Cervical Spine Flashcards
(100 cards)
1
Q
what two scalenes form the scalenes triangle? what goes through the triangle?
A
anterior and middle
brachial plexus, subclavian artery and vein
2
Q
scalenes OIA
A
O: TP C2-7
I: 1st and 2nd ribs
A: ipsilateral SB, contralateral rotation, accessory inspiration
3
Q
SCM OIA
A
O: mastoid process
I: sternum, clavical
A: ipsi SB, contra rot, extension
*flexion bilaterally
4
Q
what is the deepest and most important anterior muscle of c-spine?
A
longus cervicis (coli)
5
Q
longus coli OIA
A
O: T3-C2 bodies
I: C3-6 TP
A: cervical flexion
*important for neck stability
6
Q
the 2 alar ligaments run from the ___ to the ____. it is life threatening if these ligs are damaged
A
dens (sup, lat)
foramen magnum
7
Q
how many transverse (cruciform/cruciate) ligs are there? what are they?
A
3
superior longitudinal, transverse, inferior longitudinal
8
Q
superior longitudinal cruciate lig attaches ____ to ______
A
atlas
occiput
9
Q
transvere cruciate lig attaches….
A
C2 bilateral
10
Q
inferior longitudinal lig attaches __ to _____
A
atlas
C2 body
11
Q
this ligament prevents the atlas from translating anterior on the axis during flexion and is life threatening if damaged
A
transverse lig
12
Q
T or F: the dens will fracture before the transverse lig tears
A
T: it tears at 130kg
13
Q
what additional subjective items should you ask about with a cervical compliant?
A
dizziness
headaches
TMJ
14
Q
T or F: the subjective exam is strongly supported by evidence
A
T
15
Q
T or F: outcome measures are strongly supported by evidence
A
T
16
Q
head and neck medical screening questionnaire
A
used to determine if patient has a serious medical condition that mimics a common MSK disorder
17
Q
neck and shoulder screening questionnaire
A
screens for diagnoses like cervical fracture, lig instability, central cord tension, tumor, and septic arthritis
18
Q
how do you ask about pain?
A
0-10
current, best, and worst in the last 24 hrs
take average
19
Q
MDC for pain scale
A
2
20
Q
MDC for neck disability index
A
10
21
Q
patient specific functional scale
A
patient gives 5 important activities that are a problem and rates from 0 (unable) to 10 (PLOF)
22
Q
MCID for PSFS
A
2
23
Q
why may PSFS be better than NDI
A
more meaning for patients
24
Q
how many items on fear-avoidance beliefs questionnaire
A
16, it must be scored 0-6
25
2 subscales of FABQ
work = 0-42 points
physical activity = 0-24 points
26
T or F: you total the subscales to get the score for FABQ
F: subscales are added seperately
27
for FABQ is a higher or lower score better
lower
28
3 high risk factors of canadian c-spine rules
- age 65 or greater
- dangerous mechanism
- paresthesias in extremities
*need an x-ray if they had a trauma with any of these factors
29
5 low risk factors of canadian c-spine rules
- simple rear-end MVA
- able to sit in ED
- ambulatory at any time
- delayed neck pain
- no midline c-spine tenderness
*if these are present, you can safely assess ROM
30
you assess your patient after a neck trauma due to the presence of low-risk factors and they have 30 degrees of active R rotation and 35 degrees of L rotation. do they need an x-ray? why or why not?
yes, because they have less than 45 degrees of active L and R rotation
31
VBI 5 Ds and 3Ns
Dizziness
Diplopia
Drop attacks
Dysarthria
Dysphagia
Nystagmus
N/V
N/T
32
VBI test
- supine, start with head in neutral
-rotate to end range, overpressure, and hold for 10 seconds
-back to neutral hold for 10 seconds
-rotate other way with overpressure and hold for 10 seconds
-watch/ask about 5Ds, 3Ns
33
If the VBI test is positive what do you do
you can still treat the patient, just avoid end range rotation and extension, Get in touch with PCP for follow-up
34
T or F: a single red flag is always predictive of a serious disease
F: a large study showed all pts had at least 1, but <1% had a serious pathology
** use clinical judgement and base on clusters
35
cancer red flags
- history of cancer
- night pain/pain at rest
- unexplained weight loss
- >50 y/o or < 17 y/o
- failure to improve over predicted time
36
infection within vertebrae red flags
- immunosuppressed
- prolonged fever of >100.4
- history of IV drug use
- history of recent UTI, cellulitis, pneumonia
37
vertebral fracture red flag
- prolonged use of corticosteroids
- mild trauma >50 y/o
- >70 y/o
- osteoporosis
- recent major trauma
- bruising over spine after trauma
38
abdominal aortic aneurysm red flags
- pulsating mass in abdomen
- history of astherosclerotic vascular disease
- age >60 y/o
39
how many view of the spine do you usually need
3 (min of 2)
40
what kind of x-ray to assess stability of c-spine
open mouth
*can also get CT scan
41
benefits of x-ray
fast
inexpensive
low radiation
42
what can you see on an AP view of an x-ray
- vertical shape
- osteophytes
- disc space
- scoliosis
- rib symmetry
43
what can you see on an oblique view of an x-ray
- neural foramen and fascia
- osteophytes
- stenosis
44
what can you see on a lateral view of an x-ray
- integrity of ALL (parallel lines)
- lordosis/kyphosis
- collapsing/wedging
- osteophytes
- forward shift of C1-2
45
benefits of CT scan
fast, better statistical properties, best for cortical bone, good for soft tissue when MRI is contraindicated
46
is metal contraindicated on CT scan
no
47
this imaging is ideal for soft tissue and trabecular bone
MRI
48
T1 MRI
fat is bright, water is dark
49
T2 MRI
water is brightest, fat is bright-ish
50
T2 fat sat/STIR MRI
water is bright, fat is dark
* better for bony pathology
51
what two imaging have the highest radiation exposure? lowest? none?
