Cervicothoracic Examination

Physical Therapy Pt 5453 with Devaney at University of Connecticut

About this deck

By: Mike Rigdon
Created: 2011-03-06
Size: 43 flashcards
Views: 5

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What is the screening process?

A process that differentiates when musculoskeletal conditions need further examination or consultation by a PT or when they need to be referred to another practitioner

Differentiate between Examination and Evaluation

Examination
- History from background info, systems review, tests and measures

Evaluation
- Make clinical judgments regarding the information gathered during the exam regarding musculoskeletal conditions

What are some red flags in the cervical spine?

1. Cancer (metastasis to the spine and ribs)
2. Fracture
3. Cardiovascular problem
4. RA
5. Meningitis
6. Cervical myelopathy
7. Vertebrobasilar artery insufficiency

What is the purpose of the screening process?

1. Differentiate neuromusculoskeletal impairments from medical conditions
2. Identify patterns that suggest origin of pain/symptoms
3. Identify signs and symptoms (yellow and red flags) that warrant attention
4. First step in making a diagnosis

Name the 5 steps in the medical screening process

1. Past medical history
2. Risk factor assessment
3. Clinical presentation
4. Associated signs and symptoms
5. Systems review

Name the red flags you are looking for in a patient's medical history

1. Family history of cancer
2. Upper respiratory infection
3. Recent history of trauma (MVA, fall, etc)
4. Osteoporosis/osteopenia

Name the red flags you are looking for when performing a risk factor assessment

1. Body mass index (BMI)
2. Tobacco use
3. Alcohol abuse
4. Age (especially >50)
5. Gender
6. Sedentary lifestyle
7. Diet
8. Occupation

Name the red flags you are looking for when you are observing the patients clinical presentation

1. No known cause, etiology, insidious onset
2. Symptoms that are unrelieved by PT intervention
3. Gradual, progressive, or cyclical presentation of symptoms (worse, better, worse)
4. Unrelieved by rest or change in position
5. Symptoms seem out of proportion to the injury

Name the red flags you are looking for when observing the patients pain pattern

1. Upper back or shoulder pain (metastasis)
2. Pain accompanied by full and painless ROM
3. Pain not consistent with emotion or psychologi overlay
4. Night pain

Name the red flags for pain pattern with a cardiac origin

Upper quadrant pain with the use of the lower extremities while upper extremities are inactive

Name some constitutional signs

1. Fever
2. Diaphoresis
3. Night sweats
4. Nausea
5. Vomiting
6. Diarrhea
7. Pallor
8. Dizziness
9. Fatigue
10. Weight loss

Name the red flags you are looking for regarding associated signs and symptoms

1. Constitutional symptoms
2. Proximal muscle weakness, especially if associated with DTR's (likely neurological)
3. Systemic joint pain (Lyme, RA)

Name the locations a patient could experience cervicogenic pain and symptoms

1. Cervical
2. Thoracic
3. Head
4. Ear
5. Upper extremities

Name the signs of systemic origin of pain

1. Increased temperature
2. HR > 100
3. Persistent fatigue
4. BP > 160/95

1. Where do the intervertebral discs begin?
2. What is the orientation of the AA facet joints? Why?
3. What is the orientation of the midcervical facet joints? Why?

1. C2/C3
2. Horizontal to allow for rotation
3. 45 degrees, posterior to anterior to allow for flexion/extension

What two structure limit extension?

1. Anterior longitudinal ligament

2. Approximation of the facet joints

What motions occur @ C0/C1?

Flexion/Extension

Side bending

1. Where does the vertebral artery normally enter the vertebral column?
2. Where is the vertebral artery most vulnerable?

1. Usually enters around C6

2. Most vulnerable in the upper cervical spine

1. What cervical vertebrae has the largest spinous process?
2. What cervical vertebrae has a bifid spinous process?

1. C7

2. C5

Why do you normally lose lateral flexion as you age?

Due to degeneration of the oncovertebral joints

1. What motions does the Alar ligament prevent?
2. What are symptoms that would lead you to believe the Alar ligament may be compromised?

1. Excessive ipsilateral rotation and contralateral sidebending

2. Chronic pain, HA, vertebrobasilar symptoms

Name and describe the 4 types of disc lesions

1. Protrusion
- Bulging of the nucleus pulposus
2. Prolapse
- Spinal disc and the associated ligaments remain in tact, but form an outpouching that can press against the nerves
3. Extrusion
- Annular fibers disrupted and nucleus is bulging
4. Sequestration
- Free nuclear material

What is the purpose of the intervertebral disc? What happens when it ruptures?

