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Cervical Red Flags and Yellow Flags (in more depth)
Terms in this set (15)
List RED flags for cervical DD
cervical instability - ligamentous
neoplastic conditions (C)
List YELLOW flags for cervical
attitudes beliefs (p! is harmful, p! is disabling, fear of mvmt, p! must be gone before activity can resume, catastrophizing, passive attitude towards wellness)
behaviours (extended rest, withdrawal from ADLs, substitution of lifestyle away from productive activity, reports high pn intensity, high intake of ETOH or other substances, smoking)
hx of trauma would lead you to be concerned about. . .
When cervical pain is precipitated by trauma, who is "Low Risk" according to Canadian C Spine rule, and therefore should not get imaging?
Able to sit in ER
have had simple rear-end collision
have delayed onset of neck p!
do not have midline C-spine tenderness
are able to ROT head 45° in each direction
When cervical pain is precipitated by trauma, who is "High Risk" according to Canadian C Spine rule, and therefore should definitely get imaging?
Pt is older than 65 yo
Dangerous mechanism of injury
Have paresthesia in extremity
Should you recommend more imaging beyond X-ray?
"Use of ultrasonography, CT, MRI. . . has not been justified in view of the infrequency of abnormalities detected, the lack of prognostic value, inaccessibility, and the high cost of the procedures"
What are sxs of cervical myelopethy/ compression or injury of spinal cord?
sensory disruption to UE / hands
hand mm wasting
unsteady gait, wide BOS
bowel and bladder probs
multi-segmental sensory changes
Explain value of Hoffman Reflex
if you find (+) Hoffman's, you know there is something else going on.
Highly specific for neuro compromise.
A positive test in pt with other neuro sxs calls for immediate referral.
What are red flags for Spinal Neoplasm/C of spine?
Prior hx of C
Non-responsive to conservative care
Unexplained weight loss
Constant pain, no relief with rest
Night pain, keeps pt up at night
What are symptoms/ "cardinal signs" for Upper Cervical Ligamentous Instability?
Pt complains of "head feeling unsteady"
overt loss of balance related to head mvmts "drop attacks"
facial or lip parasthesia
Bilateral o quad limb parashesia
What tests would you do for Upper Cervical Ligamentous Instablility
look for cardinal signs
Alar ligament test
Sharp purser test
What are red flags for Inflam disease?
RHR >100 bpm
Resting respiration >25 bpm
What are the clinical features/sxs for VAI (vertebral artery insufficiency)
5 D's and 3 N's
What are the 2 kinds of cervical artery dysfunction?
Vertebral Artery Insufficiency
Internal Carotid Artery dissection
What are the clinical features/sxs for Internal Carotid Artery dissection?
CN palsies (frequently CN IX to CN XII)
Retinal sxs, eyeball problems
Cluster HA on temples
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