Deck 3 Flashcards by Suzanne Maggioni

Which of the following is not a high risk factor according to the Canadian C-Spine rules in the evaluation of a patient with cervical pain after an accident?

A. Age > 65
B. Hx of paresthesias in extremities
C. Delayed onset neck pain
D. Fall from height of 6 feet

C. Delayed onset neck pain

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You are considering cervical HVLAT on a patient and are reviewing their medical hx. Which pathology is not predisposed to cervical instability or ligamentous laxity?

A. RA
B. Cervical spondylolisthesis
C. Morquio syndrome
D. Marfan syndrome

B. Cervical spondylolisthesis

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What is Morquio syndrome?

Bone dysplasia associated with C1-2 subluxation

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34 F presents with new onset dizziness. You are concerned for VBI. You passively rotate the cervical spine to end range which reproduces the dizziness. As you hold the position, the intensity decreases. What do your exam findings suggest?

A. Confirm suspicion for VBI
B. Suggest a dx of BPPV
C. Confirm a dx of migraine without aura
D. ID cervical facet dysfunction

B. Suggest a dx of BPPV

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35 M with R shoulder pain referral. During exam, you note the pt reports relief of sxs with shoulder abduction. What is the most likely pathology?

A. R RTC strain
B. Cervical radiculopathy
C. R deltoid hypertrophy due to weak RTC musculature
D. TOS

B. Cervical radiculopathy

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Shoulder pain reduced with abduction should lead to suspect cervical spine pathology, most likely where?

mid-lower cervical

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Shoulder pain reduced with abduction is a (+) ____ sign

+ Bakody sign

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40F recreational softball player with dull global L shoulder and neck pain. UA to describe aggs, symptoms intermittent. Inc’d shoulder weakness since starting softball. Also started a new job in HR 4 weeks ago.

PE: 3+/5 L shoulder ER (5/5 on R); L infraspinatus atrophy; limited cervical AROM rot 55˚ B; cervical radiculopathy cluster (-) What is the most likely dx?

A. Nerve entrapment at suprascapular notch
B. C4 radiculopathy
C. Nerve entrapment at spinoglenoid notch
D. C5 radiculopathy

C. Nerve entrapment at spinoglenoid notch

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What should you expect when the nerve is entrapped at the suprascapular notch? (atrophy)

atrophy of both supraspinatus and infraspinatus

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What should you suspect if the suprascapular nerve is entrapped at the spinoglenoid notch? (atrophy)

infraspinatus atrophy only

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45 M with cervical radiculopathy without improvement. MRI of shoulder showed minimal cervical disc disease/degeneration and isolated fatty infiltration of the teres minor. Primary sx’s are shoulder ER and abd weakness and post shoulder pain. What is the most likely dx?

A. Quadrilateral space syndrome
B. C5-6 radiculopathy
C. Suprascapular nerve entrapment
D. Parsonage-Turner syndrome

A. Quadrilateral space syndrome

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Characteristics of quadrilateral space syndrome

fatty infiltration of the teres minor

- compression of the axillary nerve

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Classic presentation of Parsonage-Turner syndrome is absence of ___ and presence of ____

absence of pain

presence of weakness

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Quadrilateral space syndrome can mimic

cervical radiculopathy

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Which nerve root would cause symptoms to the dorsal and lateral neck down to the anterior portion of the clavicle, trapezius, and ACJ?

A. C2-3
B. C3-4
C. C4-5
D. C6-7

B. C3-4

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40F referred for cx radiculopathy with paresthesias in digits 1-3. Hx of HTN and smokes 1 ppd. Sx in R arm and hand x 8 mos with no precipitating injury or mechanism. Hypersensitive to light touch of R forearm. Yells in pain from taking BP. She perceives inc temp of forearm and sometimes has swelling. What is the most likely dx?

A. C6-7 radiculopathy
B. Reflex sympathetic dystrophy
C. TOS
D. Central sensitization

B. Reflex sympathetic dystrophy

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Why would you think reflex sympathetic dystrophy vs. central sensitization?

temp change

hypersensitivity to light stimuli

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Which of the following is not part of the CPR for cervical radiculopathy by Wainner et al in 2003?

A. ULTT IA
B. ULTT IIB
C. Spurlings
D. AROM cervical rot < 60˚

B. ULTT IIB

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45M with radicular symptoms (3 of 4 inclusion criteria). 
flex 70˚ with pain
ext 80˚ with sx centralizing to elbow
R SB 75˚ with sx centralizing with elbow
L SB 55˚ NC in symptoms
RR 65˚ NC in symptoms
LR 75˚ with PAER

A. Mechanical constant traction
B. Repeated L cervical SB
C. Repeated R cervical SB
D. Nerve tensioners

C. Repeated R cervical SB

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According to the 2008 CPG, which intervention has the strongest evidence for a pt with cervical radiculopathy?

A. Median nerve tensioners
B. Mechanical constant traction
C. Repeated cervical extension (at least 10 reps)
D. Mechanical intermittent traction

D. Mechanical intermittent traction

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If a patient fails to centralize (neck) during the examination and is very irritable, what should be performed?

intermittent mechanical traction

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34 with cervicogenic HA. Inc HA and neck pain at end of workday (secretary). Which is the best tx option?

A. Cervical manipulation
B. Grade III/IV mobilizations and DNF strengthening
C. Cervical mobs G I-IV
D. Thoracic manipulation

B. Grade III/IV mobilizations and DNF strengthening

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Which of the following is the best tx option for decreasing the frequency of cervicogenic HA based on current evidence?

