Msk - Cervical Spine - Exam

Front 1

What questions should be asked in the Hx regarding pain?

Back 1

• 0-10: Now, worst, best

• What makes it better? Worse?
• Any change in the morning/night?
• Constant/intermittent?
• How are you trying to control it?

Front 2

Hx questions specific to C/S?

Back 2

HAs?

Clumsy/weak hands?

Grip changes?

Jaw/facial pain?

Leg/B&B symptoms?

Front 3

• What is the worst possible score on NDI?
  
• MDC?

Back 3

• 50/50
  
• 5/50 for uncomplicated pain, 10/50 for radiculopathy

Front 4

• What do Babinski's sign and the Hoffman sign reveal?
  
• How is Hoffman's sign tested? What is normal/positive?
• What is a normal response to Babinski's test? Positive?

Back 4

• UMN lesions or myelopathy
  
• Flick down on pt's 3rd nail with PT's thumbnail, typically results in no motion of 1st/2nd digits, but positive test elicits flexion
• Plantarflexion; Extension and splaying

Front 5

• How do instructions for AROM testing change based on pain levels?
• How should a pt cross arms during ROM testing? Why would this be done?
• Is this test specific, sensitive, or both?

Back 5

• If there is pain at rest, ask whether or not it changes, not if it presents

• Pt grabs opposite acromions and relaxes, slackening the traps & levator. If ROM improves, the traps/levator are limiting
• Sensitive: it is designed to rule out trap & levator, not rule in scalenes/hypomobile segments

Front 6

• What repeated motions testing may produce centralization or peripheralization of pain?
  
• What is important to note regarding centralization?
  

Back 6

• Cervical protraction and/or flexion; Retraction and/or extension
• A pain that centralizes may intensify centrally; this is still centralization

Front 7

• How are passive intervertebral movements assessed in the C/S?
• How are they recorded?
• How are PA glides done?

Back 7

• Lateral glides, first OA glides s/ compression, then with PT belly-pressure in lower segments
• Normal/hypo/hyper, R vs L, PFL or not
• Typically they aren't, but may be done with direction toward the eyes

Front 8

• What is the primary function of the deep cervical flexors?
• What are the steps to assessing deep cervical flexor strength/endurance

Back 8

• Sustain low-intensity contraction to stabilize C/S

1. First, by supine nodding. Then add inflatable cuff set at 20 mmHg, have pt nod at 20 mmHg for 10 sec.
2. Then, for CCFT Strength Test, 22, 24, 26, etc. until compensation.
3. For CCFT Endurance test, 22, 24, 26, etc. with 10 sec holds at each
   

Front 9

• How is the alar ligament stress tested?

• What if the test is positive?
• What is of note?

Back 9

• Pt seated

• PT palpates C2 spinous process, then laterally flexes the head. The spinous process should move in the contralaterally (i.e. C2 rotates ipsilaterally)
• If positive, the sign is a red flag
• Upper C/S couples rotation contralaterally with C1 relative to C2, but C2 moves ipsilaterally

Front 10

• How is C1-C2 rotation biased?
  
• How is this test done?
  

Back 10

• Flex the C/S, locking the lower C/S from rotation and omitting lower C/S contribution
  
• Compare pain, ROM R vs L

Front 11

• What is done to test stability of C1-C2?
  
• How is this done?
• What constitutes a positive result? How is this interpreted?

Back 11

• Transverse ligament aka Anterior shear test
  
• Pt supine. PT fingertips under C1 (valley above C2 spinous process), passively raise pt into FHP. Pt remains in this position for some seconds, reports S&S
• ↑ paresthesia of B/L UE or LE indicate unstable ligament or cervical myelopathy. A (+) result should be treated as a red flag.
  

Front 12

• What test may be done if C1-C2 instability is suspected?
  
• How is it done
• What constitutes a positive result? How is this interpreted?

Back 12

• Sharp-purser test
• Pt seated, head & neck gently flexed. PT has one palm on pt forehead, other hand's fingers pinch-gripped onto C2 spinous process. The PT translates occiput + axis posteriorly
• If movement, "clunk," or symptom reduction occurs, subluxation was likely reduced. A (+) result requires referral to spine/neurosurgeon

Front 13

• How is vertebrobasilar artery insufficiency tested?
• How is the test done?
• What constitutes a positive test?
• What may confound this result? What can account for this?

Back 13

• Vertebral artery test
• Pt supine, placed in extension, lateral flexion, ipsilateral rotation for 30 sec.
• Dizziness, vertigo, syncope, n/v, visual change, dysarthria, sensory changes, or disorientation
• BPPV, so the test may be repeated in sitting

Front 14

What 5 tests should be performed to identify cervical radiculopathy?

Back 14

1. Shoulder abduction test (rule IN)
2. Spurling's test (rule IN)
3. Traction (rule IN)
4. Valsalva maneuver (rule IN)
5. ULTT (to rule OUT)

Front 15

• How is the shoulder abduction test done?
• What is being done with this test?
• What constitutes a positive test? Why would this happen?

Back 15

• Pt seated, pt places symptomatic arm on top of head
• Nerve roots/spinal nerves are put on slack
• Reduction/elimination of symptoms indicates positive test, raising arm opens IVF

Front 16

• How is Spurling's test done?
• What is being done with the test?
• How might this test be further sensitized? When would this be done?
• What constitutes a positive test?

Back 16

• Pt seated, laterally flex toward test side, apply gentle downward overpressure
• IVF is being closed
• If the test is negative, adding extension and ipsilateral rotation may improve sensitivity
• Reproduction/intensification of symptoms

Front 17

• How is the neck distraction test done?
  
• What indicates a positive test?

Back 17

• Pt supine, PT grasps chin/occiput, flexes neck to position of comfort, then applies up to 30 lbs of traction
  
• Reduction/elimination of symptoms

Front 18

• How is Valsalva's maneuver utilized as a test for cervical radiculopathy?
  
• What constitutes a positive test?

Back 18

• Pt takes holds breath while attempting exhalation
  
• Reproduction/intensification of symptoms

Front 19

What structures should be palpated in PW-neck pain?

Back 19

• SCM
• Scalenes
• Semispinalis cervicus/capitus
• Splenius capitus
• Upper trap
• Levator
• Suboccipitals

Front 20

• How can cervical myelopathy and radiculopathy be differentiated?
  
• What are 6 other common S&S of cervical myelopathy?

Back 20

• Myelopathy leads to 3+ or 4+ reflexes while radiculopathy leads to 0 or 1+ reflexes
  

1. Paresthesia in >1 dermatome
2. LE/Sacral neuro signs
3. Hypertonia (spasticity)
4. Ataxia/gait distubance
5. Drop attacks
6. C/S pain/radicular pain/HA worsens with ext.,rot.,ipsi-L/F

Front 21

When will a pt require an X-Ray for C/S trauma?

Back 21

• Age >65 y.o.

• MOI is dangerous
• Paresthesias in extremities
• Pt unable to sit or ambulate afterwards
• Pain onset is immediate
• Midline tenderness is present
• If above is clear, assess ROM: Lacking 45º in rotation indicates need for x-ray

Front 22

When considering pt need for an x-ray of the C/S following trauma, what constitutes a "dangerous MOI?"

Back 22

• Axial load
• Fall > 5 stairs or 3' elevation
• MVA >60mph, or involving oncoming traffic, rollover/ejection, or a bus/truck, or if pt was on a motorcycle/bicycle