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Semester 3 PM Exam 1 > Clinical Presentation Cervical > Flashcards

Clinical Presentation Cervical Flashcards

(92 cards)

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1
Q

What percentage of individuals have had neck pain in the past six months

A

54%

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2
Q

What percent of all patients receiving PT are neck pain

A

25%

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3
Q

Of patients with neck pain what percentage will develop chronic symptoms

A

44%

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4
Q

Subjective info

A 
Area
Nature
Type of symptoms
Severity
Behavior
Present hx
Past hx
Special questions
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5
Q

Special questions

A 
Functional/Comparable postures
IF trauma - loss of consciousness, seatbelt, speed and direction
Sleep position or difficulties
Headaches
Strength changes
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6
Q

3 components to irritability

A
  1. Vigor - how much activity it takes to flare up
  2. Severity - how bad is it when flares up
  3. Duration - how long does it take to go back down
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7
Q

Red flags

A 
Constant pain
Night pain/sweats
Inc symptoms with cough or sneeze
Extremity weakness
Bilateral UE symptoms
LE symptoms
Signs and symptoms of VBI
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8
Q

Red flags - also looking for

A

Non musculoskeletal
Vertebrobasilar injury
Craniovertebral ligament injury
Cervical myelopathy (injury to cord)

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9
Q

Vertebrobasilar artery insufficiency - what is it and what can it be caused by

A

Blood flow compromised

Due to stenosis of artery, atherosclerosis (plaque), trauma

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10
Q

Vertebrobasilar artery insufficiency - may lead to

A

brain stem ischemia - decreased bloodflow to the basilar region

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11
Q

Vertebrobasilar artery insufficiency - motions that make it worose and why

A

There is an acute angle in the artery from C1 to the occiput (foramen magnum) so if there is already an issue there, rotation will lengthen or stretch the artery and further occlude it

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12
Q

Vertebrobasilar artery insufficiency - testing

A

Ultrasound doppler is the gold standard

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13
Q

Vertebrobasilar artery insufficiency - things to look for

A

5 Ds And 3 Ns
Dizziness, Diplopia, Dysphagia, Drop attacks, Dysarthria
Ataxia
Nausea, Nystagmus, Numbness

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14
Q

Craniovertebral ligament injuries

A

Alar
Transverse
Tectorial membrane

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15
Q

Craniovertebral ligament injuries - Alar

A

Runs from dens (C2) up to the occiput btw the head and C2

Stabilize at C2 SP and move head

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16
Q

Craniovertebral ligament injuries - Transverse

A

holds dens against C1

Stabilize at C2 SP so that C1 and the head move together

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17
Q

Craniovertebral ligament injuries - tectorial membrane

A

Attaches the head and neck - Keep the head on the neck

Continuation of the anterior longitudinal ligament

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18
Q

Craniovertebral ligament injuries - due to

A

TRAUMA

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19
Q

Craniovertebral ligament injuries - risk to

A

brainstem and upper cord
May require surgical fixation or orthosis
May be associated with dens fracture - need radiograph

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20
Q

Craniovertebral ligament injuries - Signs and symptoms

A

Signs seen with VBI
Mouth/lip numbness
Sensation of having a lump in throat

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21
Q

Cervical Myelopathy - what is it

A

UMN lesion

Injury to the spinal cord

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22
Q

Cervical myelopathy - signs

A

UMN lesion signs - spasticity, hyper-reflexia, visual and balance disturbances, ataxia, bowel/bladder changes
Multi segmental paresthesia

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23
Q

Craniovertebral ligament injuries - tests

A

Babinski, Clonus, Hoffmans test

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24
Q

Impaired posture

A

Muscle imbalances

Seen with neck pain with headache AND neck pain with movement coordination impairments

