1
Q
neck pain with mobility deficits symptoms
A
- central/unilateral neck pain
- limitation in mobility that consistently reproduces neck pain
- referred shoulder girdle/UE pain may be present
2
Q
neck pain with mobility deficits expected exam findings
A
- limited cervical ROM
- neck pain reproduced at end range of active and passive motions
- restricted cervical and thoracic segmental mobility
- intersegmental mobility testing reveals characteristic restriction
- neck and referred pain reproduced with provocation of the involved cervical or upper thoracic segments or cervical musculature
- deficits in cervicoscapulopthoracic strength and motor control may be present in individuals with subacute or chronic neck pain
3
Q
neck pain with movement coordination impairements common symptoms
A
- MOI linked to trauma or whiplash
- referred shoulder girdle or UE pain
- associated varied nonspecific concussive signs and symptoms
- dizziness/nausea
- headache, concentration, or memory difficulties, confusion, hypersensitivity to mechanical thermal, acoustic, odor, or light stimuli; heightened affective distress
4
Q
neck pain with movement coordination impairments expected exam findings
A
- positive cranial cervical flexion test
- positive neck flexor endurance test
- positive pressure algometry
- strength and endurance deficits of the neck muscles.
- neck pain with mid-range motion that worsens wit end-range positions
- point tenderness may include myofascial trigger points.
5
Q
neck pain with movement coordination impairments expected exam findings
A
- positive cranial cervical flexion test
- positive neck flexor endurance test
- positive pressure algometry
- strength and endurance deficits of the neck muscles.
- neck pain with mid-range motion that worsens wit end-range positions
- point tenderness may include myofascial trigger points.
- sensorimotor impairment may include altered muscle activation patterns, proprioceptive deficit, postural balance or control
- neck and referred pain reproduced by provocation of the involved cervical segments
6
Q
neck pain with headache symptoms
A
- noncontinuous, unilateral neck pain and associated headache
- headache is precipitated or aggravated by neck movements or sustained positions/postures
7
Q
neck pain with headache expected exam findings
A
- positive cervical flexion rotation test
- headache reproduced with provocation of the involved upper cervical segments
- limited cervical ROM
- restricted upper cervical segmental mobility
- strength, endurance, and coordination deficits of the neck muscles
8
Q
neck pain with radiating pain symptoms
A
- neck pain with radiating (narrow band of lancinating) pain in the involved extremity
- upper extremity dermatomal paresthesia or numbness, and myotomal muscle weakness
9
Q
neck pain with radiating pain expected exam findings
A
- neck and neck-related radiating pain reproduced or relieved with radiculopathy testing; positive test cluster
- may have UE sensory strength or reflex deficits associated with the involved nerve roots
10
Q
clinical prediction rule for cervical manipulation
A
- symptoms <38 days
- positive expectation manipulation will help
- cervical rotation ROM side to side difference is 10 degrees or greater
- pain with PA testing med-cervical spine
11
Q
treatment of acute neck pain with mobility deficits
A
- thoracic manipulation
- cervical mobilization or manipulation
- cervical ROM, stretching, and isometric strengthening exercise
- advice to stay active plus home cervical ROM and isometric exercise
- supervised exercise, including cervicoscapulothoracic and UE stretching, strengthening, and endurance training
- general fitness training
12
Q
treatment of subacute neck pain with mobility deficits
A
- cervical mobilization or manipulation
- thoracic manipulation
- cervicoscapulothoracic endurance exercise
13
Q
treatment of chronic neck pain with mobility deficits
A
-thoracic manipulation
- cervical mobilization
- combined cervicoscapulothoracic exercise plus mobilization or manipulation
- mixed exercise for CST regions, neuromuscular exercise; coordination, proprioception, and postural training; stretching, strengthening, endurance training, aerobic conditioning, cognitive affective elements
- supervised individualized exercises
- stay active lifestyle approaches
- dry needling, low-level laser, pulsed or high-power ultrasound, intermittent mechanical traction, repetitive brain stimulation, TENS, electrical muscle stimulation
14
Q
