cervical

What is the cluster tests for cervical radiculopathy?

1. Spurling's 2. distraction 3. ULTT

risk factors of cervical pain

1. female>male 2. advancing age 3. job demands 4. current or previous smoker 5. prior hx of LB pain **findings on imaging not indicative of outcomes

Describe Tension HA

1. generalized B symptoms 2. moderate intensity 3. pressure w/o throbbing 4. tightness or aching 5. lasts 30 minutes intermittently up to 7 days 6. Provoked by fatigued 7. associated with depression worry, and anxiety

Describe Pancoast tumor

1. tumor of the apical lung 2. can involve caudal cervical nerve roots 3. can initially cervical radiculopathy 4. Horner's syndrome5 - develop 2/2 sympathetic nerve damage - signs: affected side of the face *Ptosis *myosis (constricted pupil) *dilation lag * thalamus (eye sunken in) * decrease sweating on affected side * facial flushing 2/2 dilated blood vessels

prognosis of cervical pain- recovery from acute onset of neck pain occurs within what time frame?

6-12 weeks little to no recovery through 12 months

What is the normal range of motion available at the C1-C2 joint? A. 25 degrees of flexion and extension B. 30 degrees of side bending C. 25 degrees of coupled flexion/extension/side bending D. 10 degrees of side bending

A. 25 degrees of flexion and extension Explanation Correct. Although the C1-C2 joint is primarily responsible for rotation here, there is still approximately 25 degrees of available flexion and extension at the C1-C2 joint.

Which of the following statements is TRUE regarding posterior circulatory insufficiency? A. A majority of patients present with prodromal symptoms B. Hemianopia is the most common symptom indicating occlusion C. Vertebral artery testing can also assess carotid artery insufficiency D. None of the statements are true

A. A majority of patients present with prodromal symptoms Explanation Correct. In almost 75% of cases, prodromal and progressive symptoms are present in patients with posterior circulatory insufficiency.

All of the below are indicative of cervical myelopathy except: A. Babinski B. Ataxia C. Hyporeflexia D. Ankle clonus

C

A physical therapist is utilizing individual special tests to rule in or rule out cervical radiculopathy. Which of the following is best for the physical therapist to use as a guide for use of special tests? A. Spurling's test to rule in cervical radiculopathy B. Spurling's test to rule out cervical radiculopathy C. Upper limb tension test A to rule in cervical radiculopathy D. Upper limb tension test A to rule out cervical radiculopathy

D. Upper limb tension test A to rule out cervical radiculopathy Explanation Correct. In the Wainner et al. derivation study on the diagnosis of cervical radiculopathy, the upper limb tension test A has a sensitivity of 97%, so should be used to rule out cervical radiculopathy.

A 56-year-old male is referred to physical therapy with chronic neck pain. He is a very active individual, partaking in at least five half marathons a year, as well as sprint triathlons every few months. After the subjective, the physical therapist determines that one particular activity in sprint triathlons are a probable cause of his neck pain.NOTE: As part of the OCS Prep Program, the following learning assessment is modeled after questions in the OCS Exam and may require additional study. Which of the following is a large risk factor for chronic neck pain? A. Bicycling B. Running C. Swimming

A

The patient is a 40-year-old male with complaints of right shoulder pain for the last 6 weeks following a motor vehicle collision. He has received physical therapy services for his shoulder pain and has recently reported a new onset of headache. Which of the following examination findings will help discern if the headache is of cervicogenic origin? A. Symptoms are unilateral, occipital and associated with neck movements. B. Symptoms are located behind the eyes and associated with impaired memory. C. Patient demonstrates forward head posture and 45 degrees of cervical rotation to the right and left. D. Patient demonstrates tightness in the upper trapezius and levator scapulae and reports nausea and photophobia.

A. Symptoms are unilateral, occipital and associated with neck movements.

Which upper cervical ligament prevents anterior displacement of C1 on C2? A. Alar Ligament B. Transverse Ligament C. Ligamentum Nuchae D. Anterior Longitudinal Ligament

A. Alar Ligament Incorrect: The Alar ligament limits rotatory movements of the occiput-atlas-axis complex. *B. Transverse Ligament Correct: The Transverse ligament prevents anterior displacement of C1 on C2* C. Ligamentum Nuchae Incorrect: Ligamentum nuchae limits cervical flexion D. Anterior Longitudinal Ligament Incorrect: The ALL limits cervical extension and reinforces the anterior aspect of the annulus fibrosis.

Your patient has complaints of intermittent headache and has been recently diagnosed with migraine with aura. Which of the following statements is not true of migraine headaches? A. The gender of the patient is likely female B. The patient may also report experiencing nausea, vomiting, phonophobia associated with the headache. C. Vasospasm within the cerebral cortex may result in a visual 'aura' or premonition of an impending headache. D. The patient is likely to complain of dull, diffuse and bilateral head pain

D. The patient is likely to complain of dull, diffuse and bilateral head pain Explanation Correct: Migraine headache is typically throbbing and unilateral. Non-throbbing, dull, diffuse bilateral headache is more akin to the tension variant.

