Cervical Flashcards by Heather Stephens

Features of the cervical spine

extreme mobility
complex series of joints 
different functions of IVD and ZPJ 
vertebral and internal cartoid artery 
7 vertebrae and 8 nerve root
close approx to shoulder

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Symptoms of this pathology are little pain, stiffness more than pain, no referred or neurological symptoms, AM stiffness, grinding when turn head

a. disc
b. radiculopathy
c. myelopathy
d. uncovertebral joint

uncovertebral joint

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This pathology shows a loss of extension, neck in forward flexed position, limited side bend in flexion, neutral and extension, decreased rotation and crepitus or grinding

a. disc
b. radiculopathy
c. myelopathy
d. uncovertebral joint

uncovertebral joint

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What are treatment options for uncovertebral joints?

central PA
distraction and add flexion
mechanical traction

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What disc changes occur with age?

loss of disc height > formation of UC osteophytes and hard posterior disc protrusions

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a loss of disc height causes

stiffness

loss of extension and SB

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Where is disc thinning and resorption seen?

C5-C6 or C6-7 in 50-60s

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_ cervical discs fissure before _

upper

lower

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When there is no nucleus in the disc there is a (increase/decrease) incidence of upper cervical disc injury and radiculopathy

decrease

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When there is a nucleus in the disc there is a (increase/decrease) incidence of lower cervical disc injury and radiculopathy

increase

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What changes occur to the disc with age?

becomes compressed and distorted by UV osteophytes and disc protrusions

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Fissuring with age is due to _

UVJ

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The disc can project into the _ and in the _

IV foramina

spinal canal

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Discs can project into the IV foramina and into the spinal canal with potential compressive effects on nerve roots, Vertebral arteries, and Spinal cord (True/false)

true

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What are treatment options for disc issues?

central PA

unilateral PA or PA in rotation

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What grade mobilization should be done for disc issues?

a. grade 1
b. grade 4
c. grade 2 or 3
d. grade 2 only

grade 2 or 3

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The nerve in the vertebral canal supplies the disc at _

their level of entry and the disc above

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Branches of the vertebral nerve supply _ aspects of the cervical discs

a. anterior
b. posterior
c. lateral
d. medial

lateral

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discogenic pain is referred pain (True/false)

true

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Symptoms of c-spine relatively pain-free/stiff/sore, deep burning, toothache pain around the scapular border, supraspinous fossa and scapula, referral to the shoulder

a. radiculopathy
b. cervical myelopathy
c. facet joint
d. discogenic

discogenic

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This structure is a little fat pad that protudes into the disc, cushions and occupies any irregularities, it can get pinched

a. branch of nerves
b. disc
c. menisci
d. uncovertebral ostyeophyte

menisci

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c-spine is innervated by

medial branch

dorsal ramus

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This c-spine pathology shows symptoms of sharp, localized pain, uniltareal, spasms, referral into the UE with neck pain being worse than UE pain

a. radiculopathy
b. disc issue
c. ZPJ
d. cervical myelopathy

ZPJ

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Patient shows signs of limited extension, rotation to same side, side flexion to same side

a. radiculopathy
b. disc issue
c. ZPJ
d. cervical myelopathy

ZPJ

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ZPJ pain can be due to

entrapment of meniscoidal

_ closes down producing pain in a patient with ZPJ

extension

Treatment for facet joints includes

unilateral | opening

For facet joint pathology, start with the neck in _ and progress towards more _

flexion | extension

What treatments can be done for facet joint pain?

unilateral PA or PA in rotation opening techniques - UPSLOPE transverse vertebral pressure or lateral glide longitudinal cephalad

There is forgiveness in the cervical spine so patients can have a bulge without knowing (True/false)

true

Radiculopathy can be caused by trauma of

annulus tears end-plate injuries annulus bruising

A bulge can irritate the _ and cause radiculopathy

DRG

Patients presents with unilateral pain, in a dermatomal pattern, distal more than proximal, deep toothache pain, numbness, pins and needles, weakness in myotome pattern a. cervical myelopathy b. radiculopathy c. ZPJ d. disc issue

radiculopathy

Patient shows protective deformities, positive neurodynamic testing, spurling test, and distraction, what could they be diagnosed with? a. cervical myelopathy b. radiculopathy c. ZPJ d. disc issue

radiculopathy

Protective deformity with arm above head indicates injury at a. C4 b. C5 c. C6 d. C7

Protective deformity with arm at their side indicates injury at a. C4 b. C5 c. C6 d. C7

Protective deformity with forward head can indicate a. cervical myelopathy b. radiculopathy c. ZPJ d. disc issue

radiculopathy

What are the signs of threatening nerve root pain?

dermatome, distal more than proximal severe pain, latency slight movement irritating protective deformity

A patient shows more distal pain than proximal, severe pain with latency, slight movement is irritating and a protective deformity of C5. This could be a. radiculopathy b. cervical myelopathy c. threatening nerve root pain d. stenosis

threatening nerve root pain

What is the CPR for radiculopathy?

