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msk 3 > Cervical Health Conditions and Clinical Presentations > Flashcards

Cervical Health Conditions and Clinical Presentations Flashcards

1
Q

What are risk factors that might signal infection?

A
  • immunosuppression
  • diabetes
  • cirrhosis
  • AIDS
  • oral steroid use
  • recent/current infection
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2
Q

Signs of meningitis

A
  • fever
  • neck stiffness
  • Kernig’s sign/Brudzinski’s sign
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3
Q

What is Kernig’s sign?

A

Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees

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4
Q

What is Brudzinski’s sign?

A

when you flex the child’s neck, they have to flex their knees
- due to tightness/discomfort of meninges

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5
Q

Why are Kernig’s sign and Brudzinski’s sign a sign of meningitis?

A
  • These occur with meningitis because spinal sheath is stretched and since it is irritated the distal segments need to flex to reduce the discomfort
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6
Q

What are signs of a neoplasm?

A
  • prior history of cancer
  • fever, night sweats
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7
Q

What is a patient with RA more at risk for? What does this cause?

A

Basilar invagination - top of the spine pushes into the base of the skull
Atlantoaxial instability – laxity of ligamentous structures between C1 and C2
- Usually causes C2 to shift superiorly

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8
Q

complaints of ankylosing spondylitis

A
  • men 10x > women - most often in 3rd decade (20s)
  • back pain that is worse at night and in morning (worst at rest but better with exercise)
  • decreased chest wall expansion (barrel chested)
  • back stiffness
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9
Q

Physical exam findings of ankylosing spondylitis

A
  • chin on chest position
  • multi-directional ROM limitations of the spine/diminished mobility of the spine
  • radiographic sacroiliitis on imaging
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10
Q

What is Klippel Feil syndrome?

A

congenital; failed C-spnine segmentation
- no neck, limited c-spine ROM, low posterior hairline

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11
Q

What is cervical arterial dysfunction (CAD)? What can occur because of it?

A

Intimal tear with penetration of circulating blood into the vessel wall and formation of intramural hematoma
- stroke (retinal or brain ischemia)
- compression or stretching causes local symptoms
- subarachnoid or intra-cerebral hemorrhage

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12
Q

Consequences of Cervical Arterial Dysfunciton (CAD)

A
  • retinal or brain ischemia (stroke)
  • compression or stretching causes local symptoms
  • subarachnoid or intra-cerebral hemorrhage
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13
Q

What is the average age for cervical arterial dysfunction (CAD)?

A

39-45 y/o

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14
Q

cervical arterial dysfunction (CAD) symptoms

A
  • neck pain - 60-80%
  • face pain
  • Severe headache - worst HA they have ever had
  • severe pain - > 70%
  • pulsatile tinnitus (comes in bursts)
  • bilateral extremity dysesthesia, motor dysfunction, pain
  • 5 D’s and N’s
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15
Q

What are the 5 D’s and N’s?

A
  • Dizziness
  • Dysarthria - difficulty speaking
  • Dysphagia - difficulty swallowing
  • Diplopia - double vision
  • Drop attacks - beginning of LOC
  • Nystagmus
  • Nausea
  • Numbness - dysesthesia of face/lip/extremities
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16
Q

Physical exam finds of cervical arterial dysfunction (CAD)

A
  • ipsilateral Horner’s syndrome
  • CN signs
  • HTN
  • positional testing (sustained end range, modified sphinx, pre-manipulative positioning)
  • Neuro testing (UMN hyperreflexia and LMN hyporeflexia)
  • VBI tests
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17
Q

What constitutes Horner’s syndrome?

A
  • ptosis - dropping of upper eyelid
  • miosis - constriction of pupil
  • enopthalmos - sinking of orbit (shadowing)
  • anhydrosis - dry eyes/absence of sweating
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18
Q

What is cervical spine Myelopathy?

