Cervical Spine Evaluation

Question 1

Canadian C-Spine Rule’s for Acute Trauma Patient

Answer 1

1. Are they cognitively intact?
2. Are they under 65 y.o.
3. Can they move more than 45 d Rot (even with pain)
4. No crazy MOI
5. No midline pain at rest
6. No paresthesia in arms following trauma

Question 2

Checking ligament integrity in Upper Cervical Spine

Answer 2

1. Modified Sharp-Purser Test
2. Alar Ligament Stress Test
3. Transverse Ligament of Atlas Test

Question 3

S/S of Cervical Instability

Answer 3

1. Severe Muscle spasm
2. Resistance and apprehension to movement (esp. flexion)
3. Lump in throat
4. Lip/fascial paresthesia
5. Severe HA
6. 5 D’s And 3N’s
7. Soft end feel

Question 4

Cervical Instability Clearing Tests used for what?

Answer 4

Tests to determine if patient should even be in our office. We want to clear or filter them to rule out rare but serious pathology

Question 5

Positive finding for Modified Sharp-Purser Test

Answer 5

Feel a clunk

Patient feels relief of symptoms

Question 6

Transverse ligament is also part of what ligament

Answer 6

Cruciform ligament

Question 7

Transverse ligament test positive findings

Answer 7

Soft end feel, VBI symptoms, lump in the throat

Question 8

Failure of transverse ligament causes what symptoms

Answer 8

Dizziness, nausea, lip/face/limb paresthesia, nystagmus, myelopathy

Question 9

What is a positive finding when doing Anterior shear or sagittal stress test

Answer 9

Nystagmus, pupillary changes, dizziness, soft end feel, nausea, fascial/lip paresthesia, lump sensation in the throat…. excess displacement during the shearing movement

Question 10

How to perform Alar Ligament Stress Test

Answer 10

Slightly flexed
Hold C2
SB or rotate
C2 should move opposite direction isntantly or within first 20-30 degrees…. IF NOT THEN STOP

Question 11

Positive Test for Rotational Alar Ligament Stress Test

Answer 11

more than 20-30 deg without moment of C2 - contralateral alar ligament tear..
2. excessive motion in opposite direction indicates instability due to increase in neutral zone in joint

Question 12

Positive sign of Pettman’s distraction test

Answer 12

1. symptom reproduction

2. > 1 mm distraction

Question 13

Jefferson’s Fracture

Answer 13

Fracture of C1

Question 14

Nodding vs. flexion

Answer 14

Nodding in UCS during flexion movement… Flexion occurs in LCS

Question 15

Upper limb scan to see if there is anything else causing complaint

Answer 15

1. peripheral joints
2. Myotomes
3. Sensory Scan

Question 16

C1-C2 Test Action

Answer 16

Neck Flexion

Question 17

C1-C2 Muscles

Answer 17

1. Rectus lateralis
2. Rectus capitis anterior
3. Longus Coli
4. Longus Cervicis
5. SCM

Question 18

C3 Test Action

Answer 18

Neck Lateral Flexion

Question 19

C3 Muscles

Answer 19

1. Longus capitis
2. Longus Cervicis
3. Trapezius
4. Scalenus medius

Question 20

C4 Test Action

Answer 20

Shoulder elevation

Question 21

C4 Muscles

Answer 21

1. Diaphragm
2. trapezius
3. levator capulae,
4. scalenus anterior
5. scalenus medius

Question 22

C5 test action

Answer 22

shoulder abduction

Question 23

C5 muscles

Answer 23

1. Rhomboid major/minor
2. Deltoid
3. Supraspinatus
4. infraspinatus
5. teres minor
6. biceps
7. scalenus anterior and medius

Question 24

C6 test action

Answer 24

elbow flexion and wrist extension

Question 25

C6 Muscles

Answer 25

1. Serratus anterior 2. Latissimus dosi 3. Pectoralis major (sternal head) 4. Triceps 5. Pronator teres 6. Scalenus medius/posterior

Question 26

Sensory Scan 1. Myelopathy 2. Nerve root lesion 3. Peripheral nerve lesion

Answer 26

1. UMN lesion 2. LMN lesion 3. LMN lesion

Question 27

Biceps reflex spinal segment

Answer 27

C5, C6

Question 28

Brachioradialis reflex spinal segment

Answer 28

C6

Question 29

Triceps spinal segment reflex

Answer 29

C7/ maybe C8

Question 30

Hoffmann Sign

Answer 30

UMN lesion suspected. flick fingernail of middle finger and check for flexion of thumb

Question 31

Functional Assessment

Answer 31

1. ADL 2. Functional strength tests 3. Whiplash disability questionnaire (WDQ) 4. Bournemouth questionnaire 5. neck disability index

Question 32

2 types of special tests

Answer 32

Provocative | Symptom relief

Question 33

Provocative tests

Answer 33

ULNT Foraminal compression (spurlings, jacksons) cervical flexion rotation test

Question 34

Symptom relief test

Answer 34

distraction test | shoulder abduction

Question 35

Cloward's Sign

Answer 35

Referred pain to medial scapula - pain from a disc/nerve root issue

Question 36

Maximal foraminal compression test

Answer 36

need some radiating symptoms in order to be positive. Negative test if just feel neck pain

Question 37

Clincal prediction rule for cervical radiculopathy

Answer 37

positive spurlings positive relief with distraction less than 65 deg ROM w/ rotation Positive upper Limb Tension Test - All present 90% certain - 3 present - 60%

Question 38

Bakody's Sign

Answer 38

Shoulder abduciton relief test for C4-C5 or C5-C6. | Decreased neurological symptoms

Question 39

Upper limb tension test 1

Answer 39

Median nerve | anterior interosseous nerve

Question 40

Upper limb tension test 2

Answer 40

median, axillary, and musculocutaneous nerves

Question 41

upper limb tension test 3

Answer 41

radial nerve

Question 42

upper limb tension test 4

Answer 42

ulnar nerve (c8-T1)