Unit 1 Weeks 1-2 Flashcards
what is considered the upper cervical spine?
occiput, C1, C2 and sometimes C3
what is considered the mid cervical spine?
C3, C4, C5
what is considered the lower cervical spine?
C4, C5, C6, C7
what is the C-T junction?
C5 or C6, C7, T1, T2
what is the cranio-cervical junction?
upper cervical spine or junction between C1, C2
what are the three parts of the vertebrobasilar artery?
proximal: can be compressed by muscles such as the anterior scalene
transverse: through the transverse foramen, susceptible to osteophytes and subluxation
suboccipital: sigmoid path, cranio-cervical motion
what are the 4 parts of the suboccipital portion of the vertebrobasilar artery?
in the transverse foramen of C2, between C1 and C2, inside the transverse foramen of C1, and between the atlas and the foramen magnum
where do spinal nerves C1-C7 exit?
above their corresponding spinal segment
where does spinal nerve C8 exit?
below the C7 vertebra
what is “opening” in the cervical spine? what motions cause this?
-gap facet joint and open intervertebral foramen where the spinal nerve roots exit
-flexion, contralateral flexion (side bend away), contralateral rotation (rotate away)
what is “closing” in the cervical spine? what motions cause this?
-compress the cervical facets and close down the intervertebral foramen
-extension, ipsilateral flexion (side bend towards), ipsilateral rotation (rotate towards)
what are some risk factors of neck pain?
female
prior history of neck pain
older age
high job demands
smoking history
low soc/work support
LBP history
when does the most rapid recovery occur for those with neck pain?
in the first 6-12 weeks; little recovery after 12 months
what are the prognostic indicators for neck pain?
high pain
high reported self-disability
high pain catastrophizing
high acute PTS
cold hyperalgesia
prior health: exercise, neck pain, sick leave
age
other MSK conditions
what are the red flags associated with spinal fractures?
major trauma
sever limitation during neck active ROM in all direction
what are the red flags associated with cervical myelopathy?
sensory disturbance of the hands
muscle wasting of hand intrinsic muscles
unsteady gait
hoffmann reflex
hyperreflexia
bowel and bladder disturbances
multisegmental weakness, sensory changes, or both
what are the red flags associated with neoplastic conditions?
age over 50 years
previous history of cancer
unexplained weight loss
constant pain, no relief with bed rest
night pain
what are the red flags associated with upper cervical ligamentous instability?
occipital headache and numbness
severe limitation during neck AROM in all directions
signs of cervical myelopathy
what are the red flags associated with vertebral artery insufficiency?
drop attacks
dizziness or lightheadedness related to neck movement
dysphasia
dysarthria
diplopia
positive cranial nerve signs
what are the red flags associated with inflammatory or systemic disease?
temperature > 100F
blood pressure > 160/95 mmHg
resting pulse > 100bpm
resting respiration >25bpm
fatigue
according to the Canadian cervical spine rule (CCR) what is considered low risk and does not require acute imaging?
- able to sit in the ED, or
- simple rear-end MVA, or
- ambulatory at any time, or
- had delayed onset of neck pain, or
- do not have midline spine tenderness…
- and, are able to rotate head 45 degrees each direction
according to the Canadian cervical spine rule (CCR) what is considered high risk and does require acute imaging?
- > 65 years age, or
- dangerous MOI, or
- have paresthesia in extremities
what are the causes/risk factors of VBI?
traumatic cervical hyperextension with or without rotation, cervical side flexion
atherosclerotic involvement, sickle cell disease, rheumatoid arthritis, arterial fibroplasias, arteriovenous fistula, other congenital syndromes
what are the 4 classifications of neck pain?
mobility deficit, headache, radiating pain, movement coordination impairment
what are the common symptoms of neck pain with mobility deficits?
central and/or unilateral neck pain
limitation in neck motion that reproduces symptoms
referred should girdle or upper extremity pain
what are the common symptoms of neck pain with movement coordination impairments?
MOI linked to trauma or whiplash
referred shoulder girdle or UE pain
varied nonspecific concussive signs and symptoms
dizziness/nausea
headache, concentration, or memory difficulties; confused; hypersensitivity to mechanical, thermal, acoustic, odor, or light stimuli; heightened affective distress
what are the common symptoms of neck pain with headache?
non-continuous, unilateral neck pain and referred headache
headache is precipitated or aggravated by neck movements or sustained postures
what are the common symptoms of neck pain with radiating pain?
neck pain with radiating pain in the involved extremity
UE dermatomal paresthesia or numbness, and myotomal muscle weakness
what is the most common serious adverse event?
craniocervical artery dissection
what is the most common site for an acute arterial dissection in PT treatment?
vertebral artery
what are the common signs/symptoms of craniocervical vascular pathology?
neck pain, headache, facial pain
what are the risk factors for a dissecting stroke?
recent trauma, vascular anomaly
what are the risk factors for a non-dissecting stroke?
current or past smoker, HTN, high cholesterol
what are the 5D’s and 3N’s?
dizziness, diplopia, drop attacks, dysphagia, dysarthria
nausea, numbness, nystagmus
what cranial nerves are purely sensory?
1 (smell), 2 (vision), 8 (hearing, equilibrium)
what cranial nerves are purely motor?
3, 4, 6 = control pupillary constriction and eye movements
11, 12 = innervate trap, SCM and tongue
what cranial nerves have mixed sensory and motor?