A diagnostic cluster has been developed to determine those who have cervicogenic headaches. Which of the following is one of the characteristics in the cluster? A. Decreased AROM cervical flexion B. Deep neck flexor endurance test deficits C. Trigger points in the levator scapulae musculature D. Painful palpation of the C1-C2 joint

D. Painful palpation of the C1-C2 joint Explanation Correct. Painful palpation of the upper cervical spine, including C1-C2, was one of the characteristics included in the cluster by Jull et al.

Of the following, which may be seen in migraine and cervicogenic headaches but not in tension headaches? A. Female predominant B. Intense pain C. Radiating pain from the back to the front D. Unilateral headache

D. Unilateral headache Correct. Tension headaches are bilateral headaches, whereas migraine headaches and cervicogenic headaches are isolated to one side.

A 26-year-old male with neck pain reports an acute onset of neck pain. He indicates he has had three other episodes of neck pain in his life, but they resolved within a few days without treatment. He seems rather downtrodden regarding the onset of symptoms, and exhibits a significant amount of worry towards the neck pain and how it will impact his overall life. He states that he is very active, working out six times per week (both cardiovascular and weight training), and he has stopped doing so because of the current onset of symptoms. He has stopped working as a brick layer for the time being.NOTE: As part of the OCS Prep Program, the following learning assessment is modeled after questions in the OCS Exam and may require additional study. From this patient's presentation, which is most likely to predispose him to the development of chronic neck pain? A. Age B. Lack of employment C. Prior episodes of neck pain D. Worrisome attitude

D. Worrisome attitude Explanation Correct. Bot et al determined that older individuals with a long duration of symptoms and a worrisome attitude were predisposed to chronic neck pain.

Which of the following conditions can lead to vertebrobasilar insufficiency? A. Reduced intervertebral disc height B. Postural changes C. Ligamentous thickening D. A and C only E. All of the above

E

Risk factor for cervical arterial dysfunction

females 30-39 migraine oral contraception diabetes HTN smoking

prognosis for cervical pain chronicity

1. 6 or greater on the numeric rating scale 2. greater than 30% on NDI as high 3. score 20 or greater on pain catastrophizing scale 4. cold hyperalgesia-cold metal bar over affected area for 5 seconds, should not cause pain more than 12/20. 13 or greater indicate cold hyperalgesia (this needs validation)

Describe cluster HA

1. unilateral 2. 90% males>females 3. usually nocturnal 4. occurs 1-2 hours after falling asleep 5. quick-on set 6. Severe pain behind eyes

describe cervicogenic HA

1. unilateral w/ neck symptoms aggravated by movement 2. HA produced w/ ipsilateral posterior cervical joints/myofacia 3. restricted cervical ROM 4. restricted segment mobility 5. abnormal performance on cranial cervical flexion test

A patient has been referred to physical therapy with a preganglionic brachial plexus injury and is having very high amounts of pain that do not seem to be decreasing. What type of pain describes this patient's symptoms? A. Causalgic pain B. Neuropathic pain C. Somatic pain D. Visceral pain

A. Causalgic pain Explanation Correct. Causalgic pain is described as burning, and patients with causalgia have very significant amounts of pain. This is commonly seen in patients who have certain types of preganglionic brachial plexus injuries.

Which objective findings from this case will be most helpful to the resident physical therapist in determining the appropriate physical therapy diagnosis? A. Cervical AROM rotation, positive Spurling's test, positive distraction test, and positive upper limb tension test A B. Cervical AROM rotation, and weakness in deep neck flexors, middle and lower trapezius, and triceps C. Positive findings in Spurling's test, distraction test, shoulder abduction test, and upper limb tension test A D. Weakness in deep neck flexors, middle and lower trapezius and triceps and hypomobility in C5-C7

A. Cervical AROM rotation, positive Spurling's test, positive distraction test, and positive upper limb tension test A Explanation Correct. Wainner et al. developed a diagnostic cluster for cervical radiculopathy via a clinical prediction rule derivation study, in which cervical AROM rotation less than 60 degrees and positive Spurling's, distraction, and upper limb tension test A were all indicative of cervical radiculopathy. **not C because the ABD test is not in the cluster

