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CERVICAL SPINE Flashcards

(52 cards)

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1
Q

Cervical Spine

Non-musculoskeletal pathologies causing referred pain to the Thoracic Spine

A
  • Myocardial Ischemia (pain worse during exercise)
  • Thoracic Aortic Aneurysm (sudden onset)
  • Peptic Ulcers
  • Cholecystitis ​(inflammation of the gallbladder)
  • Neoplasms (previous Hx of cancer, weight loss)
  • Inflammatory pathologies
  • Fractures (thoracic)
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2
Q

Cervical Spine

Cervical Spondylosis symptoms:

A

headache, loss of motion, crepitus, pain

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3
Q
A

spondylosis

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4
Q

Cervical Spine

TRANSVERSE LIGAMENT TEST

A
  • Cervical Instability
  • Examiner places hands under the occiput with the index fingers in the space between the
    occiput and C2 spinous process.
  • The examiner shears the occiput and head anteriorly together as a unit
  • A positive test is excessive movement, no end-feel, lump in the throat or any increase in myelopathic
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5
Q

Cervical Spine

Order of the interventions​ ​ACROSS sessions will be guided by:

A

Pain reduction as needed → achieve mobility → achieve control → achieve strength and function

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6
Q

Cervical Spine

SHARP PURSER TEST:

A
  • Cervical instability (Sp 96%)
  • Stabilize C2 spinous process using a pincer grasp
  • Examiner applies a posterior translation using the palm of the hand
  • Assess displacement, end-feel, and symptoms
  • A positive test:
    • reproduction of myelopathic symptoms during neck flexion OR
    • decrease in symptoms with the posterior translation
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7
Q

Cervical Spine

diagnosis of sprain and strain of cervical spine and the associated ICF diagnosis of neck pain with movement coordination impairments is made with a reasonable level of certainty when the patient presents with the following clinical findings:

A
  • Associated with whiplash or longer symptom duration
  • Neck pain +/- UE symptoms
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8
Q

Cervical Spine

ALAR LIGAMENT TEST

A
  • Cervical Instability
  • Examiner stabilizes C2 spinous process using a pincer grasp with a firm grip
  • Examiner performs passive side bending to the right and assess for movement of C2
  • A positive test is failure to feel movement of C2

Rotation and side bend-ing tighten the contralateral alar (e.g., rotation or side bending to the right tightens the left alar), whereas flexion typically tightens both alar ligaments.

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9
Q

Cervical Spine

For our clinical reasoning regarding diagnosis, we will use a “mixed model,” combining:

A
  • Hypothetical deductive reasoning: systematic application of rules, which may result in more accurate diagnoses, but take more time
  • Inductive Pattern recognition: used by experienced clinicians, can create errors; confirmation bias.
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10
Q

Cervical Spine

Canadian Cervical Spine Rule (100% sensitivity) to determine if the patient needs an X-Ray, includes the following factors:

A
  • for patients with trauma who are alert ONLY:
    • Age >65 with paresthesias in extremities
    • Unable to rotate the neck 45 deg
    • dangerous MOI
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11
Q

Cervical Spine

TESTS FOR CERVICAL INSTABILITY

A
  • Sharp Purser Test
  • Alar ligament test
  • Transverse ligament test
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12
Q

Cervical Spine

Hoffman test is for

A

Cervical Myelopathy

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13
Q

Cervical Spine

spine stenosis is

A

narrowing of the opening of the spine

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14
Q

Cervical Spine

a spinal disorder in which vertebrae slips forward onto the bone below it

A

spondylolisthesis

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15
Q

Cervical Spine

These tools are useful for identifying a patient’s baseline status relative to pain, function, and disability and for monitoring a change in a patient’s status throughout the course of treatment:

A
  • Neck Disability Index and the
  • Patient-Specific Functional Scale
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16
Q

Cervical Spine

acute, subacute, and chronic timing

A
  • Acute: ~ 6 wks
  • Subacute: 6-12 wks
  • Chronic: over 3 mo
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17
Q

Cervical Spine

Compression of nerve roots from osteophytes, disc or tumor; dermatomal pattern

A

Cervical Radiculopathy

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18
Q

Cervical Spine

For our diagnosis of the spine, we will primarily use which classification system?

