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MS II > Cervical > Flashcards

Cervical Flashcards

1
Q

Features of the cervical spine

A 
extreme mobility
complex series of joints 
different functions of IVD and ZPJ 
vertebral and internal cartoid artery 
7 vertebrae and 8 nerve root
close approx to shoulder
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2
Q

Symptoms of this pathology are little pain, stiffness more than pain, no referred or neurological symptoms, AM stiffness, grinding when turn head

a. disc
b. radiculopathy
c. myelopathy
d. uncovertebral joint

A

uncovertebral joint

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3
Q

This pathology shows a loss of extension, neck in forward flexed position, limited side bend in flexion, neutral and extension, decreased rotation and crepitus or grinding

a. disc
b. radiculopathy
c. myelopathy
d. uncovertebral joint

A

uncovertebral joint

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4
Q

What are treatment options for uncovertebral joints?

A

central PA
distraction and add flexion
mechanical traction

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5
Q

What disc changes occur with age?

A

loss of disc height > formation of UC osteophytes and hard posterior disc protrusions

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6
Q

a loss of disc height causes

A

stiffness

loss of extension and SB

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7
Q

Where is disc thinning and resorption seen?

A

C5-C6 or C6-7 in 50-60s

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8
Q

_ cervical discs fissure before _

A

upper

lower

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9
Q

When there is no nucleus in the disc there is a (increase/decrease) incidence of upper cervical disc injury and radiculopathy

A

decrease

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10
Q

When there is a nucleus in the disc there is a (increase/decrease) incidence of lower cervical disc injury and radiculopathy

A

increase

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11
Q

What changes occur to the disc with age?

A

becomes compressed and distorted by UV osteophytes and disc protrusions

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12
Q

Fissuring with age is due to _

A

UVJ

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13
Q

The disc can project into the _ and in the _

A

IV foramina

spinal canal

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14
Q

Discs can project into the IV foramina and into the spinal canal with potential compressive effects on nerve roots, Vertebral arteries, and Spinal cord (True/false)

A

true

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15
Q

What are treatment options for disc issues?

A

central PA

unilateral PA or PA in rotation

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16
Q

What grade mobilization should be done for disc issues?

a. grade 1
b. grade 4
c. grade 2 or 3
d. grade 2 only

A

grade 2 or 3

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17
Q

The nerve in the vertebral canal supplies the disc at _

A

their level of entry and the disc above

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18
Q

Branches of the vertebral nerve supply _ aspects of the cervical discs

a. anterior
b. posterior
c. lateral
d. medial

A

lateral

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19
Q

discogenic pain is referred pain (True/false)

A

true

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20
Q

Symptoms of c-spine relatively pain-free/stiff/sore, deep burning, toothache pain around the scapular border, supraspinous fossa and scapula, referral to the shoulder

a. radiculopathy
b. cervical myelopathy
c. facet joint
d. discogenic

A

discogenic

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21
Q

This structure is a little fat pad that protudes into the disc, cushions and occupies any irregularities, it can get pinched

a. branch of nerves
b. disc
c. menisci
d. uncovertebral ostyeophyte

A

menisci

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22
Q

c-spine is innervated by

A

medial branch

dorsal ramus

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23
Q

This c-spine pathology shows symptoms of sharp, localized pain, uniltareal, spasms, referral into the UE with neck pain being worse than UE pain

a. radiculopathy
b. disc issue
c. ZPJ
d. cervical myelopathy

A

ZPJ

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24
Q

Patient shows signs of limited extension, rotation to same side, side flexion to same side

a. radiculopathy
b. disc issue
c. ZPJ
d. cervical myelopathy

A

ZPJ

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25
Q

ZPJ pain can be due to

A

entrapment of meniscoidal

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26
Q

_ closes down producing pain in a patient with ZPJ

A

extension

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27
Q

Treatment for facet joints includes

A

unilateral

opening

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28
Q

For facet joint pathology, start with the neck in _ and progress towards more _

A

flexion

extension

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29
Q

What treatments can be done for facet joint pain?

