C-Spine lecture1

Question 1

Why is the c-spine more mobile than other regions of the spine?

Answer 1

positioning of head (vision, balance), need for rapid motion at times

Question 2

which joints comprise upper c spine

Answer 2

C0-2

Question 3

which jts comprise lower c spine

Answer 3

C3-C7, C7 transitional segment

Question 4

neck pain is ___ greatest contibutor of global disability

Answer 4

4th

Question 5

Chronic neck pain ___ to chronic LBP as most common MSK disorder associated with injury and disability claims in workplace and MVA

Answer 5

2nd

Question 6

Lifetime prevalence of neck pain

Answer 6

66%

Question 7

prevalence ___ with age, peaking in ____ year group

Answer 7

increases, 35-49

Question 8

C-spine risk factors (health, psychological)

Answer 8

cycling, smoking, previous neck pain, depression, job stress, low co-worker social support

Question 9

demographic risk factors

Answer 9

female, 45-59 years, better prognosis in younger pts.

Question 10

occupation risk factors

Answer 10

heavy labor, office jobs, healthcare workers, unemployed

Question 11

physical work risk factors

Answer 11

sedentary, repetitive work, working with neck flexed, working with arms above or at shoulder height, head carrying

Question 12

T/F most patients with neck pain:specific pathoanatomic cause is not known

Answer 12

T

Question 13

Non-MSK causes of neck pain

Answer 13

infection, tumor, cardiac, endocrine, gastrointestinal, neurological, pulmonary, systemic disease

Question 14

MSK causes of neck pain

Answer 14

soft tissue injury, degenerative changes in facet joints, joint pain, fracture, dislocation

Question 15

Onset exam questions

Answer 15

insidious or acute

Question 16

trauma exam questions

Answer 16

incident details, loss of consciousness, immediate treatment

Question 17

neuro exam questions

Answer 17

pain pattern, sensory changes, muscle weakness, gait changes, loss of balance/coordination

Question 18

Other exam questions (a lot)

Answer 18

bowel and bladder, weight loss, night pain, fever, dizzines, fainting episodes, headache-location, TMJ symptoms, facial pain, pulmonary symptoms-SOB, coughing, blood in sputum, effect of cough/sneeze on neck/arm pain, cardiac symptoms-palpitations, angina, sleeping habits, postural stressors, litigation

Question 19

Score summary of NDI

Answer 19

0-4 - no disability
5-14- mild
14-24- moderate
25-34- severe
>35- complete disability

Question 20

T/F elevated fear-avidance beliefs do not contribute to muscle guarding and the persistence of pain and disabiltiy

Answer 20

F - these beliefs will result in altered movement patterns and reduced physical activity

Question 21

Nerve roots exit

Answer 21

above the named level

Question 22

which neurological sequelae of impingement will you get with sensory/motor changes

Answer 22

radiculopathy: nerve root

Question 23

which neurological sequelae of impingement will you get with UMN signs

Answer 23

Myelopathy

Question 24

Which nerve keeps us alive

Answer 24

phrenic (C345) to the diaphragm

Question 25

Tracheobronchial conditions

Answer 25

inflammation, infection (viral, bacterial), tumor

Question 26

Potential symptoms of tracheobronchial conditions

Answer 26

referred neck pain, dyspnea, dysphagia, persistent cough, fever, chills, hemoptysis

Question 27

Conditions referring to the neck

Answer 27

tumors, infection, cardiovascular pain, gastrointestinal, Lyme disease, RA, ankylosing spondylitis, fibromyalgia,Klippel-Feil syndrome, Hypo/hyperthyroidism

Question 28

This syndrome is a congenital fusion of cervical vertebrae. Mutation in genes GDF6 and GDF3

Answer 28

Klippel-Feil Syndrome

Question 29

Briefly look over conditions referring to the neck

Answer 29

yaaa

Question 30

____ of patients with neck pain will go on to develop chronic symptoms

Answer 30

44%

Question 31

_____ of general pop who experience neck pain at some time will report neck pain 1-5 years later

Answer 31

50-85%

Question 32

Age and male were _____associated with PT use

Answer 32

negatively

Question 33

Lower ed level, having workers comp and litigation were ____ associated with PT use

Answer 33

positively

Question 34

compared to centralization exercicises, traction, and neural mobilizations; cervical manual therapy with exercise has ____ evidence of success

Answer 34

stronger

Question 35

classification for recent onset of symptoms and no radic

Answer 35

Mobility (manual therapy and exercise)

Question 36

classification for radic, symptoms below elbow

Answer 36

centralization

Question 37

classification for no radic, chronic symptoms

Answer 37

Exercise and condtioning

Question 38

classification for primary complaint of headache, specifically cervicogenic

Answer 38

Headaches (manual therapy and neck flexor/scapular strengthening)

Question 39

classification for acute and traumatic mechanism

Answer 39

pain control (gentle ROM and activity)

Question 40

staging the patient is based on the level of

Answer 40

acuity

Question 41

acuteness is determined by

Answer 41

the nature of the presenting symptoms and the goals for treatment

Question 42

Goal of stage 1 acuity

Answer 42

decrease severity

Question 43

goal of stage 2 acuity

Answer 43

address relative impairments

Question 44

goal of stage 3 acuity

Answer 44

return to work/sport

Question 45

Decision rule developed for radiographs of the c spine following trauma

Answer 45

canadian cervical spine rule

Question 46

what is the canadian cervical spine rule looking to detect

Answer 46

any fracture, dislocation, or ligamentous instability demonstrated by dx imaging

Question 47

Pt is older than 65 or dangerous mechanism or paresthesias in extremities after a traumatic incident (MVA, fall, collision). Do we send for Radiography according to Canadian C-spine rule

Answer 47

YES

Question 48

According to the CCS rule, after establishing that there is no high risk factor that mandates radiographs, what are the low-risk factors that allow for a safe assessment of ROM?

Answer 48

Simple rear-end MVC, sitting position in the emergency department, ambulatory at any time, delayed onset of neck pain, absence of midline cervical spine tenderness

Question 49

If the patient passes the low risk factor that allows safe assessment of ROM in the CCS rule, how many degrees to the left and right are required to not get radiography

Answer 49

45 in each direction

Question 50

Signs/symptoms of upper cervical instability

Answer 50

suboccipital (C2) pain, bilateral UE/LE paresthesias, clumsiness/loss of balance, nystagmus, headaches, blurred vision

Question 51

UMN signs

Answer 51

Hyperreflexia, spasticity, abnormal gait, clumsiness, babinski's sign.

Question 52

Causes of atlantoaxial instability

Answer 52

congenital bony malformation, downs, inflammatory conditions, trauma, chronic coritcosteroid use

Question 53

_____ of patients with RA have cervical involvement

Answer 53

50% (destruction of dens, transverse lig, or both

Question 54

which inflammatory conditions do we worry about for atlantoaxial instability

Answer 54

RA, psoriatic arthritis, anklyosing spondylitis, osteomyelitis