Term
| Serious conditions to be screened in cervical spine patients (7) |
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Definition
fx
instability
vascular insufficiency
neoplasm
CNS degenerative disease
CVA
cord compression/myelopathy |
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Term
| steps of eval/rx of cervical pain pts (6) |
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Definition
screen for serious conditions
screen for non-spinal ortho & peripheral nn entrapment
determine tissue at fault
quantify pain/impairments/fxnl loss
(determine if pain processing issues are present)
determine effective rx |
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Term
| Assume the presence of cervical fx when... |
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Definition
pt experienced ANY trauma c loss of consciousness
until excluded by CT/MRI |
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Term
| Canadian C-Spine Rules (3) |
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Definition
high risk factor (mandating radiography)
low risk factor (prevents safe ROM assessment)
ability to rotate 45º bilat |
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Term
| Canadian C-Spine Rules: high risk factors (3) |
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Definition
age >65
dangerous mechanism
paraesthesias in extremities |
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Term
| Canadian C-Spine Rules: high risk factors - dangerous mechanisms (3) |
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Definition
fall >1m or 5 stairs
MVA >100km/hr (62mph), rollover or ejection
bicycle accident |
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Term
| Canadian C-Spine Rules: low risk factors (5) |
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Definition
not simple rearend MVA
unable to sit in ER
not amb since injury
immediate onset of pain
midline pain |
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Term
| Canadian C-Spine Rules: sensitivity & specificity |
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Definition
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Term
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Definition
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Term
| neural arch fx: mech of injury |
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Definition
hyperext (post ring of C1 jammed betwn C2/occiput)
OR
axial load |
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Term
|
Definition
collar
C0-C2 fusion if lateral masses spreading (2º to rupture of transverse ligt) |
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Term
| odontoid fx: mech of injury |
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| C3-C7 flex-compression types of injury (2) |
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Definition
ant wedge fx
burst fx (post fragment may >> spinal canal >> cord injury) |
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Term
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Definition
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Term
| C3-C7 hyperext injuries: pathology (3) |
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Definition
tear ant ligt
avulsion fx
facet compression |
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Term
| C3-C7 hyperext injuries: Rx |
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Definition
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Term
| C3-C7 hyperext injuries: xray |
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Definition
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Term
| C3-C7 flex injuries: types (2) |
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Definition
dislocation s fx,
fx dislocation |
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Term
| C3-C7 flex injuries: dislocation s fx description (3) |
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Definition
post ligt torn;
unilat OR bilat facet dislocation;
Rx = fusion |
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Term
| C3-C7 flex injuries: fx dislocation description (2) |
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Definition
usually assoc c cord damage
injury sufficient to cause burst fx AND post ligt tear |
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Term
|
Definition
atlas-dens interval
(AP gap; ant portion of C1) |
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Term
|
Definition
2-3 mm
(>2-3 mm is too high) |
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Term
| Causes of non-traumatic instability (9) |
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Definition
arthritis
Marfan's syndrome
Grisel's syndrome
Down's syndrome
Ehlers Danlos syndrome
prolonged corticosteroid use
osteoporosis
congenital abnormalities
Chiari malformation (types I-IV) |
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Term
| complications of RA in c-spine |
|
Definition
cord compression >> sudden death
AA instability (12%)
sub-axial sublux (20%) |
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Term
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Definition
genetic ST disorder;
usually tall, thin individual (arm span longer than height)
more likely to have spondylo defects |
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Term
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Definition
wrist sign (overlap thumb/little finger @ wrist)
thumb sign (thumb ext beyond wrist)
pectus excavatum |
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Term
|
Definition
| spontaneous AA dislocation |
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Term
| Grisel's syndrome: signs (3) |
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Definition
children 6-12 y/o
upper resp infection/chronic sore throat
spontaneous torticollis >> cock-robin posture |
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Term
|
Definition
early: antibiotics, collar, rest
late: fusion |
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Term
| Down's syndrome: consequences (2) |
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Definition
odontoid hypoplasia (22% of children, 15% of adults)
incr ADI |
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Term
|
Definition
ST disorder;
incr elastin in ST
(+ Beighton index) |
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Term
|
Definition
| prone to jt dislocation; AA sublux |
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Term
| Dens: full development at age... |
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Definition
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Term
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Definition
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Term
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Definition
| inf displacement of cerebellum into foramen magnum (sometimes causes instability) |
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Term
| Chiari malformation: types |
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Definition
I: SLOW development, UE weakness, HA, clumsiness, hearing loss, ataxia, hoarseness/dysphagia
II-IV: early dx |
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Term
| Chiari malformation: avoid... |
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Definition
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Term
| Non-traumatic instability: S/Sx |
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Definition
sub-occ neck pain, possible HA
fever (Grisel's)
pain during ROM (rather than EOR)
MAYBE cord signs, deformity (cock-robin)
perioral symptoms, face numbness, tinnitus
mm spasm |
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Term
| Cardinal signs of non-traumatic instability (6) |
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Definition
perioral anesthesia/peristhesia
quad limb paresthesia
drop attack
