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OMM M1 CB > E4: Examination of the Neck > Flashcards

E4: Examination of the Neck Flashcards

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1
Q

What are the elements of the problem focused history?

A

OPQRST

Onset/Course
Provocation/Palliation
Quality
Radiation
Severity
Timing/Tests
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2
Q

What are the red flags for possible fracture in the patient’s history?

A

Major trauma

Fall from a height

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3
Q

What are the red flags for possible fracture in the PE?

A

Severely restricted Active ROM

*always do active first

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4
Q

What are the red flags for possible infection in the patient’s history?

A

Age over 50 years
Age under 20 years
Fever/chills
Pain worse supine (muscles are relaxed; no longer protecting you from pain)
Recent UTI (travels through blood)
IV drug abuse
Immune suppression (cancer pts, transplant pts)

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5
Q

What are examples of cervical infection?

A

Osteomyelitis

Epidural abscess

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6
Q

What are the red flags for possible infection in the PE?

A

Fever

Spinous process percussive pain: C7 & T1 only

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7
Q

What are the red flags for possible tumor in the patient’s history?

A 
Age over 50
Age under 20
Unexplained weight loss
Pain worse when supine
Severe nocturnal pain
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8
Q

What are the red flags for possible tumor in the PE?

A

Palpable paravertebral edema or deformity

Spinous process percussive pain: C7 & T1

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9
Q

What is a red flag for vertebrobasilar artery compromise in the PE?

A

Have the sitting patient look up, then turn head right and left
Observe for NYSTAGMUS

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10
Q

Which test is not recommended for possible vertebrobasilar artery compromise?

A

DeKleyn test (normal test done passively)

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11
Q

Which age group is at greatest risk for vertebrobasilar artery compromise?

A

20-50

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12
Q

What is the etiology of Wallenberg syndrome?

A

Vertebrobasilar artery occlusion

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13
Q

What are the symptoms of Wallenberg syndrome?

A

Homolateral facial pain (same side as occlusion)
Homolateral paresthesias
Vertigo
Vomiting
Unilateral paralysis of the palate, pharynx, and vocal cords
Dysphagia
“Brassy” dysarthria
Contralateral loss of pain and temperature sensation of the limbs and trunk
Nystagmus
Homolateral dysmetria
Intention tumor

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14
Q

What is dysmetria and what is it a symptom of?

A

A condition in which there is improper measuring of distance in muscular acts (touching fingers to nose)

Wallenberg syndrome

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15
Q

What are the physical findings of Wallenberg syndrome?

A

Ataxia
Positive Romberg test with a tendency to fall toward side of arterial occlusion
Horner syndrome unilaterally (side of arterial occlusion)

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16
Q

What is a red flag for cerebral ischemia?

A

Any sense of acute anxiety or panic on the part of the patient during any part of the examination or treatment

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17
Q

What happens before a routine exam?

A

History and searching for red flags

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18
Q

Etiology of torticollis

A

Spasm of SCM

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19
Q

Physical presentation of torticollis

A

Head is sidebent

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20
Q

What skin markings are you looking for on inspection?

A

Blisters (burns, staph, autoimmune)
Discoloration (ecchymosis, congenital or acquired nevi)
Scars (surgical)