A 54-year-old female, who works as a research specialist, was referred for physical therapy services after 3 weeks of unsuccessful treatment with anti-inflammatory nonsteroidal drugs. The symptoms started approximately 3.5 weeks prior and were associated with a traumatic incident in which the patient's head was pushed quickly to the right side. Initially, she felt a stabbing ache at the back of her neck that gradually spread as a sharp pain radiating to the left shoulder and down to the arm and forearm. The pain was worse with head movements of left rotation or when using the left arm at work. Which of the following would be most beneficial in terms of making a differential diagnosis? A. Cervical AROM, Distraction, ULTT A, Spurling's. B. Cranial nerve exam and assessment for upper cervical instability C. Cervical AROM, neuro-motor sensory exam D. Deep neck flexion strength assessment

A. Cervical AROM, Distraction, ULTT A, Spurling's. Explanation Correct: The test item cluster for identifying cervical radiculopathy. 3 of 4 positive, +LR 6.1, 4 of 4 positive +LR 30.3

Which of the following statements is true regarding cervicogenic headaches? A. Cervicogenic headaches are three times more likely to occur in female patients. B. Cervicogenic headaches are usually felt bilaterally C. Cervicogenic headaches are preceded by an aura D. Cervicogenic headaches typically resolve within 4-72 hours

A. Cervicogenic headaches are three times more likely to occur in female patients. Explanation Correct. Cervicogenic headaches can be seen in both genders, but females are more likely to have cervicogenic headaches. They also will be more likely to have migraine or tension headaches.

When considering electrodiagnostic testing, which of the following is most consistent with the physiologic demonstration of a muscle spindle stretch reflex? A. H-reflex B. F-reflex C. G-reflex D. Spontaneous potentials

A. H-reflex Explanation Correct. The H-reflex (also known as Hoffmann's reflex) reflects the reaction of a muscle after electrical stimulation of the sensory 1a afferent fibers and, therefore, is more consistent with a muscle spindle stretch reflex.

Which population of patients is most at risk for upper cervical ligamentous instability? A. Patients with Down syndrome B. Patients with psoriatic arthritis C. Patients with systemic lupus erythematosus D. Patients with osteogenesis imperfecta

A. Patients with Down syndrome Explanation Correct. Patients with Down syndrome have congenital compromise of their collagen, which can lead to ligamentous stability throughout their entire body, including the upper cervical spine.

Cindy, a 35 year-old female, was referred to you with complaints of intermittent unilateral posterior head and neck pain. Symptoms onset 1 month ago. She is employed as a data systems analyst and reports her head and neck pain is consistently at its worse at the end of the work day, (6/10 on NPRS) and improves upon leaving the office. Which of the following is true of cervicogenic headache? A. Provoked by sustained or awkward neck postures B. Provoked by fatigue, depression, worry and anxiety. C. Symptoms are generally worse later in the day and exacerbated by noise and light. D. Symptoms are unilateral, orbitoral-temporal region, and more likely to affect males than females

A. Provoked by sustained or awkward neck postures Explanation Correct: Unilateral headache with neck/suboccipital area symptoms aggravated by movements or sustained postures is a hallmark sign of cervicogenic headache. Other headache symptoms B. Provoked by fatigue, depression, worry and anxiety. Explanation Incorrect: Complaints of head and neck tightness and aching when provoked by fatigue and nervous strain, along with associated depression, worry, anxiety are characteristic of tension headaches. C. Symptoms are generally worse later in the day and exacerbated by noise and light. Explanation Incorrect: Migraines may be present upon waking or later in the day, lasting between 4-24 hrs. Patients may present with phono/photophobia. D. Symptoms are unilateral, orbitoral-temporal region, and more likely to affect males than females Explanation Incorrect: Cluster headaches and cervicogenic headaches can both present with unilateral symptoms, however, cluster headache variants are nearly 90% males, usually occur 1-2 hours after falling asleep, may occur daily for several months and are not reproduced with movements of the head and neck.

A patient is presenting with neck and arm pain with insidious onset three weeks prior to referral to physical therapy. The patient states that the pain started in the anterior shoulder and radiated proximally to the neck and distally to the mid-forearm. The patient had a diminished C6 reflex upon evaluation, and also showed significant weakness in the elbow flexion manual muscle testing. Which of the following diagnoses is least likely to be implicated in this patient's symptoms? A. Arterial compression from thoracic outlet syndrome B. Biceps tendonitis C. Median nerve injury D. Musculocutaneous nerve entrapment

A. Arterial compression from thoracic outlet syndrome Explanation Correct. There is no information provided that would lead one to believe that this patient has any arterial compression due to thoracic outlet syndrome. If an individual has thoracic outlet syndrome, they may have shoulder and neck pain, but the likelihood of diminished reflexes and weakness in elbow flexion manual muscle testing is low.

