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PCM > Neck & Cervical Spine Exam > Flashcards

Neck & Cervical Spine Exam Flashcards

1
Q

AA Joint

A

Primary motion of rotation

Atlas rotates around dens of C2

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2
Q

C2-C7

A

Rotation and SB occur to the same side typically
Motion to opposite sides found clinically in some

Modified Type II Mechanics

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3
Q

Observations

A

Abnormal findings

  • carrying angle increase
  • decrease lordosis
  • distended external jugular vein (increased JVP) - elevate head of bed 30 degrees
  • masses or goiter
  • tracheal deviation: masses in the neck, mediastinal mass, atelectasis, large pneumothorax

Thyroid

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4
Q

Palpation and Inspection

A

Landmarks
- occiput, mandible, clavicle and manubrium, sternocleidomastoid and trapezius muscles, hyoid bone, thyroid and cricoid cartilage, trachea, spinous processes & vertebral prominens (C7), inter spinous ligament, transverse process, facets, articular pillars

Anterior Triangle
- mandible, SCM, midline

Posterior Triangle

  • SCM, trapezius, clavicle
  • omohyoid crosses lower portion

Carotid pulse
- auscultation for bruit using stethoscope bell

Trachea
- use spaces between thyroid and SCMs as landmarks for deviation

Lymph nodes

  • normally small, round or ovoid, and smooth
  • LAD = lymphadenopathy
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5
Q

Range of Motion

A

Flexion: 45 - 90 degrees
- SCM, scalene, prevertebral muscles

Extension: 70 - 90 degrees
- splenius capitus, splenius cervicis, intrinsic spinal muscles

Rotation: 70 - 90 degrees
- SCM, intrinsic spinal muscles

Sidebending: 20 - 45 degrees
- scalenes, intrinsics

Segmental ROM

  • SB: translational force
  • rotation: load and spring on TPs
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6
Q

Thyroid Findings

A

Goiters - simple (non-nodular) or multinodular

Graves’ Disease - soft

Hashimoto’s Thyroiditis and Malignancy - firm

Thyroiditis - tenderness

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7
Q

Muscle Strength Testing

A

C1: resisted rotation
C2-C4: scapular elevation
C5: shoulder abduction (deltoid m.)
C6: elbow flexion (biceps), wrist extension
C7: elbow extension (triceps), wrist flexion
C8: finger flexion
T1: Finger abduction

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8
Q

Sensory Exam

Dermatomes

A

C1-C4:
Lesser occipital - sensory behind ear/mastoid
Greater auricular - jaw angle, front of mastoid
Cervical cutaneous - anterolateral neck
C4: superior shoulder/lateral neck
C5: lateral upper arm (over deltoid m.)
C6: lateral forearm
C7: middle finger
C8: right/little finger, medial wrist and forearm
T1: medial elbow & upper arm

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9
Q

DTRs

A

C5 = biceps

  • deltoid, biceps
  • lateral arm - axillary n.

C6 = brachioradialis

  • biceps, wrist extensors
  • lateral forearm - musculocutaneous n.

C7 = triceps

  • triceps, wrist flexor a, finger extension
  • middle finger - median n.
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10
Q

Normal Neck & Cervical Spine Documentation

A

Neck: supple, non-tender, no masses or LAD. No thyroid nodules or tenderness, trachea midline and mobile. FROM active.
CV: no carotid bruits of JVD
Neuro: MS 5/5 in BUE, DTR +2/4 for bilateral biceps, brachioradialis, triceps. Sensation intact BUE.

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11
Q

Compression Neuropathy

A

Nerve entrapment by musculoskeletal or myofasical tissue that produces paresthesias in the area of the distribution of the nerve and creates sensory dysfunction/pain & may also decrease muscle strength.
Common sites include intervertebral foramen and the thoracic outlet.

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12
Q

Central Neuropathy

A

Compression Test (upper extremity pain, paresthesias, numbness)
Spurling’s Maneuver (reproduction of symptoms)
Neck Distraction Test (alleviation of symptoms)
Valsalva Test (pain in cervical spine, radiation to dermatomal distribution) - increase in tracheal pressure

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13
Q

Peripheral Neuropathy

Thoracic Outlet Syndrome

A

Roos or EAST Test (reproduction of symptoms) (compression of subclavian a.) - increased pair at shoulder and down arm, paresthesia, arm pallor, cyanosis, swelling

Adson Test (loss or change in pulse, reproduction of symptoms) (compression by 1st rib - head toward affected side; compression by tight scalene muscles - head way from affected side) - subclavian a.

Wright’s Hyperabduction Test (loss or change in pulse; exacerbation of pain/paresthesia; reproduction of symptoms) - neurovascular entrapment by pectoralis minor m.

Costoclavicular Test (decrease in radial pulse) - decrease space between 1st rib and clavicle

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14
Q

Thoracic Outlet Boundaries

A

1st rib, 1st thoracic vertebra, manubrium

Structures:

  • brachial plexus
  • subclavian a.
  • subclavian v.

3 Zones

  • scalene triangle
  • costoclavicular space
  • retropectoralis minor
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15
Q

Nuchal Rigidity & Brudzinski’s Sign

A

Test of inflammation in subarachnoid space
- meningitis or subarachnoid hemorrhage

Nuchal Rigidity (marked neck stiffness/resistance to flexion)

  • 57-92% of cases of acute bacterial meningitis
  • 21-86% of subarachnoid hemorrhage

Brudzinski’s Sign (flexion in both hips and knees
- low sensitivity

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16
Q

Spinal Injury in Athletics

A

Axial load - over 1/2 of C-spine injuries

Football, hockey, lacrosse - unique challenge due to protective equipment

Neck flexion to 30 degrees - lordosis lost

Protective soft tissue no longer protective

Force transmitted to bone and disc

Subluxation w/o fracture
Dislocation w or w/o neurologic injury
Fracture w or w/o neurologic injury

Flexion injury - anterior subluxation, wedge fracture
Extension injury - hangman fracture (C2), teardrop fracture
Axial compression - Jefferson fracture (C1)

17
Q

Cervical Spine Fractures

A

MVA - C1 most common, followed by C5, C6, C7
Falls and sports injuries - C5, C6, C7

C1 - fracture usually from axial load or external force
C1 - burst fracture (Jefferson)
C2 - arch fracture, hyperextention (hangman = both arches, unstable)
C2 - odontoid - fracture junction of process and body, often require surgery; avulsion of tip - immobilization

18
Q

Subluxation

A

Flexion injury

Unilateral vs bilateral facet dislocation

19
Q

Wedge Fracture (Compression)

A

Flexion loading force

Buckled anterior cortex
Loss of height of anterior vertebral body
Anterosuperior fracture of vertebral body

20
Q

Teardrop Fracture

A

Flexion and compression = fracture - dislocation

Anterior-inferior teardrop fragment = unstable

21
Q

Burst (Jefferson Fracture)

A

Comminuted, ex: diving injury
Can result in severe spinal cord injury

Compression fracture of the bony ring of vertebra C1 with lateral masses splitting and transverse ligament tear
Occurs by axial blow to the vertex of the head

Displacement of lateral masses of vertebrae C1 beyond the margins of the body of vertebra C2
Lateral displacement of >2mm of unilateral displacement may be indicative of a C1 fracture
CT required to define extend of fracture and detect fragments in spinal canal

22
Q

Spinous Process Fracture

A

Hyperextention or avulsion force from muscle contraction

Clay shoveler’s fraction: C6 or C7

23
Q

OA Joint

A

Flexion & extension primarily
Minor motions SB & rotation
Occiput rotates and SB to opposite sides

PCM (26 decks)

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