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MSK II > Vertebral Artery > Flashcards

Vertebral Artery Flashcards

1
Q

The vertebral artery supplies __% of blood supply to the brain

A

20%

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2
Q

Name the 5 D’s AND 3 N’s

A 
Dysphagia
Dysarthria
Drop Attacks
Dizziness
Double Vision
Ataxia
Nystagmus
Nausea
Numbness
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3
Q

What are the 5D’s and 3N’s for?

A

Vertebral Basilar Insufficiency

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4
Q

Describe Wallenberg’s position, it’s purpose, and the positive for the test

A

For VBI
The patient is placed in a sitting position.
○ The head is rotated to one side and extension is added. This position is held for 30 seconds.
○ The process is repeated on the opposite side.
○ A positive test is identified by initiation of symptoms such as dizziness, diplopia, dysphasia, dysarthria, drop attacks, nausea, and nystagmus.

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5
Q

Describe the VBI test and its positive

A

end range rotation without extension hold 10 secs, return to neutral for 10 seconds, other side for 10 seconds. Dizziness, diplopia, dysarthria, drop attacks, nausea and nystagmus

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6
Q

CPR for Manipulating Cspine(4)

A

■ symptom duration less than 38 days,
■ positive expectation that manipulation will help,
■ side-to-side difference in cervical rotation range of motion of 10° or greater, and
■ pain with posteroanterior spring testing of the middle cervical spine) was identified.

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7
Q

What is the Canadian C-Spine Rules? 6 total

A

○ 1. Are they cognitively intact?
○ 2. Are they under 65 y/o?
○ 3. They can move more than 45d rotation (even if it causes pain)
○ 4. No crazy injury circumstances (distraction/high speeds, etc)?
○ 5. No Pain at rest in midline?
○ 6. No paresthesia in arms following trauma

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8
Q

What are the 3 main tests to check for ligament integrity of the upper cervical spine following the Canadian C-spine rules?

A

Modified sharp purser
Alar ligament stress test
Membrane Test

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9
Q

Name 3 s/s of cervical instability

A 
○	Severe muscle spasms
○	Patient resistant and apprehensive about movement of head (especially into flexion)
○	Lump in throat
○	Lip of facial paresthesia
○	Severe HA
○	Dizziness
○	Nausea
○	Vomiting
○	Soft-end feel
○	Nystagmus
○	Pupil changes
○	**Horner’s syndrome, 
○	RISKY HA’s
■	Thunderclap HA (sudden and severe) or worst HA of your life or HA that is different than any other HA I’ve even had)
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10
Q

What other conditions could mimic VBI?

A

BPPV, Migraines, anemia, menieres, facial palsy

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11
Q

Is pain a positive test for modified sharp purser?

A

No
■ 3 potential “positive findings”
● Movement felt during passive translation
● Symptoms that were present during forward flexion are relieved
● clunk

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12
Q

Tectorial membrane posterior atlanto-occipital membrane test is when the therapist does what?

A

Distracts/traction the neck
AKA longitudinal ligament test.
Best for instability

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13
Q

How do you perform the transverse ligament test

A

Place one hand on the occiput with the index finger on the space between C2 spinous process and occipital protuberance (where the posterior arch of C1 lies). Place the other hand on the forehead. Lift the head straight up in a vertical plane (not flexion, more of a protraction motion). The test is positive if the patient experiences some feelings of weakness, dizziness, numbness, nystagmus, or an odd feeling in the back of the throat. There is normally a firm end-feel.

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14
Q

How do you perform the alar ligament test?

A

Place one hand on the occiput and use the other hand to palpate the spinous process of C2. Laterally flex or rotate the head to one side; you should feel the spinous process move to the opposite side. Repeat on the other side. Absence of the spinous process moving to the opposite side may indicate alar ligament injury. If you block the spinous process of C2 from moving, you may stress the ligament. You should encounter a firm end-feel in this case. Significant movement may indicate ligamentous injury.

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15
Q

Anterior shear or transverse ligament test or sharp pursor or anterior translation stress test or upper cervical flexion test are all names for 1 test(T/F)

A

True

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16
Q

What is the difference between cervical flexion and cervical nodding?