A 23-year-old female is referred to physical therapy with a headache and posterior neck pain. The patient points to the right temple and the occipital region on the right side. She states she felt dizzy and had severe nausea when she woke up the morning she came to physical therapy. She gave birth to her third child two weeks prior to the onset of this headache.NOTE: As part of the OCS Prep Program, the following learning assessment is modeled after questions in the OCS Exam and may require additional study. What is the most likely diagnosis for this patient? A. Carotid artery dissection B. Cervicogenic headache C. Migraine headache D. Upper cervical ligamentous instability

A. Carotid artery dissection Explanation Correct. This patient has several factors that point to a carotid artery dissection. She recently gave birth, she has two of the "5 Ds and 3 Ns" related to vertebrobasilar artery insufficiency, and the location of her symptoms points to a carotid artery dissection.

desctibe deficits for the following: A. stroke in cerebral cortex B. circle of willis C. basilar artery D. Dorsal pontine region OCS question

A. Cerebral cortex- the individual will still be able to perform basic functions, but there may be deficits in areas like speech, voluntary movements, thought processing, memory, and vision. Individuals with locked-in syndrome are unable to perform any basic functions and are left with complete paralysis. B. Circle of Willis- The Circle of Willis includes both the basilar artery and the internal carotid arteries, so the symptoms are not consistent with locked-in syndrome. C. Basilar artery- Locked-in syndrome is related to a stroke in the brainstem, and the brainstem's arterial supply is from the basilar artery. This leads to a lack of blood supply to several major structures, and individuals have complete paralysis, but are fully aware and conscious and often use their eye muscles to communicate. check_circle D. Dorsal pontine region- Strokes to the dorsal pontine region will result in issues with eye movements, and those with locked-in syndrome retain their visual

Consider the 54-year-old female patient from the previous chapter. The patient's chief complaint was a constant deep ache in the posterior aspect of the arm, an intermittent stabbing pain in the center and left side of the lower neck, and a burning sensation at the area superior to the left scapula. She stated that sometimes the pain felt like an electric sensation that shot down the arm to the wrist. Prone cervical P-A motion testing reproduced her familiar arm symptoms, as did ULTT A. These were subsequently relieved with manual distraction to the head and neck in supine. Current best evidence supports which of the following as the best course of management for this patient? A. Cervical traction B. Gentle range of motion and activity C. Manual therapy and cervico-scapular muscle exercise D. Repeated cervical retraction exercises

A. Cervical traction Explanation Correct: This individual is likely to respond favorably with cervical traction. Cervical traction coupled with impairment based manual therapy and exercise promotes centralization in individuals presenting with radicular signs and symptoms, and/or symptoms distal to the elbow.

A 32-year-old female patient with a two week history of neck pain is referred to physical therapy. The patient had a score of 15 points on the Neck Disability Index (NDI), and reported the symptoms in her neck started at the occiput and referred to the region of the upper trapezius on the left side, but she had no symptoms on the right side. During AROM assessment, the patient had increased pain with cervical flexion, but her pain did not feel worse during cervical extension. The physical therapist determined cervical thrust manipulation was appropriate.NOTE: As part of the OCS Prep Program, the following learning assessment is modeled after questions in the OCS Exam and may require additional study. Which subjective or objective finding provided by the patient is included in a list of factors that predict improvement of pain after manipulation of the cervical spine? A. Pain that did not feel worse during cervical extension B. Patient's age C. Score of 15 points on the NDI D. Unilateral symptoms

A. Pain that did not feel worse during cervical extension Explanation Correct. Tseng et al discovered six predictors that led individuals receiving cervical thrust manipulation to experience improvement in the perception of their condition, pain or satisfaction. Not feeling worse during extension of the neck is one of these variables.

Your patient is a 60 year-old female with head and neck pain and occasional intermittent paresthesias shooting into both upper extremities with coughing and sneezing. A review of her medical history notes a diagnosis of Rheumatoid Arthritis and long term corticosteroid use. Your examination includes performing the supine anterior shear test which reproduces her familiar complaints of upper extremity symptoms. Upon finding this, what is the next most appropriate action for the physical therapist to perform? A. Perform Sharp-Purser B. Perform ULTT A C. Assess Hoffman's Reflex D. Assess tandem gait

A. Perform Sharp-Purser Explanation Correct: Dorsal movement of the occiput and C1 reduces the anterior translation caused by anterior shear test and associated symptoms.

A physical therapist assesses the upper limb tension test for the median nerve on a patient. The patient has no reproduction of symptoms in the median nerve distribution, but the patient feels some pulling in the radial nerve distribution. The physical therapist still documents a positive upper limb tension test in his note.NOTE: As part of the OCS Prep Program, the following learning assessment is modeled after questions in the OCS Exam and may require additional study. How can this patient still be positive for the upper limb tension test even though they have no reproduction of symptoms? A. The patient exhibited a side to side difference of greater than 10 degrees of elbow extension or wrist extension B. The patient felt a stretch in the upper trapezius bilaterally during contralateral and ipsilateral side flexion during the test C. The patient had limited forearm supination during the test D. The patient reported symptoms in the radial nerve distribution, so this is still a positive test

A. The patient exhibited a side to side difference of greater than 10 degrees of elbow extension or wrist extension Correct. A patient does not necessarily need to exhibit a reproduction of symptoms. Instead, tension that creates a side to side difference of greater than 10 degrees of elbow extension or wrist extension is also considered a positive finding.