A

Treatment Based Classification (TBC) System

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19
Q

Cervical Spine

spondylosis, spondylolysis, spondylolisthesis

A
  • spondylosis : arthritis
  • spondylolisthesis: vertebrae slips forward onto the bone below it.
  • spondylolysis: a defect/stress fracture in the pars interarticularis of the vertebral arch
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20
Q

Cervical Spine

The following physical examination measures may be useful in classifying a patient in the ICF impairment-based category of neck pain with spondylosis with radiculopathy or cervical disc disorder with radiculopathy

A
  • Upper limp tension test
  • Spurling’s test
  • Distraction test
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21
Q

Cervical Spine

Caused by compression of spinal cord from osteophytes or disc degeneration

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A

Cervical Myelopathy

22
Q

Cervical Spine

once serious medical pathology (such as cervical fracture or myelopathy) has been ruled out, patients with neck pain are often classified as having either

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A

a nerve root a nerve root compromise or a “mechanical neck disorder”

23
Q

Cervical Spine

Clinicians should consider {….} as predisposing risks factors for the development of chronic neck pain

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A
  • age greater than 40
  • coexisting low back pain
  • loss of strength in the hands
  • poor quality of life
  • worrisome attitude
  • and less vitality
  • a long history of neck pain
  • bicycling as a regular activity
24
Q

