Spine Notes
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| sensory disturbance of the hands, mm wasting of hand intrinsics, unsteady gait, hoffman's reflex, hyperreflexia, B/B Problems, Multisegmental wkness/sensory changes | Red Flag: CERVICAL MYOPATHY
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| >50 y/o, Previous hx of CA, Unexplained wt loss, Constant pn, no relief with bed rest, Night pain | Red Flag: NEOPLASTIC CONDITIONS
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| Occipital HA, Severe limitation during neck AROM in all directions, Signs of cervical myelopathy | Red Flag: UPPER CERVICAL LIGAMENTOUS INSTABILITY
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| Drop attacks, Dizziness(light-headed from neck mvmt), Dysphasia, Dysarthria, Diplopia, +CN tests, (nausea, nystagmus, numbness-lip) | Red Flag: VERTEBRAL ARTERY INSUFFICIENCY
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| Temperature >100, BP >160/95 mmhg, Resting Pulse >100bpm, RR >25 bpm, Fatigue | Red Flag: INFLAMMATORY OR SYSTEMIC DISEASE
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| What are the 6 criteria present to have success with Thoracic Manipulation? (3 of 6 86% success) | 1. Symptom duration <30 days
2. No symptoms distal to the shoulder
3. FABQPA <12
4. Looking up does not aggravate symptoms
5. Cervical ext <30
6. Flat T3-T5
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| What are the 6 criteria present to have success with Cervical Manipulation? (4 of 6 89% success) | 1. Initial NDI <11.5
2. Bilateral involvement pattern
3. Not performing sedentary work >5 hrs/day
4. Feeling better with movement
5. Did not feel worse while extending neck
6. Diagnosis of spondylosis without radiculopathy
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| What are the adjunct treatments for all patients with neck pain? | Goal:Help to improve AROM, decrease pn and disability
-Thoracic, CT Mob/Manip
-Mobilization with movement
-AROM exercises
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| What are the criteria for the mobility category? | 1. Recent onset <4 weeks
2. Rarely have upper quarter symptoms
3. AROM does not peripheralize sx
4. No signs of nerve root compression
5. AROM discrepancy (SB,Rot)
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| How would you treat someone in the mobility category? | -Mobilizations: opening/closing/traction
-MET
-Soft tissue techniques (suboccipital release)
-AROM exercises
-Thoracic/CT Manipulations
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| What are the criteria for the centralization category? | 1. Referral of pain into the upper extremities/hand
2. Radiculopathy
3. Referral to mid-scapular area
4. Peripheralization with AROM
5. Increased symptoms with closing pattern (<60 SB, Rot ipsi)
6. +Spurling, ULTTA, Distraction Test
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| What four variables significantly increased the likelihood the patient has cervical radiculopathy? | 1. Ipsilateral cervical rotation <60
2. ULTTA
3. Distraction Test
4. Spurling's Test
+LR= 30
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| How would you treat a pt in the centralization category? | Goal: centralize symptoms, decrease pn and disability.
-Mechanical cervical traction
-Manual cervical traction
-Traction manip
-Chin retraction ex
-Lateral slide glide with neurodynamic positioning
-Thoracic/CT Manip
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| What are the criteria for pain category? | 1. Higher level of pain and disability
2. Very recent onset of symptoms
3. Referred or radiating symptoms into upper quarter
4. Cervicogenic HA
5. Difficult exam due to exacerbation of sxs
6. Poorly tolerates manual or movement interventions
7. Trau
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| How would you treat a pt in the pain category? | Goal: decrease pn and disability, permit further examination
-Thoracic/CT Manip
-Gentle AROM
-Gentle massage
-Modalities
-Activity modification
-Short term cervical collar
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| What are the criteria for the exercise/conditioning category? | 1. Lower pn and disability scores
2. Longer duration of symptoms
3. No signs of nerve root compression
4. No peripheralization/centralization with AROM
*often started in another category and progressed to conditioning
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| How would you treat someone in the ex/cond category? | -Strength and endurance exercises for the neck and upper quarter (deep cervical flexors)
-Aerobic conditioning exercises
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| What are the criteria for HA category? | 1. Unilateral HA "ram's horn"
2. Onset preceded by neck pn
3. Triggered by neck movement or positions
4. Reproduced by pressure on posterior neck
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| How would you treat someone in HA category? | -Cervical spine mobility interventions
-Suboccipital release, strain/counterstrain
-Strengthening of neck and upper quarter mms
-Postural education
-MET to AA jt
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