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25
Muscle imbalances
muscle pain tightness trigger points
26
Muscle imbalances - examination
Posture Muscle strength/function testing Muscle length testing Palpation
27
Muscle imbalances - examination - muscle strength/function testing
Deep neck flexors Neck flexor endurance Scapular stabilizers
28
Muscle imbalances - examination - muscle length testing
``` Upper trap Levator scap Scalenes Suboccipital mm Pec major and minor Lat dorsi ```
29
Muscle imbalances - interventions
``` Strengthening exercises Exercises to lengthen Trigger point release Tender point SCS Postural education ```
30
Trap and Levator scap
Global muscles that work together for postural stability
31
Longus Colli and Capitis
Local muscles that can lead to stability or stiffness at the segmental level
32
Suboccipital muscles
ATTACHMENTS
33
If suboccipital muscles are tight what will you see
extension at head on neck and compensation with flexion at the lower neck
34
Scalene mm
ATTACHMENTS
35
Upper crossed syndrome - what is tight
Line indicating tightness passes through the levator scap, upper trap, and pec
36
Upper crossed syndrome - tightness can cause
shoulder elevation and scap protraction
37
Upper crossed syndrome - what is inhibited
deep neck flexors and lower scap stabilizers
38
Connective tissue dysfunction includes what
Zygo/Facet joint dys Cervical spondylosis IV disc Acute torticollis
39
Zygo - Typical cervical vertebral joints - close packed position
Full extension
40
Zygo - Typical cervical vertebral joints - with flexion, the superior segment moves
Ant and sup
41
Zygo - Typical cervical vertebral joints - with extension, the superior segment moves
Post and inf
42
Zygo - Typical cervical vertebral joints - with LF the superior segment moves so that the
ipsilateral side closes and the contralateral side opens
43
Zygo - Typical cervical vertebral joints - Coupled motion Typical
LF and Rot is the same
44
Zygo - Typical cervical vertebral joints - Coupled motion Atypical
OA - flex/ext are primary motion - LF and Rot are opp | AA - rotation is primary motion (convex on convex, only roll)
45
Zygo - Typical cervical vertebral joints - OA flexion is limited by
dens at foramen magnum
46
Zygo - Typical cervical vertebral joints - OA extension is limited by
bony approximation
47
Uncinate processes
Posterolateral | Form uncovertebral joints or joints of luschka
48
Uncinate processes - development
Develop btw ages of 6-9 | Degenerate changes due to shear forces that occur with rotation
49
Facet Joint Dysfunction - cause
Trauma, degeneration, insidious
50
Facet Joint Dysfunction - Presentation
Localized, sharp pain Pain with ext, ipsilateral SB, quadrant Can refer pain - diagnostic blocks
51
Facet Joint Dysfunction - presentation - btw shoulder blades
``` Upper = C5/6 Lower = C6/7 ```
52
Cervical Spondylosis - causes
degenerative changes - disc, vertebral bodies, facets, U joints Nerve root compression, edema, cord compromise
53
Cervical spondylosis - presentation
C/O stiffness, diffuse, dulle ache Painful movement Accessory motion limitations Broader and can't localize as well
54
Capsular pattern - Bilateral OA
Equal limitation in ext and LF
55
Capsular pattern - Bilateral Typical
Ext and then equal with rot and LF
56
Capsular pattern - Unilateral OA
contralateral LF
57
Capsular pattern - unilateral Typical
contralateral LF and rot
58
Stenosis - what is it
Narrowing - can be lateral of central
59
Stenosis - lateral
In IV foramen - degenerative, mechanical, space occupying lesion like tumor or disc herniation
60
Stenosis - central
in the spinal canal - usually degenerative
61
Stenosis - presentation
Symptoms of nerve or cord compression may result depending on degree of narrowing and if lateral or central
62
IVD - C spine make up
25% of the height in c spine No disc at OA Smaller than vertebral bodies
63
IVD - C spine thicker
thicker ant than post
64
IVD - C spine Contact
uncinate processes laterally
65
IVD - C spine stressed by
rotation
66
IVD - C spine
Gelatinous nucleus pulposs becomes fibrous early | Peripheral annulus fbrosus, concentric rings alternate direction
67
Intervertebral disc dysfunction includes
Dis herniation Degeneration Rim lesion
68
Disc herniation - subjective
C/O scapular, paraspinal sx with or w/o neck pain | Inc with sustained posture and better with activity (move fluid)
69
Disc herniation - examination
``` Relief with traction Pain with compression Pain with rx flexion Most common at C6 Possible neurological signs and symptoms ```
70
Disc herniation - intervention
Traction to unload disc | Treat reason it is aggravated - maybe postural impairment
71
Disc Degeneration
Spondylosis In youth - proteoglycans and H20 are abundant Nucleus begins to resemble the annulus Lose height
72
Disc degeneration - Examination
All same - neuro eval too though is symptoms
73
Disc degeneration - Intervention
same - unload the disc | heat feels good too
74
Rim lesion
Horizontal annular tear at anterior vertebral rim, without tearing anterior longitudinal ligament Often multilevel injury Poor prognosis cuz not good circulation Can be caused by whiplash injury
75
Rim lesion - predisposing factors
Extension trauma MVA hit from behind/poor headrest position Forward head posture
76
Rim lesion - signs and symptoms
``` Immediate pain upon impact Highly irritable neck SAME symptoms with comp and distrac (both painful) Difficulty lifting head off pillow XR appear normal - MRI would show ```
77
Rim lesion - intervention
Rest, immobilization, education, distal intervention
78
Acute torticollis
SCM contracture | Congenital, traumatic, spasmodic
79
Localized inflammation
Whiplash associated disorders (WAD)
80
Definition of WAD
An acceleration - deceleration mechanism of energy transfer to the neck
81
Causes of WAD
MVA, Diving, Other bony or soft tissue injuries
82
Prognosis in WAD - Higher NDI score at 2-3 yrs post injury is associated with
Higher initial NDI score Older age Cold hyperalgesia Higher PTSD symptoms
83
Acute vs Chronic WAD - history
History - mechanism, head position, amount and direction of force
84
Acute vs Chronic WAD - examination
``` Cranio vertebral ligaments Vascular structures Soft tissue (muscles, ligaments) Joint and joint capsule IVD Central or peripheral neurologic symptoms ```
85
Referred pain syndromes - peripheral nerve entrapment
Radiculopathy | Thoracic outlet syndrome
86
Cervical nerve roots exit
laterally from the spinal cord
87
Intervertebral foramen does what with flexion and what with extension
Widens with flexion | Narrows with extension
88
Dermatome pattern
ADD MORE C6 - thumb C7 - index and middle C8 - ring and pinky
89
Cervical radiculopathy - clinical presentation
Unilateral C/O neck/shoulder/arm/hand symptoms Worse with movements that narrow foramen
90
Cervical radiculopahty - examination
sensory, motor, reflex changes
91
Cervical radiculopathy - intervention
unload the nerve open the area correct any mm imbalances neurodynamics
92
Cervical radiculopathy - clinical exam - best variables to diagnose
Neurodynamics Cervical rotation toward painful side less than 60 degrees Distraction test pos (pain dec with distraction) Spurling test pos (comp inc their pain)

Semester 3 PM Exam 1 (2 decks)

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