cervical - 1 at risk neck

Question 1

T3

Answer 1

at the root od the scapula

Question 2

T7

Answer 2

at the inf angle of the scapula

Question 3

L3

Answer 3

umbilicus

Question 4

L4-L5

Answer 4

the ASIS

Question 5

S2

Answer 5

PSIS

Question 6

what do we see with fracture/dislocation red flag

Answer 6

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

Severe limitations of motion all planes

Deformity may be present

diagnostic imaging needed

Question 7

what is the point of the Canadian spine rules

Answer 7

does the pt require a diagnostic work up

Question 8

what is the first question of the canadian spine rules

Answer 8

are there any high risk factors that mandate radiography

Question 9

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

Answer 9

age >65

dangerous mechanism of injury

parathesis in the extremities

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

Question 10

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

Answer 10

fall onto head

highspeed MVA

axial load to the head

motorized recreational vehicle

bicycle collision

Question 11

what is the 2nd question in the canadian spine rules

Answer 11

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

Question 12

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

Answer 12

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)

Question 13

Cancer – neoplasm redflag

Answer 13

Medical history is (+) for cancer

Night pain and other atypical pain manifestations

Unexplained weight loss

Fatigue

Question 14

Visceral referred pain - Gallbladder/liver

Answer 14

R thoracic/lower rib, R scapula region

Question 15

Visceral referred pain - Lungs

Answer 15

Thoracic, chest, possibly the shoulder and cervical pain

Question 16

Visceral referred pain - Cardiac

Answer 16

• Chest, neck, arm pain

C8 distribution

Question 17

Inflammatory/Systemic red flag - vitals

Answer 17

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

Question 18

Inflammatory/Systemic red flag - presentation

Answer 18

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

Question 19

Myelopathic Involvement

Answer 19

Gait and balance disturbances, generalized weakness

May not be associated with any radiating pain

• (+) Signs of UMN involvement

Question 20

what are the DTR that we use with the cervical region

Answer 20

jaw jerk

pectoral

ankle clonus

babinski

Question 21

babinski and ankle clonus are testing what

Answer 21

anywhere on the cord

Question 22

hoafmann’s and tromners is testing what

Answer 22

C-spine and higher

UMN

Question 23

shimizu is testing what

Answer 23

more likely the brain and not the neck

Question 24

jaw jerk is testing what

Answer 24

C5 and higher (brain)

UMN

Question 25

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

Answer 25

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

Question 26

what is the purpose of the rhomberg test

Answer 26

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

Question 27

jaw jerk what is a positive sign

Answer 27

the swift closure of the mouth clenching of the jaw

Question 28

what do we do with the pectoral reflex

Answer 28

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

Question 29

what is the point of the pectoral reflex

Answer 29

to see if the pt is hyper-reflexive

Question 30

what is the procedure for Scapular humeral reflex (Shimizu)

Answer 30

Strike: Distal third of the spine Strike: midpoint Strike: acromion Positive: robust shoulder shrug brain

Question 31

Pronator drift test - procedure

Answer 31

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

Question 32

what is a positive - Pronator drift test

Answer 32

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

Question 33

what is the meaning of the pronator drift test

Answer 33

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

Question 34

what is the procedure for hautard's test

Answer 34

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

Question 35

what is the purpose of hautard's test

Answer 35

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

Question 36

hautard's test and reproduction of VBI symptoms

Answer 36

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

Question 37

what is purpose of the neck torsion test

Answer 37

Differentiate cervical from vestibular

Question 38

what is the procedure of the neck torsion test

Answer 38

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

Question 39

neck torsion test outcomes

Answer 39

Mechanical: this rotary movement causes symptoms Vestibular: no symptoms provocation

Question 40

what are the ligamentous test for the neck

Answer 40

Sharp-Purser Test Spinous shear C2 kick test Tectorial membrane test

Question 41

Sharp-Purser Test is testing what ligament

Answer 41

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

Question 42

Sharp-Purser Test procedure

Answer 42

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

Question 43

what is the positive sharps purser test

Answer 43

Positive: abnormal endfeel, clunk

Question 44

what is the function of Spurling’s test

Answer 44

cervical radiculoathy

Question 45

Spurling’s procedure

Answer 45

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

Question 46

what does apostive spurling test look like

Answer 46

Reproduction of cervical radiculopathy sym

Question 47

what is Axial Compression test for

Answer 47

cervical radiculopathy

Question 48

axial compression test procedure

Answer 48

- Pt head in neutral - PT applies even pressure over pt’s head

Question 49

what ligamament is the Spinous shear test looking at

Answer 49

Alar ligament

Question 50

Spinous shear test procedure

Answer 50

hand on C1 transverse process Push on right and then left side Looking for: good firm end feel

Question 51

C2 kick test testing what ligament

Answer 51

Alar ligament

Question 52

C2 kick test procedure

Answer 52

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

Question 53

Tectorial membrane test ligament

Answer 53

the tectorial membrane

Question 54

Tectorial membrane test - procedure

Answer 54

supine: Axial distraction – light and gentle Positive: pain provocation - Pain response to the distraction of the neck