Lecture 2B: Cervical Spine Exam And Eval Flashcards by sophia carrasco

In the C spine what other pain is common

Neck and UE

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Does c spine have a high or low potential for serious injury

Hig

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T/f: we need to examine the c spine w caution bc exam may be harmful , especially w hx of trauma

True

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When doing a c spine exam what do we need to make sure is intact

Vertebral artery ,
Transverse ligament
Alar ligament

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If we find reduced AROM of c spine what 2 paths can we go down and what do we think

Capsular pattern —> suspect arthritis

Noncapsular pattern—> assess glides , if reduced then mobilize (WD40) if normal then do MET

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If we asses AROM of c spine and it is normal so then we assess combined motions and it is normal what can we suspect ?? And then what do we do

Suspect hypermobility —> do stress test —> can be negative which means hypermobility or can be positive which means instability but u would do stabilization exercises for both

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When does c spine pain usually start (age)

3rd decade of life

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If a patient comes in w c spine pain and they have a MOI of trauma what are we automatically on high alert for

Transverse lig
Alar leg
VBI

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What are the 5D’s and 3N’s

D: diplopia , dysphagia , dysarthria , drop attack , dizziness

N : nausea, numbness in face , nystagmus

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How do the neurologic symptoms present with patient history of C spine pain

Paresthesias
Dizziness
Tinnitus
Visual disturbances
LOC

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Paitnet w C spine pain can also have pain where else

Neck or arm or both

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What does the pateint health questionnarie ask

Over the past 2 weeks, how often
have you had little interest or
pleasure in doing things?
Over the past 2 weeks, how often
have you felt down, depressed or
hopeless?

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What 3 domains of psychological distress foes the OSPRO-YF assess

• Negative mood
• Fear-avoidance
• Negative affect/coping

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C spine dysfucntion = ___ poteiental for ___ injury

High
Serious

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When doing a C spine examination it it’s important to DDx __ pain … and how

Neck

• Mobility deficits
• Movement coordination impairments
• Headaches
• Radiating pain
• Serious injury/pathology

Basically all the buckets for neck

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How should u sequence your exam when doing a c spine exam

• Patient safety**
• Efficient data collection
• Effective clinical decision-making

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Hx of recent trauma in the last ___ ___ demands cautious approach

6 weeks

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Presence of yellow flags can ___ complexity of symptoms and __ pt outcomes

Increased
Decrease

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What is the purpose of the Canadian C spine test

Determine whether radiograpthy is necessary prior to initiating PT treatment

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When are the Canadian C spine rules not applicable (8)

• Non-trauma cases
• Glasgow coma scale <15
• Unstable vital signs
• Age <16
• Acute paralysis
• Known vertebral disease
• Previous c-spine surgery
• Pregnant

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Describe how to do the CanadianC spine rules

Any high risk factors that mandated radiography
- age 65 or older or dangerous mechanism or paresthesiasa in extremities

If yes then get radiography if no then go on to 2

simple rearened MVC
Or
sitting position in ED
Or
ambulatory at any time
Or
delayed onset of neck pain
Or
-absence of midline C spine tenderness

If ANY ARE NO then go get radiography … if all yes then go on to 3

Can the patient actively rotate neck 45° L and R if no then go get pics

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What is considered a dangerous mechanism for Canadian C spine rules

fall from elevated > 3 feet/ 5 stairs
-axial load to head (diving)
MVC high speed (> 100)
motorized recreational vehicles
bike crash

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What does the simple rearend MVC excludefor teh Canadian c spine

-pushed into oncoming traffic
- hit by the bus
- rollover
- hit by a high speed vehicle

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What are the 5 cervical conditions that must be ruled out

• Ligamentous instability
• Myelopathy
• Malignancy
• Spinal fx’s
• Vascular pathologies (ie. VBI)

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What are the 2 evaluation and interventional schools of thought

Structures based (Cyriax) Impairment/treatment based (McKenzie and Maitland)

The **selective tissue tension test** for the **structures based** eval and interventions does what 2 things

Identified pathologic strucutre Stage of pathology

What is the intervention based on for the **Strucutres based** (cyriax) school of thought

Based on treating pathologic strucutre - connective tissue healing model

Which school of thought for eval and intervention seldom seek to identify pathological structures

Impairment/Treatment-Based (McKenzie and Maitland)

What is the intervention of the Impairment/Treatment-Based (McKenzie and Maitland) based on

Based on response to tissue loading an SYMTOMS response

What is the ultimate goal for the 2 schools of thoughts for Eval and intervention