A

unilateral PA or PA in rotation
opening techniques - UPSLOPE
transverse vertebral pressure or lateral glide
longitudinal cephalad

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30
Q

There is forgiveness in the cervical spine so patients can have a bulge without knowing (True/false)

A

true

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31
Q

Radiculopathy can be caused by trauma of

A

annulus tears
end-plate injuries
annulus bruising

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32
Q

A bulge can irritate the _ and cause radiculopathy

A

DRG

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33
Q

Patients presents with unilateral pain, in a dermatomal pattern, distal more than proximal, deep toothache pain, numbness, pins and needles, weakness in myotome pattern

a. cervical myelopathy
b. radiculopathy
c. ZPJ
d. disc issue

A

radiculopathy

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34
Q

Patient shows protective deformities, positive neurodynamic testing, spurling test, and distraction, what could they be diagnosed with?

a. cervical myelopathy
b. radiculopathy
c. ZPJ
d. disc issue

A

radiculopathy

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35
Q

Protective deformity with arm above head indicates injury at

a. C4
b. C5
c. C6
d. C7

A

C5

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36
Q

Protective deformity with arm at their side indicates injury at

a. C4
b. C5
c. C6
d. C7

A

C7

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37
Q

Protective deformity with forward head can indicate

a. cervical myelopathy
b. radiculopathy
c. ZPJ
d. disc issue

A

radiculopathy

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38
Q

What are the signs of threatening nerve root pain?

A

dermatome, distal more than proximal
severe pain, latency
slight movement irritating
protective deformity

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39
Q

A patient shows more distal pain than proximal, severe pain with latency, slight movement is irritating and a protective deformity of C5. This could be

a. radiculopathy
b. cervical myelopathy
c. threatening nerve root pain
d. stenosis

A

threatening nerve root pain

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40
Q

What is the CPR for radiculopathy?

A

ipsilateral rotation < 60 degrees
positive ULNT A
positive distraction
positive spurling

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41
Q

What is the hallmark sign for radiculopathy?

a. positive distraction test
b. positive spurling test
c. protective deformity
d. distal symptoms more severe and follow dermatome

A

distal symptoms more severe and follow dermatome

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42
Q

What are signs of nerve root compression?

A

numbness in dermatome
heavy feeling in extremity
hypersensitivity
cramping

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43
Q

A loss of sensation, motor weakness/atrophy, decreased reflexes can indicate

a. radiculopathy
b. referred pain
c. nerve root compression
d. disc issue

A

nerve root compression

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44
Q

What treatment should be done for radiculopathy?

A

intermittent traction

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45
Q

Spinal cord encroachment leads to

a. VBI
b. radiculopathy
c. foraminal stenosis
d. cervical myelopathy

A

cervical myelopathy

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46
Q

cervical myelopathy is more common with _

A

age

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47
Q

Patient shows gait abnormality, hyper reflexive, hoffmans sign, babinksi which could indicate

a. VBI
b. radiculopathy
c. foraminal stenosis
d. cervical myelopathy

A

cervical myelopathy

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48
Q

cervical myelopathy indicates (UMN/LMN) signs

A

UMN

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49
Q

A patient presents with cervical myelopathy

a. treat them without screening
b. screen then treat
c. do not treat
d. treat only if medically cleared

A

treat only if medically cleared

50
Q

What treatment can you do for cervical myelopathy?

A

avoid extension
treat in flexion
cervical traction

51
Q

it is normal to turn head and occlude to the opposite die (true/false)

A

true

52
Q

Cervical rotation with extension or only extension causing occlusion indicates

A

internal carotid artery insufficiency

53
Q

symptoms of VA insufficiency

A

D’s: dizziness, diplopia, dysphagia, drop attacks, dysarthria
A: ataxia
N’s: nystagmus, nausea, numbness

54
Q

Testing for VAI is reliable (true/false)

A

false

55
Q

What ligament holds the dense from C2 up into C1?

a. alar ligament
b. transverse ligament
c. dura
c. atlanto ligament

A

transverse ligament

56
Q

What is the function of the ligaments on either side of the arch of C1?

A

keep dens pushed into arch

57
Q

This ligament is a passive restraint to excessive rotation and lateral flexion

a. alar ligament
b. transverse ligament
c. dura
c. atlanto ligament

A

alar ligament

58
Q

This ligament has a primary passive restraint of C1 displacement in the sagittal plane

a. alar ligament
b. transverse ligament
c. dura
c. atlanto ligament

A

transverse ligament

59
Q

_ ligaments check rotation and side bending

A

both alar and transverse

60
Q

How can the upper cervical spine be treated?

A

unilateral PA in rot
proprioception
soft tissue
neurodynamics

61
Q

_ attaches to the dura of the spinal cord

A

rectus capitis posterior minor

62
Q

if the _ is hyperactive it can pull and cause a headache

A

rectus connecting to the dura

63
Q

_ can atrophy causing chronic TTH

A

rectus

64
Q

What sends feedback to the brain on where head is in space?

