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MSK basics > cervical - 1 at risk neck > Flashcards

cervical - 1 at risk neck Flashcards

1
Q

T3

A

at the root od the scapula

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2
Q

T7

A

at the inf angle of the scapula

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3
Q

L3

A

umbilicus

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4
Q

L4-L5

A

the ASIS

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5
Q

S2

A

PSIS

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6
Q

what do we see with fracture/dislocation red flag

A

Trauma - motor vehicle accident , Falls, Direct blow or impact

Severe limitations of motion all planes

Deformity may be present

diagnostic imaging needed

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7
Q

what is the point of the Canadian spine rules

A

does the pt require a diagnostic work up

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8
Q

what is the first question of the canadian spine rules

A

are there any high risk factors that mandate radiography

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9
Q

are there any high risk factors that mandate radiography - what are the three factors

A

age >65

dangerous mechanism of injury

parathesis in the extremities

(of any of these are present then the person needs a

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10
Q

what are the dangerous mech of injury dicussed in canadian spine rule

A

fall onto head

highspeed MVA

axial load to the head

motorized recreational vehicle

bicycle collision

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11
Q

what is the 2nd question in the canadian spine rules

A

are there low risk factors that allows for safe ROM assesment?

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12
Q

are there low risk factors that allows for safe ROM assesment? - what are teh low risk factors

A

simple rear-end

normal sitting posture in the ER

amb since the time of injury

delyaed onset of of neck pain and absence of midline tenderness

(if these are true then we can perform a ROM assessment for the pt)

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13
Q

Cancer – neoplasm redflag

A

Medical history is (+) for cancer

Night pain and other atypical pain manifestations

Unexplained weight loss

Fatigue

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14
Q

Visceral referred pain - Gallbladder/liver

A

R thoracic/lower rib, R scapula region

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15
Q

Visceral referred pain - Lungs

A

Thoracic, chest, possibly the shoulder and cervical pain

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16
Q

Visceral referred pain - Cardiac

A
  • Chest, neck, arm pain

C8 distribution

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17
Q

Inflammatory/Systemic red flag - vitals

A
  • Body Temperature > 100 F
  • Blood pressure > 160/95 mmHg
  • Resting pulse > 100 bpm
  • Resting respiration > 25
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18
Q

Inflammatory/Systemic red flag - presentation

A
  • Redness, warmth, swelling
  • Discoloration (eg. Jaundice)
  • Fatigue, malaise, unwellness
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19
Q

Myelopathic Involvement

A

Gait and balance disturbances, generalized weakness

May not be associated with any radiating pain

  • (+) Signs of UMN involvement
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20
Q

what are the DTR that we use with the cervical region

A

jaw jerk

pectoral

ankle clonus

babinski

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21
Q

babinski and ankle clonus are testing what

A

anywhere on the cord

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22
Q

hoafmann’s and tromners is testing what

A

C-spine and higher

UMN

23
Q

shimizu is testing what

A

more likely the brain and not the neck

24
Q

jaw jerk is testing what

A

C5 and higher (brain)

UMN

25
Q

what tests are included in the in depth screening exam for the neck

A

history
DTR
hoffmans/trommners
rhomberg
AROM in sitting
huatards
neck torsion
sharps purser
Positional Provocative Testing
Modified Shear Test
C2 Spinous Kick Test
Tectorial Membrane

26
Q

what is the purpose of the rhomberg test

A

determines if your balance issues are related to the function of your dorsal column (DCML) - removes the vestibular and visual component that contribute to balance

27
Q

jaw jerk what is a positive sign

A

the swift closure of the mouth

clenching of the jaw

28
Q

what do we do with the pectoral reflex

A

hit inferior to coracoid process

Positive: movement in the shoulder, similar to what we see with shimizu (shoulder shrug

29
Q

what is the point of the pectoral reflex

A

to see if the pt is hyper-reflexive

30
Q

what is the procedure for Scapular humeral reflex (Shimizu)

A

Strike: Distal third of the spine
Strike: midpoint
Strike: acromion

Positive: robust shoulder shrug
brain

31
Q

Pronator drift test - procedure

A

hand in front of pt supinated and EC
- Hold for 20 -30 secs

32
Q

what is a positive - Pronator drift test

A

one arm and palm turn inward and downward, change in what the hands are doing

33
Q

what is the meaning of the pronator drift test

A

pain in neck, stiffness (combine with UMN presentation)

muscle weakness and an abnormal function of the corticospinal tract, the upper motor neurons in the brain and spinal cord that control voluntary muscle

34
Q

what is the procedure for hautard’s test

A

tall sitting, arms out in front, close eye, turn head to left, count down from 15 secs

Do the same thing for the right side and extension

35
Q

what is the purpose of hautard’s test

A

looking at the VBI, upper body proprioception, positional provocative testing

36
Q

hautard’s test and reproduction of VBI symptoms

A

Headache, nausea, nystagmus, redness of face

As the pt maintains this position the symptoms get worse

While symptomatic screen cranial nerves – if they have CN signs then this

37
Q

what is purpose of the neck torsion test

A

Differentiate cervical from vestibular

38
Q

what is the procedure of the neck torsion test

A

sitting at the end of the table twist your body towards me while I hold your head

You are not using your vestibular system in this movement

39
Q

neck torsion test outcomes

A

Mechanical: this rotary movement causes symptoms

Vestibular: no symptoms provocation

40
Q

what are the ligamentous test for the neck

A

Sharp-Purser Test

Spinous shear

C2 kick test

Tectorial membrane test

41
Q

Sharp-Purser Test is testing what ligament

A

transverse ligaments is affected – the atlas moves away from the odontoid

42
Q

Sharp-Purser Test procedure

A

Neutral sitting position

Pt head forward 30-35 degrees

Hand in key form on C2 SP, block and stabilize it

Posterior force is directed at pt forehead

43
Q

what is the positive sharps purser test

A

Positive: abnormal endfeel, clunk

44
Q

what is the function of Spurling’s test

A

cervical radiculoathy

45
Q

Spurling’s procedure

A
  • Pt seated, head neck in extension, lateral flexion
  • Rotation towards isp
  • Apply axial pressure when pt is in this position, 10 -15 secs
46
Q

what does apostive spurling test look like

A

Reproduction of cervical radiculopathy sym

47
Q

what is Axial Compression test for

A

cervical radiculopathy

48
Q

axial compression test procedure

A
  • Pt head in neutral
  • PT applies even pressure over pt’s head
49
Q

what ligamament is the Spinous shear test looking at

A

Alar ligament

50
Q

Spinous shear test procedure

A

hand on C1 transverse process

Push on right and then left side

Looking for: good firm end feel

51
Q

C2 kick test testing what ligament

A

Alar ligament

52
Q

C2 kick test procedure

A

o Pt supine, make sure that the pt is straight (midline)
o Hands on the side of the C2 SP
o Side bend the head to left – should feel the bone on right side
o Kick should be brisk

53
Q

Tectorial membrane test ligament

A

the tectorial membrane

54
Q

Tectorial membrane test - procedure

A

supine: Axial distraction – light and gentle

Positive: pain provocation
- Pain response to the distraction of the neck

MSK basics (20 decks)

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