Your patient is a 59-year-old female with head and neck pain and occasional intermittent paresthesias shooting into both upper extremities with cervical flexion. A review of her medical history notes a diagnosis of Rheumatoid Arthritis. Your examination includes performing the Sharp Purser test. While executing, you note manual pressure from the hand on the patient's forehead causes the head to translate posteriorly. What does this posterior translation indicate? A. The test is positive because of the reduction of the occiput and C1. B. The test is negative due to the reduction of anterior translation of the occiput and C1. C. The test is positive due to the reduction of posterior translation of the occiput and C1. D. The test is negative due to the reduction of posterior translation of the occiput and C1.

A. The test is positive because of the reduction of the occiput and C1. Explanation Correct: The test is considered positive. Through palmar pressure on the forehead the occiput and atlas are translated posteriorly. Dorsal movement of the occiput and C1 reduces the forward slip. C. The test is positive due to the reduction of posterior translation of the occiput and C1. Explanation Incorrect: An insufficient transverse ligament allows C1 to translate anteriorly, not posteriorly, on C2 when the head is in a flexed position. Dorsal movement of the occiput and C1 reduces the anterior translation.

A patient tests positive for the shoulder abduction test. What constitutes a positive finding for this test? A. Patient finds relief when affected arm is internally rotated and resting at the side (adducted position of the shoulder) B. Patient finds relief when affected arm is placed on the head and allowed to rest there C. Patient has onset of symptoms when affected arm is internally rotated and resting at the side (adducted position of the shoulder) D. Patient has onset of symptoms when affected arm is placed on the head and allowed to rest there

B

A 62-year-old female presents to physical therapy one week after an insidious onset of aching neck pain and burning pain around the left medial scapula (patient points to the T6-T9 region) after a tennis game. She also says she gets an ache and some intermittent numbness and tingling in her left thumb, sometimes spreading to the index finger. She states she is feeling weak with certain activities, specifically if she has to lift something up because her "biceps just can't do anything anymore." The patient also has decreased strength in the deep neck flexors, middle and lower trapezius, and serratus anterior. Active range of motion is full for flexion, extension, and side flexion bilaterally, but the patient has limited left rotation to 45 degrees due to pain that radiates to the medial scapula. The shoulder abduction, Spurling's, and distraction tests are all positive.NOTE: As part of the OCS Prep Program, the following learning assessment is modeled after questions in the OCS Exam and may require additional study. The patient's symptoms around the medial border of the scapula are likely due to: A. C5-C6 pathology B. C6-C7 pathology C. T2-T3 pathology D. T4-T5 pathology

B. C6-C7 pathology Explanation Correct. Individuals with a pathology at the level of C6-C7 will show symptoms that radiate across the upper trapezius, but will also feel symptoms in the medial scapular region.

A poor prognosis in those with neck pain is seen if other factors are present. Which of the following is one of these factors? A. Age greater than 35 B. Concomitant low back pain C. Lack of employment D. Previous surgical procedure anywhere in the spine

B. Concomitant low back pain Explanation Correct. In a study by Hoving et al as reported in the neck pain clinical practice guidelines, concomitant low back pain is a large risk factor for a poor prognosis if neck pain is present. check_circle

A 16-year-old male is referred to physical therapy with a stinger and was consequently diagnosed with Klumpke's palsy. The patient describes symptoms in his hand, with grasp mainly affected. He states it is difficult to hold onto any objects that require him to use fine motor skills. Which of the following regions of the brachial plexus was impacted to create the patient's symptoms? A. Anterior division B. Inferior trunk C. Medial cord D. Posterior division

B. Inferior trunk Explanation Correct. This patient presents with signs and symptoms of Klumpke's palsy, which is a lower or inferior trunk injury of the brachial plexus.

In looking at the range-of-motion values provided for this case, which of the following is most important in helping determine if this patient may have cervical radiculopathy? A. The patient has 50 degrees of cervical rotation bilaterally B. The patient has fifty degrees of painful cervical rotation to the right C. The patient has full cervical extension D. The patient has peripheralization of symptoms into the dorsal wrist with cervical extension

B. The patient has fifty degrees of painful cervical rotation to the right Explanation Correct. Using the Wainner et al. diagnostic cluster for cervical radiculopathy, if patients have less than 60 degrees of active cervical rotation to the affected side, it can be clustered with other findings to help lead toward a potential diagnosis of cervical radiculopathy. So this finding is important. check_circle

A physical therapist observes during an examination that a patient has severe spasms of the posterior upper cervical musculature. When the spinous process of C2 is palpated and the head turned, C2 remains stationary for approximately 25 degrees of cervical rotation. Which of the following is true regarding this finding? A. This is a normal finding; all cervical ligaments are intact B. This is an abnormal finding. The spinous process of C2 should move immediately in the contralateral direction of head rotation if the alar ligament is within normal limits. C. This is an abnormal finding. The spinous process of C2 should move immediately in the contralateral direction of head rotation if the transverse ligament is within normal limits. D. This is an abnormal finding. The spinous process of C2 should move within 15 degrees of head rotation.

