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Flashcards in Cervical Spine Deck (49):

Which demographic is expected to have the greatest prevalence of neck pain?

  • A) Males 20-29yo
  • B) Females 30-49yo
  • C) Males 50-59yo
  • D) Females 40-49yo

D) Females 40-49yo (5th Decade of Life)


Your patient with first time neck pain is worried their pain may not go away. What can you tell them about general prognosis?

  • A) 50% with neck pain will recover
  • B) 60% with neck pain will recover
  • C) Only 30% develop chronic neck pain
  • D) Only 10% develop chronic neck pain

C) Only 30% develop chronic neck pain


What are the Canadian Cervical Spine Rules for Radiographs?

  1. Any high-risk factors which mandate a radiograph?

If Yes=image     If No=next rule

  1. Any low-risk factors which allow for safe assessment of AROM?

If No=image     If Yes=next rule

  1. Able to actively rotate greater than or equal to 45º bilaterally?

If No=image     If Yes=continue examination


What are considered high-risk factors for the Canadian Cervical Spine Rules?

  1. Age greater than or equal to 65yo
  2. Dangerous Mechanism of Action
    1. Fall from 3ft (or higher) or 5 stairs
    2. Axial load to head
    3. MVA > 62mph, rollover, ejection
    4. Motorized recreational vehicles
    5. Bicycle struck or collision
  3. Paresthesia in extremities?

****Two or more requires imaging


What low-risk factors allow for safe assessment of AROM in the Cervical Spine Rules?

  1. Simple Rear-end MVA

Excludes: Pushed into oncoming traffic and hit by bus/large truck

  1. Sitting position in emergency department
  2. Ambulatory at any time
  3. Delayed onset of neck pain

Not immediate onset of neck pain

  1. Absence of midline C-spine tenderness


What is considered the Minimal Detectable Change (MDC) on the NPRS

  • A) 1.3
  • B) 2.1
  • C) 3.3
  • D) 3.9

B) 2.1


**Minimal Clinical Important Difference (MDIC) is 1.3***


What is considered the Minimal Detectable Change (MDC) on the Neck Disability Index?

  • A) 7 points
  • B) 9.5 points
  • C) 10 points
  • D) 14 points

B) 9.5 points


***Minimal Clinical Important Difference (MCID) is 10 points***


What is the Minimal Detectable Change on the Patient-Specific Functional Scale?

  • A) 2.1 points
  • B) 3.3 points
  • C) 4 points
  • D) 5.1 points

A) 2.1 points


***Minimal Clinical Important Difference 2 points***


If you had to choose one subjective test to assess patient functional progress from initial eval to re-eval, which is felt to be a most accurate reflection of patient improvement?

  • A) Fear-Avoidance Beliefs Questionnaire
  • B) Neck Disability Index
  • C) Numeric Pain Raiting Scale
  • D) Patient-Specific Functional Scale

D) Patient-Specific Functional Scale


How do you perform the Sharp-Purser Test for the cervical spine?


  1. Pt is seated, therapist stabilizes spinous process of C2 with one hand
  2. Passively flex the pts head 20-30º
  3. Apply posterior translational forcece to the pts forehead

*Positive= Cranial movement without C2 spinous process movement OR reduced myelopathic symptoms

*Specificity .96      Sensitivity .69


How do you perform the Alar Ligament Test?

  1. Pt is supine, therapist stabilizes spinous process of C2
  2. With other hand, passively sidebend opposite direction of the thumb


*Positive=if spinous process of C2 doesn't move immediately into the fat pad of the thumb


What findings indicate a low probability (Sensitivity .99) of a need for imaging in the cervical spine?

  1. No midline cervical tenderness
  2. No focal neurological deficits
  3. Normal alertness
  4. No intoxication
  5. No painful, distracting injury


What are the common clinical findings for "Neck Pain with Mobility Deficits?"

  1. Age < 50yo
  2. Acute
  3. Isolated Symptoms to the neck
  4. Restricted Cervical Motion


How do you perform the Cranial Cervical Flexion Test (CCFT)? 

  1. Pt is hooklying with head/neck in neutral
  2. Biofeedback unit is inflated to 20mmHg to fill space between the cervical lordotic curve
  3. Pt is instructed to keep thee posterior head/occiput stationary (don't lift/push)
  4. Pt performs cranial cervical flexion in a manner of five increments (22, 24, 26, 28, 30mmHg)

Goal= hold each position for 10sec with a 10sec rest in between


What is considered "normal" on the Cranial Cervical Flexion Test (CCFT)? 

Ability to hold 28mmHg for 10seconds without superficial muscle activation.


What cue can help reduce the activation of the superficial Platysma muscle during the CCFT? 

Place the tip of our tongue on the roof of your mouth with your teeth slightly apart


True or False

A single HVLA manipulation to the CTJ is more beneficial than low velocity high amplitude mobs for cervical pain?



What are the six predictors for a favorable immediate improvemnt following a cervical spine manipulation?

