Week 2 Cervical

Question 1

1 - 3 - 1 “First Three First”

Answer 1

Observe, Fracture Screen, Active Range of Motion!

Question 2

Rust’s Sign

Answer 2

Pt walks in supporting head/neck. Indicates cervical instability (severe sprain, R.A., subluxation, fracture)
Refer for immediate imaging!!!!

Question 3

Bakody’s Sign

Answer 3

Pt has hand over their head (b/c it brings relief). Indicates cervical radiculopathy. (Not an amazing test, but ok.) More specific than sensitive.

Question 4

Things (besides specific signs) that we’re observing for

Answer 4

Posture (head position, upper cross syndrome, lateral flexion, rotation), Deformities, Bruising, Swelling, Scars

Question 5

Fracture Screen

Answer 5

Spinous percussion, looking for lingering pain on SPs. Could mean fracture, infection, or pathologic lesion. Refer for imaging.

Question 6

What might impact active ROM?

Answer 6

Degeneration, strain/sprain, herniation, facet irritation.

Question 7

“Normal” ROM for cervical spine

Answer 7

Flexion: 60-90 degrees
Extension: 75-90 degrees
Rotation: 80-90 degrees
Lateral flexion: 45-55 degrees

Question 8

Valsalva Maneuvar

Answer 8

If it causes radicular pain, there may be a space occupying lesion. Likelihood ratio is “meh” more specific than sensitive.

Question 9

Cervical Compression

Answer 9

Press straight down on their head to increase load on discs & facets. (+) = Peripheral pain (radiculopathy), Local pain (facet)

Question 10

Spurling’s Test (foraminal compression)

Answer 10

Press straight down with pt’s neck in slight flexion. (+) Peripheral pain (radiculopathy), local pain (same side = facet, opposite side = sprain/strain)

Question 11

Maximal Cervical Compression

Answer 11

Press straight down with pt’s neck in ipsilateral rotation, lateral flexion, and extension! (+) peripheral pain (radiculopathy/IVF), local pain (same side = facet, opposite side = sprain/strain)

Question 12

Cervical Distraction

Answer 12

Axial unload! Lifting with thumbs under mastoid process. (+) Decreased pain (radiculopathy or facet), increased local pain (strain/sprain)

Question 13

Shoulder Depression

Answer 13

Stabilize head & push shoulder away. Periph pain = radiculopathy, local pain = sprain/strain, contralateral pain = facet

Note - if they normally have pain in this position and it is less when YOU put them in this position, they may have a pain pathway that is no longer relevant to health.

Question 14

Orthos for Strain vs. Sprain

Answer 14

Strain - Resisted Range of Motion
Sprain - Passive Range of Motion
For flexion, extension, lateral flexion & rotation.

Question 15

Soto-Hall

Answer 15

Passive cervical flexion with sternal pressure (put their hand on their chest… “sniff my fingers”) (+) Peripheral pain (radiculopathy), Local pain (Strain/sprain), Spinal pain w/Brudzinski’s sign (Meningitis)

Question 16

Brudzinski’s Sign

Answer 16

Involuntary knee/hip flexion with passive cervical flexion. (+) Meningitis. Get analysis of CSF (looking for WBCs). If a child or fast onset ER referral!

Question 17

Diagnostic Cluster for Cervical Radiculopathy

Answer 17

(+) ULTT of median n., Active cervical rotation <60degrees, (+) Distraction test, & (+) Spurling’s Test.
2 of 4 is okay, 3 of 4 has good specificity, and 4 of 4 has 99 specificity & LR+ of 30.3!