B. This is an abnormal finding. The spinous process of C2 should move immediately in the contralateral direction of head rotation if the alar ligament is within normal limits. Explanation Correct. The C2 spinous process moves with the head during any cervical motion if the alar ligament is intact, so if the patient rotates their head, the C2 spinous process will move and will do so in the contralateral direction of head rotation.

Your patient complains of neck and back pain following a low velocity motor vehicle collision 3 months ago. The patient's family physician ordered routine x-rays of the cervical spine at the time of injury which were negative for fracture. Symptoms of neck pain have persisted, and the patient has requested a referral for physical therapy services. You begin your examination and find the patient to have active cervical rotation to the right to 55 degrees and to the left to 52 degrees. ROM is limited into flexion and extension secondary to pain experienced at end range. Your patient is non-tender to palpation of bony landmarks. Based on knowledge of imaging guidelines, which is the most appropriate action? A. Suggest to referring provider that the patient receive new radiographic examination before continuing with physical therapy. B. Call the physician to be certain an open mouth view was ordered. C. Proceed with the exam and intervention. D. Suggest to the referring provider that the patient receive MRI evaluation to determine pathoanatomic cause of chronic neck symptoms.

C Proceed with the exam and intervention. Explanation Correct: According to the Canadian C-Spine Rules, in the absence of midline cervical spine tenderness and the fact that the patient has greater than 45 degrees cervical rotation to the right and left, radiographs are unnecessary as a fracture is not likely. Therefore it is appropriate to continue with the exam and initiate treatment based on identified impairments.

Which of the following is the MOST correct about muscle fibers at rest? A. They are spontaneously active B. They are not spontaneously active C. The motor end plate is spontaneously active, but the muscle fiber is not D. The motor end plate is not spontaneously active, but the muscle fiber is spontaneously active

C The motor end plate is spontaneously active, but the muscle fiber is not Explanation Correct. When a muscle fiber is at rest, the motor end plate is spontaneously active, but the muscle fiber is not.

Stroke resulting of blockage or insufficiency of the posterior circulation is not uncommon and can result in injury of the mid or hind brain as well as the cerebrum. Locked-in syndrome is related to which of the following structures? A. Cerebral cortex B. Circle of Willis C. Basilar artery D. Dorsal pontine region

C. Basilar artery Explanation Correct. Locked-in syndrome is related to a stroke in the brainstem, and the brainstem's arterial supply is from the basilar artery. This leads to a lack of blood supply to several major structures, and individuals have complete paralysis, but are fully aware and conscious and often use their eye muscles to communicate. check_circle

Your patient complains of unilateral headache present for approximately 6 weeks. The patient reports dull aching pain of moderate intensity, which began in the neck and spread to the head. There is associated tenderness of the C2-3 articular pillars on the affected side. Current best evidence supports which of the following as the best course of management for this patient? A. Cervical traction B. Gentle range of motion and activity C. Manual therapy and cervico-scapular muscle exercise D. Repeated cervical retraction exercises

C. Manual therapy and cervico-scapular muscle exercise Explanation Correct: Cervical and upper thoracic manual intervention has demonstrated significant reduction in headache intensity and have low load endurance cervico-scapular muscle exercises, 2 x day, which lead to significantly reduced headache intensity, frequency, and neck pain. check_circle

Which of the objective findings provided for the patient in this case would be most helpful in deciding if the patient had cervical radiculopathy? A. Hypomobility in C3-C7 region B. Positive cervical rotation lateral flexion test C. Positive upper limb tension test D. Weak deep neck flexors

C. Positive upper limb tension test Explanation Correct. Wainner et al. discussed a cervical prediction rule for the diagnosis of cervical radiculopathy, and positive findings of the upper limb tension test were one of the variables in the clinical prediction rule.

