7.3: Cervical Spine - Examination Flashcards by Robert Benedict Santamaria

T/F: Tone of the subjective assessment will not rely on how well the patient understands you

False, it does rely

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T/F: Always consider pt’s educational background and match what language the pt is used to

True

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T/F: You can ask the occupation in the demographic part of the subjective

true

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Why is distance from home to work or clinic asked

the distance or the commute to these areas may be a big factor in manifesting neck pain

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what is asked in the demographic

name, age, sex, handedness, systemic conditions (sometimes occupation if the need arises but is documented in lifestyle)

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T/F: in pt’s c neck conditions, asthma will not cause hypertrophy of the breathing muscles in any way

False

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Most common complaint of pts with neck conditions

pain

weakness

heaviness

stiffness or LOM

numbness/paresthesia (sometimes referred in other regions)

headaches/dizziness

funcional limitations

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Characteristics of pain

Intensity

Onset

Location

Description of sensation

Frequency and duration

Pattern

Aggravating & relieving factors

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why ask type of pain

to know what structure is affected

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why is location of pain important

it can also help with differential diagnosis as some conditions present with localized pain while some present with diffused pain, radiating pain, referred pain

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quality and quantity of pain

Consistency/duration
Location
Intensity
Type of pain

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T/F: PT should establish the 24 hour behavior of pain

true

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persistent pain may indicate what?

malignancy or other conditions that may have something that occupies the spaces in the cervical region

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Weakness & heaviness may signify what

myotomal problems

heavines may indicate vascular problems

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Why can headaches & dizziness be a chief complaint?

d/t the msk dysfunction of the spine especially in the C1-C3 levels

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What may headaches indicate

muscle tightness

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how does headaches that are musculoskeletal in origin present

unilaterally

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What to ask if the pt complains of headaches?

frequency, when does it stop, is it recurring (these are not all)

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Next step if the pt’s headache is a major complaint after trauma

bring to ER ASAP and defer treatment and refer to other professionals in that specific field

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Reports of dizziness is under what realm?

usually vestibular (ear) function

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What to suspect if pt complains of dizziness?

Vestibular problems or Vertebrobasilar insufficiency

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what are the 5Ds of VBI

dizziness

diplopia

drop attack

dysarhria

dysphagia

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what to ask in pts c dizziness

intensity, duration, and if it associated with certain positions

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what does dizziness associated c positions indicate?

may indicate a semicircular canal problem

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fainting of the pt c intact consciousness and is usually associated c Hypoxia in the brain

drop attack

what is the usual reason why the pt does not go to school/work/other events in their daily lives and is usually the trigger why they go to PT

functional limitation

the longer the interview, the ____ the considered conditions should be

lesser

by the end of the subjective, the PT has at least ____ conditions that are considered

2-3 (accdg to sir jose)

What do we usually ask in the HPI of pts c neck problems

identify cause of the symptoms (may be bc of trauma) insidious sx course of sx from the onset until the moment the pt meets with PT concurrent Tx such as medications or other Mx done (if applicable) Ask for ancillary procedures

What is usually asked in PMHx

any history of weight loss or gain previous meds (including the meds taken for the systemic conditions e.g. meds for DM or Htn if applicable) previous PT sessions Systems review

What to ask in the physical environment

pertinent house furnitures or appliances ask also about sleeping arrangements such as mattresses and pillows work ergonomics type of commute

T/F: pillow height does not contribute to neck pain

false

T/F: position of the arms during sleep can strain the neck or overstretch the contralateral brachial plexus

true

Why do we consider the type of chair used by the pt

the chair is one of the causes of spinal alignment alteration

T/F: PT should ask pt to estimate the height of the chairs and tables used

True

subdivisions of the subjective assessment

demographics chief complaint hpi pmhx physical environment psychosocial environment lifestyle and hobbies pt's goal

why do we need to ask the psychosocial environment

identify behavioral problems present that may contribute to the condition

what is usually asked in the psychosocial environment

beliefs influences family or social support dependents level of stress and anxiety coping strategies if pt can pay for the Tx

why is it important to know if pt can pay for the treatment

If the pt does not have the means to pay, how will they get better? some centers do not allow Tx without pay and it can cause a big impact on patient both physically, mentally, and emotionally