A. Cervical manipulation
B. Low level laser
C. Shoulder girdle strengthening
D. All of the above

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A. Cervical manipulation

Strong support for low level laser and shoulder girdle strengthening for cervicogenic HA?

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What best describes an Arnold-Chiari malformation? A. Excessive buildup of CSF B. Displacement of cerebellar and brain stem tissue into foramen magnum C. Hydrocephaly D. Brain aneurysm

B. Displacement of cerebellar and brain stem tissue into foramen magnum

This condition may result from Arnold-Chiari malformation

Hydrocephalus

This condition may result from brain aneurysm

hydrocephalus

35M with thoracic SCI with R anterolateral shoulder pain. R shoulder weakness and dec performance in WC basketball games. PE: teres minor and deltoid atrophy, 3+/5 strength with MMT What is the most likely pathology? A. anterior interosseous nerve entrapment B. TOS C. Posterior interosseous nerve entrapment D. Quadrilateral space syndrome

D. Quadrilateral space syndrome

With quadrilateral space syndrome, this nerve is frequently involved

axillary nerve

Quadrilateral space syndrome most commonly seen in what groups?

- OH athletes | - individuals with SCI - repetitive strain from WC propulsion

35M with thoracic SCI with R anterolateral shoulder pain. R shoulder weakness and dec performance in WC basketball games. PE: teres minor and deltoid atrophy, 3+/5 strength with MMT Which nerve is most likely affected in this case? A. Axillary B. Musculocutaneous C. Radial D. Ulnar

A. Axillary

Which of the following is not part of the quadrilateral space in the shoulder? A. Humeral shaft B. Posterior head of the deltoid C. Teres major D. Long head of triceps

B. Posterior head of the deltoid

What artery passes through the quadrangular space in the shoulder?

posterior circumflex humeral artery

Which cervical nerve roots innervate the teres minor and deltoid? A. Axillary B. C5-6 C. C4-5 D. C6-7

B. C5-6

Compression of the axillary nerve results in atrophy and weakness of which muscles?

- teres minor | - deltoid

Compression of the axillary nerve results in pain referral where?

lateral shoulder

Quadrilateral space: superior border

teres minor

Quadrilateral space: inferior border

teres major

Quadrilateral space: medial border

long head of triceps

Quadrilateral space: lateral border

humeral shaft

The posterior circumflex humeral artery follows this nerve through the quadrilateral space and encircles the humeral head

axillary nerve

Which nerve roots provides innervation to deltoid and teres minor

C5-6

55 yo with rapid onset severe neck, UE, radial forearm pain. Pt had influenza vaccine 2 weeks prior. Weakness with AROM shoulder abd/ER. Was treated for mechanical neck pain. Over time, the neck pain resolved, but weakness progressed. EMG revealed supraspinatus P waves and fibrillations. What is the most likely dx? A. RTC tear B. Parsonage-Turner Syndrome C. Cervical radiculopathy D. Amyotrophic lateral sclerosis

B. Parsonage-Turner Syndrome

What age is Parsonage-Turner syndrome commonly seen?

5th decade of life

Parsonage-Turner syndrome has been associated with recent...

illness or vaccinations

Parsonage-Turner syndrome: NCV testing will be

normal

Parsonage-Turner syndrome: trademark s/s

- severe pain at onset which resolves | - muscle weakness as it progresses

33M security guard referred for R cervical radiculopathy. C/o radicular sx into 4th and 5th fingers x 3 weeks. Developed after practicing hammer punch (hit pad with ulnar side of hand in a pronated position as the elbow extends). Can only produce radicular symptoms with OH lifting. What is the most likely dx? A. R lateral stenosis of C6-7 causing radiculopathy B. R posterolateral disc bulge causing radiculopathy at C6-7 C. R anteroinferior shoulder instability D. Parsonage-Turner syndrome of ulnar nerve

C. R anteroinferior shoulder instability

Parsonage-Turner syndrome typically presents after what age?

33M security guard referred for R cervical radiculopathy. C/o radicular sx into 4th and 5th fingers x 3 weeks. Developed after practicing hammer punch (hit pad with ulnar side of hand in a pronated position as the elbow extends). Can only produce radicular symptoms with OH lifting. What is the best treatment option for this pt? A. Mechanical intermittent traction B. Repeated cervical retraction with pt OP C. RTC strengthening D. Referral to physician if sx's do not resolve

C. RTC strengthening

Wartenberg sign is indicative of entrapment affecting which nerve?

ulnar nerve

Wartenberg sign: weakness of

palmar interossei

Wartenberg sign: weakness of palmar interossei leads to

abduction of 5th digit in hand

Pt presents after FOOSH when slipping on ice. Radiographs showed middle ⅓ of humerus fx. What nerve most likely to be compromised?

radial

35M with TMD pain. Already being treated for mechanical neck pain. Only able to open his mouth 2 finger widths. Pt states he used to hear a click with mouth opening but hasn't heard in a few weeks. Symptoms suggestive of what pathology? A. Anterior DDWR B. Anterior DDWOR C. Posterior DDWR D> Posterior DDWOR

B. Anterior DDWOR

When is it common to see posterior disc displacement?

dental procedures where the pt is required to keep the mouth open for an extended time.

With (anterior/posterior) disc displacement, the pt may not be able to close the mouth

posterior

Deck 3 Flashcards

(57 cards)