Spine

Question 1

What are the suboccipitals and their actions?

Answer 1

Rectus capitis posterior minor: OA extension
Rectus capitis posterior major extension and ipsilateral rotation
Obliquus capitis inferior: AA ipsilateral rotation
Obliquus capitis superior: extension and lateral flexion

Question 2

What are the actions of the following anterior neck muscles?

1. SCM
2. Longus capitis
3. Longus Colli
4. Anterior scalene
5. Middle scalene
6. Posterior scalene

Answer 2

1. B extension, unilateral lateral flexion and Contralateral rotation
2. Flexion and rotation of neck and head
3. Flexion and rotation of neck and head
4. Elevates 1st rib or ipsilateral lateral flexion and Contralateral rotation of neck if rib is fixed
5. Same as anterior scalene
6. Elevates 2nd rib or lateral flexion of neck

Question 3

What are the arthrokinematics of the

1. Upper cervical spine
2. Lower cervical spine

Answer 3

1. In neutral: SB and rotate away; in non-neutral: SB and rotate towards
2. Flexion and SB same side

Question 4

What are the Canadian cervical spine rules?

Answer 4

2+ high risk factors need radiograph
- age>65
- Paresthesia in extremities
- dangerous MOI (fall from >1m or MVA>100kpm or with ejection/rollover, bike collision)
Can ROM be assessed? If not, need radiograph
If rotation <45 in either direction need radiograph

Question 5

What are the ICF classifications for neck pain?

Answer 5

Neck pain with mobility deficits
Neck pain with headaches
Neck pain with movement coordination deficits
Neck pain with radiating arm pain

Question 6

What is clinical presentation of patient with neck pain with mobility deficits?

Answer 6

<50 years old
acute
Isolated to neck
Decreased cervical ROM

Question 7

What symptoms do you get with positive tests of the following:

1. Sharp Purser’s
2. Alar ligament test
3. VBI

Answer 7

1. ROS of myelopathic symptoms during flexion or decreased symptoms after push
2. Delayed C2 movement during exam
3. Perceptual changes, fainting

Question 8

What are predictors that patients will benefit from HVLA for cervical spine?

Answer 8

NDI <11.5
B involvement
Not sedentary at work for >5hr/day
Feels better while moving neck
Did not feel worse when extensing neck
Dx of spondylosis without Radiculopathy
(4/6 = 89% success with manipulation)

Question 9

Another study that predicted 4 attributes of patients that would respond well to HVLA of cervical spine:

Answer 9

1. Symptoms <38 days
2. positive expectation that thrust will help
3. Side to side difference ROM > or equal 10 deg
4. pain with PA spring test of middle C/S

Question 10

What are predictors that patients with neck pain will will benefit from HVLA of thoracic spine?

Answer 10

Sxs <30 days
No sxs distal to shoulder
Reports looking up doesn't aggravate sxs
FABQ <12
Decreased thoracic kyphosis at T3-5
C/S extension >30
(3/6 predicted 86% positive outcome)

Question 11

What are clinical findings of patients with neck pain with HAs?

Answer 11

Unilateral HA with neck and suboccipitals sxs aggravated by neck movements and positions
Provocateur by cervical myofascial and joints
Restricted cervical segmental mobility and restricted cervical ROM
Restricted upper cervical ROM and mobility and decreased DNF

Question 12

What cervical ROM contributions does C0-1 and C1-2 make?

Answer 12

C0-1 flexion

C1-2 does 50% of cervical rotation (about 45 deg)

Question 13

Neck flexor endurance test stops when one of the following happens:

Answer 13

Edge of dawn lines across skin fools no longer approximate each other
Subjects head rested of testers hand >1sec
Subjects head lifts off testers hands
Subject unwilling to continue

Question 14

What are clinical findings for patient with neck pain with movement coordination deficits?

Answer 14

Long standing neck pin (>12 weeks)
Abnormal CCFT
Abnormal deep neck flexor performance
Coordination, strength, endurance deficits of neck and UQ muscles - Longus Colli, middle/lower trapezius, serratus anterior
Flexibility deficits of UQ muscles - scalene S, upper trapezius levator, pectoralis major/minor
Sxs associated with UQ paint

Question 15

What are clinical findings for neck pain with radiating pain? What are common diagnoses/

Answer 15

Diagnoses: spondylosis with Radiculopathy or cervical disc disorder
UE symptoms provoked by spurring, ULNTT, and decreased with distraction
Decreased cervical rotation (<60)
Signs of nerve root compression
Success with reducing UE sxs with initial exam

Question 16

What is considered a positive ULNTT?

Answer 16

ROS or side to side difference of >10 degrees of sensitizing joint

Question 17

What are predictors for short-term success with multimodal approach of treating patients with neck pain with radiating arm pain?

Answer 17

Age <54
Dominant arm not affected
Sxs don't worsen when looking down
Multimodal treatment included during 50% of visits (traction,manual, DNF)
4/4 = 90% success
3/4 = 85% success

Question 18

What is the cervical traction CPR?

Answer 18

Reported peripheralization with lower cervical spine mobility testing
Positive shoulder abduction sign
Age > 55
+ ULNTT
Relief of symptoms with manual distraction test
4/5 = 94% success

Question 19

What is the rule of 3 in the thoracic spine?

