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PHTH 565 - MSK > CERVICAL SPINE > Flashcards

CERVICAL SPINE Flashcards

1
Q

In the cervical spine if you do Right side flexion you will get _____ rotation

A

Right

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2
Q

Where do cervical disc issues refer to

A

medial border of scapula

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3
Q

What is the purpose of a cervical scan

A
  • Out rule serious pathology e.g. Tumour, #, vertebral artery compromise
  • Determine suitability for physiotherapy treatment
  • Zero in on the appropriate area
  • Formulate a treatment plan that may include co-treatment with physician
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4
Q

When should a cervical scan be performed

A

for every patient with neck pain or upper extremity pain (apart from those with obvious local injury)

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5
Q

Components of a subjective cervical scan

A
  • Name
  • Age
  • Occupational demands
  • Activity levels
  • Insideous or traumatic? Forces + movement involved?
  • Aggravating + easing
  • Onset of pain
  • Pain location + behaviour
  • Diurnal variation
  • Visual analog scale
  • Effect on ADL, work, leisure
  • Sleep, sleep setup
  • PMhx
  • Previous treatment and response
  • Fhx
  • Meds
  • General health
  • Investigations AND results
  • Mandtory questions
    • Bilateral or quadrilateral paraesthesis or anaesthesia
    • Bowel and bladder symptoms
    • Neuro symptoms
    • 5Ds + 2Ns
    • Headaches or upper respiratory tract infections
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6
Q

What would indicate a cervicogenic headache

A
  • One sided
  • Restricted ROM one way
  • Point tenderness on cervicogenic PIVMs
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7
Q

Why do you ask about recent upper respiratory tract infections?

A

Ligament laxity

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8
Q

What is included in a cervical scan objective

A
  • Active ROM tests (upper and mid cervical)
  • Clear UE with scratch test
  • Special active tests
  • Passive tests
  • Cervical muscle tests
  • Neurological tests
  • Arterial patency tests
  • Traction + compression
  • Craniovertebral stability tests
  • Palpation
  • PA Pressures
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9
Q

What do you note when doing active ROM tests

A
  • Willingness to move
  • Axis of movement
  • ROM
  • Pain
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10
Q

What is the special active test you include in a cervical scan

A

Foraminal compression test or Spurlings

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11
Q

What is the active motion in a Spurlings test

A

Extension, ipsilateral SF and Rotation

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12
Q

A spurlings test will be symptomatic in which patient group

A

Compromised foramen or irritable nerve root

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13
Q

When would you consider doing a passive overpressure in a cervical scan

A

If there is pain free active ROM and the subjective history is not indicative of an irritable condition or neurologic, ligamentous, or vascular damage

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14
Q

When should you do cervical muscle tests

A

Following assessment of stability and ability to contract deep neck flexors

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15
Q

when conducting cervical muscle tests, what could the finding of painful weakness of the short neck flexors indicate?

A

Serious pathology in that region such as isntability or fracture

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16
Q

What is a contraindication to testing cervical muscles

A

Presence of 5Ds

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17
Q

What is included in the neurological tests of a cervical scan

A
  • Dural mobility (slump, SLR, UL tension tests)
  • Cord tests (plantar response + clonus)
  • Conduction tests = motor, sensory, reflexes
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18
Q

What is weakness of the hand intrinsics not typically associated with? What may be a serious cause?

A

Not associated with disc pathology in cervical spine

Serious cause: tumour at apex of lung

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19
Q

What are the arterial patency tests included in the cervical spine scan

A
  • Upper limb pulses

- Vertebral artery tests

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20
Q

What are the 3 craniovertebral stability tests included in the cervical scan

A

Anterior
Vertical
Rotation

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21
Q
  • Neck disability index ? Scoring? clinically important change? What does it not take into account?
A
  • Outcome measure
  • 50 points = 100% patient rated max disability
  • CIC : 5 points
  • Does not take into account emotional or psychological factors
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22
Q

What is the best way to correct posture

A

Cueing sternum up

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23
Q

What region of the cervical spine does rotation occur in

A

Craniovertebral

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24
Q

What region of the cervical spine does side flexion occur in

A

mid cervical

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25
Q

how do you cue for craniovertebral extension

A

Jut chin out and look up at a 45 degree angle

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26
Q

How do you cue for craniovertebral flexion

A

chin to adams apple

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27
Q

how do you cue for craniovertebral side flexion

A

ear to neck

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28
Q

How do you cue for craniovertebral rotation

A

Hard to isolate

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29
Q

Is a difference side to side of the scratch test normal?