Your patient is a 35 year-old male who is employed as a landscape architect. His chief complaint is left sided neck pain which he noticed while turning to look over his shoulder when backing his truck out of the driveway a few weeks ago. Since then, his symptoms have not worsened, but have not really improved either. He reports occasional headaches, which he feels are not related to his neck pain. Your exam reveals the following: • negative responses to red and yellow flag questioning • no evidence of upper cervical instability • pain and stiffness noted with active and passive flexion, and end range cervical rotation and lateral flexion to the left • hypomobile left C0-1, C1-2, CT junction and mid-thoracic spine Current best evidence supports which of the following as the best course of management for this patient? A. Cervical traction B. Gentle range of motion and advice to act as usual C. Thoracic thrust followed by mobility exercise to the cervical and thoracic spine. D. Cervical manual therapy and muscle energy techniques to C0-1 and C1-2 followed by Self-SNAGS

C. Thoracic thrust followed by mobility exercise to the cervical and thoracic spine. Explanation Correct: This patient fits into the mobility category (younger age, no radicular symptoms or nerve root compression, presence of hypomobility on examination, and symptom duration less than 1 month.) Current best evidence supports use of cervical and/or thoracic manual therapy coupled with exercise.

A physical therapist is treating a patient with complaints of headaches. The patient reports that the headaches occur in the evening while leaning back in a reclining chair watching television. They also occur at work, when the patient is working on prolonged reading tasks on a computer screen. The patient reports that the pain is retro-orbital and can occur on either side but is usually only felt on one side at a time. During physical examination, cervical range of motion increased the patient's complaint of a headache. Which type of headache is the patient likely experiencing? A. Migraine B. Tension C. Cluster D. Cervicogenic Explanation

C. Cluster headaches are often seen in a retro-orbital pattern and can occur on either side. They can also be brought on by specific neck positions.

Which of the following reasons highlight why measures of disability (FOTO, NDI, etc.) should be utilized in clinical practice? A. Disability measures assist in determining the severity of the condition. B. Disability measures aide in establishing goals and documenting patient progress. C. Disability measures allow for benchmarking with national data and are required by third parties. D. All of the above are true.

D

You are performing an initial examination on a 62 year old male patient with complaints of neck pain and unilateral posterior occipital headache which began 2 weeks ago. He also reports a new onset of hoarseness, loss of taste on the right side and vertigo. The clinical examination reveals ataxia with gait and nystagmus with visual tracking. What is the most appropriate action for the physical therapist? A. Proceed with physical therapy examination and advise the patient to follow up with his physician. B. Proceed with physical therapy examination and intervention related to chief complaints of head and neck pain. C. Include a careful vestibular and balance evaluation in today's session. D. Call for emergency services.

D. Call for emergency services. Explanation Correct: The following are associated with ischemic events and necessitate emergent referral: dizziness, dysarthria, ataxia, nystagmus.

The patient is a 75 year old female with complaints of neck pain and stiffness associated with movements of the cervical spine. Additionally, she complains of weakness in both hands and reports dropping her keys and coffee cup. Examination reveals limited mobility into cervical flexion, extension, sidebending and rotation to the right more than the left. She demonstrates hyperreflexia with Achilles and patella tendon reflex testing, a positive Hoffman's and relief from her neck pain with supine manual cervical distraction. What is the most likely source of the patient's symptoms? A. Cervical Radiculopathy B. Carpal Tunnel Syndrome C. Cervical Degenerative Disc Disease D. Cervical Myelopathy

D. Cervical Myelopathy Explanation Correct: Cervical myelopathy can occur secondary to cervical spondylosis. It is a chronic degenerative condition of the cervical spine that affects the vertebral bodies and intervertebral disks of the neck as well as the contents of the spinal canal (nerve roots and/or spinal cord), and results in weakness, spasticity, hyperreflexia.

A 62-year-old female presents to physical therapy one week after an insidious onset of aching neck pain and burning pain around the left medial scapula (patient points to the T6-T9 region) after a tennis game. She also says she gets an ache and some intermittent numbness and tingling in her left thumb, sometimes spreading to the index finger. She states she is feeling weak with certain activities, specifically if she has to lift something up because her "biceps just can't do anything anymore." The patient also has decreased strength in the deep neck flexors, middle and lower trapezius, and serratus anterior. Active range of motion is full for flexion, extension, and side flexion bilaterally, but the patient has limited left rotation to 45 degrees due to pain that radiates to the medial scapula. The shoulder abduction, Spurling's, and distraction tests are all positive.NOTE: As part of the OCS Prep Program, the following learning assessment is modeled after questions in the OCS Exam and may require additional study. In helping make a physical therapy diagnosis, the physical therapist feels they are missing one piece of information. Which of the following is most helpful in determining an appropriate physical therapy diagnosis? A. Deep tendon reflex findings for upper extremity B. Palpation findings C. Results of joint mobility assessment D. Upper limb tension test findings

D. Upper limb tension test findings Explanation Correct. This physical therapist has already assessed cervical AROM for rotation and found it to be less than 60 degrees, and they have positive findings in the Spurling's and distraction special tests, so the result of the upper limb tension test A will determine if this individual is likely to have cervical radiculopathy.

