First Exam and SG

First exam and SG A decerebrate posture is identified when there is flexion of the elbows and wrists, clenched fists, and extension of the lower extremity - False Axial loading of the C-spine combined with what other motion is most likely to produce a catastrophic injury - Flexion A syndrome characterized by the narrowing of the spinal canal that can impinge the spinal cord resulting in burning and tingling bilaterally is known as - Spinal stenosis Degeneration the vertebral epiphyseal endplates that results if the following kyphosis deformity is known as - Scheuermann’s disease SCM OIA - O: Manubrium, clavicle I: Mastoid process, superior nuchal line A: Neck extension, shoulder elevation Spinal nerve root that innervates the cutaneous pattern on the deltoid - C5 Characteristics that would suggest a cervical sprain rather than a strain - Symptoms that persist for several days A burst fx typically occurs in which part of the vertebral column - Cervical spine Crushed in all directions Clay shovelers fx - Avulsion of the spinous process Jefferson fx - Burst fx of the bilateral anterior/posterior arches Due to axial compress and HE Hangmans fx  Bilateral fx of pars interarticularis of axis Extension tear drop fx - Looks like a tear drop Lower or upper C spine Cervical dislocation - Violent flexion and rotation of the head Avoid head down contact Educate patients Burner/stinger - Define: Brachial plexus is stretched or compressed and the peripheral nerve function is disrupted, no degenerative changes Anatomy: Brachial plexus MOI: Lateral flexion of c spine and depression of the shoulder S&S: Burning sensation, N&T, weakness in arm/shoulder Risk factors: Improper tacking techniques, spinal stenosis, can re occur Diagnostic methods: shoulder depression test Tx/referral: Dermatomes myotomes, reflex testing, rule out spinal cord injury, stretch and strengthen Facts: Transient symptoms can occur Increases intrathecal pressure; suggest disc or nerve root pathology - Valsalva maneuver Relieves symptoms in the presence of a herniated disc - Shoulder ABD test Exacerbates radicular symptoms; suggests nerve root impingement - Compression test Exacerbates radicular symptoms; suggests nerve root impingement more from spondy injuries - Spurlings Reproduces symptoms; suggest brachial plexus irritation - Shoulder depression test Fatigue or numbness with holding arm elevation and finger flexion, suggests TOS - ROOS Nerve root compression or related pathology - Cervical distraction test Symptoms subside Pulse diminishes with head rotation toward affected side, suggest scalene compression of the subclavian artery - Adsons Pulse decreases with shoulder ABD position; indicates TOS compression - Allens Pulse decreases with shoulder depression and neck movement; suggests TOS costoclavicular compression - Military brace A positive may cause dizziness, nystagmus, syncope - Vertebral artery test A patient exhibits abnormal posturing with arms flexed toward the chest, wrists and fingers bent, and legs extended. This type of posturing is most associated with damage at which level of the central nervous system - Brainstem at the level of the midbrain or above Which of the following best differentiates cervical radiculopathy from brachial plexus neuropathy in clinical presentation - Brachial plexus neuropathy results in transient symptoms, while cervical radiculopathy may have persistent deficits What is most suggestive of C-spine stenosis rather than an acute disc herniation - Sudden onset of unilateral radicular symptoms Patients with cervical radiculopathy often experience relief with manual traction or distraction of the C-spine - True In TOS, neurogenic TOS is the least common type, while vascular TOS accounts for majority of cases - False C-spine allows for more ROM than the thoracic or lumbar spine - True C-spine fractures at C1 or C2 can be life threatening due to their proximity to the brain stem - True The brachial plexus originates from the nerve roots C4-T1 and can be affected by Cspine injuries - False Brachia plexus - C5-T1 - Atlas - Axis C1 C2 Cervical sprain - Define Anatomy MOI S&S - Risk factors Diagnostic methods Tx/referral Facts Involuntary, repetitive, rhythmic movement of the eyes - Nystagmus Uncoordinated, unsteady walking pattern - Ataxia gait Loss of consciousness or fainting - Syncope Difficulty swallowing - Dysphagia Perception of double vision - Diplopia Slurred or impaired speech - Dysarthria Anatomical landmark where the brachial plexus is most superficial - Erbs point TOS - Define: Collection of syndromes that cause compression of brachial plexus, subclavian artery or vein due to ligament or muscle obstacles Anatomy: Subclavian artery/vein, brachial plexus MOI: Acute neck injury (neuro), gradual or spontaneous, arterial insufficiency, venous obstruction (arterial/venous) - S&S: Cold intolerance, occipital headache (All) achy pain in axillary region, nocturnal pain (neuro), chest pain (venous), radiating pain (arterial) Risk factors: Costoclavicular syndrome, hyper ABD syndrome, C-rib syndrome, scalene anterior syndrome Diagnostic methods: ROOS, adsons, allens, military brace Tx/referral: Improve posture, work on ergonomics, reduce pain, modify activities Normal consequence of aging - Degenerative disc disease Kehrs sign - Ruptured spleen Decorticate posturing - Injury above brain stem Ridig ext of legs and flexion of arms wrist and hands towards Decerebrate posturing - Injury of upper brain stem Rigid extension of all 4 extremities, arms IR and pronated CRANIAL NERVES i. ii. iii. iv. v. Olfactory: Smell (sensory) Optic: Vision (sensory) Oculomotor: Most eye movement (motor) Trochlear: Eye adduction (motor) Trigeminal: Face sensation, mastication (both) vi. vii. viii. ix. x. xi. xii. Abducens: ABD the eye (motor) Facial: Facial expression, taste (both) Vestibulocochlear: Hearing, balance (sensory) Glossopharyngeal: Taste, gag reflux (both) Vagus: Gag reflex, parasympathetic innervation (both) Accessory: Shoulder shrug (motor) Hypoglossal: Swallow, speech (motor) Reflexes - Biceps: C5 Brachioradialis: C6 Triceps: C7 1: Diminished reflex 2: Normal reflex 3: Excessive or exaggerated 4: Very brisk Myotomes - C1-C2: Neck extension C2-C3: Neck flexion C4: Shoulder shrug C5: Deltoid/fly’s C6: Wrist extension/elbow flexion C7: Wrist flexion/elbow extension C8: Thumb extension T1: Abduction Dermatomes - C1: Vertex of the skull C2: Temple, forehead, occiput C3: Neck C4: Shoulder area, clavicle C5: Deltoid area C6: Radial side of hand to thumb and index finger C7: Middle finger C8: Medial arm and forearm to index, long and ring fingers - T1: Medial forearm Cervical strain - MOI: Sudden turn of head, forced flexion, extension, rotation Anatomy: Upper traps, scalenes, splenius capitis, cervicis S&S: Localized pain, pt tenderness, restricted ROM, won’t move neck TX: ROM exercises, Estem, Cervical traction Cervical sprains - MOI: Snapping of head/neck (same as strain but more violent) Anatomy: A/P longitudinal ligament, interspinous ligament, supraspinous ligament S&S: Radiating pain to shoulders/upper back, muscle spasm, headaches, N&T in arm/hand, weakness in arm Tx: Cervical traction, posture correction, avoid activities that aggravate - Herniated disc - Extruded posterolateral disk fragment or degeneration MOI: Sustained repetitive C loading S&S: Neck pain, decreased ROM, radicular symptoms, UE motor weakness C-spine disc degeneration - Wearing of the spinal disc Aging, repetitive strain Radiating pain, stiff neck, decreased ROM