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PT9133 - Lecture/Textbook/Research Paper Notes > C-Spine Labs > Flashcards

C-Spine Labs Flashcards

1
Q

Name each cranial nerve and how to test them

A

C1 - Olfactory (smell)
C2 - Optic (visual acuity) -> symmetrical visual field in periphery (side to side and do one at a time
C3 - Oculomotor (H) and pupillary reflex (light reflex cover eye one at a time) and levator palpibrae (lifts eyelids ->watch for drooping) -> doesn’t supply lateral recti because its supplied by abducens and also superior oblique because that’s applied by trochlear
C4 - Trochlear (eye moving down and in) -> superior oblique
C5 - Trigeminal (face sensation) + muscles of mastification (resisted jaw opening) + jaw jerk reflex (open jaw and tap on chin -> don’t want it to close as it is UMN lesion = hyperreflexive response so there is a lesion in brain or spinal cord
C6 - Abducens
C7 - Facial (facial expressions) + Taste of 2/3 anterior + lacrimal gland (cant produce tears and no salvation in mouth + cant close eye)
C8 - Vestibulcochlear (hearing = snap fingers + vestibular assessment)
C9 - Glossopharyngeal (swallowing/gag reflex) +posterior 1/3 taste
C10- Vagus open mouth with tongue out and say ahhh = look for uvula to elevate symmetrically) + gag
C10 - Accessory (scapular/trap elevation and scm (rotation))
C11 - Hypoglossal (protrude tongue and move side to side

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2
Q

C4 myotome

A

Traps (but not really cause levator scapulae) -> More cranial nerve 11 than C4 becuae it is nerve iss

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3
Q

C5 myotome

A

Shoulder abduction, Shoulder ER

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4
Q

C6 myotome

A

EF, WE

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5
Q

C7 myotome

A

EE, WF

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6
Q

C8 myotome

A

Ulnar deviation, thumb extension

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7
Q

T1 myotome

A

Finger abduction, adduction

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8
Q

Compare cervical radiculopathy vs cervical arthrosis

A

Cervical Radiculopathy: Reproduces pain and will limit ROM in extension vs flexion is more of an easing factor, reproduce arm pain in right side pain with right side bend (if right side is the affected side) on left side bend it will be tight and stiff on right side but not as aggravating, left rotation will cause slight symptoms with tightness and stiffness on right side vs right side rotation will reproduce painful symptoms in right arm
Cervical Arthrosis: Reproduces neck pain and medial border of scapula pain

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9
Q

What movements provoke and ease cervical arthrosis

A

C4/C5 arthrosis = extension + rotation + side bend to side of atherosclerosis = provocation -> flexion + rotation + side bend to opposite side of arthrosclerosis = easing

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10
Q

What active and passive and resisted testing can be done on cervical spine

A
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11
Q

What is included on a C-Spine nerve scan

A
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12
Q

What components make up Wainner’s Cluster

A
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13
Q

Purpose of ULTT and when should you do it and when should you not

A
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14
Q

Describe deep neck flexor and neck extensor endurance testing

A
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15
Q

Describe somatosensory testing (joint position error)

A
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16
Q

Describe the NDI

A
17
Q

Describe cervical/segmental traction and list contraindications

A

Segmental Traction:
* Put one hand on one segment and one hand under other segment (eg. C5-C6 = one under C5 and one under C6). Hands are vertical with finger on top of finger
* Use knees in flexion and extension to cause movement
* Remember to support head with shoulder
Bring traction on slowly and sustain it longer

18
Q

Describe unilateral and central P/A and contraindications

A
  • Can do central or unilateral
    • Place folded pillowcase under their face for comfort and for sanitary reasons when lying in prone
    • Lower headrest so neck is in slight flexion
    • Ensure pull skin away and keep other fingers besides thumb relaxed and put two thumbs together for movement
    • Arms can rest at sides or over edge of bed
    • Ensure spine is in a neutral position
    • Landmark which discs are the issues so we can locate the problem disc through a central PA then can provide treatment with unilateral or central depending on the issue
    • If unilateral move muscle bulk out of way towards midline and work through soft tissue
    • Angle at 45 degrees for unilateral PA and straight at 90 degrees for central PA
    • Unilateral caudal causes side bending/rotation to opposite side
    • Unilateral cranial causes side bending/rotation to same side
    • Caudal will piss off symptoms (radiculopathy and arthrosis) because going into extension and causes convergence
    • Cranial relieves symptoms (radiculopathy and arthrosis) because going into flexion and causes divergence
19
Q