A

Nodding occurs between C0-C1 while flexion occurs between C2-C7

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17
Q

Name that myotome! Neck flexion:

A

C1,C2

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18
Q

Name that myotome! Neck side flexion

A

C3

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19
Q

Name that myotome! Shoulder Elevation

A

C4

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20
Q

Name that myotome! Shoulder Abduction

A

C5

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21
Q

Name that myotome! Elbow Flexion

A

C6

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22
Q

Name that myotome! Wrist extension

A

C6

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23
Q

Name that myotome! Elbow extension

A

C7

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24
Q

Name that myotome! Wrist flexion

A

C7

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25
Q

Name that myotome! Thumb extension

A

C8

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26
Q

Name that myotome! Finger Abduction

A

T1

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27
Q

UMN vs LMN: myelopatyh

A

UMN

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28
Q

UMN vs LMN: Nerve root lesion

A

LMN

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29
Q

UMN vs LMN: peripheral nerve lesion

A

LMN

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30
Q

Name that reflex: C5,C6

A

Biceps

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31
Q

Name that reflex C7, C8

A

Triceps

32
Q

Describe the shoulder abduction test for radicular pain

A

Patient is sitting, places head on top of head, positive if pain/radicular symptoms dissipate

33
Q

Should distraction be relieving or aggravating to a radicular pain patient?

A

Relieving

34
Q

Should distraction be relieving or aggravating to a muscular patient who has no radicular symptoms

A

Aggravating

35
Q

What is a significant test for cervicogenic headaches?

A

Flexion and rotation test

36
Q

T/F A patient cannot be diagnoses with a cervicogenic headache unless they have neck pain

A

True

37
Q

What 3 muscles are commonly implicated with Headaches?

A

SCM, Upper trap, sub occipitals(superior obliqus capitis)

38
Q

CPR for Cervical Radiculopathy(4)

A

Spurling’s Test
Upper limb tension 1
Distraction test
Cervical Rotation Test

39
Q

Shoulder abduction test is also known as:

A

Bakody’s sign

40
Q

ULTT 1 is for which nerve

A

Median Nerve, anterior interosseous N. C5, C6, C7

41
Q

ULTT 2 is for which nerves(3)

A

Median, Axillary and Musculocutaneous N

42
Q

ULTT3 is for which nerve

A

radial

43
Q

ULTT 4 is for which nerve

A

Ulnar(C8-T1)

44
Q 
Clinical Prediction Rule for ?
o	+ Spurlings
o	+ ULTT Median nerve
o	+ cervical distraction test
o	< 60d involved c-spine rotation
A

Cervical Radiculopathy

45
Q

Clinical Prediction rule for cervical traction for neck pain(5)

A 
Pt reported peripheralization with lower c-spine mobility
\+ shoulder abduction test
Age > 54
\+ ULTTA(median nerve)
\+ central distraction test
46
Q

Patient has pain localized to her neck that she sometimes feels into her temples and ears. She has limited and restrictive passive rotation bilaterally with abnormal tenderness along the neck muscles. The pain is precipitated by neck movements or sustained posture. What is your diagnosis?

A

Cervicogenic HA

47
Q

Name two conditions might you see L’hermittes sign?

A

MS and Cervical Radiculopathy

48
Q

Patient has reports neck pain that comes and goes, bright pain within her UE. You perform myotome and dermatomes which appear abnormal. She also has a positive L’hermitt’s sign. What might be her diagnosis

A

Cervical Radiculopathy

49
Q

With cervical radiculopathy, should the ULTT be symmetrical or asymmetrical

A

Asymmetrical

50
Q

Review cervical facet referral patterns

A 
C2/C3: Right Occipital, above the ear
C3/C4: Left Side of neck near left ear
C4/C5: Right lower occiput into right shoulder
C5/C6: Left shoulder
C6/C7: Right scapula
51
Q

Patient comes in with moderate pain in right shoulder and difficulty side bending and rotating to the same side(close packed position). They often feel their symptoms into their UE. What might they have?

