Cervical spine Flashcards
1
Q
What levels of the spine are uncovertebral joints aka joints of luschka present?
A
C3-C7
2
Q
What age does the uncovertebral joints aka joints of luschka start developing and when are they fully mature?
A
Age 9, Age 33
3
Q
T/F: cervical discs have a true annulus
A
F
4
Q
Which cervical vertebrae does not have a spinous process?
A
C1/Atlas
5
Q
Which cervical spinous process is not bifid?
A
C7
6
Q
What are the attachments of the nuchal ligament?
A
Occiput to spinous processes of C3-C5 and merges with the supraspinous ligament
7
Q
What cervical ligament is most commonly injured in pediatric patients following high speed collisions?
A
Tectorial membrane - causes neurologic symptoms during flex/ext movement
8
Q
Which scalene muscles attach to the 1st rib?
A
Ant/med scalene
9
Q
The greater occipital nerve (C2) pierces through what muscle? And what condition can entrapment cause?
A
Semispinalis cervicis, greater occipital neuralgia
10
Q
What are the primary symptoms of greater occipital neuralgia?
A
Constant ache, burn, throb w/ intermittent shock/shooting; may have pain behind the eye
11
Q
Which regions do the external CA/internal CA provide blood flow?
A
External: face, neck, c-spine
Internal: brain
12
Q
What does the carotid sinus do?
A
Senses blood pressure and oxygenation levels
13
Q
Where is the carotid sinus located?
A
By the jaw line @ the bifurcation of the common carotid artery
14
Q
What does the cervical plexus originate from?
A
Ventral rami of C1-C4
15
Q
What does the brachial plexus originate from?
A
Nerve roots C5-C8
16
Q
How much motion is at the OA joint?
A
15-20 total degrees of flexion/extension (1:2 ratio)
17
Q
How much motion is at the AA joint?
A
Rotational about 50% total neck rotation (35-40 degrees)
18
Q
Coupled motion of C3-C7
A
Couple ipsilaterally, meaning RR also has SB to the R
19
Q
What is the purpose of coupling?
A
To maintain level gaze
20
Q
What are the 5 factors that can strongly predict chronicity in WAD cases?
A
- High pain intensity (>6/10)
- High self-reported disability (NDI >30%)
- High pain catastrophizing (>30)
- High acute post-traumatic stress symptoms
- Cold hyperalgesia
21
Q
What are the strongest risk factors for non-traumatic neck pain?
A
Female sex, prior hx of neck pain
22
Q
What is horners syndrome?
A
Ptosis (dropping eyelid)
Miosis (constricted pupil)
Anhidrosis (lack of face sweat)
23
Q
T/F: recent trauma or infections of the head and neck can be risk factors for cardiovascular disease?
A
True
24
Q
Top signs of vertebrobasilar artery dissection
A
Unsteadiness/ataxia
Dysphagia/dysarthria/aphasia
LE weakness
UE weakness
25
Top signs of internal carotid dissection
Ptosis
UE weakness
Facial palsy
LE weakness
26
What is the validity of VBI testing?
Poor, positional testing such as sustained extension and/or rotation of the C-spine to test for VBI is NOT recommended
27
What are symptoms consistent with ligamentous instability of the craniovertebral junction?
headaches, severe sub-occipital muscle spasms, fear/anxiety associated with head motion
28
Is the Sharp-Purser test valid?
Found to be inconsistent with diagnostic accuracy
29
What population is the Sharp-Purser test appropriate for?
RA & neck pain
30
What are some common symptoms of cancer in the the head/neck?
Persistent sore throat, difficulty swallowing, ringing in the ears
31
What is the sensitivity for 2-item PHQ-2?
High
32
What is the minimal detectable change in the NDI?
5/50 for uncomplicated neck pain
10/50 for cervical radiculopathy
NOTE: can fluctuate
33
What is the first critical step to effective patient management?
Taking a thorough patient hx (open ended, patient led)
34
What is the classic distribution of cervicogenic headaches?
Rams horn
35
What is nociceptive pain?
Produced by nociceptive afferents, acute mechanical or inflammatory pain
36
What is peripheral neuropathic pain?
neuropathic pain derived from disease of the somatosensory system
37
What is central nociplastic pain?
Not the result of peripheral input, similar to "central sensitization"
38
What is maladaptive cognition?
Illogical or incorrect beliefs related to pain, i.e. pain catastrophizing
39
What is sensorimotor dysintegration?
altered input or disagreement between 2 different sensory inputs (i.e. visual vs vestibular)
40
T/F: Posture has shown strong associations with pain and/or function
False
41
Loss of combined cervical extension and rotation may hint at what?
Degenerative changes of a facet joint
42
T/F: Cervical radiculopathy is associated with loss of rotation motion in the lower c-spine
True
43
What is the sensitivity/specificity of segmental mobility testing associated with report of neck pain?
Sensitivity: 0.82
Specificity: 0.79
44
What are the 4 categories for neck pain classification?
