Flashcards in Cervical Spine Assessment & Treatment Deck (18):
When is a neurological exam indicated?
- Patient reports pins & needles or numbness
- Pain past the shoulder
What movements are tested for each upper limb myotome?
C1: CSp flexion
C2: CSp extension
C3: CSp lateral flexion
C4: Shoulder shrug
C5: Shoulder abduction
C6: Elbow flexion
C7: Elbow extension
C8: Thumb extension, finger flexion
T1: Finger abduction/adduction
What are the upper limb neurodynamic tests?
Upper limb tension tests
What is the cervical flexion-rotation test used for?
- Assess dysfunction at the C1-C2 motion segment
- Rotation at this level accounts for 45-50% rotation in cervical spine
- Normal > 44 degrees
- Restricted in patients with cervicogenic headaches
What is a positive Spurling's test?
- Reproduction of arm symptoms
- Indicates nerve root compression
What is the diagnostic test cluster that indicates a radiculopathy?
- ULTT 1a
- Cervical rotation <60 degrees
- Distraction test
- Spurling's test
What pathologies are associated with poor deep neck flexor strength?
Cervicogenic headaches, whiplash, chronic neck pain
What are the important deep neck flexor muscles?
- Longus capties
- Longus colli
What does evidence show about immobilisation in neck pain?
- Use of soft collar, rest, time off work associated with poor recovery
- Better outcomes in the "act as usual" group
- Exceptions: Cervical spine instability or fracture
What are the first line treatments for whiplash?
- Reassure & stay active
- Return to usual activities
- ROM, load load isometric endurance & strengthening exercises
What treatments are not recommended in acute whiplash?
Not routinely recommended:
- Manual therapy
- Kinesio tapiing
- Reduction of usual activity
- Muscle relaxants
- Steroid injections
What evidence is there for massage for neck pain?
- May be beneficial if there is excessive tightness or trigger points
- No long term studies so far
What is mechanical traction used for?
Relieving nerve root compressions (poor evidence)
What are the CIs to mechanical traction?
- Medical red flags
- CNS symptoms
- Infection of spine/bone
- Vascular compromise
What are the indications for mobilisations?
Joint pain & dysfunction
What are the CIs for mobilisations?
- Acute inflammatory disease
- Spinal cord compromise
- Cauda equina syndrome
What are the precautions for mobilisations?
- Neurological changes
- Ligament laxity
- Prolonged use of anticoagulants & corticosteroids