A

Cervical Facet Syndrome

52
Q

CPR for C-spine manipulation(Misc)

A

o Initial scores on NDI < 11.50
o Presence of bilateral pattern of involvement
o Not performing sedentary work for more than 5 hours each day
o Report of feeling better while moving the neck
o No report of feeling worse while extending the neck
o The diagnosis of spondylosis without radiculopathy

53
Q

CPR for cervical manipulation (4)

A

o Symptoms < 38 days
o Positive expectation that it will help
o Side to side difference in cervical rotation ROM of 10d or more
o Pain with PA spring test (PAIVM) of the mid cervical spine

54
Q

Cervical Myelopathy CPR(5)

A

(1) gait deviation; (2) +Hoffmann’s test; (3) inverted supinator sign; (4) +Babinski test; and (5) age >45 years

55
Q

Patient enters with loss of ROM in all planes. Widespread pain they cannot localize. Increased guarding and re-occurring HA. What might they have?

a. myelopathy
b. cervicogenic
c. radicuolopathy
d. whiplash

A

D

56
Q

T/F A grade 3 whiplash injury if considered a fracture/dislocation injury

A

False

Grades- 1= mild strain, 2 = neck pain and decreased ROM, 3=neurological +msk 4=Fracture/dislocation

57
Q

Who is more at risk for WAD?

A

Women due to hypermobility of c-spine

58
Q

Hypermobility is common but not always (rare hypomobile)
Lack of neuro symptoms
Lack of definitive ortho test, palpation often most provocative(trigger points)
Possibly repetitive trauma or postural in nature.
What is it?

A

Myofascial disorders/Fibromyositis

59
Q

Which torticollis is: limited in all planes of motion, typically seen upon waking (no trauma, head is often held in neutral) no known cause

A

psedo

60
Q

Which torticollis is: painful SCM spasm with movement restricted in one plane worse than others

A

adult/ congenital

congenital= fixed asymmetry

61
Q

T/F:Point tenderness and tenderness with vibration of the spinous process are indicators of internal disc derangement

A

TRUE

62
Q

Name that HA! visual aura and sensory symptoms first then HA, vomiting and nausea common, often concentrated to one side of the head

A

Migraine

63
Q

Name that HA! Worse with movement, cervical flexion/rotation test positive, neck pain, goes from suboccipitals to forehead

A

Cervicogenic

64
Q

Name that HA! Very common “featureless” headache, tightness/pressing not a pulsatile HA, feel like a band across forehead

A

Tension

65
Q

Name that HA! caffeine or medications used frequently, HA when not on meds or several hours after ingesting caffeine

A

Rebound

66
Q

Name that HA! Felt behind the eye

A

Cluster

67
Q

CPR for thoracic manipulation

A
  • Duration of symptoms < 30 days
  • NO symptom distal to shoulder
  • Looking up does NOT aggravate symptoms
  • FABQ assessment score < 12
  • Diminished upper thoracic spine kyphosis at T3-5
  • Cervical extension ROM < 30d
  • Excluded stenosis pts, red flags, WAD <6 weeks ago, CNS disorder, nerve root compression pts
68
Q

T/F If repeated cervical movements increase the shoulder pain then the problem is most likely within the shoulder?

A

False, cervical

69
Q

Lump in throat, nystagmus, soft end feel, lip and face paresthesias and orners syndrome(ptosis and miosis) are all s/s of what?

a. myelopathy
b. radiculopathy
c. tumor
d. instability

A

instability

70
Q

What is the max amount of opening ROM for the mouth?

A

50mm

71
Q

What is the functional amount of opening ROM for the mouth?

A

35mm of opening

72
Q

The 2-3 finger test is a special test for:

A

TMJ dysfunction

73
Q

Dizziness with changes in body position from low to high position

A

OTH

74
Q

Dizziness that is worse with rolling in bed or changes in head position

A

Vestibular

75
Q

If dizziness and nystagmus are present but the symptoms are fatigable most likely

A

Vestibular

76
Q

If dizziness and nystagmus are NOT fatigable then most likely

A

VBI

MSK II (4 decks)

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