1. Neck pain with mobility deficits
2. Neck pain with movement coordination impairments (WAD)
3. Neck pain with headache
4. Neck pain with radiating pain
45
T/F: radiating pain into the distal UE would exclude someone from the category "neck pain with mobility deficits"
True
46
What does the cervical rotation lateral flexion (CRLF) test assess?
CT junction and 1st rib mobility
NOTE: should be used in conjunction with 1st rib spring/mobility assessment
47
What is a + cervical rotation lateral flexion (CRLF) test?
Discrepancy/limitation in lateral flexion ROM with a hard end-feel
48
What are common symptoms of "Neck pain with mobility deficits"?
- central/unilat neck pain
- ROM limitations that consistently reproduce symptoms
- associated (referred) shoulder girdle or UE pain may be present
49
What are common symptoms of "Neck pain with movement coordination impairments"?
- MOI linked to trauma
- Associated (referred) shoulder girdle or UE pain
- non specific concussive signs/symptoms
- dizziness/nausea
- HA/concentration issues/confusion/memory loss/hypersensitivity to stimuli
50
What are common symptoms of "Neck pain with headache (cervicogenic)"?
-noncontinuous, unilateral neck pain and associated (referred) HA
- HA is precipitated or aggravated by neck ROM of sustained postures
51
What are common symptoms of "Neck pain with radiating pain (radicular)"?
- neck pain with radiating pain in involved UE
- UE dermatomal paresthesia or numbness or myotomal muscle weakness
52
What percentage of people will recover from WAD injuries without persistent issues?
50%
53
T/F: the mechanism of whiplash event including direction and speed of impact seem to strong prognostic factors
False (it's poor/weak)
54
What is the craniocervical flexion (CCF) test used for?
To assess activation/endurance of the deep neck flexor muscle group
(10" hold x 5 reps, 10" rest, increase mmHg by 2 - start @20mmHg)
55
What is the neck flexor muscle endurance test used for? And what is the reliability of the test?
Assess deep cervical flexor muscles, good to high reliability
56
What is allodynia?
pain to non-painful stimuli
57
What is hyperalgesia?
Exaggerated pain perception to painful stimuli
58
Reliability for the pressure pain threshold test (PPT) is excellent for intra-rater or inter-rater agreement?
Intrarater
59
Do tension-type, cluster, or migraines respond well to PT?
No
60
Those with cervicogenic headaches are more likely to present with ROM deficits and painful segments in which vertebrae?
Upper 3
61
Common findings of cervicogenic headaches?
intermittent unilateral symptoms, weakness of deep cervical flexors, segmental hypomobility of the upper cervical spine
62
What is the cervical flexion-rotation test used for?
Assess upper cervical joint mobility (measurement of the PROM rotation at the AA jt)
63
What is a positive cervical flexion-rotation test?
restriction of rotation ROM w/ a cut off of less than 32 degrees OR a 10 degree reduction to either side
64
What is Cloward sign?
Numbness/tingling that radiates into the medial scapular border
65
T/F: There is no gold standard to identify cervical radiculopathy outside of nerve conduction and electromyography tests?
True
66
Cluster of 4 findings for cervical radiculopathy
1. limited ipsilat rotation to <60°
2. + ULTT A (median)
3. + Spurlings
4. + neck distraction test (+ = decrease in symptoms)
67
What is the most sensitive test in the cervical radiculopathy cluster?
+ ULTT A (median bias) - can be used to rule out when negative
68
What are the probability of cervical radiculopathy if 4/4 tests are +? And if 3/4 are +?
4/4 = 95%
3/4 = 65%
69
T/F: spurlings test is indicated if the reporting symptoms are present?
False - because provocation of additional symptoms are not warrented
70
Should you use the neck distraction test if the patient has no UE or scapular region symptoms?
No
71
What is the most common area/segments for cervical nerve root involvement?
C5-C6
72
What are positives when testing ULTT A?
- reproduction of all or part of pt's symptoms
- side-to-side differences of greater than 10° of elbow extension or wrist extension
- contralat SB increases pt's symptoms OR ipsilat SB decreases symptoms
73
What is a contraindication to using the Valsalva test?
hypertension
74
Interventions for ACUTE neck pain with mobility deficits
- thoracic manip
- cervical mob/manip
- ROM/stretching/isometrics
- stay active/general fitness
75
Interventions for SUBACUTE neck pain with mobility deficits
- cervical mob/manip
- thoracic manip
- cervicoscapulothoracic endurance activities
76
Interventions for CHRONIC neck pain with mobility deficits
- thoracic manip
- cervical mobs
- cervicoscapulothoracic exercise in combo w/ mob/manips
- dry needling/laserUS/intermittent traction/TENS
77
Interventions for ACUTE neck pain with movement coordination impairments (WAD)
- education (remain active/act as usual)
- HEP (pain-free ROM)
- minimize collar use
78
Interventions for SUBACUTE neck pain with movement coordination impairments (WAD)
- education
- combined exercise (AROM, isometric +manual +modalities)
- supervised exercise
79
Interventions for CHRONIC neck pain with movement coordination impairments (WAD)
- education (prognosis/encouragement/pain management)
- cervical mobilization + individualized progressive exercise
- TENS
80
Interventions for ACUTE neck pain with headache
- Exercise: C1-C2 self SNAG
81
Interventions for SUBACUTE neck pain with headache
- cervical manip/mob
- exercise: C1-C2 self SNAG
82
Interventions for CHRONIC neck pain with headache
- cervical manip/mob
- thoracic manip
- exercise for cervical and scapulothoracic region
- combined manual therapy + exercise
83
Interventions for ACUTE neck pain with radiating pain
- exercise: mobilizing and stabilizing elements
- low-level laser
- possible short-term collar use
84
Interventions for CHRONIC neck pain with radiating pain
- Combined exercise + manual therapy for c/t-spine (mob/manip)
- Education counseling to encourage participation in occupational and exercise activity
- intermittent traction
85
Thoracic manipulation has supporting evidence for use in which stages of neck pain with mobility componant? (acute, subacute, chronic)
All stages
86
What is the speed and duration of intervention mobilizations?
