PT851: Cervical Spine Lecture Notes - Flashcards

Flashcards covering neck pain prevalence, pathology, lifespan changes, clinical examination, diagnosis, classification systems, cervical spine biomechanics, red flags, instability screening, specific tests (Spurling's, Sharp-Purser), pain patterns, and conditions beyond PT scope.

What is the annual prevalence of neck pain?

30%

According to Cohen et al, 2015, what is the ranking of neck pain as a cause of disability?

4th leading cause of disability

Is neck pain more prevalent in males or females?

Females > males

At what age is atraumatic neck pain very common?

Middle age (40s & 50s)

What percentage of neck pain presentations have no clearly identifiable patho-anatomical origin?

90+% of presentations

When do transverse fissures begin forming in the anulus fibrosus (AF) of the cervical spine?

~age 8-9

What do cervical discs progressively become over the lifespan due to transverse fissures?

Almost bipartite

According to De Bruin et al, 2016, why might low signal intensity or dehydration of intervertebral discs be present even in young patients?

Pre-existing and part of the natural course of aging

What is considered a 'normal' process of aging for the cervical spine and is frequently evident at disc-body margins, Z-joint margins, and uncinate processes?

Osteophytic enlargement

What imaging characteristic is common in the 30s and almost all by 50s in the cervical spine, but has minimal association with symptoms?

Extension of disc beyond margins of vertebral bodies

According to Nakashima et al, 2015, where is MRI evidence of DDD common in 20s?

Especially C5-6 & C6-7

According to Park et al, 2014, where is CT Z-joint degeneration greatest?

C2–C3, C3–C4, & C4–C5

What often results in decreased IV foraminal dimensions due to 'degenerative' processes?

Loss of disc height & osteophytic growth

What is the primary role of a physical therapist in initial patient assessment for neck pain related to scope of practice?

Determine appropriateness for PT, and if not, refer to the best provider.

What is a PT's ethical and legal obligation if a patient's presentation is outside their scope of practice?

Duty to refer

What is an example of a condition considered outside the scope of PT practice for initial detection?

CNS/UMN involvement, such as suspicion of cervical spondylotic myelopathy

What is an example of a serious pathology that may masquerade as an MSK condition and is outside PT scope?

Pancoast tumor

What are some associated conditions that are typically within the scope of PT practice for mechanical neck pain?

Cervicogenic dizziness, portion of concussion care

What is the purpose of 'screening' in physical therapy?

To recognize conditions beyond the scope of PT practice, NOT to achieve differential diagnosis.

What are the four categories in the impairment/function-based classification system for neck pain?

Neck Pain w/ Mobility Deficit, Neck Pain w/ Headache, Neck Pain w/ Movement Coordination Impairments, Neck Pain w/ Radiating Pain

Why is a patho-anatomically based system often not used for neck pain diagnosis in PT?

It's difficult to selectively test specific structures without concurrently stressing others.

Where can clinical practice guidelines for orthopaedic physical therapy be found?

Published by the Academy of Orthopaedic Physical Therapy (orthopt.org)

Approximately what percentage of overall rotation in the cervical spine comes from the atlanto-axial (A-A) joint complex?

Apx 50%

According to Zhou et al, 2020, which two segments are the least mobile in the cervical spine during in vivo fluoroscopy?

O-C1 & C7-T1

Which cervical segment is the most mobile?

C1-2 (Atlanto-Axial joint)

What arthrokinematic motion occurs at the O-C1 joint during flexion?

Posterior glide of occiput on atlas OR anterior glide of atlas on occiput

What arthrokinematic motion occurs at the O-C1 joint during extension?

Anterior glide of occiput on atlas OR posterior glide of atlas on occiput

How many articulations comprise the Atlanto-Axial (C1-2) joints?

3 articulations: 2 lateral joints and a central joint of odontoid with anterior arch of C1

Rotation greater than 30 degrees at the Atlanto-Axial (A-A) joint can affect which arteries?