A

yes

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30
Q

What is a sign to stop spurlings

A

arm pain at any point in the test

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31
Q

What is the expected response in alar ligament testing

A

for the SP of C2 to move the opposite direction

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32
Q

What is a positive on a craniovertebral stability test

A
  • Spinal cord symptoms
  • Vertebral artery symptoms
  • Pain
  • Laxity
  • Empty end feel
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33
Q

What is needed to rule in a radiculopathy (nerve compression)?

A
  • Positive spurlings
  • Relief with traction
  • Loss of ipsilateral rotation
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34
Q

What can rule of a nerve compression?

A
  • negative ULTT
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35
Q

What are the Canadian Cspine Xray rules?

A
  • Age >65
  • Dangerous mechanism
  • Unable to achieve 45 degrees of rotation left and right, paraesthesia in extremities
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36
Q

What is a positive neurodynamic test

A
  • Reproduction of the patients symptoms and/or

- Restriction of mobility when compared with the opposite side

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37
Q

What should you do following a positive neurodynamic test

A
  • Educate patient to stay out of positions of neural tension
  • Mobilise the nervous system grade 1-3
  • Continually monitor symptoms
  • Treat based on irritability of the condition
  • Remember the latent effect of neural mobilisations
  • Always treat interface
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38
Q

What are contraindications to neurodynamic testing

A
  • Neurological signs
  • Condition worsening
  • Undiagnosed condition
  • Spinal cord or cauda equina compromise
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39
Q

What is the normal response of a median nerve bias neurodynamic test

A
  • Stretch sensation in the antecubital fossa

- Tingling in thumb and first 3 fingers

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40
Q

What is the normal response of a radial nerve bias neurodynamic test

A
  • Stretch sensation in lateral forearm

- Stretch or pain in the lateral upper arm

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41
Q

What is the normal response of an ulnar nerve bias neurodynamic test

A
  • Stretch pain hypothenar eminence and med 2 fingers

- Pins and needles same distribution

42
Q

Do you depress the scapula in median nerve bias 1

A

No just prevent it from elevating

43
Q

What are the known positions of vertebral artery compromise

A

Extension
Rotation
Traction

44
Q

When do you complete craniovertebral stability tests

A
  • As part of cervical scan

- Always prior to manual therapy techniques of the craniovertebral region

45
Q

What is a positive finding on a craniovertebral stability test

A
  • Soft end-feel with pain and/or spasm
  • Lump in the throat/shortness of breath
  • Spinal cord signs
  • Vertebral artery signs
46
Q

What may be another cause for the sensation of a lump in the throat/shortness of breath

A

swelling post MV

Retropharyngeal haematoma

47
Q

What is the process of events if a positive is found on a craniovertebral stability test

A
  • Pt put in hard collar

- Referred back to doctor for possible MRI, open mouth X-ray, orthopaedic consult and stabilisation

48
Q

In the anterior (sharp purser/supine anterior shear) tests what structures are being tested

A

Transverse ligament

Dens

49
Q

In the Vertical stability test what structures are being tested

A
  • Tectorial membrane
  • AO
  • AA anter and post membranes
  • All vertically orientated ligaments
50
Q

In the rotational kinetic stability test what structures are being tested

A

alar ligament

joint capsule

51
Q

What are the two anterior stability tests

A

Sharp purser test

Supine anterior shear tests

52
Q

Do not do the anterior shear test if what other test is position

A

Sharp purser

53
Q

On the sharp purser, if positive when the patient actively flexes the neck what occurs at the bones

A

produces an anterior subluxation of C1 on C2

54
Q

In the anterior shear test what do you move anteriorly

A

Occiput and C1

55
Q

In the vertical stability test for the CV complex - what is being stabilized

A

C2

56
Q

What ligament is the kinetic test testing

A

alar ligament

57
Q

On the kinetic test what would indicate a torn alar ligament

A

Lack of or delayed movement

58
Q

What is the therapist role in the alar ligament stability test

A

Fix the lamina of C2 preventing SF or Rotation

Other hand passively SF head about a saggital axis

59
Q

What are the mid cervical stability tests

A

Vertical (compression + traction - fix caudal vertebra)