  1. Initial NDI < 11.5
  2. Bilateral involvement pattern
  3. Nor performing sedentary work > 5 hours/day
  4. Does not feel worse while extending the neck
  5. Feels better when moving the neck
  6. Dx of spondylosis without radiculopathy


What are the four attributes of neck pain patients who will respond positively to thrust?

  1. < 38 days of symptoms
  2. Positive expectation that manipulation with help
  3. Cervical rotation difference of greater or equal to 10deg
  4. Pain with Posterior-Anterior Spring Test


When can thoracic manipulations be used to treat cervical spine impairments?

  1. Symptoms < 30 days
  2. No symptoms distal to shoulder
  3. Looking up doesn't aggravate symptoms
  4. FABQ < 12
  5. Diminished upper thoracic kyphosis
  6. Cervical extension


If the patient demonstrates less than 45º of cervical rotation, what segments are most likely affected?


**50% of rotation occurs at AA joint (39-45deg)**


What is the proper way to bias/assess C1-C2 rotational movement?

Pt is supine while the therapist maximally flexes the patients head.

While maintaining flexion, the therapist rotates the head left and right.


How do you perform the Neck Flexor Muscle Endurance Test?

  1. Pt in hooklying, instruct them to maximally retract the chin and maintain that position with the head off the table by one inch.
  2. Therpaist hans is then placed under the head and watchs the folds in the anterior neck.
  3. If the pt touches the hand or folds start to expnd, they are given one cue to correct.

*If they lose control for > one second, test is terminated*


What is the big difference between the Dx classification of "Neck Pain with Movement Coordination Impairment" and "Neck Pain with Mobility Deficits?"

Neck Pain with Coordination Impairments is NOT acute.

(Greater than or equal to 12 weeks)


What is the single best neurological screening test for the Dx of "Cervical Radiculopathy?"

Biceps Reflex Test


While screening for a myelopathy, you perform the Babinski Test. What indicates a negative finding on the Babinski Test?

Slight big-tNextoe flexion less than the rest 


Where do you assess the C5 Deep Tendon Reflex?

Biceps Brachii


Where does the C5 dermatome cover?

Lateral forearm


How can you assess the C5 myotome?

Deltoids with arm abducted 90º


Where do you assess the C6 Deep Tendon Reflex?



Where does the C6 dermatome cover>

Distal Thumb


How can you assess for C6 myotome activation?

Biceps Brachii (Elbow Flexion)


Wrist Extensors


Where do you assess the C7 Deep Tendon Reflex?



Where does the C7 dermatome cover?

Distal Middle Finger


How can you assess the C7 myotome?

Triceps (Elbow extension) with arm overhead


Where does the C8 dermatome cover?

Distal 5th finger


How can you assess for C8 myotome recruitment?

Abductor Pollicis


Where is the best place to assess the T1 dermatome?

Medial forearm


What muscle can you assess for activation of the T1 myotome?

First dorsal interossi

(Index finger abduction)


When is it NOT appropriate to perform the Spurling Test?

If the patient does not have upper extremity or scapular region symptoms


What cluster of tests have a high specificity for the Dx of "Cervical Radiculopathy?"

  • Cervical Rotation < 60º to the involved side
  • Positive ULTT-A
  • Positive Distraction Test
  • Positive Spurling Test


What four variables suggest a positive prognosis for multimodal intervention while treating a patient with a cervical radiculopathy? 

  • Age < 54yo
  • Non-dominant arm affected
  • Symptoms don't get worse when looking down
  • Use of manual strengthening, and traction are used for > 50% of the treatments


True or False


Physical Therapy Outcomes for "Neck Pain with Radiating Symptoms" are LESS favorable than surgical outcomes.



Outcomes have been shown to be equal in recovery


How do you perform the ULTT to bias the Median Nerve?

  1. Shoulder girdle depression
  2. Shoulder Abduction
  3. Shoulder External Rotation
  4. Forearm Supination
  5. Wrist + Finger Extension
  6. Elbow Extension
  7. Cervical Lateral Flexion to contralateral side


What is the difference between ULTT1 and ULTT2a?

ULTT2a incorporates the addition of thumb extension


How do you bias the radial nerve during ULTT?

  1. Scapula depression
  2. Shoulder Abduction 10º with the elbow fully extended
  3. Medially rotate the shoulder
  4. Pronate the forearm
  5. Flex fingers/wrist
  6. Ulnarly deviate wrist
  7. Abduct the arm until provacative
  8. Cervical contralateral lateral flexion


How do you bias the Musculocutaneous nerve during the ULTT?

  1. Shoulder girdle depression
  2. Elbow Extension
  3. Shoulder Extension
  4. Ulnar devation of wrist with thumb flexed
  5. Either medially or laterally rotate the arm


How do you bias the Ulnar Nerve during ULTT?

  1. Depress the scapula
  2. Flex elbow approximately 115deg with the forearm pronated (keep wrist/fingers extended)
  3. Laterally rotate the shoulder to end range
  4. Abduct the shoulder until symptoms are felt
  5. Cervical contralateral lateral flexion