A

sub occipital triangle

65
Q

How can you create space to treat foraminal stenosis?

A

lateral glide

longitudinal cephalad

66
Q

the neurovascular bundle is located

A

under the scalene

67
Q

_ and _ scalenes attach to the first rib under the clavicle

A

anterior and middle

68
Q

the _ scalene attaches to the second rib

A

posterior

69
Q

Exercise for WAD should be

A

multi modal

70
Q

When is it indicated to do AROM unloaded?

A

high levels of pain

surgery or WAD

71
Q

What AROM exercises can be done unloaded?

A

nodding
rotation
side flexion

72
Q

When is it appropriate to move from unloaded AROM to loaded?

a. when symptoms are gone
b. as pain eases
c. when they show control
d. immediately

A

as pain eases

73
Q

What exercise is useful to improve the stabilization of the c-spine?

a. head nods
b. head lifts
c. rotation
d. side bending

A

head nods

74
Q

These muscles are able to exert force due to larger lever arms and cross-sectional areas

a. superficial muscles
b. deep muscles
c. deep flexors
d. anterior muscles

A

superficial muscles

75
Q

These muscles are more localized to either region, have segmental attachments, larger spindle densities and guide and support segments

a. superficial muscles
b. deep muscles
c. deep flexors
d. anterior muscles

A

deep muscles

76
Q

When can exercises be progressed to functional tasks?

A

once sufficient control with stabilization

77
Q

What sensorimotor changes are seen post injury?

a. less function
b. decreased endurance
c. decreased strength and endurance
d. more recruitment of muscles

A

decrease strength and endurance

78
Q

Which muscles show a decrease in isometric strength and endurance?

A

cervical flexors
craniocervical flexors
cervical extensors

79
Q

How does low intensity contractile affect the neck?

a. recruitment of muscles
b. less strength
c. hypermobility
d. detrimental to stability

A

detrimental to stability

80
Q

What alterations are seen in motor control?

a. frequency of firing
b. co contraction
c. duration of firing
d. amplitude and timing

A

amplitude and timing

81
Q

What muscle properties change after WAD?

A

fatty infiltration

82
Q

What is the purpose of the craniocervical flexion test?

A

monitors change in shape of curve as it flattens with contraction of deep cervical flexors

83
Q

This is defined as the ability to relocate neutral head posture with eyes closed

a. motor control
b. joint motion
c. sensory sensation
d. joint position sense

A

joint position sense

84
Q

The angular difference between starting postural position and that assumed after neck movement

A

joint position error

85
Q

Errors with joint position sense occur with

a. side bending
b. return from extension and rotation to left or right
c. rotation to painful side
d. return from flexion and rotation

A

return from extension and rotation to left or right

86
Q

Posture is correlated to pain in the c-spine (true/false)

A

false

87
Q

Errors with joint position sense occur with

a. side bending
b. return from extension and rotation to left or right
c. rotation to painful side
d. return from flexion and rotation

A

return from extension and rotation to left or right

88
Q

Posture is correlated to pain in c-spine (true/false)

A

false

89
Q

Traction should be used as a form of _ or _

A

oscillation

static hold

90
Q

How much weight should be used for traction initially?

a. 5 lbs
b. 10-12 lbs
c. 15-20 lbs
d. 20 lbs

A

10-12 lbs

91
Q

Traction weight should be adjusted to _

A

the patients’ symptoms

92
Q

Traction and exercise are indicated for which patient population

a. cervical myelopathy
b. VBI
c. WAD
d. radiculopathy

A

radiculopathy

93
Q

Research indicates adding traction to _ will lower disability and pain

a. ULNT
b. exercise
c. mobilization
d. heat

A

exercise

94
Q

Traction and exercise are indicated for which patient population

a. cervical myelopathy
b. VBI
c. WAD
d. radiculopathy

A

radiculopathy

95
Q

What is a good indicator for mechanical traction?

a. neural symptoms
b. negative response to manual traction
c. claustrophobia
d. good response to manual traction

A

good response to manual traction

96
Q

Mechanical traction is indicated for

A

favorable response to manual
severe nerve root pain
recent worsening neurological changes
unloading eases pain

