Cervicothoracic Screening

Question 1

If a patient received trauma to their cervical neck (such as an MVA) what high risk factors would warrant an imaging referral?

Answer 1

• If they are over 65 years old
• Dangerous mechanism (fall from over 3 ft/5 stairs, MVC over 60mph or rollover/ejection, or bicycle collision)
• Upper extremity parasthesia

Question 2

If a patient has no high risk factors after receiving trauma to their cervical spine and they have a low risk factor which allows range-of-motion assessment (such as a simple rear-end MVC, sitting position in ext. rotation, ambulatory at any time, delayed onset neck pain, or absence of midline cervical spine tenderness) what is the last factor which would warrant a referral for imaging?

Answer 2

The patient is not able to rotate their neck 45* to the left or right

Question 3

True or False: the Canadian Cervical spine rule is more sensitive than the NEXUS low-risk criteria.

Answer 3

True, the Canadian Cervical Spine Rule is 99.4% sensitive and great for ruling out a cervical fracture

Question 4

What are the mechanical causes of cervical myelopathy?

Systemic Causes of myelopathy?

Answer 4

• Trauma
• Spinal Cord Compression
• Degenerative changes
• bulging disks, thickened ligamentum flavum
• RA with subsequent atlanto-acial subluxation
• MS, ALS
• Guillain-Barre
• Multipfocal motor myopathy

Question 5

What five tests are used in the cervical myelopathy rule?

how many tests need to be positive to achieve a 99% specificity?

Answer 5

• gait deviation
• +hoffman’s test
• inverted supinator sign
• +babinksi sign
• Age over 45 years old

3 out of 5 positive tests = 99% specificity

Question 6

What are the signs and symptoms of upper cervical ligamentous laxity?

what are some causes of this laxity?

Answer 6

• occipital headache and numbness
• severe limitation during neck AROM in all directions
• signs of cervical myelopathy

causes

• trauma
• RA with atlanto-axial subluxation, down syndrome, kleepel-feil
• Os odontoideum
• odontoid fracture

Question 7

What signs suggest a patient has a spinal infection?

what do you do if they have positive spinal infection signs?

Answer 7

• spine pain that is unrelenting, worse at night and does not change substantially with positional changes
• history of diabetes
• potential fever and chills or fatigue
• concurrent infection or IV drug use
• local tenderness over spinous processes
• spinal percussion is painful

Refer out for imaging and clinical lab tests

Question 8

What MSK complaints will a patient that suffered a cardiovascular event have?

Answer 8

• jaw, neck, shoulder, arm and back pain
• myalgias, muscular fatigue, and muscle atrophy
• weakness and fatigue
• poor exercise tolerance

Question 9

What signs and symptoms are common with cardiovascular events?

Answer 9

• chest pain
• abdominal pain
• shortness of breath
• heart palpitations
• irregular heartbeat
• dizziness, nausea
• syncope
• peripheral edema

Question 10

What are the 5 D’s And 3 N’s of cervical arterial dysfunction?

Answer 10

• Dizziness
• drop attacks
• dysphagia
• dysarthria
• diplopia

-Ataxia

• Nausea
• numbness
• nystagmus

Question 11

How will a patient who suffered a pulmonary event describe their pain?

What would be there signs and symptoms?

Answer 11

Pain

• sharp, localized
• aggravated by breathing
• better in upright/worse in recumbent
• better with autosplinting

SxS

• Shortness of breath (Dyspnea)
• persistent cough
• fevers, chills, and general malaise
• weak rapid pulse with fall in BP
• cyanosis

Question 12

What are the signs of a pneumothroax?

Answer 12

• shortness of breath
• acute sharp pain in chest (upper and lateral chest wall_
• can refer pain to ipsilateral shoulder/upper trapezius region
• change in respiratory movements
• drop in blood pressure, increased venous distention in neck
• more pain in recumbent positions/better in sitting

Question 13

What are common signs of GI issues? (stomach, duodenal, or pancreatic conditions)

Answer 13

• gnawing, cramping, burning, “heartburn” or aching
• constant or suddent onset, weight loss, nausea, vomiting, fever, malaise
• may have pain in waves or may be related to eating or drinking in timing
• early satiety, black “tarry” or light colored stools (pancreatic cancer)

Question 14

True or False: cervical spine is the most common location for spinal metastases.

Answer 14

False, metastases are rare in C-spine, more common in thoracic (60%) and lumbar (40%) spine

Question 15

What cancers can commonly cause spinal pain?

Answer 15

Prostate
breast
kidney
thyroid
lung
lymphoma

Question 16

Which cancers more commonly effect the cervico-thoracic spine?

Answer 16

thyroid and esophageal cancer
Hodgkin's lymphoma
Pancoast's tumor
Multiple myeloma
breast cancer

Question 17

Ture or False: If a patient has an injury to a C-spine artery pain is usually not a common complaint due to arteries not being innervated.

Answer 17

False, pain is a predominant symptoms in these patients as arterial walls are liberally supplied with pain fibers

Question 18

What are the components of the neruovascular physical exam?

Answer 18

BP
BMI
Pulse check
Neuro exam
Functional positional tests
Ligamentous Tests
Eye exam

Question 19

True or False: Generally we as PTs should avoid performing cervical thrust manipulations to patients with recent onset of head and neck pain but we should perform thoracic manipulations

Answer 19

True, as well as ROM exercises for the neck and scapulothoracic and upper extremity stretching and strengthening

Question 20

When do roughly 72% of patients that reported feeling adverse symptoms say they felt their symptoms start?

Answer 20

Withing minutes after manipulation, most commonly they report onset during the manipulation