Describe Upper Trap Length Test/Stretch

A
  • Purpose: To assess/increase muscle length of upper trap
    • Origin: Occipital protuberance, ligamentum Nuchae
    • Insertion: Lateral 1/3rd of the clavicle
    • Action: Elevation and UR of the scapula
    • Steps:
      1. With patient lying in supine, lift the head off the table to create cervical flexion. Have them look down their nose.
      2. Use hand opposite of side you are stretching to cradle patient’s head and bring them into contralateral sidebend and ipsilateral cervical rotation through partial ROM of each component (eg. When stretching right upper trap -> sidebend to left and rotate right; NOTE: Movement should not be excessive)
      3. Use your ipsilateral hand to apply and inferior force through the lateral spine/acromion of the scapula to create scapular depression and downward rotation
      4. Get patient to bring shoulder up to ear to counter against force you are applying downwards
20
Q

Describe Levator Scap Length Test/Stretch

A
  • Purpose: To assess/increase muscle length of levator scap
    • Origin: Transverse processes of C1-C4
    • Insertion: Vertebral border of scapula from superior angle to root of spine
    • Action: Elevation and downward rotation of the scapula
    • Steps:
      1. With patient in supine, lift the head off the table to create cervical flexion (no need for chin tuck with eyes looking down nose)
      2. Use hand opposite of the side you are stretching to cradle patients head and bring them into contralateral side bend and cervical rotation (eg. When stretching the right levator scap, sidebend and rotate to the left; NOTE: Movement should not be excessive)
      3. Bring arm into UR
      4. Use ipsilateral hand to apply an inferior force through the medial spine of the scapula to create scapular depression
      5. Then get shoulder elevated while applying pressure
21
Q

Describe the Sharp Purser Test and contraindications

A

Sharp-Purser Test:
* Subluxation reduction test
* For transverse ligaments
* Steps:
1. Tuck chin towards adams apple (slightly)
2. Let head fall forward into flexion (not full flexion) and looking for symptom reproduction-> C1 moves forward on C2 if loss of integrity of transverse ligaments/ prevents anterior translation of C1 on C2 (ask patient if experiencing any symptoms such as bilateral/quadrilateral paraesthesia in UE, any recent traumas, experiencing any sense of instability = red flag)
3. With one hand come in on posterior aspect of C2 with elbow up to create a downward line and bring other hand onto forehead to push back in that direction
4. Apply a direct posterior translation of C1 on C2 by shearing through the forehead -> would feel excessive movement if loss of integrity of transverse ligament

22
Q

Describe upper cervical flexion rotation test and when it should be performed

A

Flexion-Rotation Test:
* Determines hypomobility/impairment of the upper cervical spine
* Important for those who get cervicogenic headache from cervical impairments
* Don’t use for radiculopathies -> instead use Weiner’s cluster
* Steps:
1. Have patient in supine
2. Bring cervical spine into maximal flexion
3. Rotate patients head to left and right until reaching end range (44 degrees normally in healthy individuals)
4. Positive if reduction of visual estimate of 10 degrees of 44 degrees of rotation

23
Q

Describe craniovertebral active and passive flexion/extension

A

Craniovertebral Active Flexion/Extension:
Flexion= tuck chin in
Extension= extend neck like a turtle

Craniovertebral Passive Flexion/Extension:
NOTE: Can keep pillow underneath head but make sure you dig down into pillow so their c-spine is neutral and not in extension when performing technique. Can also just not use pillow. Up to you or whatever
Flexion= Tuck chin in for them with thumbs on tempol
Extension= Scoop up with thumbs on tempol

