Cervical

Question 1

3 predictors of poor outcomes after neck surgery

Answer 1

1. workers comp
2. dermatomal sensory loss
3. use of weak narcotics prior to sx

Question 2

Canadian C-spine rule

Answer 2

algorithm

1. Did you have high risk fracture episode (fall > 3 ft or fall > 5 steps?) If yes,
   do you
2. Have any tingling into either UE? if yes-xray. If no,
3. are you older than 65? If yes, x-ray, if no did you
4. Have low risk factor (that allows for safe ROM)
   - simple MVA? can you sit up in the ER? walk after the trauma? no cervical midline tenderness?
5. Can you rotate > 45 degrees? No-xray needed. If no x-ray

Question 3

cruciform ligament

Answer 3

made up of transverse lig and longitudinal ligament

- supports dens C2 on C1

Question 4

c/s outcome measures

Answer 4

NDI

Patient specific Functional Scale

Question 5

Cranial cervical flexion test

Answer 5

supine with biofeedback under c/s

• perform chin tucks at 22,25,26,28 and 30 mm/hg and hold for 10s at each pressure
• (-) test if you can sustain 26-30 mm/hg x10” with no SCM or superficial mm compensation
• (+) test if < 26 mmhg for 10 s, compensates with superficial mm

Question 6

Neck flexor endurance test

Answer 6

Normal: hold 38.95s
Abnormal: with neck pain 24.1 seconds

Question 7

thoracic manip for neck pain

Answer 7

C evidence

Question 8

A evidence neck pain

Answer 8

Exam; NDI: 7% (think c/s has 7 vertebrae) ; PSFS (>2)

Interventions

• manips
• coordination,strength,endurance therex
• patient ed and counseling

Question 9

Traction and nerve mobs

Answer 9

level B evidence

Question 10

Signs of a stroke

Answer 10

think FAST

1. Facial droop- ask person to smile
2. Arms- can pt raise both arms up or does one arm shift downward
3. Speech- can pt repeat a simple phrase? slurred or not making sense?
4. Time- call 911 immediately!

Question 11

Contraindications to manual therapy at neck

Answer 11

• Worsening neuro function (multi level root pathology)
• unremitting severe pain
• recent trauma
• UMN signs
• spinal cord damage

Question 12

Contraindications to cervical manipulation

Answer 12

ACUTE soft tissue, ACUTE fracture
- dislocation, ligamentous rupture, RA, AS, osteoporosis, vascular disease, anticoagulation therapy, instability, tumor, infection, acute myelopathy

Question 13

CPR for cervical myelopathy

Answer 13

1. Age > 45
2. (+) gait deviations (ataxic gait, wide BOS)
3. (+) Hoffman
4. (+) Babinski
5. (+) inverse supinatior

3 or more = 94% post test probability

Question 14

Manual tx for myelopathy

Answer 14

• stay away from c/s manips! (contra)
• but can manip upper/mid thoracic spine and intermittent cervical traction
• saw improvements in strength

Question 15

CPR for cervical radiculopathy

Answer 15

1. (+) ULTT A (median nerve)
2. (+) Spurlings
3. (+) distraction
4. Rot < 60 degrees to involved side

3/4: 6.1 LR

4/4: 30.3 LR

Question 16

CPR for cervical manipulation

Answer 16

1. (+) opinion that manip will help
2. Acute, symptoms < 38 days
3. ROM rotation with > 10 degrees difference side to side
4. pain with PA to middle c/s

Question 17

Tx for cervical radiculopathy

Answer 17

MULTIMODAL

1. Manual therapy
2. Cervical traction
3. DNF exercise

Question 18

CPR for cervical traction

Answer 18

1. Age > 55
2. (+) distraction test (30#)
3. (+) peripheralization with p/a C4-C7
4. (+) ULTT A
5. (+) Shoulder abd test

3/5 LR 4.81
4/5 LR 23

Question 19

Cervical Traction parameters

Answer 19

Position neck at 24 degrees of flexion
15 min, intermittent 1 min pull, 20” rest
- initial pull force 10-12# (weight of head, 10% BW), increase throughout session (max pull 35-40#)

