Cervical Spine

Question 1

What are symptoms of vertebral artery compromise?

Answer 1

1. Vertigo
2. nausea
3. tinnitus
4. fainting,
5. visual disturbances

Question 2

How are C1’s facets shaped?

Answer 2

Superior - face cranially to accept occipital condyles

Inferior - flat to slightly concave, lateral edges sloped downward approximately 30 degrees

Question 3

How are C2’s facets shaped?

Answer 3

Superior - large, flat to slightly convex processes that generally face cranially, with 30* slope

Question 4

What vertebrae is vertebral prominent?

Answer 4

C7

- large single pointed spinous process

Question 5

What is the most important ligament of upper Spine complex?

Answer 5

Cruciform ligament

• prevents atlas from translating anterior on axis during flexion
• protects SC, medulla, and VAs

Question 6

ROM at OA joint: flex, ext, rotation, lat flex

Answer 6

Flex = 5
Ext = 10
Rot = negligible
Lat flex = 5 per side

Question 7

ROM at AA joint: flex, ext, rotation, lat flex

Answer 7

Flex = 5
Ext = 10
Rot = 40-45 each side*
Lat flex = negligible

Question 8

ROM at C2-7 joints: flex, ext, rotation, lat flex

Answer 8

Flex = 35*
Ext = 70*
Rot = 45 each side
Lat flex = 35 each side*

Question 9

Total ROM in the craniocervical region: flex, ext, rotation, lat flex

Answer 9

Flex = 45- 50
Ext = 85
Rot = 90 each side
Lat flex = 40 each side

Question 10

Where does most degenerative changes occur in the Cspine?

Answer 10

C4-7

Question 11

Coupling pattern in upper Cspine: Side flexion and rotation generally thought to occur to the ______ side

Answer 11

Opposite

- i.e., left lateral flexion is coupled with right rotation

Question 12

Coupling pattern in lower Cspine (C2-7): Side bending and rotation occur to the ___ side

Answer 12

Same

Question 13

What actions does protraction and retraction have on the Cspine?

Answer 13

• Protraction = Flexes the lower-to-mid cervical spine and extends the upper craniocervical region
• Retraction = Extends or straightens the lower-to-mid cervical spine and flexes the upper craniocervical region

Question 14

What are symptoms of neoplastic conditions?

Answer 14

1. Age over 50 years
2. Previous history of cancer
3. Unexplained weight loss
4. Constant pain, no relief with bed rest
5. Night pain

Question 15

10 item self report functional outcome measure; Change of 6 points a clinician can be 90% confident a change has occurred

Answer 15

Neck disability index

- disability assessment

Question 16

Pain type: presents with varying symptoms

intensity varies with different postures and positions; caused by placing abnormal stress and strain on anatomy

Answer 16

Mechanical pain

Question 17

Pain type: more constant with no change in intensity or symptoms with change in position

Answer 17

Inflammatory pain

Question 18

What 5 findings are consistent in ruling in compression fx?

Answer 18

1. Age > 52 yrs
2. No presence leg pain
3. BMI < or = 22
4. Doesn’t exercise regularly
5. F gender

Question 19

What are S and S of cervical myelopathy?

Answer 19

1. Wide-based spastic gait
2. Clumsy hands
3. Visible change in handwriting
4. Difficulty manipulating buttons or handling coins
5. Hyperreflexia
6. Positive Babinski test
7. Positive Hoffman sign
8. Lhermitte’s sign - Lighting rod feeling down UE as there is spinal flexion
9. Urinary retention followed by overflow incontinence (severe myelopathy

Question 20

What are the 5 findings that are consistent in ruling in cervical myelopathy?

Answer 20

1. Gait deviation
2. +Hoffmann’s
3. Hyperreflexia of Brachioradialis
4. +Babinski
5. Age > 45 yrs

Question 21

What are the S and S of VA insufficiency?

Answer 21

1. Drop attacks*
2. Dizziness* or lightheadedness related to neck movement
3. Dysphasia*
4. Dysarthria*
5. Diplopia*
6. Malaise and nausea*
7. Vomiting
8. Severe headaches
9. Unsteadiness in walking, incoordination
10. Weakness in extremities
11. Sensory changes in face or body
12. Hearing difficulties
13. Facial paralysis

Question 22

Pain from VA damage is referred to which side of the neck?

Answer 22

ipsilateral neck and head

- 5 D’s and 3 N’s

Question 23

What is contraindicated if a patient has symptoms that are present during patient history?

Answer 23

Placing pt in ANY vertebral artery test position

Question 24

What are the tests for VA insufficiency?

Answer 24

1. Prayer position test

2. Traditional VA test in quadrant position

Question 25

How do you tell the difference between vestibular symptoms and VBI?