Answer 19

SP T1-3 at same level as TP
SP T4-6 1/2 level below TP
SP T7-9 full level below TP
SP T10-12 same level

Question 20

What is pectoralis major effect on rib cage?

What is serratus anterior effect on rib cage?

Answer 20

Serratus anterior: posterior force on ribs

Pectoralis major: Anterior, lateral,superior force on rib cage

Question 21

Where can TLJ refer to? Upper T/S?
What is T4-9 called?
What cervical segments can refer to thoracic spine and where?

Answer 21

TLJ refers to hip
Upper thoracic can refer down arms
T4-9 is critical zone
C5-6, C6-7 can refer to upper thoracic spine and inter scapular region

Question 22

What positions stretch the thoracic sympathetic chain?

Answer 22

Elongated with flexion, Contralateral SB, Contralateral rotation

Question 23

What are clinical findings of T4 syndrome?

Answer 23

HA, neck pain, UE pain, B stocking glove Paresthesia

Question 24

What are potential visceral causes of thoracic spine pain?

Answer 24

MI, dissecting thoracic aortic aneurysm, peptic ulcer, acute Cholecystitis, renal colic, acute pyelonephritis

Question 25

What are clinical findings of thoracic aortic aneurysm? | What are clinical findings of MI?

Answer 25

Thoracic aortic aneurysm: Sudden onset of unrelenting pain not relieved by position MI: anterior chest pain or heaviness, nausea, pain radiating to back

Question 26

What is the CPR for coronary artery disease?

Answer 26

``` Female >/= 65 Male >/=55 Known CVD Pain worse with exercise Pain not producible with Palpation Patient assumes pain is of cardiac origin 3/5 can either rule in or out ```

Question 27

What are clinical findings for peptic ulcer? | What are clinical findings for Cholecystitis?

Answer 27

Peptic ulcer: boring, triggered or relieved with eating, prolonged NSAID use Cholecystitis: R UQ/infra scapular pain, with moderate fever, nausea, vomitting, sxs 1-2 hours after meal

Question 28

What are predictors of cancer?

Answer 28

>50 y.o. History of cancer Unexplained weight Loss Failure of conservative therapy

Question 29

What are predictors of Ankylosing spondylitis?

Answer 29

Stiffness >30 min Decreased pain with movement, increased pain with rest Awaken at night during second half of night because of pain Alternating buttock pain 2 or 3/4 Physical exam shows chest expansion <2.5cm

Question 30

What are osteoporosis risk factors?

Answer 30

``` Caucasian History of smoking Early menopause Thin body build Sedentary lifestyle Steroid treatment Excessive caffeine/alcohol consumption ```

Question 31

What is normal chest wall ROM?

Answer 31

5cm

Question 32

What are clinical findings that would suspect presence of infection of disc or vertebrae?

Answer 32

Patient is immunosuppressed Prolonged fever >100.4 History of IV drug abuse Hx of recent UTI, cellulitis, pneumonia

Question 33

What are clinical findings of potential undiagnosed vertebral fracture?

Answer 33

``` Prolonged use of corticosteroids Mild trauma >50 years Age >70 Know history of osteoporosis Recent major trauma at any age Bruising over spine following trauma ```

Question 34

Signs of AAA

Answer 34

Pulsating mass in abdomen History of atherosclerotic vascular disorder Throbbing, pulsing back pain at rest or with recumbancy Age>60

Question 35

What should patient education include?

Answer 35

1. Stay active; avoid bed rest; good pain vs bad pain 2. Behavioral education on graded increases in activity Physiology of pain

Question 36

What are the layers of meninges?

Answer 36

Dura mater Arachomater Pia mater

Question 37

Treatment based classification for manipulation of lumbar spine:

Answer 37

``` No sxs distal to the buttock Duration of sxs <16 days Hypo mobility with print test Low FABQ <19 Hip IR >35 ```

Question 38

Treatment based classification criteria for stabilization

Answer 38

``` SLR >90 Prone stability test + Age <40 Aberrant movements Increasing episode frequency Hyper mobility with spring test ```

Question 39

Treatment based classification for traction | Treatment based classification for specific exercise

Answer 39

Traction: peripheralization of symptoms with no ability to centralize with movement Specific exercise = directional preference - centralization with movement in one direction and peripheralization with movements in opposite direction

Question 40

What are clinical finding with low back pain with mobility deficits?

Answer 40

- pain with movement - limited mobility Objective: Lumbar AROM Lumbar segment mobility assessment

Question 41

What are clinical findings with low back pain with related lower extremity pain? Diagnosis?

Answer 41

``` Diagnosis: lumbar disk disorder/stenosis LE symptoms related to movement bias (flexion/extension) Objective: Neural screen Side glide/shift assessment if present Lumbar AROM Repeated movement Nerve mobility Lumbar segmental mobility ```

Question 42

What are clinical findings of Lumbar paing with radiating LE pain? Diagnosis?

Answer 42

``` Diagnosis: lumbar Radiculopathy or radiculitis, HNP LE symptoms not related to a movement Objective: Neural screen Lumbar AROM assessment Nerve mobility assessment Piriformis length and provocation Lumbar segmental mobility ```