ipsilateral rotation < 60 degrees positive ULNT A positive distraction positive spurling

What is the hallmark sign for radiculopathy? a. positive distraction test b. positive spurling test c. protective deformity d. distal symptoms more severe and follow dermatome

distal symptoms more severe and follow dermatome

What are signs of nerve root compression?

numbness in dermatome heavy feeling in extremity hypersensitivity cramping

A loss of sensation, motor weakness/atrophy, decreased reflexes can indicate a. radiculopathy b. referred pain c. nerve root compression d. disc issue

nerve root compression

What treatment should be done for radiculopathy?

intermittent traction

Spinal cord encroachment leads to a. VBI b. radiculopathy c. foraminal stenosis d. cervical myelopathy

cervical myelopathy

cervical myelopathy is more common with _

age

Patient shows gait abnormality, hyper reflexive, hoffmans sign, babinksi which could indicate a. VBI b. radiculopathy c. foraminal stenosis d. cervical myelopathy

cervical myelopathy

cervical myelopathy indicates (UMN/LMN) signs

UMN

A patient presents with cervical myelopathy a. treat them without screening b. screen then treat c. do not treat d. treat only if medically cleared

treat only if medically cleared

What treatment can you do for cervical myelopathy?

avoid extension treat in flexion cervical traction

it is normal to turn head and occlude to the opposite die (true/false)

true

Cervical rotation with extension or only extension causing occlusion indicates

internal carotid artery insufficiency

symptoms of VA insufficiency

D's: dizziness, diplopia, dysphagia, drop attacks, dysarthria A: ataxia N's: nystagmus, nausea, numbness

Testing for VAI is reliable (true/false)

false

What ligament holds the dense from C2 up into C1? a. alar ligament b. transverse ligament c. dura c. atlanto ligament

transverse ligament

What is the function of the ligaments on either side of the arch of C1?

keep dens pushed into arch

This ligament is a passive restraint to excessive rotation and lateral flexion a. alar ligament b. transverse ligament c. dura c. atlanto ligament

alar ligament

This ligament has a primary passive restraint of C1 displacement in the sagittal plane a. alar ligament b. transverse ligament c. dura c. atlanto ligament

transverse ligament

_ ligaments check rotation and side bending

both alar and transverse

How can the upper cervical spine be treated?

unilateral PA in rot proprioception soft tissue neurodynamics

_ attaches to the dura of the spinal cord

rectus capitis posterior minor

if the _ is hyperactive it can pull and cause a headache

rectus connecting to the dura

_ can atrophy causing chronic TTH

rectus

What sends feedback to the brain on where head is in space?

sub occipital triangle

How can you create space to treat foraminal stenosis?

lateral glide | longitudinal cephalad

the neurovascular bundle is located

under the scalene

_ and _ scalenes attach to the first rib under the clavicle

anterior and middle

the _ scalene attaches to the second rib

posterior

Exercise for WAD should be

multi modal

When is it indicated to do AROM unloaded?

high levels of pain | surgery or WAD

What AROM exercises can be done unloaded?

nodding rotation side flexion

When is it appropriate to move from unloaded AROM to loaded? a. when symptoms are gone b. as pain eases c. when they show control d. immediately

as pain eases

What exercise is useful to improve the stabilization of the c-spine? a. head nods b. head lifts c. rotation d. side bending

head nods

These muscles are able to exert force due to larger lever arms and cross-sectional areas a. superficial muscles b. deep muscles c. deep flexors d. anterior muscles

superficial muscles

These muscles are more localized to either region, have segmental attachments, larger spindle densities and guide and support segments a. superficial muscles b. deep muscles c. deep flexors d. anterior muscles

deep muscles

When can exercises be progressed to functional tasks?

once sufficient control with stabilization

What sensorimotor changes are seen post injury? a. less function b. decreased endurance c. decreased strength and endurance d. more recruitment of muscles

decrease strength and endurance

Which muscles show a decrease in isometric strength and endurance?

cervical flexors craniocervical flexors cervical extensors

How does low intensity contractile affect the neck? a. recruitment of muscles b. less strength c. hypermobility d. detrimental to stability

detrimental to stability

What alterations are seen in motor control? a. frequency of firing b. co contraction c. duration of firing d. amplitude and timing

amplitude and timing

What muscle properties change after WAD?

fatty infiltration

What is the purpose of the craniocervical flexion test?

monitors change in shape of curve as it flattens with contraction of deep cervical flexors

This is defined as the ability to relocate neutral head posture with eyes closed a. motor control b. joint motion c. sensory sensation d. joint position sense

joint position sense

The angular difference between starting postural position and that assumed after neck movement

joint position error

Errors with joint position sense occur with a. side bending b. return from extension and rotation to left or right c. rotation to painful side d. return from flexion and rotation

return from extension and rotation to left or right

Posture is correlated to pain in the c-spine (true/false)

false

Errors with joint position sense occur with a. side bending b. return from extension and rotation to left or right c. rotation to painful side d. return from flexion and rotation

return from extension and rotation to left or right

Posture is correlated to pain in c-spine (true/false)

false

Traction should be used as a form of _ or _

oscillation | static hold

How much weight should be used for traction initially? a. 5 lbs b. 10-12 lbs c. 15-20 lbs d. 20 lbs

