MS III cervical b

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  1. neutral c-spine
    slightly extended, slight lordosis
  2. what could cause a flattening of the c-spine (reduction in lordosis)
    muscle spasm, like in whiplash
  3. close-packed c-spine -- what position?
    complete extension
  4. capsular pattern of c-spine if there's a R facet problem
    on L lat bending, L rotation, and FB, head will deviate to the R
  5. most unstable pos for c-spine
  6. Grieves' 3 mandatory questions for c-spine pain
    • 1) dizziness, vertigo, drop attacks?
    • 2) H/O RA, other inflam arthritis, treatment by steroids, Down's
    • 3) neuro involvement of LEs (indicates SCI)
  7. 3 things to observe in c-spine pt
    • head/neck posture
    • rel of head to midline
    • willingness to move head/neck
  8. specific history to ask about for C-spine troubles
    • bifocals or progressive glasses (they make people hold their heads at funny angles)
    • swallowing (is it difficult? discs can press on the esophagus, which is just ant to c-spine)
    • mouth breathing
    • sleeping positin
    • pillows
    • headaches
  9. in structural exam, look for what conditions?
    • temp
    • moisture
    • edema
    • nodules
    • spasm
    • alignment
  10. hyoid is at level of what c-spine?
  11. thyroid -- at what level of vert?
    • C4-5
    • try for lat-lat mobility (pt must be very relaxed)
  12. cricoid
    what is it? what vert level?
    • ring of cartilage around trachea
    • C6
  13. where to find C1 TPs?
    btwn mastoid and inf angle of mandible, ant to SCM
  14. trick for finding C@ SP in supine
    have pt tuck chin to make C2 drop into your hand
  15. posterior triangle's borders
    • ant: SCM
    • post: trap
    • inf: clavicle

    inside, find scalenes, first rib, carotid artery
  16. scalenes - general attachments
    TPs of cervical vert to 1st and 2nd ribs
  17. swallowing tests what?
    • lips, jaw, pharynx, larynx, suprahyoid, infrahyoid
    • (palpate while they swallow)
  18. borders of ant triangle
    midline, mandible, SCM
  19. functional tests for neck
    • swallow
    • look at ceiling
    • look at shoes
    • look over shoulder (rot)
    • tuck chin (nod)
    • poke chin out (jut)
  20. cerv motion happening in a chin-tuck
    • upper c-spine flex
    • lower c-spine ext
  21. c-spine motion in chin-jut
    • upper c-spine -- ext
    • lower c-spine -- flex
  22. active movement testing of AO joint w jut and nod
    • look for lat deviation of nose and head
    • the restriction is on the side to which the head deviates
  23. active movement testing of AA joint
    • fully flex neck to lock the c-spine (don't just tuck the chin, rather roll down so you use the lower c-spine too)
    • rotate
    • see if there's restricted rot to R or L
  24. active movement testing of flexion - how to do it, what you want to see
    • first nod (retract head)
    • then fold forward
    • chin should reach chest w mouth closed, or be no more than 2 finger widths away
  25. extension in active movement testing
    • start motion with a jut, then tilt back
    • never do over pressure in this position! but do over pressure in all others if there's no pain
  26. motions for active movement testing
    • nod
    • jut
    • flex and rotate
    • flex
    • ext
    • lat flex
    • rot
  27. tips on overpressure
    • don't do it for extension
    • for others, use supporting hand on pecs or contralat shoulder
    • for rot, bury her nose in your elbow / really wrap her head with your arm
  28. passive movement testing tips
    • do force coupling -- put hands on opp sides of head so they work together, pressing and supporting
    • palpate ROM, location of end feel, type of end feel
    • test in sitting
  29. resisted testing hand positions
    • ext -- inion
    • lat flex -- beside of sagital sutures - so, high on head, but lateral
    • flex -- forehead
  30. compression and distraction of head
    • compress from the top
    • distract by grasping sides of head and pulling up
  31. patellar reflex tests what nerves?
  32. triceps reflex tests what nerves
    C6,7, 8
  33. VBI stands for what
    what is it?
    • vertebral basilar insufficiency
    • reduction of blood flow thru vertebrobasilar arterial system
  34. the vertebrobasilar arterial system supplies what?
    posterior brain
  35. tectorial membrane
    • attaches to foramen magnum
    • upper continuation of PLL
  36. ant AO and AA membrane
    runs up anteriorly, as the upward continuation of the ALL
  37. posterior AO and AA membrane
    cont of ligamentum flavum

    (the tectoral membrane is the cont of the PLL)
  38. before doing any manip, or even just taking a pt of end of range, if the pt is > 30 yo or if you're at all concerned, you must ...
    • check the pt for VBI to check the vertebral artery
    • and put results in your chart!
  39. vertebral artery test
    • (tests for VBI)
    • pt supine, head off table in your hands
    • extend, SB, and rot head to each side, holding 15-30 seconds, looking for nystagmus, blurry vision vyrtigo, dizzy, HA, pain, tinnitus, ear feels clogged, nausea, difficulty standing
  40. what to look for in a VBI test
    • nystagmus,
    • blurry vision
    • vyrtigo,
    • dizzy,
    • HA,
    • pain,
    • tinnitus,
    • ear feels clogged,
    • nausea,
    • difficulty standing
  41. what's happening to the vertebral artery in a VBI test?
    you're compressing the artery on the side you turn to, and you're stretching it on the opp side
  42. a way to differentiate cervical vs vestibular problems
    • rotate body on head (keep head steady and move body beneath it)
    • if this leads to symptom it's cervical, not vestib
  43. mobilization of upper c-spine if pt has any pos signs for VBI?
    NO! sooo contraind!
  44. spurling test the basics of the motions
    • ext, SB, rot to same side
    • with compression (Magee)
    • with distraction (Saunders)
  45. Spurling test - what's a positive sign? what does it indicate?
    assesses nerve root pain / impingement

    • paraesthesia, spasm, neuro complaints
    • compression of neural foramen and vertebral artery
  46. l'Hermitte's sign - how to do this test
    pt in long sit, now PT flex the head and the hip (raising the leg straight) (pt is passive)
  47. L'hermitte's sign - what's the positive sign, what does it indicate?
    • sharp pain like an electric shock
    • meningeal or dural irritation
  48. if pt does L'Hermitte test but pt does the motion actively it's called...
    Sotohall test
  49. shoulder abduction test (relief test)
    • pt sitting
    • passively or actively, raise arm thru abd til hand rests atop head
  50. shoulder abd test, positive sign, what does it indicate
    • decrease or relief of symptoms
    • cervical extradural compression (ie. disc, nerves C4-5_
  51. valsalva test -- how, indicates what?
    • bear down, see if it increases symptoms
    • space occupying lesion (herniation or tumor)

    (but you already asked about this in hx when you asked if there's pain on coughing, sneezing, pooping)
Card Set:
MS III cervical b
2013-11-10 17:20:44

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