A

Spinal cord compression as a result of impingement from surrounding structures

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19
Q

symptoms of cervical spine myelopathy

A
  • neck pain/stiffness
  • shoulder pain
  • imbalance/fall Hx
  • UE dysesthesia
  • may involve LEs first (gait, weakness)
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20
Q

physical exam findings of cervical spine myelopathy

A

Neurologic signs
- gait impairment
- spasticity
- pathologic reflexes
- hyperreflexia
- dis-coordinated extremity movements
- radicular signs (weakness, sensory impairments)
- balance impairment

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21
Q

5 signs for clinical prediction rule for cervical spine myelopathy

A

1) gait deviation
2) hoffmann’s sign
3) inverted Supinator sign
4) Babinski sign
5) patient age > 45 y/o

good confirmation is 3 or more + tests

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22
Q

upper cervical instability symptoms

A
  • neck pain
  • occipital headache/numbness
  • multidirectional ROM at end range
  • radicular vs myelopathic symptoms
  • reports needing to support head/tires easily w/ prolonged static upright positioning of head
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23
Q

upper cervical instability physical examination findings

A
  • limitation in c-spine ROM multidirectional
  • muscle guarding
  • potential radicular vs myelopathic signs
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24
Q

special tests for upper cervical instability

A
  • modified/sharp-purser test
  • alar ligament stability test
  • lateral shear test
  • tectorial membrane test
  • posterior A-O membrane test
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25
Q

What fractures may occur during traumatic axial loading?

A

Fractures involving the occipital condyles, C1, C2, traumatic spondylolysthesis

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26
Q

Presentations of fractures involving the occipital condyles, C1, C2, traumatic spondylolysthesis

A
  • limited ROM (multidirectional)
  • neck pain
  • c-spine spasm
  • difficulty swallowing
  • radicular pain/radiculopathy
  • CAD s&s
  • myelopathy s&s
27
Q

What is a Jefferson fracture? What is the mechanism of injury?

A

C1 fracture - 4 part burst fracture of atlas
- involves anterior and posterior ring of C1

  • Mechanism of injury – compression load like diving
28
Q

What is spondylolysis?

A
  • defect of pars interarticularis
  • stress fracture forming at the pars interarticularis (uni or bilateral)
29
Q

What is spondylolysthesis? Where is it most common?

A
  • anterior displacement of vertebral body
  • degenerative spondylolysthesis - most common at C3/4 and C4/5
30
Q

Grades of spndylolysthesis

A

1 - 0-25%
2 - 25-50%
3 - 50-75%
4 - 75-100%

31
Q

Canadian c-spine rules
- When to send patient for radiography

A
  • Have high-risk factor (age >= 65, dangerous mechanism, or paresthesias in extremities
  • not able to rotate neck actively 45 deg L or R
32
Q

5 criteria for NEXUS Low Risk Rule (low probability of injury)

A
  • no midline cervical tenderness
  • no focal neurologic deficit
  • normal alertness
  • no intoxication
  • no painful, distracting injury
33
Q

What is the difference between radicular and referred pain?

A

radicular pain - Pain from irritation to spinal nerve or root(s) (nociception)

referred pain - pain felt in one part of a body that comes from another but does not follow a dermatomal or myotome pattern

34
Q

What affects vertebral bodies and discs by the formation of osteophytes around the margin of bodies?

A

spondylosis

35
Q

What affects zygapophysial joints and AA joints by the formation of osteophytes that cause joint narrowing?

A

osteoarthrosis

36
Q

What is lateral canal stenosis?

A

encroachment on spinal nerve in lateral foramen/lateral recess of spinal canal

37
Q

What does lateral canal stenosis result in?

A
  • loss of disc height w. degenerative processes (as disc height shrinks, lamina on both vertebra become smaller)
  • z-joint and uncovertebral joint hypertrophy
  • spondylolisthesis
  • radicular symptoms
38
Q

Which motion is commonly assoicated with acute z-joint arthropathy?