5 (chewing), 7 (facial expression), 9 (swallowing), 10 (swallowing and vocal sounds)
what do you differentiate if dizziness is caused by the vestibular system or other causes?
vestibular = dizziness when the head moves but not when the head is kept still
what observation should be done with performing a cervical exam?
gait pattern, gross coordination, balance, and muscle atrophy/wasting (especially bilateral)
what is proximal crossed syndrome?
-Elevated, protracted shoulder girdle
-Rotated, abducted, winged scapula
-Forward head
-Decreased GHJ stability
-Increased Lev Scap & Trap activity
-Shortened Pec major & minor, SCM
-Weak/lengthened DCFS, rhomboids, serr ant, lower trapezius
what is a closing restriction?
flexion + side bending towards + rotation towards
what is an opening restriction?
flexion + side bending away + rotation away
what position should PROM be performed? AROM?
PROM = supine
AROM = sitting
what does the cervical flexion-rotation test look for? what is a positive test?
A-A rotation motion
<32 degrees rotation or 10 degree visual deficit to either side
what does the cranial cervical flexion test look for? what is a positive test?
test the action of the 4 deep cervical flexors
unable to perform, uses superficial cervical muscles, can’t control force
what muscles should be palpated in a cervical exam?
suboccipitals, lev scap, upper trap, scalenes, pec major and minor
also - rhomboids, middle trap, lower trap, and thoracic paraspinals
what may be occurring if deep tendon reflexes are hypo-reflexive in a particular reflex distribution?
radiculopathy
what may be occurring if deep tendon reflexes are hyper-reflexive in a particular reflex distribution?
UMN disorder
what are the 4 tests in the test cluster for radiculopathy?
restricted cervical rotation
(+) ULTT 1 median nerve
(+) spurling’s test
(+) cervical distraction
what are the 4 special tests for craniocervical instability?
modified sharp purser
anterior shear test
lateral/transverse shear
alar ligament stress test
what are the indications for stability testing of the craniocervical region?
history of neck trauma
pt report of neck instability (head feeling heavy)
presence of signs and symptoms: lump in throat, lip paresthesia, nausea or vomiting, serve headache and muscle spasm, dizziness
what is the difference between localized, referred, and radicular pain?
localized: in the spot of pressure
referred: pain in diffused area that is distant from pressure
radicular: pain following nerve root pathway
what is the diagnostic criteria required to diagnose cervicogenic headache?
unilateral pain, pain in neck triggered by movement or sustains postures, lying down will alleviate symptoms, reduced ROM, possible reduced deep neck cervical flexor strength, probable poor posture which increases stress on cervical musculature
what are the 4 types of headaches?
cervicogenic, migraine, muscle tension, cluster
what is spondylosis?
describes varying levels of degenerative changes in the spine (arthritis, cervical disc disease, DDD, arthrosis)
what is the clinical presentation of spondylosis?
gradual onset of neck or arm symptoms
increased frequency or severity
morning stiffness of neck, improving throughout day
may present with acute stiff neck, cervical myelopathy, and vertebrobasilar insufficiency
what are the common physical exam findings of spindylosis?
reduced motion in sagittal plane
decrease in SB
capsular pattern
possible “giving way” or a catch in movement
radicular symptoms
what is zygapophyseal joint dysfunction; cervical facet syndrom? MOI?
acute cervical joint lock, or “wry neck”
axial, unilateral pain “neck locking”
MOI: sudden closing motion or sustained position
what are the levels of degenerative disc disease?
small bulge > protrusion > extrusion > sequestration
what is the degenerative process of DDD?
reduction of mucopolysaccharides in NP > increase of collagen in NP > loss of disc bulk, turgor and ability to resist compression
what is the MOI for cervical radiculopathy?
associated usually with degenerative changes, disc herniation
what is the MOI of cervical myelopathy?
spinal cord compression due to compressive or tensile forces
what are the early signs of myelopathy?
gait disturbances, clumsy hand syndrome (bilateral hand atrophy), Lhermitte’s sign, spastic paresis (lower>upper), puri-segmental sensory involvement
drop attacks, autonomic disturbances, vertigo
what is the difference between myelopathy and radiculopathy?
myelopathy: bilateral, multilevel weakness in legs and or arm, usually no sensory component, hyper-reflexia, UMN reflexes
radiculopathy: unilateral weakness (not multilevel), unilateral sensation disturbance, +ULTT, depressed DTR’s (single level)
what is cervical instability? MOI?
an inability for the cervical spine to maintain correct alignment and limit pattern of displacement from normal physiological loads
MOI: trauma, surgery, systemic disease, tumors, degenerative changes
what are the main signs of cervical instability?
history of major trauma
catching/locking/giving way
poor muscular control
excessively free/loose end feel
unpredictability of symptoms
spondylolisthesis
what is the MOI of whiplash associated disorders?
MVA
sporting injuries involving blow to head or neck, or a heavy landing
trauma to neck or body
pulls and thrust on the arms
falls, landings, on the trunk or shoulder
what are the common clinical findings of whiplash associated disorders?
central nervous system signs, periodic loss of consciousness, pt does not move neck, painful weakness of neck muscles, gentle traction and compression are painful, severe muscle spasm, complaints of dizziness
what are the prognostic factors for WAD?
risk factors for persistent problems
high neck pain intensity
high self-report disability
high post-traumatic stress symptoms
strong catastrophic beliefs
cold hyperalgesia