1. Control movement and shock absorption

2. If the annular fibers tear you have increased segmental motion

What disc lesions cause local pain? Radicular pain?

1. Protrusion and Prolapse

2. Extrusion and Sequestration

What signs and symptoms are associated with cervical myelopathy

1. Expanding symptoms
2. Multi-segmental symptoms
3. Changes in walking/balance
4. Changes in handwriting
5. Changes in bowel/bladder function
6. Parathesias (can be UE, LE, or both)
7. Falls
8. Difficulty swallowing

What are signs and symptoms of radiographic cervical instability

1. (+) Alar ligament, Sharp-purser, vertebral artery
2. HA in occipital region/numbness
3. Difficulty with prolonged positions (esp sitting)
4. Difficulty/reluctance to rotate head
5. Bilateral parathesias
6. Any sign of myelopathy
7. Supporting head on hands

What are signs and symptoms of clinical instability (CCSI)?

1. Head feels heavy
**2. Abhorrent motion (poor quality)
**3. Difficulty with prolonged positions (esp sitting)
4. Recurrent attacks of pain

What is clinical cervical instability? How do you treat?

Instability that can occur anywhere in the cervical spine, but is not picked up on x-ray.

There is no major structural damage

Treat with stabilization exercises

What are the risk factors for fractures?

1. Age (65+)
2. Osteoporosis

What are the clinical indicators for fracture?

1. Active rotation <45 degrees
2. Parathesias
3. Proximal weakness of arms
4. Immediate, worsening, unrelenting pain
5. Midline tenderness

What are red flags for neoplasm?

1. Age (>50)
2. Personal history (NOT family hx)
3. Night pain
4. Pain unrelieved with position change
5. Unexplained weight loss
6. Multisegmental, expanding pain
7. Increased sed rate

What are red flags for systemic disease?

1. Increased temperature (>37 C)
2. Change in vital signs
- BP >160/95
- HR >100
- RR >25
3. Fatigue
4. Multiregion involvement

What was wrong with the original Quebec Task Force Classification of Grades of WAD?

They didn't consider the psychological components, so there were proposed adaptations

What is hyperalgesia?

Increased sensitivity to normally non-painful stimuli

When do you want to begin strengthening exercises after someone comes to you with decreased mobility?

Don't start strengthening until mobility is restored

What factors influence prognosis in patients with WAD neck pain?

1. High baseline pain (>7)
2. Presence of pain @ intake (>52 on NDI)
3. WAD 2 or 3 (not 4 because of immobilization and they can rationalize pain)
4. Female
5. Lower education level
6. History of previous neck pain
7. Catastrophizing
8. Didn't use seat belt

What treatments would you want to perform on a WAD patient?

1. Education
2. Pain Control
3. Traction (for WAD III)
4. Desensitization
5. Psych. counseling

Would you want to perform a sensory and proprioception test on WAD patients?

Yes on all patients

What are signs and symptoms of Cervicogenic Headache

1. Unilateral HA associated with neck/suboccipital location
2. Aggravated by neck movements
3. Aggravated by provocation of facet joints
4. Aggravated by provocation of cervical myofascia
5. Restricted/painful cervical ROM
6. Restricted cervical segmental hypomobility (esp upper cervical)
7. Substandard performance on the CCFT

What are signs and symptoms of TMD?

1. Pain on palpation of TMJ
2. Clicking/popping with opening/closing
3. Restricted ROM in opening
4. Crepitus
5. HA

What is the prediction rule for thoracic manipulation

1. Symptom duration <30 days
2. No symptoms distal to the shoulder
**3. Subjective reports that looking up does not aggravate symptoms
4. Fear Avoidance score <12
5. Diminished upper thoracic kyphosis (T3-T5)
6. Cervical extension <30 degrees

Name the precautions/contraindications for mobilization/manipulation

1. Hypermobility
2. Fracture
3. Increased Fear Avoidance beliefs
4. Collagen Disorder
5. Pregnancy
6. Cancer
7. Inflammation and pain

What is more effective:
Manipulation/mobilization or manipulation/mobilization with exercise

Manipulation/Mobilization with exercise

About this deck

By: Mike Rigdon
Created: 2011-03-06
Size: 43 flashcards
Views: 5

About StudyBlue

“Simply amazing. The flash cards are smooth, there are many different types of studying tools, and there is a great search engine. I praise you on the awesomeness.”
Dennis