MSK 2 - Cervical Spine Safety Considerations

what are you asking yourself when screenning a c-spine patient

manage/co-manage/refer out

do you have the canadian cervical spine rules memorized?

yes??? there is no other option

why do we screen cranial nerves

posterior neck and cranial nerves are supplied by same circulation --> strong association

patient presentation that would steer you away from a vasculogenic approach

no headache, no PMHx, no CN signs

patient presentation that would steer you towards a vasculogenic hypothesis

CN signs, dizziness, severe pain, etc

most common risk factors for vascular dissection in order (there are 9)

recent trauma

vascular anomaly

current/past smoking

migraine

high total cholesterol

recent infection

hypertension

oral contraception

family stroke history

most common risk factors for nondissection vascular events are similar to dissection EXCEPT you add

recent infection, recent trauma

common complaints for dissection events in order

headache

neck pain

vision disturbance

UE paresthesia

dizziness

facial paresthesia

LE paresthesia

common complaints for nondissection events in order

headache

UE paresthesia

LE paresthesia

vision disturbance

facial paresthesia

dizziness

clinical features of VBA dissection

unsteadiness/ataxia

dysphasia/dysarthria/aphasia

LE weakness

UE weakness

dysphagia

N/V

facial palsy

dizziness/disequilibrium

ptosis

loss of consciousness

confusion

drowsiness

clinical features of ICA dissction

ptosis

UE weakness

facial palsy

LE weakness

dysphasia/dysarthria/aphasia

unsteadiness/ataxia

N/V

drowsiness

loss of consciousness

confusion

dysphagia

clinical features of nondissection of VBA or ICA

UE weakness

dysphasia/dysarthria/aphasia

LE weakness

ptosis

facial palsy

unsteadiness/ataxia

confusion

N/V

dysphagia

loss of consciousness

drowsiness

where would you pick up a lot of signs of vasulogenic involvement

history, CN exam

what is positional provocative testing used for

vertebral artery

vertebral artery testing should start in ___ and proceed to ___

seated; supine

how do we screen brainstem and wernicke's area?

count backwards from 15

consensual light reflex

have pt stick tongue out

what are we looking for when pt is counting backwards

changes in pupils

strabismus

nystagmus

reddening of face

how can we differentiate between BPPV and VBI

BPPV lasts a few seconds-1min while VBI lasts several minutes

BPPV is effected by gravity, VBI is not

VBI nystagmus is not fatiguable and cannot stabilize with fixation while BPPV does and is fatiguable

what is VBI

cranial nerve signs in response to movement/sustained positions of the C-spine

when should we use caution (memorize this)

trauma (especially hyperextension + axial load)

RA, psoriatic arthritis, ankylosing spondylitis

extensive corticosteroid use

congenital malformation

down syndrome

children <12 (developmentally immature)

osteoporosis

what do corticosteroids do in the C spine

soften dens and ligaments, promote osteoporosis

what does the sharp-purser test assess

AA stability, intactness of transverse ligament

what might disrupt the transverse ligament

fracture at base of odontoid

what is a positive sharp-purser test

clunk (NOT A SYMPTOM REPRODUCTION TEST)

clunk indicates relocation of head onto C2

what does the C2 spinous kick assess

alar ligament integrity

what is a positive C2 spinous kick test

asymmetry of C2 spinous process with passive sidebending

what are you evaluating with the lateral shear test

translation of atlas in frontal plane (should not be much)

what is a positive lateral shear test

soft end feel (normal is firm)

what is a positive tectorial membrane test

reproduction of symptoms (suggest upper cervical ligamentous instability, esp tectorial membrane)

most common risk factors for nondissection vascular events are similar to dissection EXCEPT you ad in

most common risk factors for nondissection vascular events are similar to dissection EXCEPT you ad in

most common risk factors for nondissection vascular events are similar to dissection EXCEPT you ad in