high = CT, bone scan
low = radiograph
none = MRI
52
why does poor posture cause spine pain
weight becomes anterior/posterior to the joint and the muscles have to work harder
53
In FHP, the upper cervical facets become ______ and the connective tissues _______. There is a tendency toward facet ___mobility
compressed
shorten
hypo
54
In FHP, the mid-lower cervical/thoracic facets are ____ and ___. there is a tendency toward facet ___mobility.
up and forward
hyper
55
what muscles become weak in FHP? which ones become overworked and tight
weak = anterior neck (longus colli), rhomboids, mid/lower traps
tight = posterior neck, pecs, lats, teres major, subscap
56
What does FHP do to the abdominal wall
constricts it, lessening diaphragmatic breathing and accessory muscles have to work harder
57
results of FHP
- tissues held in shortened range lose sarcomeres
- abnormal movement and firing
- ligamentous creep
58
abnormal stress to normal tissue...
may produce pain w/o causing damage
59
T or F: normal stress applied to abnormal tissue will not produce pain
F: it does! and abnormal stress would increase pain
60
common subjective findings with capsular restrictions
- limited mobility
- pain only at end range
- no pain with rest
- no weakness
- no N/T
61
capsular restrictions are usually the result of...
poor posture
past trauma
repeated inflammation
62
objective findings with capsular restrictions
- limited AROM/PROM that open facets
- hypomobile PAs
- possibly hypermobile in surrounding area (could be where pain is)
63
arthritis in the spine is also known as...
- spondylosis
- osteoarthritis
- DDD
- DJD
64
spondylosis most commonly affects
facet joints and discs
65
DJD
- thickening of subchondral bone/capsule
- causes increase calcium deposits and joint surface erosion
66
DDD
- hardening of NP
- causes decreased disk height and annular strength
67
With DJD, sometimes if spurs have already developed surgery may be the best option. why?
getting them in a good posture could make it worse if spurs are already there
68
spondylosis causes _____ blood supply
decreased
69
T or F: spondylosis is typically a chronic condition
T
70
what age is peak spine health
25
71
T or F: in the early stage of spondylosis, damage is reversible
T: there is only minor involvement of the disc/facet
*this is why early PT is important
72
T or F: spondylosis can occur at any age
T
73
what happens in the intermediate instability phase of spondylosis
- laxity of joint capsule/lig
- annular loss of proteoglycans
- decreased flexibility
- joint surface starts to erode
74
what happens in the final stabilization phase of spondylosis
- several joints become hypomobile so other joints increase their mobility
- stiff but may not be painful
- stenosis may occur
75
with spondylosis, pain is usually worse when
- in the morning
- if too much movement
- at end range
76
what typically decreases pain with spondylosis
mobility/activity
*important to find the sweet spot between too much movement and not enough
77
DDD typically causes pain with ___ while DJD causes pain with _______
sitting
standing/walking
78
lateral stenosis is narrowing of the...
neural foramen
79
lateral stenosis usually has a positive ____ test
quadrant
*because you are closing the facets
80
stenosis is the ___ and radiculopathy is a ______
diagnosis
symptom
81
can you have stenosis without radiculopathy
yes, but you cannot have a radiculopathy without stenosis
82
what could cause lateral stenosis
HNP
DDD/DJD
poor posture
83
radiculopathy is rare in the _____ spine
thoracic
*if there is it is usually due to a compression fx or trauma
84
subjective findings with radiculopathy
- not usually relieved with rest
- deep, burning, sharp pain
- specific dermatomal pattern or may think its entire arm/hand
- possible weakness (grip)
85
is radiculopathy usually unilateral or bilateral
unilateral
86
objective findings with radiculopathy
- positive neural tension
- LMN symptoms
- reproduced with foramen narrowing
- decreased pain with traction
87
what is the most common disc herniation
C6/7
88
T or F: there is a decreased likelihood of disc herniations with advanced age
T
89
cervical myelopathy
compression of the spinal cord in the cervical spine
90
symptoms of cervical myelopathy
- impaired fine motor skills
- pain/stiffness in neck
- loss of balance, difficulty walking
91
what kind of image for myelopathy
MRI
92
can we typically help with myelopathy
no, need to refer out, treatment is spinal decompression surgery
93
possible causes of thoracic outlet
- trauma
- poor posture
- hypertrophied scalenes
94
thoracic outlet usually involves the...
1st rib
95
common age/sex for thoracic outlet
middle aged women
96
subjective findings for thoracic outlet
- edema, skin tightness, cyanosis (vascular)
- heaviness
- hight pain
- N/T, usually C8/T1
97
problems with OA/occiput-C1 usually cause headaches where
over orbit
98
problems with C2-3 usually causes headaches where
lateral head inner ear
99
problems with C6 usually cause headaches where
globally
100
problems with T4 usually cause what kind of headache
feels like head is in a vice
