Observation and Clearing Tests in Orthopedic Physical Assessment

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Questions and Answers

What is the result of the Alar ligament test?

Not performed

Inconclusive

Negative (correct)

Positive

What is indicated by the presence of pain on the left side during right-sided movements of the cervical spine?

Cervical spine instability

Thoracic outlet syndrome

Cervicogenic headache

Vertebrobasilar insufficiency (correct)

What is the degree of left lateral flexion of the cervical spine?

30 degrees

20 degrees

45 degrees (correct)

60 degrees

What is the posture observed in the patient?

Forward head posture with bilateral shoulder protraction Signup and view all the answers

What is the result of the Sharp Purser test?

Negative Signup and view all the answers

What is the degree of right rotation of the cervical spine?

25 degrees Signup and view all the answers

What is the strength of the left elbow flexion?

4/5 Signup and view all the answers

What is the posture of the thoracic spine observed in the patient?

Increased thoracic kyphosis Signup and view all the answers

What is the average FRT ROM in healthy individuals?

44° Signup and view all the answers

What is the primary purpose of the Cranial Cervical Flexion Test (CCFT)?

To assess neck pain and movement coordination deficits Signup and view all the answers

What is a common symptom associated with cervicogenic headaches?

Long-standing neck pain (> 12 weeks) Signup and view all the answers

How is the C0-C1 (AO joint) physiological motion assessed?

By having the patient rotate their head in one direction and then perform a capital nod Signup and view all the answers

What is a possible source of cervicogenic headaches?

Limited range of motion at C1-2 Signup and view all the answers

What is the goal of the Cranial Cervical Flexion Test (CCFT)?

To hold each position for 10 seconds with 10 seconds rest in between each stage Signup and view all the answers

What is a common finding in individuals with cervicogenic headaches?

Abnormal performance of the deep flexor endurance test Signup and view all the answers

How is the patient positioned during the Cranial Cervical Flexion Test (CCFT)?

Supine Signup and view all the answers

What is the recommended age range for cervical spine myelopathy diagnosis?

Age > 45 Signup and view all the answers

Which muscle is used to test the C5 nerve root?

Deltoid Signup and view all the answers

What is the typical presentation of a patient with neck pain and headaches?

Restricted cervical range of motion and unilateral headache Signup and view all the answers

What is the primary purpose of the cranial cervical flexion test?

To assess cervical segmental mobility Signup and view all the answers

Which test is used to assess the flexibility of the upper quarter muscles?

Flexibility test of the anterior, middle, and posterior scalene muscles Signup and view all the answers

What is the typical presentation of a patient with neck pain and radiating pain?

Upper extremity symptoms produced or aggravated with Spurling maneuver and upper limb tension tests Signup and view all the answers

What is the primary purpose of the Spurling maneuver?

To assess the presence of nerve root compression Signup and view all the answers

What is the recommended initial examination procedure for a patient with neck pain and radiating pain?

Spurling maneuver and upper limb tension tests Signup and view all the answers

What is the primary purpose of the deep neck flexor test?

To assess the endurance of the deep neck flexor muscles Signup and view all the answers

What is the typical finding in a patient with cervical spine myelopathy?

All of the above Signup and view all the answers

Study Notes

Observation and Posture

Forward head posture with bilateral shoulder protraction and increased thoracic kyphosis, and decreased lumbar lordosis.

Clearing Tests

Vertebral/Basilar Artery: pain with right-sided movements on the left, no dizziness.
Alar ligament: negative.
Sharp Purser & Transverse cruciate ligament (Ligament of Life Test): negative.
Clearing (scanning) - Shoulder: clear.
Thoracic spine clearing: clear.
TMJ: clear.

Palpation

Moderate tenderness to palpation in the left cervical paraspinal region, most notably at C5-C6.

Neurological Screening

Reflexes: bilateral - biceps 2+, brachioradialis 2+, triceps 2+.
Dermatomes: intact C1 – T2 (light touch).
Myotomes: normal C1 – T1 except for left shoulder abduction and left elbow flexion.

Range of Motion (ROM)

Cervical flexion: 15 degrees, moderate limitation, with pain on the left side (6/10).
Cervical extension: 60 degrees, full ROM, no pain with and without overpressure.
Left lateral flexion: 45 degrees, full ROM, no pain with and without overpressure.
Right lateral flexion: 20 degrees, moderate limitation, with pain on the left side (6/10).
Left rotation: 70 degrees, full ROM, no pain with and without overpressure.
Right rotation: 25 degrees, moderate limitation, with pain on the left side (6/10).

Manual Muscle Testing (MMT)

All motions of the upper limb are 5/5 except left elbow flexion and left shoulder abduction 4/5.
Left upper trapezius: 4/5.
Left middle trapezius: 4/5.
Left lower trapezius: 3+/5.
Right upper, middle, lower trapezius muscles are 5/5.
Grip Strength: Right dominant: normal, Left: normal.

Muscle Length

Normal FRT ROM in healthy individuals is 44°, indicating some limitation of ROM at C1-2 and a possible source for cervicogenic headaches.

C1-C2 Rotation Assessment

The therapist can ask the patient to nod their head while maintaining a neutral spine.
Another method is to have the patient rotate their head in one direction and then instruct them to perform a capital nod, comparing the amount of capital nod with the head and neck rotated in the opposite direction.

Clinical Findings for Diagnosis of Cervical Spine Myelopathy

Long-standing neck pain (>12 weeks).
Abnormal/substandard performance of the CCFT.
Abnormal/substandard performance of the deep flexor endurance test.
Coordination, strength, and endurance deficits of neck and upper quarter muscles.
Flexibility deficits of upper quarter muscles.
Ergonomic inefficiencies with performing repetitive activities.

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Description

This quiz assesses knowledge of observation and clearing tests in orthopedic physical assessment, including posture, cervical spine, and joint tests. It covers common conditions and tests used in physical therapy and orthopedic medicine.