cervical myelopathy cluster
A
- gait deviation
- Hoffmann’s test
- inverted supinator sign
- Babinski test
- age > 45
4/5 = 99%
15
Q
intermittent traction parameters
A
- supine
- 60 sec pull force, 20 sec relaxation force (off cycle force is 50% of pull force)
- force is 12 lbs
- angle of pull is 15 to 24 degrees
- 15 minutes
16
Q
cervicogenic headache symptoms
A
- 50/50 F/M
- unilateral without sideshift
- located occipital to frontoparietal and orbital
- chronic or episodic
- moderate to severe
- lasts 1 hour to weeks
- non-throbbing, non lancinating, pain usually starts in neck
- triggers: neck movement, postures, limited ROM, pressure over C0-C3
- similar migraine associated symptoms but milder, decreased ROM
17
Q
migraine symptoms
A
- 75/25 F/M
- 60% unilateral with sideshift
- located in frontal, periorbital, temporal
- 1-4 per month
- moderate to severe
- lasts 4-72 hours
- throbbing, pulsating
- triggers: multiple, not neck movement
- associated with nausea, vomiting, visual changes, phonophobia, photophobia
18
Q
tension-type headache symptoms
A
- 60/40 F/M
- diffuse bilaterally
- diffuse location
- 1-30 per month
- mild-moderate
- lasts days to weeks
- triggered by multiple things, not neck movements
- associated with decrease appetite, phonophobia, photophobia
19
Q
intercranial pathology
A
- sudden onset of severe headache with increasing intensity
- persistently unilateral headaches
- headaches that wake patient in night or morning
- generalized stiff neck or other signs of meningitis
- weight loss, fever, malaise
- focal neurologic symptoms
20
Q
5 D’s, and 3 N’s
A
dizziness
drop attacks
diplopia (double vision)
dysarthria (speaking)
dysphagia (swallowing)
ataxia
nausea
numbness
nystagmus
21
Q
cervical flexion rotation test
A
positive if less than 32 degrees
22
Q
cranial cervical flexor test
A
chin tuck, not retraction
normal shoulder be 26-30mmHg pressure for 10 sec without compensation
23
Q
neck flexor muscle endurance test
A
chin tuck with lift up to 2.5cm
normal is >38 seconds
24
Q
cervicogenic headache cluster
A
- decreased AROM cervical extension
- palpably painful somewhere from OA to C3-4 joint dysfunctions
- deep cervical flexor strength impairments w cranio-cervical flexion test
25
6 muscles tight with cervicogenic headaches
upper trap
levator
scalenes
SCM
pec major
pec minor
26
acute treatment of neck pain with HA
- supervised instruction in active mobility exercise
- C1-2 SNAG
27
subacute treatment of neck pain with HA
- cervical manipulation and mobilization
- C1-2 SNAG
28
chronic treatment of neck pain with HA
- cervical or cervicothoracic manipulation or mobilization combined with shoulder girdle and neck stretching, strengthening and endurance exercise
29
nonischemic signs of CAD
- horners syndrome
- pulsatile tinnitus
- cranial nerve palsies (9-12)
30
less common nonischemic signs of CAD
- ipsilateral carotid bruit
- scalp tenderness
- neck swelling
- CN 6 palsy
- orbital pai
- anhidrosis
31
ischemic signs of CAD
- TIA
- ischemic stroke
- retinal infarction
- amaurosis fugax (temporary loss of vision in one or both eyes due to lack of blood flow)
32
how fast do CAD symptoms present after manipulation
72% within minutes
most within set up
33
stable angina
- chest pain/pressure
- occurs during exercise
- predictable
- alleviated with rest or nitroglycerin
34
unstable angina
- unpredictable pattern
- does not respond to nitroglycerin
- signs consistent with MI
- angina >30 min
35
pericarditis s/sx
- swelling in LE
- anxiety
- difficulty breathing and increased pain when supine
- relieved by sitting up and leaning forward
- sharp, stabbing pain
- dry cough
- fatigue
- fever
- chest pain with possible left UE symptoms
36
pulmonary embolus s/sx
- sudden onset of dyspnea
- chest pain
- tachypnea
- wheezing
- hypotension
- chest pain with possible left UE symptoms
37
pleurisy s/sx
- sharp stabbing pain
- aggravating with deep breaths, coughing, ribcage movements
- chest pain with possible shoulder pain
- shortness of breath
- cyanosis
- tachypnea
38
pneumothorax s/sx
- impaired chest expansion on involved side
- decreased breath sounds
- hyperresonance with percussion
- sharp chest pain
- aggravated with deep breath or cough
- SOB
- easy fatigue
- tachycardia
- cyanosis
39
pneumonia s/sx
- chills
- fever
- malaise
- nausea
- vomiting
- cough that produces colored sputum
- SOB
- confusion
- HA
- loss of appetite
- sharp/stabbing chest pain
40
esophageal ulcer s/sx
- pain with swallowing
- pain with lying down