nystagmus
trauma
ROM in supine > ROM in sitting/standing |
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Term
| Non-traumatic instability: Rx |
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Definition
sx stabilization (if neuro compromise)
exercise program (isometrics to subocc mm)
avoid flex |
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Term
| Cervical Arterial Dysfxn: 2 parts |
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Definition
VAI
ICA (internal carotid) |
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Term
| Parts of vertebral artery (4) |
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Definition
pars prevertebralis
pars transversaria
pars axo-atlantis
pars subarachnoidealis |
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Term
| Pars prevertebralis: point of compression |
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Definition
| between ant/mid scalenes (mm spasm, TOS) |
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Term
| Pars transversaria: point of compression |
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Definition
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Term
| Pars axo-atlantis: point of compression |
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Definition
| contralat rot >> intima damage >> bleeding/embolus |
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Term
| Pars subarachnoidealis: point of compression |
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Definition
| subocc ext (impinged between occiput & C1) |
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Term
| Dangerous components of cervical manip (comps that >> vertebral a. trauma) (3) |
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Definition
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Term
|
Definition
ipsilat post neck pain
occipital HA
5 Ds
3Ns
(ataxic gait, dysmetria, dyssynergia, rotatory nystagmus, CN VII palsy, paresthesia) |
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Term
|
Definition
dizziness
diplopia
drop attacks
dysarthria
dysphagia |
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Term
|
Definition
nausea
numbness (usually extremities)
nystagmus |
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Term
| S/Sx of internal carotid a dysfxn (6) |
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Definition
Horner's syndrome
pulsatile tinnitus
CN VI palsy
scalp tenderness
neck swelling
orbital pain |
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Term
| Causes of Dizziness: 3 categories |
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Definition
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Term
| Causes of Dizziness: inner ear (5) |
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Definition
Meniere's syndrome
infection
trauma
vestibulotoxic drugs
BPPV |
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Term
| Causes of Dizziness: central (4) |
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Definition
VBI
tumors
cervical/SCM proprioceptor dysfxn
demyelinating disease |
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Term
| Causes of Dizziness: systemic (4) |
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Definition
drugs (anticonvulsants, antihypertensives, hypnotics, alcohol, tranquilizers)
hypotension
hypothyroidism
dehydration |
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Term
| Questions to ask pt c suspected VBI (4) |
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Definition
Trauma?
Cardiovascular hx
type of dizziness
positional symptoms (e.g. at hairdresser) |
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Term
| C-spine pt neoplasm locations (3) |
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Definition
intracranial
intraspinal
pancoast |
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Term
| Intracranial tumor: S/Sx (5) |
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Definition
45-55 y/o
HA (33% of pts) - retro-orbital, worse in AM, worse c exercise/bending forward
visual blind spots (incr ICP)
lethargy, mental clouding
CN VI palsy |
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Term
|
Definition
>50 y/o
hx of CA
constant pain
night pain
HA
unexplained wt loss
visual ∆s
lethargy |
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Term
| Tests to screen for tumors (3) |
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Definition
CN testing
UMN testing
imaging |
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Term
| Intraspinal tumor: types (2) |
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Definition
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Term
| Intraspinal tumor: S/Sx (3) |
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Definition
intially: radiculopathy
progression: UMNL, Brown-Sequard
incr urinary frequency/impotence (males) |
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Term
|
Definition
apical lung CA;
asymptomatic until impingement of brachial plexus |
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Term
|
Definition
ulnar n distribution; presents like TOS
shoulder pain (90%)
ulnar n distribution of pain |
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Term
| Horner's syndrome caused by... |
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Definition
| involvement of cervical sympathetic nn (occulosympathetic) |
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Term
| Horner's syndrome: S/Sx (3) |
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Definition
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Term
| Degenerative diseases of CNS (2) |
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Definition
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Term
|
Definition
viral-induced autoimmune disease of CNS >> edema, inflammation, demyelination
F>M
relapses
L'Hermittes sign |
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Term
|
Definition
| progressive motor neuron dz (unknown cause) >> degen/scarring of lateral spinal cord/brain stem/cortex |
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Term
|
Definition
early: asymmetrical weakness
fasciculation
UMN signs
depends on whether UMN/LMN affected first |
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Term
|
Definition
>65 y/o (72% of strokes)
confused c cervical radiculopathy |
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Term
|
Definition
| cervical spondylitic myelopathy |
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Term
|
Definition
narrow spinal canal
C6 level affected
usually post part of cord
ligt flavum hypertrophy >> cord compression in ext |
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Term
|
Definition
vascular (ant spinal a. vulnerable to compression)
nerve (demyelination; Schwann cells sensitive to compression) |
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Term
|
Definition
insidious onset (abrupt = vascular ischemia)
weakness/clumsiness of UE
ataxia, wide gait
pain/temp affected on opposite side
positive Hoffman's
reflexes: diminished at level, hyper below
decr proprio/balance/vibration |
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Term
|
Definition
severe: decompression sx
mild: C traction & T manip |
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Term
| Mandatory questions of C-spine (3) |
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Definition
Dizziness, drop attacks, blackouts?
RA/inflammatory arthritis?
Neuro symptoms in legs (pain, N&T, spasticity, difficulty walking)? |
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Term
| Infectious disorders of CNS |
|
Definition
| meningitis (bacterial OR viral) |
|
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Term
|
Definition
HA
stiff/painful neck
*fever*
Kernig's sign
Brudzinski's sign
Neurological ∆s (CNs, seizures, coma) |
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