DIFFERENT THAN LUMBAR
Lumbar
QIW, 12 min, 40-60% BW force

Question 20

Thoracic outlet tx

Answer 20

conservative: stretch what’s tight
- mobilize tight structures (1st rib, spine)
- Lengthen shortened muscles: scalenes, LS, Pec minor
- teach diaphragmatic breathing
- Neural gliding techniques

Tests:
Cervical rotation Lateral Flexion test
- contralateral rotation, ipsilateral lateral flexion
(+) if you cant laterally flex ( C7 TP blocked by elevated first rib)

Question 21

Whiplash MOI

Answer 21

MVA- coup-contracoup

• s shaped spinal curve
• upper cervical flexion, lower cervical extension

facet capsulses can be stretched, pinched or torn

Question 22

Clinical predictor on acute–> chronic neck pain following whiplash

Answer 22

1. NDI > 15
2. Tampa scale for kinesiophobia > 41

5-6% development to chronic if NO to both above
up to 83% development of chronic pain if YES to both above

Question 23

Cervicogenic headache treatment

Answer 23

1. strengthen deep neck flexors
2. self SNAGS
3. manual therapy (mobs or manip)

Question 24

Cervicogenic headache dx

Answer 24

1. limited cervical ext ROM
2. pain with palpation to c3/c4
3. weakness in deep neck flexors with CC cervical flexion test

Question 25

Neck pain with radiating pain treatment

Answer 25

Acute - nerve mobs and traction (B) - mobilizing/stabilizing (C) - cervical collar (C) - stretching, thoracic mob/manip (C) Chronic (B) - intermittent traction - stretching - strengthening - C/S, and T/S manips - education

Question 26

Neck pain with mobility deficits tx

Answer 26

Acute - cervical AROM (B) - thoracic manips (B) - scapulothoracic strengthening (B) - cervical mobs (C) Subacute - neck/shoulder endurance therex (B) - throacic/cervical mob/manip (C) Chronic (multimodal) - cervical/thoracic manip (B) - strengthening/stretching, endurance training, cognitive affectiev elements (B) - neck/shoulder/trunk endurace therex (C) - pt ed (C)

Question 27

Neck pain with movement coordination (motor control) therex

Answer 27

Most commonly due to sprain/strain of c/s Acute - active exercise protocol, pt ed to return to pre-accident activities, postural/mobility exercises to decrease pain and increase ROM (B) - mobs and exercise (B) Chronic -

Question 28

CPR to know who responds well with cervical radic

Answer 28

Age < 55 non dominant arm affected looking down does not increase symptoms Multimodal approach used ( manual, traction and exercise DNF)

Question 29

Risk factors for pancoast tumor

Answer 29

1. men > 50 2. Hx of smoking 3. pain in shoulder along vertebral border of scap - can progress to pain down the arm into ulnar nerve distribution Can demonstrate - horners syndrome - wheezing

Question 30

Septic arthristis (AC jt)

Answer 30

- chest pain localized to SC jt - hx of IV drug use, diabetes, trauma, infection, fever - Tender SC jt, swelling at SC jt

Question 31

Subarachnoid hemorrhagic/ischemic stroke

Answer 31

- elevated BP, severe headache | - hx HTN, altered mental status, vertigo, vomiting

Question 32

Difference between neck with mobility and movement coordination

Answer 32

neckpain with mobility= more ACUTE < 12 weeks | neckpain with movement coordination- more CHRONIC

Question 33

Signs of neck pain with mobility issues

Answer 33

1. loss of cervical AROM 2. limited flexion rotation test 3. hypomobility in cervical/thoracic spine

Question 34

Signs of neck pain with radiating pain

Answer 34

1. (+) spurlings 2. (+) distraction 3. (+) ULTT A 4. Valsalva

Question 35

Signs of neck pain with movement coordination

Answer 35

Including whiplash 1. (+) cervical neck flexor endurance test 2. (+) craniocervical flexion test

Question 36

Signs of neck pain with headaches

Answer 36

1. upper cervical ROM 2. (+) flexion rotation test 3. upper cervical mobility