Usual questions asked in lifestyle and hobbies

Type of work, usual position, workload risk factor profile (alcohol, tobacco use, dietary habits) past & present levels of activity

why is substance use important to note?

alcohol and smoking can contribute to vascular conditions and these conditions may present Sx in the neck area

what should PT get in pt's goal

always be elimination of Sx, should follow up by asking why pt wants to eliminate the Sx

What to check in Ocular inspection

manner of arrival mental status facial expression/wincing protective posturing attachments and assistive devices signs of inflammation trophic skin changes deformities, asymmetries, deviations

what to look for in palpation

skin temp muscle tone muscle spasm muscle guarding tenderness mobility of spinous process tightness or contractures taut bands, nodules, trigger points

T/F: the postural assessment can be done without a plumb line

True but it is risky as the plumb line is important to really differentiate

Why is Postural assessment usually done first

it helps PT know if they have plenty to check later on

T/F: the dominant side is usually higher

False, it is ALWAYS lower

Injured side is usually _____

higher

in checking ROM, the most painful movement should be done _____

last

Capsular pattern for the cervical spine

side flexion & rotation > rotation

what does it imply if painful movement is relieved?

condition is not irritable

if the pain is not resolved condition is ____ and pain may ____

irritable; worsen

Normal endfeel for all 4 cervical movements

Tissue stretch (firm)

PPIVM meaning

passive physiological intervertebral movements

what should the PT do if the pt can't hold the position actively

DO NOT perform PROM and DO NOT add overpressure

If AROM is limited but not painful, _____ can be done

overpressure

possible causes of restricted extension & R lateral flexion

R extension hypomobility L flexor muscle tightness Anterior capsular adhesions R sublaxation R small disc protrusion

possible caused of restricted flexion and R side bending

L flexion hypomobility L extensor muscle tightness

Possible causes if restriction in extension & R side bending is GREATER than ext & L side bending

L posterior capsular adhesions L sublaxation L capsular pattern (arthritis, arthrosis)

Possible causes if restriction of flexion & R side bending = extension & L side bending

L arthrofibrosis (very hard capsular endfeel)

Possible cause of restriction of side bending in neutral, flexion, and extension

Uncovertebral hypomobility or anomaly

Nerve root responsible for neck flexion

C1-C2

Nerve root responsible for neck side flexion

C3 & CN XI (accessory)

Nerve root responsible for shoulder elevation

C4 and CN XI (accessory)

Nerve root responsible for shoulder abduction/ER

Nerve root responsible for elbow flexion and/or wrist extension

Nerve root responsible for elbow extension and/or wrist flexion

Nerve root responsible for thumb extension and/or ulnar deviation

Nerve root responsible for abduction and/or adduction of hand intrinsics

C1 Dermatome

vertex of skull

C2 dermatome

temple, forehead, occiput

C3 dermatome

entire neck, posterior cheek, temporal area, prolongation forward under mandible

C4 dermatome

shoulder, clavicular area, upper scapular area

C5 dermatome

deltoid, anterior aspect of entire arm to base of thumb

C6 dermatome

anterior arm, radial side of hand to thumb and index finger

C7 dermatome

lateral arm and forearm to index, long, and ring fingers

C8 dermatome

medial arm and forearm to long, ring, and little finger

T1 dermatome

medial side of forearm to base of little finger

Usual nerve roots and muscles that are usually tested for reflex

Biceps (C6) Triceps (C7) Brachioradialis (C5-C6)

What to assess during FA?

Multiplanar activities of the neck (e.g. breathing, looking up at the ceiling, looking down at belt buckle or shoe, shoulder check)

Recommended OMT to use

Neck disability index

How to interpret Neck Disability Index

Raw score or percentage: 0-4 points (0-8%) - No disability 5-14 points (10-28%) Mild disability 15-24 points (30-48%) moderate disability 25-34 points (50-64%) severe disability 35-50 points (70-100%) complete disability

7.3: Cervical Spine - Examination Flashcards

(82 cards)