Head and Neck Examination Flashcards
(19 cards)
What are some of the major categories in a cervical exam?
- outcome measures
- observation
- ROM
- strength/endurance testing (MMT gross head, DCF’s, myotomes)
- reflexes & sensation
- cranial nerve testing
- palpation
- joint play (C/T-spine)
- muscle length testing
What are some things that are included in observation of a cervical exam?
- gait pattern
- gross coordination
- balance
- muscle atrophy/wasting (especially bilateral)
- forward head posture
- proximal crossed syndrome
What is proximal crossed syndrome? (not the muscles involved)
- elevated, protracted shoulder girdle
- rotated, abducted, winged scapula
- forward head
What muscles are involved with proximal crossed syndrome?
- increased levator scapula activity
- shortened pec major & minor, SCM
- weak/lengthened DCF’s, rhomboids, serratus anterior, lower trapezius
What can forward head posture effect?
- causes myofascial pain
- zygapophyseal joints
- scapulothoracic rhythm
- postulated changes (open-mouth breathing, thoracic hyperflexion)
What motions are a closing restriction?
- Ext + side-bend toward + rotation toward
What motions are an opening restriction?
- flexion + side-bend away + rotation away
What is the Cervical Flexion-Rotation Test? (CFRT)
- used for A-A rotation
- pt in supine, fully flex c-spine to lock lower segments, rotate head and compare sides
(+) <32 degrees rotation OR 10 degrees visual difference b/w sides
Sn: 95
Sp: 97
-LR: .27
+LR: 9.4
What is the Cranial Cervical Flexion Test? (CCFT)
- tests action of 4 DCF’s
- pt in supine hooklying with a pressure biofeedback unit under cervical spine
- start at 20mmHg -> tell patient to push into PBU to increase by 2mmHg and hold for 5-10 secs -> continue increasing until 30mmHg or pt cannot hold pressure
(+) unable to perform, uses superficial cervical muscles, can’t control force
part of cluster for cervicogenic headache
What is included in the cluster for cervicogenic headaches?
- restricted AROM
- (+) upper cervical PAIVMs
- (+) CCFT
Sn: 94
Sp: 100
What is the DCF endurance test?
- pt in supine -> performs craniocervical flexion -> ask pt to raise head off table about 1in -> test stops when head/neck extends or pt loses neck crease
Average time: about 39 seconds
What are some major muscular structures to palpate during a cervical exam?
- suboccipitals
- levator scapula
- upper trap
- scalenes
- pec major & minor
What are some special tests to perform during a cervical exam?
- foraminal compression (Spurling’s test)
- Distraction test
- shoulder abduction
- upper limb tension tests
What special tests alleviate vs reproduce pain while performing?
Alleviate:
- distraction test
- shoulder abduction test
Reproduce:
- spurling’s
- Upper limb tension tests (ULTT1)
What is the test cluster for Radiculopathy? Sn & Sp?
- restricted cervical rotation
- (+) ULTT1
- (+) Spurling’s test
- (+) Cervical distraction
IF all 4: Sn 24, Sp 99, +LR 30.3
IF 3: Sn 39, Sp 94, +LR 6.1
IF 2: Sn 39, Sp 53
What are some special tests for craniocervical instability?
- modified sharp - purser
- anterior shear test
- lateral/transverse shear
- alar ligament stress test
What are some indications for stability testing?
- history of neck trauma or any causes of instability listed
- pt report of neck instability (head feeling heavy)
Presence of any s/s:
- lump in throat
- lip paresthesia
- nausea/vomiting
- severe headache and muscle spasm
- dizziness
What is the Sn/Sp for PAIVMs?
Sn: 100
Sp: 100
What muscles are normally tested for their length during a cervical exam?
- pec minor
- levator scapula
- anterior/middle scalene
- upper trap
- suboccipitals
