Lab 13/14 - C-Spine Flashcards
How to assess C-spine posture
First look at ears for symmetry (anterior), look at traps (anterior and dominant side should be lower due to stretch from use), have head extend forward to observe cervical spine and round shoulder (protract scapula and observe posteriorly), observe scapula and shoulder asymmetry (posterior)
How to palpate c-spine
Find occipital protuberance and SCM attached and goes out to side horizontally, to find C1: apply thumb to jaw and middle finger to mastoid bump and C1 should be middle with index finger in between and find where head rotates, have lying prone with hands on head and elbows elevating head and have them relaxed, from occipital protuberance first bump you feel going vertically will be C2, use index finger to count down to C7 until you feel another bump should be at bottom of neck, have them do neck extension and C6 should disappear, but C6 and C7 you can usually feel bumps without neck flexion (you can feel bumps of C4 and C5) -> may not be able to feel C3,4,5, middle will be spinous process and more lateral will be transverse processes (there will be a space in between the 2 where the pillars will be, in between the cervical will be the zygapophyseal joints that are just on side of spinous processes
How to find the posterior and anterior cervical triangles
Anterior Triangle: Find V-shaped sternal notch (anterior) -> have tuck neck and lift up in to give SCM, manubrium is inferior and trace upward in V then draw line in middle an draw line straight under jaw to make triangle and corners should make up the carotid artery = anterior triangle
Posterior triangle: Landmark clavicles and draw line across, find upper traps and landmark top of traps up to bottom of neck. Can pick up SCM between anterior and posterior triangle. If you push in center of posterior triangle can feel first rib (brachial plexus)
How to palpate anterior, middle and posterior scalenes
Anterior and Middle Scalene: Extend off SCM laterally and then should find anterior and then middle scalene
Posterior Scalene: Will be in between middle scalene and levator scap but wont really feel
How to palpate levator scapulae
Rotate neck to side and upwards to find scapulae while pushing on shoulder, should be after middle and posterior scalene
How to measure cervical AROM and ROM
AROM: Side flexion (apply a little pression, forward flexion (apply a little pressure), extension (never apply a little pressure), rotation to left and right (apply pressure).
Rotation ROM -> sitting for AROM: To measure ROM put goniometer line with top of head (stand directly over head). Line vertical arm with acromion that you are measuring direction of rotation (measuring left rotation have arm lined with acromion on left) -> TAKE 2-3 measurements to get an average
**Moveable arm goes to nose and immovable arm goes to acromion
Rotation ROM -> lying supine for PROM: Lift head and rotate side to side and flexion side to side
Cervical PROM: Cause chin tuck
PROM: Neck extension do sitting
Side Flexion ROM -> sitting for AROM (extra information not tested): Align goniometer straight down back and have them bend side to side to measure side flexion ROM
How to do strength testing for cervical spine
Strength Testing: Always have in mid range of ROM for EVERY position and then have them move in the direction needed because midrange is where they are strongest (hold for 5 seconds for each movement)
-Can combine movements -> ONLY DO IF NOTHING IS REPRODUCING SYMPTOMS such as side bending and looking down or up (support at C7 and gently apply over pressure with other hand on head -> not actually doing a make test just overpressure but don’t apply overpressure for extension) -> rotate towards armpit and when upwards rotate up with face facing inwards
How to test endurance of c-spine
Endurance Testing: Raise neck one inch off bed (put hand under to measure and chin tuck and time how long they can hold it before the head drops (SCM should not be working it should be neck flexors) -> supine
Extensor Endurance Testing: Lay prone, chin tuck and hod straight up with head off bed (line chine with head of bed), time it until they drop (activates deep and superficial fibers of neck
How to test head/neck stretch
Cradle head in one arm and push down on shoulders have face armpit (levator scapulae) then when looking upward have face inwards to opposite side of where you are extending head (upper traps)
Structures affected: Levator scap and traps would be tight, weakness in neck flexors, lower traps and serratus anterior would potentially cause winging
Education on posture, provide resource ergonomic options for their posture, changing positioning
Test endurance and strength of flexors, if endurance affected keep reps low, pec stretch, wall slides to loosen up trunk -> try and get to time goal to increase endurance of flexors (39 seconds for men and 29 seconds for female) -> increase by 2 seconds per week from baseline to bring to appropriate levels -> lengthen flexibility of traps and scap to decrease tightness (use % to reach goal 20% vs 100% function)
Strength scap -> isometric hold, 5 seconds, twice a day with moderate feel