10-12 lbs

Traction weight should be adjusted to _

the patients' symptoms

Traction and exercise are indicated for which patient population a. cervical myelopathy b. VBI c. WAD d. radiculopathy

radiculopathy

Research indicates adding traction to _ will lower disability and pain a. ULNT b. exercise c. mobilization d. heat

exercise

Traction and exercise are indicated for which patient population a. cervical myelopathy b. VBI c. WAD d. radiculopathy

radiculopathy

What is a good indicator for mechanical traction? a. neural symptoms b. negative response to manual traction c. claustrophobia d. good response to manual traction

good response to manual traction

Mechanical traction is indicated for

favorable response to manual severe nerve root pain recent worsening neurological changes unloading eases pain

``` Structural disease secondary to tumor or infection vascular compromise movement contraindicated VBI fracture these are a. precautions for traction b. contraindications c. be cautious with these d. indications for traction ```

contraindications

``` Acute strains and sprains inflammatory conditions spinal joint instability or trauma pregnancy osteoporosis claustrophobia cortical steroid intake a. precautions for traction b. contraindications c. be cautious with these d. indications for traction ```

precautions for traction

What duration of traction is indicated for pain? a. longer for 30 minutes b. shorter for 3 minutes c. as long as they can tolerate d. shorter start with 10 minutes

shorter start with 10 minutes

What duration of traction is indicated for stiffness? a. longer for 30 minutes b. shorter for 3 minutes c. as long as they can tolerate d. shorter start with 10 minutes

longer up to 30 minutes

What treatment should be done before and after traction? a. exercise b. ULNT c. ROM d. mobilization

mobilization

What is the no therapy window for ESI?

48 hours

Limit use of _ for _ days after ESI

heat | 2-3

Cervical spine surgery is generally as poor success rates as lumbar (true/false)

false

How long after surgery should the therapist wait to do manipulation?

6 months

Which subgroup? - Recent onset of symptoms - NO radicular/referred symptoms in the upper 1/4 - Restricted ROM w/ rotation and/or discrepancy in lateral flexion ROM - NO signs of nerve root compression or peripheralization of Sx in the upper 1/4 w/ cervical ROM a. mobility b. centralization c. conditioning and exercise tolerance d. pain control e. reduce headache

mobility

Which subgroup? - Radicular/referred symptoms - Peripheralization and/or centralization of Sx w/ ROM - Signs of nerve root compression present - May have Dx of cervical radiculopathy a. mobility b. centralization c. conditioning and exercise tolerance d. pain control e. reduce headache

centralization

Which subgroup? - Lower pain & disability scores - Longer duration of Sx (i.e. more chronic than acute) - NO signs of nerve root compression - NO peripheralization/centralization during ROM a. mobility b. centralization c. conditioning and exercise tolerance d. pain control e. reduce headache

conditioning and exercise tolerance

Which subgroup? - High pain & disability score - Very recent onset of symptoms (i.e. more acute than chronic) - Symptoms precipitated/caused by trauma - Radicular/referred symptoms - Poor tolerance for examination or most interventions a. mobility b. centralization c. conditioning and exercise tolerance d. pain control e. reduce headache

pain control

Which subgroup? - Unilateral headache w/ onset preceded by neck pain - Headache pain triggered by neck movement or positions - Headache pain elicited by pressure on posterior neck a. mobility b. centralization c. conditioning and exercise tolerance d. pain control e. reduce headache

reduce headache

Uncovertebral joints are (not innervated/highly innervated)

highly innervated

Uncovertebral joint symptoms: referred/not referred and neurological symptoms

referred | no neurological symptoms

What is a good indicator of uncovertebral joint symptoms?

stiffness more than pain

Which type of traction should be used for Uncovertebral joint symptoms and IVD? a. intermittent b. static

intermittent

_ from the UVJ can occlude foramen

sclerosis

Most people do not show disc problems on imaging (True/false)

false | most do but are symptom free

Lateral glides limits in neutral and flexion, this suggests a. facet joint lock b. uncovertebral lock

uncovertebral lock

Lateral glides limited in neutral and less restriction in flexion a. facet joint lock b. uncovertebral lock

facet joint lock

radiculopathy injury occurring with trauma can be caused be

annulus tears end plate injuries annulus bruising

Radiculopathy - is pain more distal or proximal?

distal

Which motion should be avoided with potential for cervical myelopathy?

extension

A patient has a loss of extension and is limited with SB, rotation and neck is kept in flexion. There is some crepitus/grinding, which would you suggest is causing this? a. ZPJ b. disc injury c. radiculopathy d. UVJ

UVJ

Cervical Flashcards

(122 cards)