy if the pt is >45 years old with a recent neck or head injury 6. Consider using pre-manipulation holds

True or False: High quality evidence supports the use of manual therapy in the management of patients with nonspecific neck pain

TRUE

True or False: Cervical thrust and non-thrust techniques may not be equivalent

FALSE They are considered to be EQUIVALENT in effects.