In those with suspected radiculopathy, what level of radiculopathy is most common? A. C4 B. C5 C. C6 D. C7

D. C7 level is the most common level of radiculopathy. The C7-T1 region is a transitional area, meaning lots of motion occurs here and hence pathology is commonly seen in this region.

Your patient is a 35 year-old male who is employed as a landscape architect. His chief complaint is left sided neck pain which he noticed while turning to look over his shoulder when backing his truck out of the driveway a few weeks ago. Since then, his symptoms have not worsened, but have not really improved either. He reports occasional headaches, which he feels are not related to his neck pain. Your exam reveals the following: • negative responses to red and yellow flag questioning • no evidence of upper cervical instability • pain and stiffness noted with active and passive flexion, and end range cervical rotation and lateral flexion to the left • hypomobile left C0-1, C1-2, CT junction and mid-thoracic spine Which of the following is the most appropriate adjunctive treatment? A. Cervical traction B. Gentle range of motion and advice to act as usual C. Repeated cervical retraction exercise. D. Cervical manual therapy and muscle energy techniques to C0-1 and C1-2 followed by Self-SNAGS

D. Cervical manual therapy and muscle energy techniques to C0-1 and C1-2 followed by Self-SNAGS Explanation Correct: Addressing upper cervical spine mobility deficits is important given the patient's complaints of occasional headaches. Additional mobilizing techniques to the upper cervical spine can be layered on with manual interventions, and should incorporate C1-2 self SNAG. Current evidence indicates statistically significant increases in C1-2 rotation (15 degree increase) when compared to placebo 5 degrees.

Your patient is a 55-year-old male with complaints of a severe unilateral temporal headache. He also reports sensitivity to touch to his scalp and stiffness in his neck pain and shoulder girdle. Examination findings reveal elevated body temperature, negative spurlings, negative distraction, decreased mobility in C4-5 lateral glides on the right, shortened anterior and middle scalene musculature on the right and the presence of a distended temporal artery. Which is the most appropriate intervention? A. Cervical mobilization to C4-5, followed by cervical AROM exercise and deep neck flexor strengthening and stretching to the scalene musculature. B. Manual cervical distraction followed by soft tissue mobilization to the scalene musculature. C. Cervical thrust manipulation followed by C1-C2 self-SNAGs. D. Generate an emergent medical referral.

D. Generate an emergent medical referral. Explanation Correct: This patient presents with findings from the examination that are concerning for temporal arteritis and necessitate an emergent medical referral.

A 62-year-old female presents to physical therapy one week after an insidious onset of aching neck pain and burning pain around the left medial scapula (patient points to the T6-T9 region) after a tennis game. She also says she gets an ache and some intermittent numbness and tingling in her left thumb, sometimes spreading to the index finger. She states she is feeling weak with certain activities, specifically if she has to lift something up because her "biceps just can't do anything anymore." The patient also has decreased strength in the deep neck flexors, middle and lower trapezius, and serratus anterior. Active range of motion is full for flexion, extension, and side flexion bilaterally, but the patient has limited left rotation to 45 degrees due to pain that radiates to the medial scapula. The shoulder abduction, Spurling's, and distraction tests are all positive. The physical therapist documents the physical therapy diagnosis to be cervical radiculopathy and is working on choosing an appropriate first day intervention. The therapist thinks that mechanical traction may be the best option for this patient.NOTE: As part of the OCS Prep Program, the following learning assessment is modeled after questions in the OCS Exam and may require additional study. Which pieces of objective data from this cluster are missing in this patient's examination and evaluation to help make the decision to use mechanical traction? A. Joint mobility assessment and deep tendon reflex findings B. Joint mobility assessment and pain level during activity C. Joint mobility assessment and palpation findings D. Joint mobility assessment and upper limb tension test results

D. Joint mobility assessment and upper limb tension test results Explanation Correct. Each of the special tests in this answer is part of a cluster from Raney et al. that was developed for the use of mechanical traction and exercise. However, peripheralization with C4-C7 joint mobility assessment, as well as a positive upper limb tension test A finding, is also included in that cluster.

What is the difference between migraine, cluster, and tension HAs?

migraines last 24 hours cluster is a quick onset and does not last long tension is related to muscles and does not last long

Describe a Migraine Headache?

neurological migraines: aura, dysphasia, vertigo, weaknesss common migraines: 1. prevalence 10% 2. occurs waking or later in day 3. last 24 hours 4. increase sensitivity to light (photophobia), noise, and tension 5. N&V 6. 50% unilateral

describe sharps purser test

pt seated with head flexed PT: one hand on forehead and other pinching C2 apply posterior force on head (occiput and atlas are translated posteriorly) (+) if following is found 1. dorsal movement of occiput and C1 2. possible a click or clunk 3. reduction of symptoms 4. a stable segment should not allow any movt with a hard elastic end feel