A/P

60
Q

What would lead you to be cautious when doing mid cervical stability tests

A
  • Creased in midcervical spine
  • Pt complains of clicking
  • Xray shows DDD or osteophytes or anterolisthesis
61
Q

Structures being tested in mid cervical traction

A

Disc

Longitudinal ligaments

62
Q

Structures being tested in mid cervical compression

A

disc
vertebral body
Facet joint

63
Q

Structures being tested in mid cervical anterior shear

A
  • All ligs

- capsule

64
Q

Structures being tested in mid cervical posterior shear

A

all ligs

capsule

65
Q

If you find stiffness of a segment on a PIVM, how do you confirm this finding?

A

PAVM

66
Q

If you find excessive mobility on a PIVM, how do you confirm this finding

A

stability testing

67
Q

What is the mechanism for reduction of pain via PIVM

A

Mechanoreceptor effect

Vascular pumping

68
Q

In PIVM you sideflex ____ and rotate ____ (Direction

A

Away

Towards

69
Q

What are you comparing side flexion and rotation PIVMS to

A

the other side and other levels

70
Q

What angle do you mobilize a cervical vertebra at?

A

45 deg (think about facet joint)

71
Q

Contraindication to PA pressure at cervical spine

A
  • Local inflammation
  • Local fracture
  • Active Neoplasm or Infection
  • Local instability
  • Acute trauma
  • Vascular pathology in vertebral or carotid arteries
72
Q

What are precautions to PA pressure in the cervical spine

A
  • Osteoporosis

- Anti-coagulant med

73
Q

On a facilitated segment you may notice a ____ on testing PAs

A

reactive spasm

74
Q

Postural neck pain History and signs

A

History:
- Gradual onset central/bilateral symptoms local or referred.
- Agg: Prolonged postures, sitting lying
- Ease: altered position or motion
Signs:
- FHP + associated poor thoracic spie posture
- May have decreased CV flexion
- Painful extension
- Weak C-V flexion
- P/A may be tender +/- spasm

75
Q

Postural back pain - Treatment

A
  • Exercise
  • Postural/ergonomic advice
  • Soft tissue Rx
76
Q

Spondylosis/DJD/DDD - history + signs

A

History:
- Longer history of problems
- Older age group
- Possibly post traumatic events
- C/O stiff/worse withs tatic postures, better with some motion
Signs:
- Xray = OA and osteophytes
- Capsular pattern of restriction = bilateral loss of SF, rotation, painful extension, full flexion
- +/- postural component
- P/As +ve stiff, +/- pain
- End feels - hard capsular/bony (osteophytic)

77
Q

Spondylosis/DJD/DDD treatment?

A
  • PAs
  • Exercise
  • Postural/ergonomic advice
  • Soft tissue Rx
78
Q

Cervical disc lesion history

A
  • Acute onset
  • Often intrascapular pain +/- radicular pain
  • may be related to trauma or poor positioning
  • Worse with specific movements (usually flexion)
  • Cough/sneeze aggravate
  • Better lying down
    Signs:
  • Deformity
  • neck held in flexion or side flexed
  • Reduced motion (particularly flexion and rotation/sideflexion to side of pain)
  • Compression increases/traction decreases
  • +/- nerve root signs
  • +/- dural signs
79
Q

Cervical disc lesion treatment

A
  • Traction
  • Soft tissue Rx
  • Exercise and postural/ergonomic advice
80
Q

Cervical radiculopathy History and signs

A 
History: 
- Onset often acute but may be slower or progressive 
Sings: 
- Decreased motion: ext/SF/rotation to same side due to pain 
- +ve spurlings 
- Opposite movement may be tight (flex/contralateral SF + rotation) 
Relief with traction 
- Neuro signs 
- +/- nerve root signs 
- +/- dural signs 
- P/A stiff/painful 
- Unilateral PA stiff/painful
81
Q

Cervical radiculopathy treatment

A
  • Traction
  • PA
  • Soft tissue Rx
  • Exercise and postural/ergonomic advice
82
Q

Cervical radiculopathy causes

A
  • Disc
  • Z-joint swelling/thickening
  • Degenerative changes - osteophytes, UV joint degenerative changes
83
Q