Answer 25

Vestibular symptoms will be different in sitting vs supine, where VBI will remain unchanged

Question 26

OA of facets and facet joints Presentation; Extension reproduces pain; Foraminal closure tests may be positive; Unilateral pain into affected dermatomes; Slow onset, pain usually not relieved with rest; Most common C5-C6, C6-C7

Answer 26

Cervical Spondylosis

Question 27

Central spinal canal narrowing; Unilateral or bilateral; Usually several dermatomes affected; Most common 30 – 60 yrs old; Pain increases with extension; Pain relieved by rest; Slow onset

Answer 27

Cervical spinal stenosis

Question 28

More common unilateral pain; Pain into affected dermatomes; Flexion may increase pain; Pain provocation tests positive; Foraminal closure tests may be positive; Pain not relieved by rest; Sudden onset

Answer 28

Cervical Disc herniation

Question 29

Acceleration and deceleration forces; Hyperflexion and extension injuries to cervical spine; Worse if no head rest to reduce extension range; Chin hits chest to break flexion; Anterior structures and TMJ take the force; Present with posterior pain

Answer 29

``` Whiplash Signs and symptoms: - Neck pain - Headaches – occipital area - Dizziness and nausea - Muscle Weakness 20-40% of patients have symptoms that are debilitating and persist for years ```

Question 30

What are signs of cervicogenic headaches?

Answer 30

1. Occipital or suboccipital component to HA 2. Neck movement alters HA 3. Painful limitation of neck movements 4. Poor head or neck posture 5. Hypomobility at OA joint 6. Sensory deficits in occipital and suboccipital areas

Question 31

Subjects instructed to "tuck in their chins" then to raise their heads; Measure time between assuming the test position until the chin begins to thrust

Answer 31

Deep Cervical Flexor Endurance test | - hold for 30 sec

Question 32

Combined movements of extension, sidebending and rotation to R, L direction + overpressure; Provocation of symptoms; Radicular pain – nerve root involvement; Localized pain – facet joint pathology

Answer 32

Quadrant testing | - foraminal closure test

Question 33

Pt. side bends; Press straight down through head; Positive test – radicular pain; Implication – cervical radiculopathy

Answer 33

Spurling's test (foraminal compression)

Question 34

One hand under chin and other hand under occiput; Slowly lift pt.’s head applying traction; Positive test – radicular pain is decreased or relieved; Implication – nerve root pressure has been relieved

Answer 34

Distraction test

Question 35

What cluster of tests indicate cervical radiculopathy?

Answer 35

- (+) ULTT (median) - Cervical rotation less than 60 degrees - (+) Spurlings test - (+) Distraction test * (+) LR of 30.3 if all 4 tests are positive

Question 36

Symptoms include: numbness or tingling in your fingers, pain in your shoulder and neck, weakening grip, arm pain and swelling, achiness, bluish color (pallor) in fingers or hand, weak or no pulse, wasting in the fleshy base of your thumb

Answer 36

Thoracic outlet syndrome

Question 37

direct Pressure over scalenes

Answer 37

Brachial plexus compression test (TOS test)

Question 38

Turn head towards symptomatic shoulder while extending UE slightly away from body. Pt should inhale, while PT checks for a pulse; + test - diminished pulse or reproduction of symptoms

Answer 38

Adson maneuvar (TOS test)

Question 39

Pt abducts arms to 90 deg, ER the shoulder, flexes elbows to 90 deg. Pt then opens and closes the hands slowly for 3 min; + test – pt is unable to keep arms in starting position or reproduction of symptoms

Answer 39

Roos Test (TOS test)

Question 40

One hand over forehead and one thumb over spinous process of axis to stabilize it; Pt. slowly flexes head while examiner presses backward with palm; Positive test – feel head slide backward; Implication – injury to transverse ligament

Answer 40

Sharp-Purser test

Question 41

what should a pt with neck pain as a result of trauma be assessed for?

Answer 41

Alar ligament integrity | - lateral flex alar lig stress test

Question 42

Patient in supine, PT palpates spinous process of C2; Side bend head (R side bend tightens L alar ligament); Spinous process of C2 should move in Contralateral direction of side bend, rotation; + test – delay or absence in SP movement of C2 may indicate pathology, ligamentous instability of alar ligament

Answer 42

Lat flex alar ligament stress test

Question 43

What are the 5 neck pain tx based classifications?

Answer 43

1. Pain control 2. Centrilization 3. Mobility 4. Conditioning and increase exercise tolerance 5. Reduce HA

Question 44

What TBC do the following examination findings fall into? - Very recent onset of symptoms - Symptoms precipitated by trauma - Referred or radiating symptoms extending into the upper quarter - Poor tolerance for examination or most interventions What is the proposed matched intervention?

Answer 44

Pain control - always start here if pt fits multiple TBC Intervention: 1. Gentle active ROM within pain tolerance 2. ROM exercises for adjacent regions 3. Physical modalities as needed 4. Activity modification to control pain

Question 45

What TBC do the following examination findings fall into? - Radicular/referred symptoms in the upper quarter - Peripheralization and/or centralization of symptoms with ROM - Signs of nerve root compression present - May have diagnosis of cervical radiculopathy What is the proposed matched intervention?

Answer 45

Centrilization Intervention: 1. Mechanical/manual cervical traction 2. Repeated movements to centralize symptoms

Question 46

What TBC do the following examination findings fall into? - Recent onset of symptoms - No radicular/referred symptoms in the upper quarter - Restricted ROM with rotation and/or discrepancy in lateral flexion ROM - No signs of nerve root compression or peripheralization in the upper quarter with cervical ROM What is the proposed matched intervention?

Answer 46

Mobility Intervention: 1. Cervical and thoracic spine mobilization/ manipulation 2. Active range of motion exercises

Question 47

What TBC do the following examination findings fall into? - Unilateral headache with onset preceded by neck pain - Headache pain triggered by neck movement or positions - Headache pain elicited by pressure on posterior neck What is the proposed matched intervention?

Answer 47

Reduce HA Intervention: 1. Cervical spine manipulation/ mobilization 2. Strengthening of neck and upper quarter muscles 3. Postural education