A

extension

39
Q

physical exam findings of acute z-joint arthropathy

A
  • painful with joint compression ROM
  • painful with segmental provocation
  • concordant pain with cervical compression and spurlings test
  • pain observed in segmental distribution, not paresthesia/anesthesia
40
Q

somatic referred pain vs radicular pain vs radiculopathy

A

somatic referred pain - altered pain preception in CNS

radicular pain - pain related to nerve root irritation (dermatomal pathway)

radiculopathy - conduction block of motor and sensory axons

41
Q

T/F: Radiculopathy is painful

A

false - technically it is not painful but it is commonly associated with radicular pain

42
Q

What cervical spine is most commonly affected by radiculopathy?

A

C6 and C7

43
Q

Hx of cervical radiculopathy

A

traumatic/acute
- local neck injury involved
- traumatic event associated with onset of radicular sign/symptoms

Degenerative
- recurrent episodes - worsening in length and intensity throughout episode progressions
- trauma in initial episode

44
Q

cervical radiculopathy symptoms

A
  • unilateral > bilateral
  • radicular symptoms
  • aggravation with activities that compress the neuroforaminal space
45
Q

cervical radiculopathy physical exam

A
  • natural bakody’s sign possible
  • painful/limited ROM w/ motions that compress foramen or place tensile load on nerve root
  • relief with opening of neuroforament
    • valsalva test
  • Wainner’s test item cluster
46
Q

What is Bakody sign?

A

hand on top of the head with palm up and it reduces pain

47
Q

Wainner’s Test Item Cluster

A

used to confirm radiculopathy - more positive items the better confirmation

  • ipsilateral C-spine rotation AROM < 60 deg
    • spurlings test
    • cervical distraction test
    • upper limb tension test - median nerve bias
48
Q

pathomechanics of whiplash

A
  • trunk thrust upward
  • lower c-spine segment rotation into extension
  • anterior annulus distracted, impaction on facet joints, meniscoid contusion
49
Q

What ligaments are stretched and what is injured during whiplash?

A
  • anterior annulus, ALL, and facet capsule strain
  • meniscoid contusion
  • intra-articular hemorrhage of facets
  • fractures of articular pillars/subchondral plates, dens, laminae C2, occipital condyles
50
Q

symptoms of whiplash

A
  • neck, shoulder, UE pain
  • radicular vs referred symptoms
  • Glove-like distribution paresthesia
  • weakness
  • dizziness
  • difficulty focusing vision
  • tinnitus
51
Q

physical exam findings of whiplash

A
  • radicular signs possible
  • multidirectional limitations
  • weakness
  • muscle guarding
  • tinnitus
52
Q

What is a key sign of cervicogenic headache?

A

Retroocular pain – pain referring to behind the eye from cervicogenic headaches

53
Q

Hx of cervicogenic dizziness

A
  • concomitant neck pain
  • hx whiplash may increase suspicion
54
Q

physical exam of cervicogenic dizziness

A
  • dizziness with neck motion (especially rotation and extension)
  • dizziness with deep palpation
  • dizziness with joint mobility testing
    • head-neck differentiation test
55
Q

discectomy

A

removal of disc or part of it

56
Q

microdiscectomy

A

arthroscopic removal of little part of disc

57
Q

laminoforaminotomy

A

shave off part of lamina to open up foramen

58
Q

laminoplasty

A

portion of lamina are removed

59
Q

arthrodesis

A

surgical immobilization of a joint by fusion of the adjacent bones
- stabilized by halo
- prevents motion at disc level to improve stability

60
Q

arthroplasty

A

surgical procedure to restore the function of a joint

61
Q

Laminectomy

A

removal of spinous process and bilateral laminae
- posterior approach

62
Q

Anterior cervical arthrodesis

A
  • removal of structures causing compression on nerve tissue
  • fusion of a joint
63
Q

What does anterior cervical arthrodesis cause?

A

increased ROM requirements on adjacent vertebral levels

64
Q

at 4-6 weeks post-op of anterior cervical arthrodesis what to work on

A

Still have external protection (collar)
- AROM of the c-spine and UE
- c-spine isometrics
- increase tolerance to sitting
- walking/stationary cycling
- limited UE activity

msk 3 (13 decks)

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