97
Q 
Structural disease secondary to tumor or infection 
vascular compromise
movement contraindicated
VBI 
fracture 
these are 
a. precautions for traction
b. contraindications
c. be cautious with these 
d. indications for traction
A

contraindications

98
Q 
Acute strains and sprains 
inflammatory conditions 
spinal joint instability or trauma 
pregnancy
osteoporosis 
claustrophobia 
cortical steroid intake
a. precautions for traction
b. contraindications
c. be cautious with these 
d. indications for traction
A

precautions for traction

99
Q

What duration of traction is indicated for pain?

a. longer for 30 minutes
b. shorter for 3 minutes
c. as long as they can tolerate
d. shorter start with 10 minutes

A

shorter start with 10 minutes

100
Q

What duration of traction is indicated for stiffness?

a. longer for 30 minutes
b. shorter for 3 minutes
c. as long as they can tolerate
d. shorter start with 10 minutes

A

longer up to 30 minutes

101
Q

What treatment should be done before and after traction?

a. exercise
b. ULNT
c. ROM
d. mobilization

A

mobilization

102
Q

What is the no therapy window for ESI?

A

48 hours

103
Q

Limit use of _ for _ days after ESI

A

heat

2-3

104
Q

Cervical spine surgery is generally as poor success rates as lumbar (true/false)

A

false

105
Q

How long after surgery should the therapist wait to do manipulation?

A

6 months

106
Q

Which subgroup?

  • Recent onset of symptoms
  • NO radicular/referred symptoms in the upper 1/4
  • Restricted ROM w/ rotation and/or discrepancy in lateral flexion ROM
  • NO signs of nerve root compression or peripheralization of Sx in the upper 1/4 w/ cervical ROM
    a. mobility
    b. centralization
    c. conditioning and exercise tolerance
    d. pain control
    e. reduce headache
A

mobility

107
Q

Which subgroup?

  • Radicular/referred symptoms
  • Peripheralization and/or centralization of Sx w/ ROM
  • Signs of nerve root compression present
  • May have Dx of cervical radiculopathy
    a. mobility
    b. centralization
    c. conditioning and exercise tolerance
    d. pain control
    e. reduce headache
A

centralization

108
Q

Which subgroup?

  • Lower pain & disability scores
  • Longer duration of Sx (i.e. more chronic than acute)
  • NO signs of nerve root compression
  • NO peripheralization/centralization during ROM
    a. mobility
    b. centralization
    c. conditioning and exercise tolerance
    d. pain control
    e. reduce headache
A

conditioning and exercise tolerance

109
Q

Which subgroup?

  • High pain & disability score
  • Very recent onset of symptoms (i.e. more acute than chronic)
  • Symptoms precipitated/caused by trauma
  • Radicular/referred symptoms
  • Poor tolerance for examination or most interventions
    a. mobility
    b. centralization
    c. conditioning and exercise tolerance
    d. pain control
    e. reduce headache
A

pain control

110
Q

Which subgroup?

  • Unilateral headache w/ onset preceded by neck pain
  • Headache pain triggered by neck movement or positions
  • Headache pain elicited by pressure on posterior neck
    a. mobility
    b. centralization
    c. conditioning and exercise tolerance
    d. pain control
    e. reduce headache
A

reduce headache

111
Q

Uncovertebral joints are (not innervated/highly innervated)

A

highly innervated

112
Q

Uncovertebral joint symptoms: referred/not referred and neurological symptoms

A

referred

no neurological symptoms

113
Q

What is a good indicator of uncovertebral joint symptoms?

A

stiffness more than pain

114
Q

Which type of traction should be used for Uncovertebral joint symptoms and IVD?

a. intermittent
b. static

A

intermittent

115
Q

_ from the UVJ can occlude foramen

A

sclerosis

116
Q

Most people do not show disc problems on imaging (True/false)

A

false

most do but are symptom free

117
Q

Lateral glides limits in neutral and flexion, this suggests

a. facet joint lock
b. uncovertebral lock

A

uncovertebral lock

118
Q

Lateral glides limited in neutral and less restriction in flexion

a. facet joint lock
b. uncovertebral lock

A

facet joint lock

119
Q

radiculopathy injury occurring with trauma can be caused be

A

annulus tears
end plate injuries
annulus bruising

120
Q

Radiculopathy - is pain more distal or proximal?

A

distal

121
Q

Which motion should be avoided with potential for cervical myelopathy?

A

extension

122
Q

A patient has a loss of extension and is limited with SB, rotation and neck is kept in flexion. There is some crepitus/grinding, which would you suggest is causing this?

a. ZPJ
b. disc injury
c. radiculopathy
d. UVJ

A

UVJ

MS II (17 decks)

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