7.2: Cervical Spine - Medsurg

Question 1

Persistence of pain whatever the neck’s position is normally present in what conditions?

Answer 1

Traumatic Conditions

Question 2

If pain is mechanical (e.g. muscle tightness or nerve root impingement) it is _____ in certain positions

Answer 2

Relieved

Question 3

Condition associated if pt presents with dizziness, diplopia, drop attack, dysarthria, dysphagia

Answer 3

Vertebrobasilar Insuffeciency

Question 4

Condition brought by forward head posture

Answer 4

Upper Cross Syndrome

Question 5

Tight and weak muscles in upper cross syndrome

Answer 5

Tight - Pecs major and minor, Upper traps, Levator scapulae

Weak - Lower traps and rhomboids

Question 6

Deformity of the neck that includes both rotation and flexion; can be congenital or acquired

Answer 6

Torticollis / Wry Neck

Question 7

Ocular Findings in torticollis

Answer 7

Head is tilted toward the affected side while the chin is rotated to the opposite side

Question 8

What is affected in torticollis

Answer 8

SCM

Question 9

Congenital torticollis is more common in

Answer 9

Females

Question 10

Common causes of acquired torticollis

Answer 10

Acute traumatic/Inflammatory - atlantoaxial rotary sublaxation; muscle inflammation; lymphadenitis

Chronic infectious or neoplastic - osteomyelitis; TB; tumor of spine or spinal cord

Arthritic - RA; OA; ankylosis spondylitis

Cicatrical - Ex: Burn Scars

Paralytic

Hysterical - psychologic inability of pt to control neck muscles

Spasmodic - CNS or cervical root lesion manifested by involuntary rhythmic contraction of neck muscles

Question 11

Signs and Sx of Degenerative Disc Disease

Answer 11

Radicular Sx; aggravated by coughing or sneezing

Occipital headaches

Blurring of vision

Arm function weakness

Vertigo

Limited Neck motion; tenderness over cervical spine; neurologic changes in the upper limb

Question 12

Three distinct spaces where TOS occurs

Answer 12

Interscalene triangle

Costoclavicular space

Retropectoralis Minor space

Question 13

Congenital Synostosis of cervical spine (usually C3-C5 vertebra)

Answer 13

Klippel Feil Syndrome

Question 14

T?F: Klippel Feil Syndrome can be acquired

Answer 14

False

Question 15

Clinical presentation of pts c klippel feil syndrome

Answer 15

Short neck

Posterior hairline is abnormally lower

Webbing of the neck

Flexion/Extension has higher ROM than lateral flexion

Head held in oblique position

Question 16

MOI of Cervical Spondylosis

Answer 16

Degenerative changes of the vertebrae c osteophyte formation

Question 17

Most common intervertebral spaces affected in cervical spondylosis

Answer 17

C5-C6 & C6-C7

Question 18

___ of those older than 45 y/o can be affected in cervical spondylosis

Answer 18

60%

Question 19

Chances of developing cervical spondylosis in ages 60 above

Answer 19

85%

Question 20

C/C of pts c cervical spondylosis

Answer 20

Unilateral neck pain and stiffness increasing c extension and decreases during flexion

Can include radicular Sx

Possible instability

Question 21

Palpation findings in cervical spondylosis

Answer 21

tenderness over affected vertebra or facet joint

Question 22

ROM findings for pts c cervical spondylosis

Answer 22

limited lateral flexion and rotation

inc pain in extension

Question 23

T/F: Pts c cervical spondylosis may present with muscle weakness

Answer 23

True, esp in affected myotomes

Question 24

Confirmatory tests for Cervical spondylosis

Answer 24

distraction test

spurling’s

bakody’s

ULNT

Question 25

rule out tests for cervical spondylosis

Answer 25

Sharp-purser to rule out ligamental instability

Question 26

Differential Dx for cervical spondylosis

Answer 26

Disc herniations

Question 27

T/F: cervical spinal stenosis may be accompanied by cervical spondylosis and/or disc herniation

Answer 27

true

Question 28

Differential diagnosis for myofascial pain syndrome

Answer 28

fibromyalgia

Question 29

How many trigger points to be considered MPS

Answer 29

at least 3

Question 30

C/C for MPS

Answer 30

localized aching pain which have lasted for 3 mos or more c no h/o trauma Muscle stiffness some cases c/o tension headaches

Question 31

Occular inspection findings in MPS

Answer 31

poor posture d/t pain atrophy in some cases

Question 32

ROM limitations in pts c MPS

Answer 32

Cervical extension and Rotation (Dutton and Delisa)

Question 33

MMT findings of pts c MPS

Answer 33

weakness of affected muscle d/t pain

Question 34

Fibromyalgia neck pain Sx

Answer 34

Persistent, dull, aching pain that can intensify into sharp pain and is widespread/generalized

Question 35

Differential Dx for pts c disc herniation

Answer 35

Cervical Spinal stenosis

Question 36

MOI for WADs

Answer 36

Traumatic; Whiplash

Question 37

MOI for cervical strain

Answer 37

Whiplash; traumatic

Question 38

Confirmatory Special tests for Disc herniation

Answer 38

Distraction test - if pain increases during procedure Spurling's Jackson's Valsalva

Question 39

Rule out test for disc herniation

Answer 39

Distraction test - if Sx are relieved or decreased

Question 40

Disc Herniation may limit what motion

Answer 40

Flexion d/t pt's apprehension

Question 41

most common OI findings in pts c cervical disc herniation

Answer 41

Pt is usually in extension to prevent disc from herniating/pressing on the affected structures

Question 42

C/C for Disc herniation

Answer 42

Neck pain which may increase in flexion/extension Radicular Sx Commonly unilateral Sx but can be bilateral

Question 43

MOI for disc herniation

Answer 43

Traumatic forces such as whiplash injury can be caused by degenerative disc disease overweight pts have increased risk

Question 44

age group that is most common for cervical disc hernitation

Answer 44

17-60 y/o (Magee)

Question 45

MOI for MPS

Answer 45

repeated motion and pressure in muscle, creating trigger points may also be caused by postural dysfunctions (Dutton)

Question 46

Injuries to the cervicobrachial region can lead to what Sx?

Answer 46

neck pain alone, arm pain alone, or both neck and arm pain. Thus, symptoms include neck and/ or arm pain, headaches, restricted range of motion (ROM), paresthesia, altered myotomes and dermatomes, and radicular signs.

Question 47

Sx related to vertebral artery lesion

Answer 47

vertigo, nausea, tinnitus, “drop attacks” (falling without fainting), visual disturbances, or, in rare cases, stroke or death.

Question 48

Injury to the cervicocephalic region leads to what Sx?

Answer 48

headache, fatigue, vertigo, poor concentration, hypertonia of sympathetic nervous system, and irritability. In addition, there may be cognitive dysfunction, cranial nerve dysfunction, and sympathetic system dysfunction.