Cervical HVLA Flashcards by Rob HUNTER

OA joint characteristics (3)

type 1 spinal mechanics (SB & rotation to opposite sides)
15 degrees flexion/extension, limited side bending, no rotation
condyles angled antero- medial>postero- lateral

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AA Joint characteristics

primarily rotation 55-85% of total rotation of Cx spine
ligamentous structures stabilise odontoid process against the anterior arch of C1 and the occiput

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Characteristics of lower cervical region

C2/C3 through to C7/T1 joints
Type 2 spinal mechanics (SB & Rotation coupled to the same side
*plane of facet changes from 35 degrees to the horizontal in the upper Cx to 65 degrees to horizontal in lower Cx

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The role of C5

C5/6 has the most flexion/extension and is the region of most mechanical strain

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Mechanical loading of Cx

1/3 of the compressive load is transmitted by z joints, 2/3 by vertebral bodies and joints

Compressive load on Cx joints found to be 10kg higher when the head position changed from 15 degrees of flexion to 40 degrees

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Cues for TMJ involvement in neck pain

Observable mouth breathing
Anterior head carriage
Waking with neck pain
Signs of stress and anxiety

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HVLA sequence

Diagnosis
Initial consent
Localising the joint
Articulation
Final consent
Practitioner final check
Deliver thrust

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Patient history for HVLA looking for (6)

Age
Migraine headaches
Smoking
Oral contraceptives
Family history of cardiovascular disease
Ischemic signs & symptoms (dizziness)

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HVLA precautions risk management physical examination

Blood pressure
BMI
Signs of cardiovascular disease
Upper cervical spine integrity tests

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HVLA precautions VBI signs and symptoms

Dizziness/vertigo/light headedness
Drop attacks &loss of consciousness
Dislopia -double vision
Dysarthria-difficulty with speech
Disphagia - difficulty swallowing
Ataxia
Nausea
Numbness in one side face/body
Nystagmus- radio uncontrolled eye movements

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Contraindications to HVLA (7)

Rheumatoid arthritis of cervical spine
Carotid or vertebrobasilar vas. disease
Presence/possibility of bony metastasis
Severe osteopenia
History of pathological fractures
Connective tissue disorders (scleroderma)
Abnormal development of osseous or ligamentous structures

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Artherosclerosis risk factors

*Hypertension
*Diabetes
*Family history of atherosclerosis
*Smoking
*High LDL (hypercholesterolemia)
*Hyperhomocysteinemia
*Infection by escherichia coli, helicobacter pylori etc
*Mechanical trauma to vessel

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HVLA Premanipulativ we testing

*case history +BP + 5Ds &3Ns
*informed consent
* cranial nerve screen
* active seated ROM
* ORTHOPEDIC TESTING
Spurlings
Compression
Distraction
Alar ligament

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In Australia for negligence to have occurred what three factors must be proven

Absence of duty of care
Breach of standard of care
Damage or loss caused by breach of standard of care

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Informed consent must include information of

The diagnosis and prognosis
Explanation of the treatment
Risks of procedure and side effects
Possible complications
Details of the treatment
Options to treatment
Cost of treatment
Option to defer treatment
Right to withdraw consent

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Symptoms of C A D for carotid artery pathologies (arthrosclerosis, stenotic thrombosis aneurysmal

Carotidnyia
Neck pain
Facial pain
Headache
Cranial nerve dysfunction
Horners Syndrome
Transient Ischemic Attack
Stroke

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Symptoms of C A D for carotid artery pathologies (hypoplasia)

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Commonly silent rare cerebral ischemia

Symptoms of C A D for carotid artery pathologies (dissection)

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Neck pain
Facial pain
Headache
TIA
Cranial Nerve Palsied
Horners Syndrome

Symptoms of C A D for vertebral artery pathologies (arthrosclerosis)

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Neck pain
Occipital headache
TIA
Stroke

Symptoms of C A D for vertebral artery pathologies (dissection)

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Neck pain
Occipital headache
TIA
Cranial nerve palsy