- black, tarry colored stools
- red color in vomit
- relief or increase pain with eating
41
gastric ulcer s/sx
- eating increases symptoms
- more common in elderly
- common in those who use NSAID's
- dull gnawing or burning pain
42
duodenal ulcer s/sx
- dull, gnawing or burning pain
- inc symptoms when the stomach is empty
- relieved with eating or taking antacids
can refer to right shoulder
43
cholecystitis
murphys sign: press left thumb just under costal margin and ask patient to take deep breath
- a sharp pain with a sudden stop in inspiration is a positive
44
kidney disorders s/sx
- chills
- fever
- nausea
- vomiting
- renal colic
45
axillary nerve entrapment
- shoulder abduction and flexion weakness
- decreased sensation in lateral upper arm
- MOI: direct blow to shoulder
46
long thoracic nerve entrapment
- serratus anterior weakness
- scapular winging
- shoulder girdle pain
- MOI- excessive shoulder use, trauma to lateral chest wall, prolonged traction to nerve
47
suprascapular nerve entrapment
- observable wasting of supra and infraspinatus muscle
- weakness in abduction and shoulder ER
- MOI: repetitive microtrauma, traction injury
48
pancoast tumor s/sx
- men >50 years old
- history of cigarette smoking
- nagging shoulder pain
- pain has progressed from nagging to burning in nature
- symptoms extend into the ulnar nerve distribution
- may have venous distention of the ipsilateral arm
49
T4 syndrome s/sx
- between 30-50 years of age
- more frequently in women 4:1
- recent new job/hobby involving stooping or bending
- poor posture
- diffuse neck, head and upper extremities
- paraethesias
- hands feel hot/cold, heavy, swollen
- non-dermatomal aches and pains
50
s/sx/causes of upper cervical ligamentous laxity
- occipital HA and numbness
- severe limitation during neck AROM in all directions
- signs
- trauma
- RA, down syndrome, klippel-feil
- Os odontoideum
- odontoid fracture
51
myocardial ischemia
- anterior chest pain or heaviness and sometimes nausea, occasionally presents with pain radiating to the back
52
dissecting thoracic aortic aneurysm
- felt in chest but can radiate to back and lower back
53
peptic ulcer pain
- posterior wall of the stomach or duodenum may also radiate to back, can be triggered or relieved by eating
54
gall bladder pain
- may be referred to right infrascapular region and accompanied by nausea and vomiting
55
pacreas pain
- posterior abdominal structure that may refer pain to back, around level of thoracolumbar junction
56
renal pain
- felt in costovertebral area or the flank
57
pain from thoracic interspinous ligaments and thoracic zygapophyseal joint
- described as dull and aching, it tends to be poorly localized, not corresponding to dermatomes, and is felt deeply in tissues
58
treatment of acute neck pain with movement coordination
- education of the patient to return to normal, nonprovocative pre-accident activities as soon as possible; minimize use of cervical collar; perform postural and mobility exercises to decrease pain and increase ROM
- reassurance to the patient that recovery is expected to occur within 2-3 months
- manual mobilization + strengthening, endurance, flexibility, postural, coordination, aerobic exercise
59
treatment of chronic neck pain with movement coordination
- patient education and advice focusing on assurance, encouragement, prognosis, and pain management
- mobilization + progressive submax exercise program including CT strengthening, endurance, flexibility, coordination, cognitive behavioral therapy
- TENS
60
treatment for acute neck pain with radiating pain
- exercise: mobilizing and stabilizing elements
- low level laser
- short term use of collar
61
treatment for acute neck pain with radiating pain
- combined exercise: stretching and strength plus manual therapy for cervical and thoracic region: manipulation or mobilization
- intermittent traction
62
best test to rule in cervical radiculopathy
DTR of biceps brachii
63
cervical radiculopathy definition
decreased strength, sensation and reflexes in a dermatomal/myotomal pattern or with the clinical prediction rule
64
Cervical laminoplasty is indicated for:
lateral stenosis
spondylitic myelopathy
degenerative changes
65
common complications following cervical surgery
hoarseness
dysphagia
infection
66
Compared to other areas of the spine, the cervical spine tends to have MORE problems with which of the following pathologies:
Degeneration of disc and joints
OCS Prep
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