CERVICAL SPINE EVALUATION MARK FIGUEROA PHYSICAL THERAPIST

Transcription

1 CERVICAL SPINE EVALUATION MARK FIGUEROA PHYSICAL THERAPIST

2 OVERVIEW OF CLINICAL REASONING Stage of disorder Pathoanatomical diagnosis Signs and symptoms Consideration of the evidence gathered Common sense and best judgement considering the problem Does this really make sense with all the information gathered

3 WORKING TOWARDS MECHANICAL DIAGNOSIS WITH SCANNING EXAM History Assess the status of the neurological system Assess the cervical spine for fractures Assess the intervertebral foramen integrity Screen the peripheral joints for normal vs. abnormal function if necessary Evaluate overall results to look for the patterns consistent with 1) Disc pathology 2) Lateral stenosis with or without nerve involvement 3) Traumatic facet joint inflammation 4) Beginning look at instability

4 PURPOSE OF SCANNING EXAM Determine working hypothesis/clinical diagnosis Screen for serious pathology Assess status of neurological system Whether can move straight to proper exercise program Identify area or areas that need further biomechanical examination

5 CARDINAL SIGNS AND SYMPTOMS Facial paraesthesias or numbness Sensory supply of the face is trigeminal nerve Carotid artery and Vertebral/Basilar artery dissections can cause these symptoms Perioral paraesthesias or numbness Represents a possible lesion in the centromedian portion of the spinothalamic tract Nystagmus Can be sign of Vertebral Artery damage History of Drop Attacks Serious Vertebral/Basilar sign

6 CARDINAL SIGNS AND SYMPTOMS Quadrilateral, hemilateral, or bilateral paraesthesia or numbness with range of motion testing Sign of VBA compromise Complete splinting of the cervical spine in all directions Sign of a fracture especially of the Dens

7 ROM TESTING C-SPINE First complete range of motion with no contact to your patient Observe for cardinal signs If positive refer out

8 RANGE OF MOTION - ROTATION Rotation 80 degrees in each direction Rotation of the cervical spine is a shared motion throughout the entire spine and restrictions can adapt quickly. Subtle restrictions Most provocative motion to osseous, ligamentous and vascular structures Majority of rotation comes from the CV region so significant loss of rotation would indicate problem there With minor loss of rotation watch for side-bending to to complete the motion. If it does upper thoracic problem. If not mid to lower thoracic problem

9 RANGE OF MOTION SIDE BENDING Normal ROM is 45 degrees in each direction This motion occurs on level at a time and cannot be compensated for by other joints At this point if see a large restriction is seen and our scan is negative it definitely warrants a more detailed biomechanical exam

10 RANGE OF MOTION FLEXION There are three types of flexion in the cervical spine Short Flexion - CV region Sharp Purser Response Long Flexion Craniothroacic junction Actual Flexion C2/3through C6/7

11 RANGE OF MOTION EXTENSION Two types of extension Short extension CV extension Long extension C2/3 through C6/7

12 SPECIAL TESTS Ipsilateral side bending and rotation in flexion Ipsilateral side bending and rotation in extension Spurling Test Traction in compression in neutral Traction in different positions

13 UPPER LIMB TENSION TESTS Median nerve Radial nerve Ulnar nerve

14 NEUROLOGIC SCREEN PEARLS Weakness what is the difference and how can you tell Nerve root vs. Peripheral nerve sensory palsy Beware of painless weakness

15 CRANIOVERTEBRAL STRESS TESTS Longitudinal Traction Tectorial Membrane Anterior Stability Test Transverse Ligament Anterior/Posterior Stability Test AO joint Anterior/Posterior Stability Test AA joint Transverse Stability Test Alar Ligaments Lateral Stability Test Dens against osseous ring

16 CRANIOVERTEBRAL BIOMECHANICAL EVALUATION Approximately 50% restriction in rotation with acute injury Atlanto-occipital vs. Atlanto-axial restriction Atlanto-axial manipulation has greatest risk for stroke than any other level in C-spine

17 MID TO LOWER CERVICAL SPINE BIOMECHANICAL EVALUATION Loss of side bending motion Use combined motion of flexion or extension coupled with side bending to define quadrant of restriction Use seated bending test to find level of restriction Confirm in supine to rule out instability

18 UNCOVERTEBRAL JOINTS OR JOINTS OF VON LUSCHKA U- joint restrictions represent a loss of side bending that is present in neutral flexion and extension May need to rule out congenital fusion

19 TESTS FOR SEGMENTAL STABILITY LOWER CERVICAL SPINE Figure of 8 test Anterior stress test Posterior stress test Lateral stress test Rotation stress test