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PT OCS Exam > C/S and T/S > Flashcards

C/S and T/S Flashcards

1
Q

Neck Outcome Predictors

A

Pre-op use of weak narcotics, dermatomal sensory loss and worker’s compensation cases decrease likelihood of improvement 50%

NDI improves by 2.3x if patient is working vs. litigation pending (33%)

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2
Q

Neck Outcome Predictors

A

Pre-op use of weak narcotics, dermatomal sensory loss and worker’s compensation cases decrease likelihood of improvement 50%

NDI improves by 2.3x if patient is working vs. litigation pending (33%)

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3
Q

Ottawa C/S rules to R/O fracture

A

No XR if there is >45 degrees Bilat. ROM and no risk factors present (if unable to rotate to 45 recommend XR)

High Risk (yes = XR if: Age >65, Dangerous MOI (fall from 1 m (5 stairs), diving injury, high speed MVC or rollover/ejection, Bike collision), Paraesthesia in UE/LE

Low Risk, (no = XR) if: Simple RE MVC, sitting position in ED, Able to ambulate, delayed pain onset, no mid C/S tenderness

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4
Q

Nexus II CT scan S/P head injury

A 
Evidence of skull Fx
Scalp hematoma
Neuro deficit
Altered alertness (GCS 15)
Age > 65
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5
Q

Neck pain classification

A 
Pain Control
Centralization
CGH
Exercise and conditioning
Mobility
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6
Q

Mobility

A

Recent onset of symptoms
No radiculopathy
Tx: MTT and exercise

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7
Q

Pain Control

A

Temporary classification until they can be classified. Acute injury.

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8
Q

Centralization

A

Radiculopathy
Sx below the elbow
Tx: Promote centralization

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9
Q

Headache

A

Primary C/O CGH

Tx:MTT, DNF training, Scapular PREs

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10
Q

Exercise/Conditioning

A

No Radiculopathy
Age>60
Chronic
Strength and conditioning exercises

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11
Q

Chronic neck pain factors

A 
Age > 40
H/O C/S pain and coexsting LBP
Cycling
Dec. strength in hands
Worrisome attitude
Poor quality of life
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12
Q

ICF classification

A

Neck pain with: Mobility Impairments, Headaches, radiating/radiculopathy, movement/coordination impairments

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13
Q

Neck pain with mobility impairment

A

C/S AROM

C/S and T/S segmental mobility

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14
Q

Neck pain with Radiculopathy

A

ULTT(A)
Spurling’s
Distraction
Involved side rotation

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15
Q

Neck pain with Radiculopathy

A

ULTT(A)
Spurling’s
Distraction

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16
Q

Use of Thoracic HVLA for neck pain (CPR) (4/6 or more is ideal)

A

Sx

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17
Q

Use of HVLA for neck pain (CPR) (3/4)

A

Sx

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18
Q

Ottawa C/S rules to R/O fracture

A

No XR if there is >45 degrees Bilat. ROM and no risk factors present (if unable to rotate to 45 recommend XR)

High Risk (yes = XR if: Age >65, Dangerous MOI (fall from 1 m (5 stairs), diving injury, high speed MVC or rollover/ejection, Bike collision), Paraesthesia in UE/LE

Low Risk, (no = XR) if: Simple RE MVC, sitting position in ED, Able to ambulate, delayed pain onset, no mid C/S tenderness

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19
Q

Nexus II CT scan S/P head injury

A

Evidence of skull Fx
Scalp hematoma
Neuro deficit
Altered alertness (GCS 65

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20
Q

Neck pain classification

A 
Pain Control
Centralization
CGH
Exercise and conditioning
Mobility
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21
Q