Self management by the pt

**pathoanatomic** diagnoses are ___ based

strucutred

what are teh 3 **deficitis** associated w **forward head posture**

- cervical hyperlordosis - shoulder protraction - CT hyperkyphosis

what is associated w **cervical hyperlordosis** * TMJ ___ * ____ compression * CV ___ * OA ___ ___ * AA ___ ___ * ___ extension HYPERmobile * CV instability * Mid-cervical ____

overcloses posterior hyperextension flexion hypo roation hypo OA hyperextedned

what is 3 things are assocaited w **CT hyperkyphosis** assocaited w forward head posture

* T-spine extension HYPOmobile * Shoulder complex HYPOmobile * RC tendinopathy

there is a **diangostic** **label** when **neck** **pain** is **NOT** cuases by what 3 things

* Trauma (ie. MVA) * Cervical radiculopathy * Non-MSK cause

what is the percent of poeple who experience **mechanical neck pain** symptoms during lifespace

20-50°

when is **mechanical neck pain** more prevalent (age)

4th adn 5th decade of ilfe

mehcanical neck pain can transition to what

chronic neck pain if symptoms are severe

**Acute disc herniation** is uncommon in what age and most common in what age

< 30 ~50

what is **disc degeneration**

end plat damaged followed by distruptive changes in the disc resultis in decreased height

does the disc have a limtied ability to self repair? yes or why not

yes bc of restricited blood supply

what corresponds w disc level in 80% of people with disc degeneration

neurologic deficit's

what is cervicla radiculopathy

compression of spinal nerve root by space occupying lesin

what kind of MOI is common for cervical radicu

hyperextension injuruies especially when combined w roation and SB

what nerve root is between these levels C4-C5 C5-C6 C6-C7 C7-T1 T1-T2

5 6 7 8 1

what are the **motor** deficits if somoen has a **C5 nerve root impingment**

deltoid and biceps

what are the **motor** deficits if somoen has a **C6** nerve root impingment

wrist extensors biceps

what are the **motor** deficits if somoen has a **C7** nerve root impingment

wrist flexors tricpes finger extesnors

what are the **motor** deficits if somoen has a **C8** nerve root impingment

finger flexors hand intrinscis

what are the **motor** deficits if somoen has a **T1** nerve root impingment

hand intrinscics

where are disc hernication rare

C2-C3

where will pain for **C 4** spinal nerver root compression be

posterior neck/medial scapular border pain

what spine nerve would **affect breathing** w physical activity which means diaphragm invovlment

C3-C5

what spinal nerve root would u think is compressed if a patient has **numbness on superior aspects of shoulders**

where will pain refer if there is a impingement at C6

radiating pain from neck to lateral aspect of upper arm , forearm and hand

where would **C7** nerve root refer pain if impinged

radiating pain from posterior neck to scpaula , posterior upper arm, forearm, and hand

what is the **most common** site for **cervical radiculopathy**

C 7

what nerve would be ivovled if a patient had radiating pain from neck to **medial aspect** of upper arm , forearm anf hand

what is a **chronic degenetative** condition affected content of spinal canal ( spinal cord and spnal nerve roots)

cervical spondylosis

**cervical spondylosis** can be related to bony changes and can causes what 2 things

cervical myelopathy —> spinal cord compression foraminla stenosis —> radiculopathy

t/f: cervical spondylosis can stay asymtomatic for a long time

true

in cervical spondylosis the IVD and facet joints are affects by degenrative changees .. what are the 3 things

• Osteophyte formation • Hypertrophy of ligamentous structures • Result in chronic inflammatory response

does **cervical spine instability** damage spina cord , nerve roots or surrounding strucutres

no .. basically u cant control the motion u have

**cervical spine instability** can occur secondary to what (4 things)

trauma sx systemic disaese degenerative changes

what is the gold standard for diagnosing mild c spine insatbility

non

what are teh S/S w **mild c spine insatbility** * Hx of major ___ * Reports of ___, __, ___ ___ * ____ of symptoms * Subjective reports of neck ____ (ie. head feels heavy) * Altered ROM * Neck pain w/ or w/o ___ spasms * Reports of ___

* Hx of major trauma * Reports of catching, locking, giving way * Unpredictability of symptoms * Subjective reports of neck weakness (ie. head feels heavy) * Altered ROM * Neck pain w/ or w/o muscle spasms * Reports of HAs

what does **whiplash** associated disorder result in

motor control deficits and pain

what are the 4 types of HA

-miagraine (whole side of head) - tension ( band above the eyes) - cluster (1 spot behind eye) -cervicogenic ( rams horn)

What are the 4 neck pain classification categories (buckets)

• Neck Pain w/ Mobility Deficits • Neck Pain w/ Movement Coordination Impairments (WAD) • Neck Pain w/ HAs • Neck Pain w/ Radiating Pain