2Hz/sec ("row, row, row your boat"), generally performed 2-3 bouts of 30"
87
Maitland grade of mobilization: Grade I
- Low/small amplitude
- Beginning of range (before any resistance)
88
Maitland grade of mobilization: Grade II
- Large amplitude
- Beginning of range before any resistance noted
89
Maitland grade of mobilization: Grade III
- Large amplitude
- Mid-range working into resistance and towards the end resistance
90
Maitland grade of mobilization: Grade IV
- Small amplitude
- End-range of resistance
91
What is cervical upglide HVLA used for?
rotation deficits (not exclusively), OPENING
92
How to perform cervical upglide HVLA?
1. Contralateral rotation
2. Ipsilateral side-bending
3. Force towards opposite eye
93
What is cervical downglide HVLA used for?
Side-bending deficits, CLOSING
94
How to perform cervical downlide HVLA?
1. Ipsilateral side-bending
2. Contralateral rotation
3. Force towards contralateral hip
95
What is the timeframe for the majority of recovery from a WAD injury?
First 3 months
96
Forward head posture causes limited OA flexion or extension ROM?
Decreased OA flexion
97
How to perform atlanto-occipital (OA) joint flexion mobilization?
Supine, roll cranium into flexion, rest of spine stays neutral, can ipsilat rotate to 30°, force through forhead towards plinth
98
What is the verbal cue for atlanto-occipital (OA) joint flexion contract-relax?
"Look up", 10" hold x 3 reps
99
Sliders (nerve glides) are optimal for which levels of irritability of radicular symptoms?
moderate to high
100
What are the 5 symptoms of cervical myelopathy (aka Cooks cluster)?
1. >45 y/o
2. + hoffman
3. + babinski
4. Gait dysfunction/ataxia/wide BOS
5. + inverted supinator sign
101
Does Cook's cluster for cervical myelopathy have poor/moderate/high sensitivity (rule IN) or specificity (rule OUT)?
Moderate to high specificity (rule IN) & poor sensitivity (rule out)
NOTE: 3+ variables present = high probability
102
Canadian C-spine: What are the 3 High-Risk Factors that mandate immobilization?
1. Age ≥ 65 y/o
2. Paresthesias in extremities
3. Dangerous mechanism (fall from ≥3' or 5 steps, axial load, MVA > 100km/hr (62mph), rollover/ejection, bicycle, rec vehicles)
103
Canadian C-spine: What are the Dangerous Mechanisms?
1. Fall from elevation >3 feet/5 stairs
2. Axial load to head, e.g. diving
3. MVC speed high (> 100km/hr or 62mph), rollover, ejection
4. Motorized recreational vehicles e.g. ATV
5. Bicycle collision with object e.g. post, car
104
Canadian C-spine: What are the 4 Low-Risk Factors which allow safe assessment of ROM?
1. Simple rear-end MVC
2. Ambulatory at any time at scene
3. No neck pain at scene when asked
4. No pain during midline C-Spine palpation
105
Canadian C-spine: What are the exceptions to simple rear-end MVC's?
1. Pushed into oncoming traffic
2. Hit by bus/large truck
3. Rollover
4. Hit by high speed vehicle (>100km/hr)
106
Canadian C-spine: What are the 3 steps in the Canadian C-Spine rule?
1. High-Risk Factors - mandate immobilization
2. Low-Risk Factors - safe assessment of ROM
3. ROM Assessment
107
Canadian C-spine: How is the 3rd step performed?
Can the patient voluntarily actively rotate neck 45° left and right when requested, regardless of pain?
108
Canadian C-spine: What must you have to rule in C-Spine immobilization?
Yes to any High-Risk Factor
and/or
No to any Low-Risk Factor
and/or
Cannot turn head 45°
109
What are exclusion criteria from the Canadian C-Spine rule?
1. Boarded and collared for reason other than C-spine
2. age < 16 years
3. penetrating trauma from stabbing or gun shot
4. acute paralysis (paraplegia, quadriplegia)
5. known vertebral disease
6. referred as a c-spine from hospital or care facility
7. pregnancy
110
Is Canadian c-spine used to rule IN or OUT?
Rule OUT, test is sensitive