Mobility

A

Recent onset of symptoms
No radiculopathy
Tx: MTT and exercise

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22
Q

Centralization

A

Radiculopathy
Sx below the elbow
Tx: Promote centralization

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23
Q

Headache

A

Primary C/O CGH

Tx:MTT, DNF training, Scapular PREs

24
Q

Exercise/Conditioning

A

No Radiculopathy
Age>60
Chronic
Strength and conditioning exercises

25
Chronic neck pain factors
``` Age > 40 H/O C/S pain and coexsting LBP Cycling Dec. strength in hands Worrisome attitude Poor quality of life ```
26
ICF classification
Neck pain with: Mobility Impairments, Headaches, radiating/radiculopathy, movement/coordination impairments
27
Dermatomes
C4 - Over the acromioclavicular joint. C5 - On the lateral (radial) side of the antecubital fossa, just proximally to the elbow. C6 - On the dorsal surface of the proximal phalanx of the thumb. C7 - On the dorsal surface of the proximal phalanx of the middle finger. C8 - On the dorsal surface of the proximal phalanx of the little finger. T1 - On the medial (ulnar) side of the antecubital fossa, just proximally to the medial epicondyle of the humerus. T2 - At the apex of the axilla.
28
Myotomes
``` C1/C2: neck flexion/extension C3: neck lateral flexion C4: shoulder elevation C5: shoulder abduction C6: elbow flexion/wrist extension C7: elbow extension/wrist flexion C8: finger flexion T1: finger abduction ```
29
Neck pain with Radiculopathy
ULTT(A) Spurling's Distraction
30
Neck pain with movement/coordination impairment
CCFT (biofeedback at 22-30 in 2 mm/Hg intervals x10 sec each DNF endurance test (40 sec average norm in patients with no neck pain)
31
Use of C/S HVLA for neck pain (CPR) (3/4 predictors ideal)
Sx 10 degrees Pain with PA to mid-C/S Positive patient expectations
32
C/S screening exam
``` Blood Pressure Cardiovascular status Craniovertebral ligament testing (Alar ligament) Neuro Exam Positional testing Carotid palpation CVA risk? (stroke card) ```
33
Cervical Artery risk factors
``` Trauma to upper C/S H/O migraine HTN High cholesterol Cardiac disease DM Coagulopathy or on thinners long-term steroids Recent infection Post-partum no mechanical cause of symptoms or trivial head/neck trauma ```
34
CONTRAINDICATIONS for C/S OMT
``` Multi-level nerve pathology Worsening neuro function Severe, non-mechanical pain Unremitting night pain Recent trauma UMN lesion SCI ```
35
Instability (Risk factors)
``` Congenital Syndrome (Down's) Throat infection H/O trauma to C/S RA or Ankylosing spondylitis Recent head, neck or dental surgery ```
36
CONTRAINDICATIONS for C/S manipulation
``` Dislocation **Acute Fx or soft tissue injury** Instability Tumor Infection Myelopathy Recent Sx Osteoporosis Anky. Spondylitis RA Vascular disease VAI Connective tissue disease Coagulopathy or thinners ```
37
Red Flags
``` **H/O VBI** dizziness blurred vision diplopia nausea tinnitus drop attacks dysarthria dysphagia ```
38
Cervical Myelopathy
``` Stocking glove sensory changes Intrinsic muscle wasting Hyperreflexia (3+) Multi-segmental neuro changes Bowel-Bladder changes Unsteady gait ``` (+) Clonus, Hoffman, Babinski (UMN lesion)
39
C/S Myelopathy Dx cluster (3+/5)
``` Gait abnormality Age > 45 Babinski + inverted supinator Hoffman's + ```
40
Radiculopathy
Usually affects C5-C6 Dermatome - Radial 1/3 of the arm Myotome - Biceps, wrist extension DTR - Biceps
41
Neural tension test false positives
ULTT occurs at 49.4 degrees of elbow extension Slump occurs at 15 degrees of knee extension
42
Cervical Radi. predictors of short-term improvement (3/4)
Age
43
Patients to benefit from traction and exercise (CPR, 4+/5)
``` Age > 55 Peripheralization with C4-C7 mobility + ULTT + Bakody + Distraction ```
44
Traction paramaters
No difference between 10-40 lbs. of force
45
Neuro glides tecniques
Sliding (distal end lengthens while proximal end shortens) Tensioning (distal and proximal end both lengthen) *sliding doubles excursion with less strain of the nerve
46
Thoracic Outlet Syndrome
Neurogenic (75%) followed by venous or arterial Pain/numbness/tingling on affected side Venous - discoloration with swollen UE, aching and heaviness Arterial - Chronic claudication with use
47
TOS exam
1st rib elevated (+)CRLF test with opposite rotation and same side bending Limited C-T junction mobility +ULTT (ulnar N) Pulse usually intact Muscle imbalance with shortened scalenes,pec. minor and LS, weak SA, Lats, LT Poor Posture
48
Whiplash (WAD)
usually grouped in the pain control group (symptoms might delay 48 hours and last for 3 months) Tx: Education on normal activity ASAP, NSAIDs, pain-free ROM *collar only if absolutely necessary for a few days but narcotics and relaxants not recommended
49
Cervicogenic headaches
Unilateral without side shift and ipsilateral UE pain Aggravated by neck movement Tx:DNF and posture training, self-snag technique for HEP
50
Trigeminocervical neucleus
TMJ, headache and neck pain all related because of this structure
51
Migraines
can be treated by greater occipital nerve block (30 day relief)
52
CGH (Dx CLuster 3/3)
Dec. AROM extension Pain with OA-C3/C4 joint palpation CFFT impaired
53
C1-C2 Ligament stability test
Sharp's Pursor (tests the cruciform ligament) Alar ligament
54
C/S ROM
CO-C1 responsible for nodding while C1-C2 is responsible for 50% of rotation ROM
55
Red Flags
Pancoast Tumor: H/O smoking in men over 50 y/o, nagging shoulder and scapular pain into ulnar distribution with possibility of Horner's syndrome Central Cord lesion: Older age, H/O trauma, RA or Down's. Presents with gait disturbance with hyper reflexia. Septic Arthritis: Insidious chest pain in the SC joint, H/O drug use, DM or trauma. Fever and swelling likely present. Cholecystitis: R side medial scapular pain

PT OCS Exam (8 decks)

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