ch21: cervical and thoracic spinal cond

Question 1

brachial plexus traction test

Answer 1

behind pt AT side bend pt head to one side and depress the shoulder
- if pain inc in arm on side being stretched = +ve brachial plexus stretch
- if inc pain on the side of the head side bending = irritation or compression of the nerve roots btw two vertebraes

Question 2

cervical compression/distraction test

Answer 2

compression = +ve if inc pain or altered sensation = pressure on a nerve root

• distraction = if pain dec = +ve test for nerve root compression
• if p! inc with distraction = ligamentous injury

Question 3

spurling test

Answer 3

foraminal comoression test
- cervical nerve pathology
- progressive test, after every reposition ask for pain or change in sensation
-1- seated, neck passively extended
2- added lateral bend
3- axial load4-

radiating pain to upper limb indicate nerve root impingement caused by narrowing of the neural foramina

Question 4

shoulder abduction test

Answer 4

+ve with a relief of symptoms associated with nerve root compression
- bakody test
- pt asked to abd sh and rest hand on top of the head

Question 5

ULTT

Answer 5

assess presence of cervical radiculopathy due to mechanical factors such as impingement or entrapment of the nerve
+ve= NTB

ULTT1=median + interosseous + C5-C6-C7
ULTT2= median + musculocutaneous + axilary
ULTT3=radial
ULTT4=ulnar + C8-T1

Question 6

vertebral artery test

Answer 6

• pt head brought into passive cervical ext, SB and Rot
• position held for 30sec
  +ve= pt dizziness, confusion, abnormal mvt of the eyes, unilat pupil change, nausea
  = possible occlusion of the cervical vertbral artery
  refered

Question 7

valsalva test

Answer 7

to det presence of space-occupying lesions:
- herniated disk
- tumor
- osteophytes
+ve with inc pain

Question 8

spring test

Answer 8

tx-s
facet jnt mobility
PA on spinous process
looking for spring on vertebrae
+ve = pain or hypomobility = facet pathology

Question 9

oppenheim test

Answer 9

upper motor neuron test
- pt supine
- AT strokes the crest of the anteromedial tibia with fingernail
+ve= extension of the big toe and abd of the other toes
= upper motor neuron lesion

Question 10

hoffmann sign

Answer 10

hold pt middle finger and briskly flicks distal phalanx
+ve = interphalangeal jnt of the thumb flexes

upper motor neuron lesion

Question 11

torticollis

Answer 11

congenital or acquired
- head tilt towards injured side and rotates away
congenital = birth trauma

Question 12

cervical spinal stenosis

Answer 12

narrowing of the sagittal canal diameter of 14mm or less and may be congenital, acquired or asymptomatic
- asymptomatic until force flexion or ext
- often c5-c6
- symptoms bilateral
- sometime neuropraxia (temporary neural change)
- need MRI

Question 13

spear tacklers spine

Answer 13

• flexion of the cervical spine, produces a straightened cervical spine that acts like a segmental column
• predisposing the spine to permanent neuro injury w/ further axial looading
• trauma
• EMS

Question 14

anterior cord syndrome

Answer 14

• damage to ant 2/3 of cord
• possible damage to ant spinal artery
• ischemia leads to variable loss of motor func and loss of pain and temp sensatin below site of injury
• sensitivity to light touch, deep pressure, vibration and proprio are preserved

Question 15

post cord syndrome

Answer 15

post third of the spinal cord: dorsal column
- sensory in nature
- sense are lost, but motor func and sense of pain and temp are preserved

Question 16

Brown-sequard syndrome

Answer 16

• hemisection of the spinal cord with loss of ipsilateral motor function and contralaeral pain and temp caused by a penetrating injury
• bony fragment, knife, gun
• some motor weakness on one side and dec pain and temp on opposite side

Question 17

central spinal cord syndrome

Answer 17

most common
- incomplet loss of motor func
- upper extramity weakness more prononced then lower ext
- hemorrhagic or ischemic injury to the corticospinal tracts bc of their somatic arrangement

Question 18

Erb point

Answer 18

• fixed plexus btw the football sh pad and the sup medial scapula, where the brachial plexus is most superficial
• 2-3cm above the clavicle at the level of the TP of C6

Question 19

classification of brachial plexus injuries

Answer 19

grade 1: neurapraxia, temporary loss of sensation and/or loss of motor func

Grade 2: axonotmesis: significant motor and mild sensory deficits

grade 3: neurotmesis: motor and sensory deficits persist for up to 1year

Question 20

RTP for pt with no know hx of brachial plexus injury and experienced an acute episode

Answer 20

• no neck pain, arm pain, or dysesthesia (impaired sens)
• full pain free ROM in the neck and upper extremity
• normal strength or MMT back to baseline
• normal deep tendon reflex
• -ve brachial plexus traction test

Question 21

chronic burner syndrome

Answer 21

chronic recurrent cervical nerve root neurapraxia
- involves neck extension with ipsilateral deviation
- associated w/ cervical canal stenosis, reversal lordosis, disk disease, foraminal stenosis,

Question 22

scheuermann disease

Answer 22

degeneration of the epiphyeal end plates of the vertebral bodies and typically includes at least 3 adjacent motion segments

Question 23

apophysitis

Answer 23

• inflammation of the apophyses
• cause by repeated flexion/extension of tx-s
• apophyses= growth centers of the vertebral bodies
• ## progressive cond