Week 1- Medical Screening & Cervicothoracic Region Flashcards
What is always the first component of the evaluation?
- Medical screening for red/yellow flags
MSK conditions to screen for in the cervical spine
- Cervical fracture
- Cervical myelopathy
- Upper cervical ligamentous laxity
- Spinal infection
Cardiovascular conditions to screen for in the cervical spine
- Cardiovascular event (myocardial infarction)
- Cervical arterial dysfunction
Pulmonary conditions to screen for in the cervical spine
- Pulmonary event
- Pneumothorax
- Pulmonary embolism
High-risk factors for cervical fracture
- > /= 65 y
- Dangerous MOA
- Upper extremity parasthesia
What is considered a “dangerous MOA”?
- Fall from 3+ ft/5stairs
- Axial load
- MVC at 60+ mph, rollover/ejection
- Motorized rec vehicle accident
- Bike collosion
What are low-risk factors for cervical fracture?
- Simple rear-end MVC
- Sitting position in external rotation
- Ambulatory at any time
- Delayed-onset neck pain
- Absence of midline C-spine tenderness
What conditions need to be met to refer for imaging of cervical spine for fracture?
- “Yes” for high-risk factors
- “No” for low-risk factors
- Unable to rotate neck 45 degrees L/R
What is cervical myelopathy?
-
Mechanical causes of cervical myelopathy
- Trauma (ligament instability, fracture)
- Spinal cord compression
- Degenerative changes
- Bulging disks, thickened ligamentum flavum
- RA with subsequent atlanto-axial subluxation
Cervical myelopathy systemic causes
- MS, ALS
- Guillain-Barre
- Multifocal motor myopathy
5 tests included in cervical myelopathy CPR
- Gait deviation
- Hoffman’s test
- Inverted supinator sign
- Babinski test
- > 45 years
What is considered a red flag for cervical myelopathy?
3/5 positive CPR tests
Signs and symptoms for upper cervical ligamentous laxity
- Occipital headache & numbness
- Severe limitation during neck
AROM in all directions - Signs of cervical myelopathy
Causes of upper cervical ligamentous laxity
- Trauma
- RA with atlanto-axial subluxation
- Down Syndrome
- Klippel-Feil
- Os odontoideum
- Odontoid fracture
Signs and symptoms of a spinal infection
- Unrelenting spine pain
- Worse/severe pain at night (no change w/ positional changes)
- Hx of DM, SCI w/ neurogenic bladder, immune suppression
- Potential fever, chills, fatigue
- Concurrent infections or IV drug use
- Possible redness, swelling, warmth
- Local tenderness over spinous processes
- Spinal percussion painful
What to do in case of a spinal infection
Refer for imaging and clinical lab tests
Treatment for spinal infection
- Antibiotic therapy
- Surgical decompression
Signs and symptoms for cardiovascular event
- Chest pain (gripping, pressure)
- Abdominal pain
- Shortness of breath
- Heart palpitations
- Irregular heartbeat
- Dizziness, nausea
- Peripheral edema
- Syncope
MSK complaints indicating a cardiovascular event
- Jaw, neck, shoulder, arm, & back pain
- Myalgias, muscular fatigue, & muscle
atrophy - Weakness & fatigue
- Poor exercise tolerance
5 D’s AND 3 N’s indicating arterial dysfunction
- Dizziness or lightheadedness related to neck movement - Drop attacks - Dysphagia - Dysarthria - Diplopia - Ataxia - Nausea - Numbness - Nystagmus
Pain Descriptors for a Pulmonary Event
- Sharp, localized pain
- Aggravated by breathing,
coughing, sneezing, laughing, etc. - Better in upright/worse recumbent
- Better with auto splinting
Signs and Symptoms for Pulmonary Event
- Dyspnea/shortness of breath (at rest or exertional)
- Persistent cough
- Fevers, chills, general malaise
- Weak, rapid pulse with fall in BP (pneumothorax)
- Cyanosis
Signs and Symptoms of a Pneumothorax
- Shortness of breath, dry cough
- Acute onset sharp pain in the chest (upper & lateral chest wall)
- Can refer to ipsilateral shoulder/upper trapezius region, across chest, to the scapular region, and to the abdomen
- Change in respiratory movements
- Drop in blood pressure, increased venous distension in neck
- More pain in recumbent positions/better in sitting
Predictor variables for pulmonary embolism
- Clinical signs and symptoms of DVT (3.0)
- No alternative diagnosis (3.0)
- Heart rate >100 bpm (1.5)
- Immobilization following surgery in the past 4 weeks (1.5)
- Previous DVT/PE (1.5)
- Hemoptysis (1.0)
- Malignancy (treated currently, in the last 6 months, or palliative) (1.0)
Levels of risk and probability of pulmonary embolism
- > 2.0 pts = Low Risk = 3.6% probability
- 2.0 - 6.0 pts = Moderate Risk = 20.5% probability
- > 6.0 pts = High Risk = 66.7% probability
Where will pancreas issues refer to?
- Left shoulder
- Anterior central abdomen
- Posterior thoracic region
Where are issues if there is pain in the posterior thoracic region?
Issues in the esophagus, liver, gallbladder, common bile duct, and pancreas
Where are issues if there is pain in the right shoulder region?
Issues in the stomach, duodenum, liver, gallbladder, and common bile duct
Signs and symptoms for stomach, duodenal, or pancreatic conditions
- Gnawing, cramping, burning, “heartburn”, aching
- Constant or sudden onset, weight loss, nausea, vomiting, fever, malaise
- May have pain in waves or may be related to eating or drinking in timing
- Early satiety, black “tarry” or light colored stools (pancreatic cancer)
Causes of stomach, duodenal, and pancreatic conditions
- Gastric, pyloric, or duodenal ulcers
- Stomach cancer
Where will kidney/renal issues refer to?
- Left inguinal region
- Posterior QL region
- Left shoulder
Where is the common site of metastases?
Skeleton
- 60% thoracic
- 40% lumbosacral
- Rare in C-spine
What is the “lead kettle” mnemonic?
PB KTLL
- Prostate
- Breast
- Kidney
- Thyroid
- Lung
- Lymphoma
Cancers most commonly affecting the cervico-thoracic spine
- Thyroid & esophageal cancer
- Hodgkin’s lymphoma
- Pancoast’s tumor
- Multiple myeloma
- Breast cancer
- Other organ cancers that can refer to the T-spine
What predicts cancer in patients?
- Age >/= 50
- Unexplaiined weight loss
- Previous Hx of cancer
- Failure to improve over 1 month
- 100% sensitive
Common Risk Factors for Depression
- Current/past hx of major depression
- Family hx of major depressions (first degree relative)
- Hx of MI, CA, CVA, substance abuse/dependency, obesity, CHF, dementia, or DM
- Currently suffering from significant loss or change in social status
- Pregnant or post-partum
- Fatigue or sleep disturbance, fatigue, weight change
- Women > men
- Chronic pain or 2+ chronic diseases
Depression screen questions?
- Over past 2 weeks, have you felt down, depressed, or hopeless?
- Over past 2 weeks, have you felt little interest or pleasure in doing things?
- Do you want help?
Suicide risk factors
- Family hx of suicide attempts
- Sense of hopelessness
- Previous attempt or plan
- Hx of chronic progressive illness
- Recent significant loss
- Unemployment
- Widowed, divorced, or living alone
- Hx of psychiatric illness
- Sex (males higher rate of completion; females higher attempt rate)
- Recent interpersonal struggle
- Presence of firearms in home (for teens)