Vertebral Arteries, by stretching and kinking contralateral side.

What is the range of flexion-extension for each typical cervical segment (C2-C7)?

~12-20 degrees

What percentage of the head's weight can the osteoligamentous cervical spine bear as a critical load?

Only 20%-25%

What contributes the remaining load-bearing capacity for the head's weight in the cervical spine?

Musculature

What arthrokinematic movements are included in lower cervical segment flexion?

Anterior & superior movement of superior facet on inferior facet

What ligaments limit lower cervical segment flexion?

Z-joint Capsules, Posterior Longitudinal Ligament, Ligamentum Flavum, Interspinous Ligaments

What arthrokinematic movements are included in lower cervical segment extension?

Posterior & inferior glide of superior facet on inferior facet

What structures limit lower cervical segment extension?

Anterior Longitudinal Ligament, Anulus Fibrosis, Impaction of Spinous Processes or Laminae

In which lower cervical segments is foraminal change with flexion-extension minimal?

C5-6 & C6-7

What happens to the canal cross-sectional area during cervical spine extension?

Significant decrease

What happens to the 'space available for the cord' with rotation?

Decreases

What are the limitations during lateral flexion of the lower cervical spine?

Contralateral ligamentous structures & muscles, and approximation of ipsilateral Z & Uncinate joints

What is the typical coupling pattern of rotation and lateral flexion in the cervical spine (C2-T4)?

Lateral flexion is accompanied by ipsilateral rotation

What functional pattern of head movement includes lower cervical flexion and upper cervical extension?

Protrusion of head

What functional pattern of head movement includes lower cervical extension and upper cervical flexion?

Retraction of head

Which cervical segment acts as a transition between the O-A-A complex and the lower segments?

C2-3

What two critical tools are used for fracture screening in significant cervical trauma?

Canadian Cervical Spine Rule and NEXUS Low Risk Rule

What is considered a 'high-risk factor' in the Canadian C-Spine Rule for imaging?

Age ≥ 65, or Dangerous Mechanism, or Upper Extremity Paresthesia

What reflex indicates an Upper Motor Neuron (UMN) lesion, distinct from an UE Babinski?

Hoffmann’s Reflex

What reflex is assessed on the plantar surface of the foot to check for an UMN lesion?

Babinski Reflex (upgoing response)

What is the key purpose of the 'Scan Exam' in cervical spine evaluation?

To recognize serious pathology, if present, and to determine the focus of a detailed exam.

What is the purpose of the 'Detailed/Biomechanical Exam'?

To identify/delineate mechanical dysfunction

What are the primary components of a neurological exam in the scan exam?

MMTs, DTRs/MSRs, Sensation, ULTTs, Cranial Nerve Screen, Myoclonus, Plantar Response

What is the general sensitivity and specificity of Muscle Stretch Reflexes for radiculopathy?

Low sensitivity, High specificity

What is the general sensitivity and specificity of Myotome Test Results for radiculopathy?

Low sensitivity for C5-C7, higher specificity

What is the general sensitivity and specificity of Sensation Testing for radiculopathy?

Low sensitivity, moderate to high specificity

What does a 'radiculopathy' imply if a Lower Motor Neuron (LMN) deficit is present and isolated to a single level?

Highly probable radiculopathy

What is 'somatic referred pain'?

Nociceptive input from a structure (MSK or visceral) perceived as pain distant from that structure.

What is 'radiating pain'?

Nociceptive input from a nerve root, perceived consistent with that nerve root distribution, often neuropathic.

What is the relationship between radiating pain and referred pain?

All radiating pain is referred pain, but not all referred pain is radiating pain.

What is the sensitivity and specificity of axial distraction for diagnosing radiculopathy and response to intervention?

Sensitivity: .40-.44; Specificity: .90-1.0

What is the purpose of the Spurling's Maneuver?

Specifically for provocation of radiating symptoms (radiculopathy).

What is another name for the 'Shoulder Abduction Test'?

