Cervical Spine

Question 1

Facet Joint Pain: key sxs

Answer 1

-Referred: HA, upper traps, periscapular.
-SB & rotation ROM limited ipsi.
-Ext ROM limited.

Question 2

Facet Joint Pain: treatment

Answer 2

Manual
Stretching

Question 3

DJD: key sxs

Answer 3

-Typically lower (C5-7).
-Segmental hypomobility (stiff).
-Posture usually related.

Question 4

DJD: treatment

Answer 4

ROM & stretching
Traction
Posture exercises

Question 5

CPR for manipulations w/ mechanical neck pain

Answer 5

-Symptoms <30 days.
-No symptoms distal to shoulder.
-Looking up does not agg.
-FABQ <12
-Decreased kyphosis
-Ext ROM <30

Question 6

Whiplash red flags

Answer 6

-Numbness into arms.
-Bowel/bladder.
-Age >50.
-Dizzy/syncope.
-Cervical instability.
-Blurry vision.
-Memory changes.

Question 7

Cervicogenic HA: common causes

Answer 7

-C2-3 facet joint.
-Lateral AA joint damage.
-Mm tension or strain.
-C1-4 DJD.
-Tumor/infection of c-spine.

Question 8

Cervicogenic HA: key sxs

Answer 8

-Unilateral HA.
-Triggered by neck movement or awkward postures.
-ROM limitations.
-P! starts in neck & spreads to headache.

Question 9

Cervicogenic HA: red flags

Answer 9

-Non-mechanical presentation.
-Sudden onset.
-Systemic illness.
-Head trauma.
-(+) UMN tests.
-5D’s & 2N’s.

Question 10

Radiculopathy CPR

Answer 10

(+) ULTT A
(+) Spurling
(+) Distraction
Rotation ROM <60 ipsi

Question 11

Disc Dysfunction: key sxs

Answer 11

Radiculopathy
Myelopathy (spinal cord)
Sensation & strength deficits following dermatome & myotome

Question 12

Disc Dysfunction: red flags

Answer 12

-Multi-level weakness.
-Multi-level sensory loss.
-Bilateral UE symptoms.
-Gait abnormalities.
-(+) Clonus, Babinski, Hoffman’s

Question 13

Instability vs hypermobility definitions

Answer 13

Instability: pathologic condition d/t fx or congenital abnormality.
Hypermobility: more than normal motion (Beighton-Hicks).

Question 14

Instability & Hypermobility red flags

Answer 14

-(+) upper cervical stability test.
-Nausea
-Dizziness
-Nystagmus
-Myelopathy symptoms

Question 15

Instability treatment

Answer 15

Refer to MD

Question 16

Hypermobility treatment

Answer 16

-Restore lordosis
-Gentle mobs (usually hypomobile segment above/below).
-Deep neck flexor strengthening.

Question 17

Canadian C-Spine Rules: 3 questions

Answer 17

1. High-Risk factors?
2. Low-Risk factors?
3. Able to rotate 45deg to B sides?

Question 18

Canadian C-Spine Rules: high risk factors

Answer 18

-Age >65
-Dangerous MOI
-Paresthesia in extremities

Question 19

Canadian C-Spine Rules: low risk factors

Answer 19

-Simple MVC
-Sits in waiting room
-Ambulatory
-Delayed onset neck P!
-No midline neck tenderness

Question 20

Canadian C-Spine Rules: what criteria indicates xray?

Answer 20

-Yes to any high risk factors.
-No to any low risk factors.
-No to rotation AROM 45deg.

Question 21

Canadian C-Spine Rules: when is xray not indicated?

Answer 21

No high risk factors, AND meets all low risk criteria, AND can rotate 45deg.

Question 22

Red flags indicating myelopathy

Answer 22

-Sensory loss in hands.
-Atrophy hand intrinsics.
-Unsteady gait.
-Hoffman’s.
-Bowel/bladder.
-Multisegmental weakness or sensory changes.

Question 23

Red flags indicating neoplasm

Answer 23

-Age >50
-Hx of cancer.
-Unexplained weight loss.
-Constant P!
-Night P!

Question 24

Red flags indicating upper cervical instability

Answer 24

-Occipital HA & numbness.
-Severe AROM limitations.
-Signs of myelopathy.
-Recent trauma.
-Prolonged corticosteroid.

Question 25

Red flags indicating vertebral artery insufficiency

Answer 25

5 Ds: -Drop attacks. -Dizziness. -Dysphagia. -Dysarthria. -Diplopia. (+) CN signs.

Question 26

Red flags indicating vertebral artery dissection

Answer 26

5 D's: -Drop attacks. -Dizziness. -Dysphagia. -Dysarthria. -Diplopia. 3 N's: -Nystagmus -Nausea -Numbness of face

Question 27

Red flags indicating systemic issue

Answer 27

-Fever -BP > 160/95 -RR >25 -Fatigue -P! at rest -Immunosuppression

Question 28

Spurling Test: procedure, purpose, (+)

Answer 28

Radiculopathy. Apply pressure to top of head in side-bent position. (+) = reproduce sxs.

Question 29

Distraction Test: procedure, purpose, (+)

Answer 29

Radiculopathy. Apply traction. (+) = reproduce sxs.

Question 30

Alar Ligament Test: procedure, purpose, (+)

Answer 30

Instability (Alar). Side bend while palpating C2. (+) = don't feel spinous process bump immediately.

Question 31

Sharp-Pursor Test: procedure, purpose, (+)

Answer 31

Instability (Transverse). Slight flex, stabilize C2 spinous, apply A>P pressure to forehead. (+) = reduction of symptoms & head slides back, possible clunk.

Question 32

Tectorial Membrane Test: procedure, purpose, (+)

Answer 32

Instability (Tectorial). Gentle traction. (+) = dizziness, drop attacks, nausea, nystagmus, paresthesia, or ataxia.

Question 33

Vertebral Artery Insufficiency Test: procedure, (+)

Answer 33

Supine, head off edge of table. 1. Max rotate to one side, hold 20sec, return to neutral. If no symptoms, then... 2. Repeat with rotate + SB. If no symptoms, then... 3. Repeat with rotate + SB + ext. (+) = dizziness, nystagmus, slurred speech, vision or hearing changes.

Question 34

Craniocervical Flexion Test: procedure, purpose, (+)

Answer 34

Strength & endurance of deep neck flexors. BP cuff under lordosis part of c-spine, inflate to 20mmHg. Perform craniocervical flex to 22mmHg, hold 10sec. Repeat in increments of 2mmHg up to 30. (+) = substitution, inability to hold pressure, jerky motions. (+) indicates weakness.

Question 35

Upper Cervical UPA promotes what motion?

Answer 35

Ipsilateral rotation

Question 36

Lower Cervical UPA promotes what motion?

Answer 36

Contralateral rotation