24
Q

Describe craniovertebral Stability Test

A

Craniovertebral Stability Test:
* For alar ligament
* Assesses stability in side flexion or rotation
* Steps
1. Place one hand under head with medial side of thumb going up against spinous process of C2. If side bending to right want to palpate C2 on left side vs if side bending to left want to palpate C2 on right side (will feel spinous process of C2 push out)
2. Take head into right side flexion (using nose as lever point) with other hand on top of head which will cause rotation of C2 to the right and the spinous process will move to the left right into medial aspect of the thumb (thumb prevents that movement of the spinous process)
3. If alar ligament is intact there should be no greater than 6 degrees of movement and should be an abrupt stop. Right side flexion = left alar ligament is primary restraint
4. Can do same thing on left side to test right alar ligament
5. If you don’t get abrupt stop take into craniovertebral flexion or extension and reevaluate the movement

25
Q

Describe PNF

A

PNF:
* Patient is in supine and have there head close to your stomach so you can use it to support the head
* Bring into side bend and have them hold into resistance against your movement for 5 seconds
* Once you release this triggers a physiological release of the muscles getting them to relax (release tone) so then you can move the neck further into side bend (repeat 10 times)
* Contract towards side limited then bring into stretch on same side by bringing head movement into opposite direction. Can also contract towards non-limited side then stretch out limited side by bringing head towards non-limited side
* Use fingers to feel tone or spasm in neck muscles

26
Q

Describe passive physiological ROM

A

Passive Physiological ROM:
* Done in rotation and it is very gentle and consistent
* Patient is laying supine with therapist behind and finger tips around C2 and around ear
* Can do grade 1 or 2 passive physiological movement either to left rotation or right. Should be very gentle and not into resistance.
* Reassess range after doing that for 30 seconds
* Once feeling good can then proceed to grade 3 or 4 into resistance which is at 50-70 degrees of rotation

27
Q

How do C1-C2 vs C3-C7 differ in rotation and side bending

A

C1-C2 when side bend to right they rotate to left vs C3-C7 rotate to right

28
Q

What is mixed pattern presentation

A

Mixed Pattern Presentation: Convergence (articular) causes pain on one side while divergences cause pain and tightness on other side (muscular)
* When working with the neck always want it in a little bit of flexion to help with ROM
* If they are having convergence on right side you could do PNF on left side and stretch out right side to reduce pain so you can focus on right side (eg. If they are articular)

29
Q

Describe specific segmental traction

A
30
Q

Describe sliders and gliders and how to perform them for medial, radial and ulnar nerve (and their function)

A

Medial Nerve: Abduction, elbow extension, supination, wrist extension
Radial Nerve: Abduction, IR, wrist flexion, ulnar deviation
Ulnar Nerve: Abduction, elbow flexion, wrist extension, radial deviation, thumb +index make an ok sign
* If patient is irritable don’t do these passively as it will make them irritable for a few days
Medial Nerve:
Tension -> Head away + wrist extension
Glide proximally -> bring wrist flexion and side bend away (glider)
Glide distally -> wrist extension and side bend toward (slider)
Radial Nerve:
Tension: Head away + wrist flexion
Glide Proximal: Head away + wrist extension
Glide Distal: Head toward + wrist flexion
Ulnar Nerve:
Tension: Head away + hand touching head
Glide proximal -> head away (glider) + hand away
Glide distal -> head towards (Slider) + hand touching head
**Symptoms should settle within 30secs to 1 minute -> adjust dosage based on control

31
Q

Describe how to perform cervical muscle reeducation for deep flexors

A
32
Q

Describe how to perform cervical muscle reeducation for deep extensors

A
33
Q

Describe SNAG

A

Cross hand if they are not irritable. If they are irritable then cross hands

SNAG: Have towel at level of segment they need treatment on

34
Q

If having convergent patterns what can you do?

A

If having convergent patterns can do side bending/rotation with traction as a combined movement (traction in the movement they get relief)

35
Q

Cranial vs caudal PA

A

Cranial mimics flexion and caudal mimics extension

PT9133 - Lecture/Textbook/Research Paper Notes (9 decks)

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