Cervical Spine

Clinical prediction rule tests for cervical radiculopathy

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A
  • + Spurling Test
  • + Distraction
  • + ULTTA (Median nerve)
  • Less than 60 degrees of rotation on involved side
25
# Cervical Spine a defect/stress fracture in the pars interarticularis of the vertebral arch
**spondylolysis**
26
# Cervical Spine **For our evaluation process,** we will focus on two categories of information:
* Biomechanical/patho-anatomical (e.g., symmetry, movement patterns, etc.) * Patient response (e.g., pain provocation primarily)
27
# Cervical Spine Babinski test procedure
* Patient is sitting or standing * Examiner applies a stimulus to the plantar aspect of the foot with the blunt end of a reflex hammer from lateral to medial * **+ve test is great toe extension**
28
# Cervical Spine divisions of the thoracic spine
* Upper thoracic spine (T1-T3) * Middle thoracic spine (T4-T7) * Lower thoracic spine (T8-T12)
29
# Cervical Spine **Hoffman test procedure**
* Patient is sitting or standing * Examiner supports forearm and stabilizes the middle finger down to the DIP joint (stabilize prox. PIP joint with pincer grip) and cradles the hand (allow space for thumb to move) * Examiner flicks the patient’s fingernail at the DIP joint * +ve test is thumb adduction/opposition and slight flexion of the fingers
30
# Cervical Spine ICF diagnosis of **neck pain with mobility deficits** is made with a reasonable level of certainty when the patient presents with the following clinical findings:
* žYounger individuals \<50 * Acute neck pain (\<12 weeks) * symptoms isolated to the neck * žRestricted cervical ROM
31
# Cervical Spine Most often, the term **spondylosis** is used to describe
**osteoarthritis** of the spine, but it is also commonly used to describe any manner of **spinal degeneration**
32
# Cervical Spine ICF diagnosis of **neck pain with headaches** is made with a reasonable level of certainty when the patient presents with the following clinical findings:
* **Unilateral HA** associated with neck/suboccipital area symptoms that are aggravated by neck movements or positions * HA reproduced with neck movements * Restricted cervical ROM and segment mobility
33
# Cervical Spine Order of interventions **_WITHIN_** _a single session_ will be guided by:
Soft tissue mobilization → joint mobilization → stretching → neuromuscular retraining
34
# Cervical Spine Common symptoms of **cervical myelopathy** include
* Hyper-reflexia (below the level of compression) * Sensory changes non-dermatomal pattern * **Clonus** **of the ankle** (Sp 96%; +LR 4) * **Babinski** (Sp 92%) and Hoffman reflexes * Weakness below level of compression * Gait clumsiness
35
# Cervical Spine Contraindications to Orthopaedic Manual Therapy​ interventions in cervical patients
* Multi-level nerve root pathology * Worsening neurological function * Unremitting, severe, non-mechanical pain * Unremitting night pain (preventing patient from falling asleep) * Relevant recent trauma * Upper motor neuron lesions * e.g. Spinal cord damage
36
# Cervical Spine what is the **gold standard** diagnostic test for cervical radiculopathy?
nerve conduction velocity
37
# Cervical Spine **Inverted supinator sign** procedure
* Patient is sitting * The examiner rests the patient’s forearm on his/her forearm in slight pronation * Examiner applies a stimulus with a reflex hammer just proximal to the styloid process of the radius * **A +ve test is finger flexion or slight elbow extension**
38
# Cervical Spine The following physical examination measures may be useful in classifying a patient in the ICF impairment-based category of neck **pain with mobility deficits**
* Cervical AROM * Cervical and thoracic segmental mobility
39
# Cervical Spine If dizziness occurs when getting up from the bed and it lasts for seconds may be due to
BP issue (orthostatic)
40
# Cervical Spine **Red Flags** in neck pain
* **Neoplastic conditions** (night pain, unexplained weight loss) * **Systemic disease** (hypertension, fever) * **Upper cervical ligamentous instability** (AROM limitations, occipital headache) * **Vertebral Basilar Insufficiency** (drop attack, dysphasia, dysarthria, diplopia) * **Cervical myelopathy** (sensory and muscle wasting in hands, Hoffman's reflex, hyperreflexia, bowel bladder disturbances)
41
# Cervical Spine **Inverted supinator sign** is for
**Cervical Myelopathy** UMN sign
42
# Cervical Spine Five tests included in the **Cervical Myelopathy Clinical Prediction Rule:**
* Hoffman test * age over 45 * gait disturbances * Babinski * Inverted supinator sign
43
# TBC (Treatment Based Classification) Unilateral neck pain Neck motion limitations +/- referred arm pain **Diagnosis and treatment**
**Neck pain with mobility deficits** * Manipulation and/or mobilization cervical (A) and/or thoracic spine (C) * Coordination, strengthening/endurance (A), stretching exercises (C)
44
# TBC Neck pain with radiating pain in involved UE UE numbness, paresthesias, and/or weakness may be present **Diagnosis and Treatment:**
**NECK PAIN WITH RADIATING PAIN** * Manual/mechanical traction (B) * Neural mobilization (B) * Thoracic spine manipulation (C) * Scapular exercises
45
# Cervical Spine Associated with whiplash or longer symptom duration Neck pain +/- UE symptoms **Diagnosis and Treatment:**
**NECK PAIN WITH MOVEMENT COORDINATION IMPAIRMENTS** * Patient counseling (A) * Coordination, strengthening, stretching, and endurance exercises (A)
46
# TBC Non continuous unilateral neck pain with headache Headache affected by neck movements **Diagnosis and treatment:**
**NECK PAIN WITH HEADACHES** * Manipulation and/or mobilization cervical spine (A) * Coordination, strengthening, stretching, and endurance exercises (A)
47
# Cervical Spine Key examination techniques for **neck pain with movement coordination impairments:**
* Cranio cervical flexion test (CCFT) * Deep neck flexor endurance test (DNF)
48
# Cervical Spine Key examination techniques for **neck pain with headaches:**
* Cervical AROM * Cranio cervical flexion test * Segmental examination AA/AO
49
# Cervical Spine Key examination techniques for **neck pain with mobility deficits:**
* Cervical AROM measurements * Cervical and thoracic segmental examination
50
# Cervical Spine PAIVM (passive accessory intervertebral motion) consists in two parts:
1. motion 2. pain (high reliability)
51
# Cervical Spine Mm energy techniques used when
* Elastic end feel * acute pain * mm spam, tightness, shortness, PT guarding * (oculomotor stimulation , reciprocal inhibition)
52
# Cervical Spine which type of headache is presents with **bilateral** symptoms
**tension type** * Migraines and cervicogenic are unilateral

Musculoskeletal III (5 decks)

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