Isolated Z-joint dysfunction - History and Signs

A

History:
- Onset: acute (wry neck) or may be gradual
- Pain unilateral local +/- referred to arm, scapula, head
- Agg: motion
- Ease: rest
SIgns:
- Restricted motion - stretch pattern - F/SF/ rot away
- Compression: E/SF/rotate towards
- Segmental muscle guarding
- P/As decrease unilat over joint +/- pain

84
Q

Isolated Z joint dysfunction treatment

A
  • Unilateral PAs,
  • soft tissue Rx,
  • Exercise
  • postural/ergonomic advice
85
Q

Cervical instability History + Signs

A

History:
- Trauma/repeat episodes/consistently inconsistent/posture
- Local +/- referred pain
- Agg: static posture/sleep positions
Signs:
- Poor posture, often head forward, may have flattened C curve due to spasm/guarding decreased active ROM
- Segmental multifidus spasm
- Weak deep cervical flexors
- P/As = reactive spasm +/- pain or increased translation
- May note other segments with hypomobility
- Stability tests positive for pain and/or soft end-feel

86
Q

Cervical instability treatment:

A

Stabilisation program
Strengthening
Soft tissue Rx
Exercise and postural/ergonomic advice

87
Q

Generalized mechanical dysfunction Signs

A

+/- Postural imbalance
+/- Muscle imbalance
+/- Segmental dysfunction - restriction or hypermobility

88
Q

Generalized mechanical dysfunction treatment

A

Per findings

89
Q

Acceleration/deceleration injury synonyms

A

Whiplash
Whiplash associated disorders
Cervical sprain/strain,
Cervical soft tissue injury

90
Q

Quebec task force classification Grades

A

Grade 1: Neck complaint or pain, stiffness, or tenderness only, no physical signs
Grade 2: Neck complaint & MSK signs (Decreased ROM, point tenderness)
Grade 3: Neck complain & neurological signs (weakness, sensory deficit, decreased reflexes)
Grade 4: Neck complaint + fracture or subluxation

91
Q

What are the key management principles for Acceleration/deceleration injury

A
  • Early motion and return to activity are important for healing and return to function
  • Patient participation and self-management are integral to recovery
  • Evidence in the literature suggests early intervention by PT is effective in decreasing pain and improving mobility
92
Q

How Acceleration/deceleration injury Goals of Treatment decided

A
  • Formulated for each individual following a detailed assessment
  • based on: assessment findings, stage of tissue repair, requirements of that individual
93
Q

Components of treatment for Acceleration/deceleration injury

A
  1. Application of controlled forces (not too much or too little)
  2. Optimizing physical performance - restoring joint function, strength, flexibility, etc.
  3. Pain management techniques
  4. Client education
  5. Ongoing evaluation
94
Q

Muscles of cervical region which tend to tighten

A
  • Pec major and minor
  • Upper trapezius
  • Lev scap
  • SCM
  • Rectus Capitis Major and minor
  • Superior and inferior occipital
95
Q

Muscles of cervical region which tend to weaken

A
  • Serratus anterior
  • Rhomboids
  • Mid and lower trapezius
  • Deep neck flexors
  • longus Colli
96
Q

Should you restore articular mobility or soft tissue length first

A

articular mobility

97
Q

How do deep neck flexors alter the movement patterns with the superficial muscles

A

They react to pain and injury with inhibition or altered movement patterns

98
Q

What is the relationship between deep neck flexors and cervicogenic headaches

A

Reduced endurance of DNF can cause cervicogenic headaches. DNF change from fibre type 1 (tonic) to fibre type 2 (phasic)

99
Q

What other (not DNF) muscles group have been found to be linked to neck pain

A

Suboccipital extensors

Scapular stabilizers

100
Q

How do you progress stabilisation in the cervical spine via DNF

A
  • Determine starting position, hold time
  • Ensure action is coming from DNF and not superficial
  • Increase speed of contraction
  • Add load
  • Add functional tasks
101
Q

When using a biofeedback unit to assess and train DNF at what increment should you increase

A

2mmHg

102
Q

How do you set someone up to test DNF

A

Tip of tongue on roof of mouth, lips together, teeth apart.

Do tiny nod/slide back of head up pillow

PHTH 565 - MSK (8 decks)

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