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21
Q

Anterior surgical scars

A

Thyroid

Spinal

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22
Q

Posterior surgical scars

A

Spinal

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23
Q

Level of thyroid cartilage

A

C4/C5

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24
Q

Level of cricoid cartilage

A

C6

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25
Level of carotid tubercle
C6
26
What does unilateral facet joint dislocation result in?
Displacement of the upper vertebra forward by <50%
27
What does bilateral facet joint dislocation result in?
Cervical spondylolisthesis | Displacement >50%
28
What does facet dislocation often result in?
Spinal cord compression
29
Common location of facet osteoarthritis
C5/C6
30
Which muscle is a common cause of stiff neck?
Levator scapulae
31
Where would a patient with levator scapulae hyptertonicity be tender?
Where the muscle attaches to the scapula
32
What causes levator scapulae hypertonicity?
Overloading the muscle from anterior head carriage
33
SCM innervation
Spinal accessory nerve | Nerve root levels C1-C8
34
What does carotid bruit/thrill possibly indicate?
Vasoocclusive disease | Carotid dissection
35
Where can a vertebral artery bruit be heard?
Mastoid processes
36
If you hear bruit in the cervical region, what should you do next?
Listen to the heart to determine if the sound is coming from an artery in the neck or from a valvular problem in the heart
37
Where can ophthalmic artery bruit be heard?
Over closed eyes
38
What are you looking for when palpating the supraclavicular fossa?
Cervical ribs
39
Cervical ribs often result in ______
Thoracic outlet syndrome | due to impingement of lower cervical nerves
40
Possible findings on palpation of supraclavicular fossa
Lumps: Lymph nodes Apical Lung Tumor Swelling: Clavicular fracture Lymphatic obstruction Bone: Cervical rib
41
Which muscle is often injured in cervical flexion traumas?
Trapezius
42
What are you looking for when palpating trapezius?
Tenderness Spasm Defects
43
Lymphadenopathy of the upper trapezius can occur due to:
Infection Lymphoma Metastatic scalp tumor
44
Which nerves will be inflamed after whiplash injury?
Greater occipital nerves
45
Significant range of motion loss can indicate:
Fracture Sprain & Strain Disc herniation Congenital anomalies (Klippel-Feil / Block Vertebrae)
46
Which joint accounts for half of rotation in the neck?
C1 (Atlanto-Axial joints)
47
Significant loss of rotation indicates a problem in one of three ways:
1. Motion loss at C1 on C2 - -Somatic dysfunction - -Levator scapulae 2. Hypertonicity of the long muscles of the neck - -SCM - -Scalenes 3. Motion loss at C3-C7 as a group
48
What does neuro evaluation consist of?
Deep tendon reflexes Muscle strength Skin sensation Special tests
49
C5 motor and sensory innervation
Motor: Deltoid abduction, bicep flexion Sensory: Shoulder
50
C6 motor and sensory innervation | **v important**
Motor: Bicep flexion, wrist extensors Sensory: First two fingers, lateral aspect of forearm
51
C7 motor and sensory innervation
Motor: Tricep extension, wrist flexion, finger extension Sensory: Middle finger
52
Most commonly herniated disc
C5/C6
53
C8 motor and sensory innervation
Motor: Finger flexors, intrinsic muscles of the hand Sensory: 4th and 5th fingers
54
C5 reflex
Biceps
55
C6 reflex
Biceps, brachioradialis
56
C7 reflex
Triceps
57
C8 reflex
None
58
T1 motor and sensory innervation
Motor: Intrinsic muscles of the hand Sensory: Inner elbow
59
T1 reflex
None
60
Distraction test decreases pain for which conditions?
Joint/Disc/Nerve problem: Disc herniation Neuroforaminal compromise Facet joint
61
Distraction test increases pain for which condition?
Muscle/Ligament problem
62
Compression test increases pain for which conditions?
Joint/Disc/Nerve problem
63
Compression test decreases pain for which conditions?
None
64
Spurling test
Sidebend and rotate head to same side; then add compression | Tests for foraminal compromise
65
What do you do after a negative compression test?
Spurling test
66
Lhermitte Sign
Passively flex the neck as far as possible | Numbness/tingling indicates spinal problem (meningitis/multiple sclerosis/etc)
67
Swallowing test may indicate which conditions?
``` Bony protuberances Bony osteophytes Hematoma Abscess Tumor ```
68
Adson test
Reproduces symptoms and often diminishes radial pulse | Tests for Thoracic Outlet Syndrome
69
What are the borders of the thoracic outlet?
Medial: First rib Anterior: Clavicle Posterior: Trapezius Medial wall: Scalenes
70
Adson test technique
Step One: Anatomic position Restrain patient's shoulder Palpate radial pulse Step Two: Hyperabduct and extend shoulder Have patient turn toward side of symptoms Bend chin to chest Step Three: Have patient turn their head as far as possible to the opposite side and attempt to tilt head backward
71
Adson test positives
Loss of radial pulse | Reproduction of symptoms (even if pulse remains normal)
72
Positive Adson test indicates:
The presence of neurovascular compression
73
Which cervical level is most prone to spinous process avulsion fractures due to whiplash type injuries?
C2

OMM M1 CB (6 decks)

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