Bakody’s Sign

What is the definition of 'instability' in the cervical spine?

Representative of a range of disorders relating to excessive movement and/or diminished motor control.

What type of spinal instability is characterized by demonstrable anatomical disruption or significant alterations in spatial relationships, often painful and potentially catastrophic?

Severe Instability

What type of spinal instability involves modest increases of magnitude of motion within normal vertebral segments with reduced motor control, not demonstrable on imaging?

Mild Instability

What is one specific upper cervical stability test primarily studied in those with established RA and AS?

Modified Sharp-Purser Test

Why is very selective use and caution advised for the Sharp-Purser Test?

Due to inconsistent validity, poor inter-rater reliability, and potential to cause harm.

What are some common clinical findings reported by Australian Physios for 'mild cervical instability'?

History of major trauma, reports of neck catching/locking/giving way, poor muscular control, unpredictability of symptoms.

According to Cook et al, 2005, what clinical indicators suggest cervical instability?

Intolerance to static postures, fatigue/inability to hold head up, frequent self-manipulation, feeling of instability, sharp pain with sudden movements, poor coordination, abnormal joint play, aberrant movement.

What are some conditions that elevate the risk for cervical instability?

Rheumatoid Arthritis, Down Syndrome, Ankylosing Spondylitis, Os Odontoideum, Klippel-Feil Syndrome, Marfan Syndrome.

What is the most common complaint associated with cervical subluxation, especially at the CV junction?

Neck pain

What is Passive Intervertebral Motion (PIVM) primarily used to identify?

Focal symptom origin, mechanical dysfunction, motion loss, excessive motion (more difficult).

According to Ingram et al, 2015, how does the cervical spine of symptomatic subjects compare to asymptomatic subjects when measured by mechanical device?

Greater 'stiffness'

What is the suggested force level for Posterior to Anterior (P-A) assessment in the cervical spine for better accuracy?

Lighter force (less than 20N or 4.5 lbs)

What is the sensitivity and specificity of the Flexion-Rotation Test?

Sensitivity: .86; Specificity: 1.0

What does the Flexion-Rotation Test assess?

Upper cervical rotation loss, correlated with headache and A-A motion.

What is the primary value of classification systems like the Impairment/Function Based Classification System?

On visit 1, for initial decisions.

What are some symptoms associated with 'Neck Pain w/ Mobility Deficit'?

Unilateral neck pain, neck motion limitations, onset often unguarded/awkward movement or position, referred UE pain may be present.

What are some impairments associated with 'Neck Pain w/ Headache'?

Headache reproduced with provocation of upper cervical segments, limited CROM, restricted upper cervical mobility, strength & endurance deficits deep cervical flexors.

What are some symptoms associated with 'Neck Pain w/ Radiating Pain'?

Neck pain with radiating pain in UE, UE paresthesias, numbness, and weakness may be present.

What are some impairments associated with 'Neck Pain w/ Movement Coordination Impairments'?

Strength, endurance, & coordination deficits of deep cervical flexor muscles, neck pain with mid-range movements (worsening at end range), neck & UE related pain reproduced with provocation of involved segments, segmental instability may be present.

What is the preferred term for 'whiplash'?

'Whiplash Associated Disorders' (WAD)

What are some conditions beyond the scope of PT practice that can mimic cervical spine presentations?

Cervical Spondylotic Myelopathy, Pancoast Syndrome, Non-cervicogenic Headache, Cervical Artery Involvement.

What are some initial subtle symptoms of Cervical Spondylotic Myelopathy?

Only sensory disturbances in UEs.

What syndrome mimics MSK conditions, with 90% of patients experiencing shoulder pain, and is often misdiagnosed early?

Pancoast Syndrome

What are the common symptoms of Horner's Syndrome, which can be present in Pancoast Syndrome?

Ipsilateral pupil constriction, eyelid droop, facial anhidrosis/flushing, anisocoria (sympathetic loss).