Symptoms of C A D for temporal/ vertebral/ occipital/ carotid arteries pathologies (giant cell arteritis)

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Temporal pain
Scalp tenderness
Jaw and tongue claudication
Visual symptoms

Symptoms of C A D for cerebral vessels pathologies ( reversible cerebral vasoconstriction syndrome

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Severe Thunderclap headaches

Symptoms of C A D for subarachnoid pathology (heammorage)

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Sudden severe headache
Stiff neck
Visual disturbance
Photo phobia
Slurred speech
Sickness
Unilateral weakness

Symptoms of C A D for jugular vein pathologies (thrombosis)

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Neck pain
Headaches
Fever
Swellingariund neck/angle of jaw

Risk factors for CAD (dissection vascular events)

Recent Trauma Vascular anomaly Current or past smoker Migraine High total cholesterol Recent infection Hypertension Oral contraception Family history of stroke

Risk factors for CAD (non dissection vascular events)

Current or past smoker Hypertension High total cholesterol Migraine Vascular anomaly Family history of stroke Oral contraception Recent infection Recent trauma

Recent symptoms for dissection events

Headaches Neck pain Visual disturbance Parathesia (upper limb) Dizziness Parathesia (face) Parathesia (lower limb)

Signs of VBA dissection

Unsteadiness/ataxia Dysphasia/ dysarthria/ aphasia Weakness (lower limb) Weakness (upper limb) Dysphagia Naesea/vomiting Facial palsy Dizziness/ disequilibrium Ptosis Loss of consciousness Confusion Drowsiness

Exam of blood pressure points

Pulse pressure (systolic - diastolic) indicator of cardiovascular health. Pulse pressure 《40 is normal Pulse pressure 》60 refer to GP

Cranial nerve examination if

Pt presents with symptoms involving face/ head Presents with new / unfamiliar headache Presents with signs of vascular involvement

Occipital-atlanto/OA + Atlanta Axial/AA joint collectively provides ROM...

In all planes

Origin and insertion of Longus Colli

Transverse processes and anterior bodies of C3 -T3 vertebrae To the Transverse processes and anterior bodies of C2-C6 and anterior arch of C1

OA structure and function: describe with attachments, function

* Paired synovial condyloid joints * no dosc * no spinal process * tubercles, anterior & posterior Anterior tubercle attaches to Longus Colli muscles and ALL Posterior tubercle attaches to ligamentum nuchae and Rectus Capitus Posterior Minor * Motion is flexion & extension (50% of the cervical spine ROM)

What are the two parts of the AA joint- What is the motion

1. Transverse ligament 2. Fibrocartilagineous snyovial joint 50% of Cx rotation

Posterior occipital membrane is closely associated with the ..... and blends with the...

Vertebral artery Dura

What are the four suboccipital muscles and the attachments of each

*Rectum capitus posterior minor (posterior tubercle of C1 to occiput) * rectus capitus posterior major (spinous process of C2 to occiput) * obliquus capitus inferior (Spinous process of C2 to transverse process of C1) * obliquus capitus superior (Transverse process of C1 to occiput)

Suboccipital anatomy: what nerves activate the suboccipital muscles?

Rectus capitus posterior major: suboccipital nerve Dorsal ramps of C1 Rectus capitus posterior minor : The suboccipital nerve Dorsal ramus of C1 Obliquus capitus inferior The suboccipital nerve Dorsal ramps of C1 Obliquus Capitis Superior The suboccipital Nerve Dorsal ramps of C1

The C2 nerve (Greater Occipital Nerve) is vulnerable to impingement at what three points

* crosses the AA joint * around Obliquus Capitus Inferior As it pierces the semispinalis capitis and trapezium muscles

The vestibulospinal tract are...

Bundle of nerve fibres that carry information from. The higher centres of the brain to the peripheral parts of the brain

What does the lateral vestibulospinal tract do

Helps adjust and maintain posture and balance by changing the muscle tone and increasing activation of anti-gravity extensor muscles, thus maintaining an upright posture in response to changing orientation of the head.

Cervical HVLA Flashcards

(40 cards)