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Flashcards in Cervical Muscle Energy Deck (27)
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1

Major motions of OA joint

Flexion and extension
- occurs along a transverse axis

Rotation
- occurs along a vertical axis

Lateral flexion (sidebending)
- occurs along an AP axis

Is type 1-like since rotation and sidebending are opposite directions, but can still be flexed or extended
- rotation one way will induce opposite side-bending

* note the alar ligament causes natural lateral flexion of the occiput to the right (2-3mm)*

2

Alar brake (ligament)

ligament that Originates at the posterior lateral aspect of the dens of C2 and angles over the atlas (C1) inserting into the medial tubercles of the occipital condyle
- **prevents sidebending of the AA**

Also takes help from the dens

3

Why is there fewer cervical radioculopathies vs lumbar?

Cervical vertebrae have uncovertebral joints on the lateral surface of the vertebral bodies in conjunction w/ facet joints
- provides additional stability and processes articular pillars for the nerves and vertebral foramen for the vertebral artery

4

Articular pillars

Transverse processes fro the cervical vertebrae

5

Superior facet orientation in each section of the spine

cervical spine (BUM)
- Backward Upward and Medial

Thoracic spine (BUL)
- Backward Upward and lateral

Lumber spine (BUM)
- Backward Upward and medial

6

How does the rotation/sidebending ratio change in the cervical spine?

gradual cephalocaudal decrease in rotation and increase in sidebending
- this is due to the increasing in the angle of incline of the facet joints as you go down the cervical spine

Ex:
- C2 = 2 degrees rotation/ 3 degrees sidebending
- C7 = 1 degree rotation/7.5 degrees side being

7

Motor strength recording

0/5 = no motor strength at all

1/5 = Trace amounts of contraction/ strength w/ no joint motion

2/5 =. Complete range of motion w/ no gravity

3/5 = complete range of motion w/ gravity but no resistance

4/5 = complete range of motion w/ gravity and some resistance

5/5/ = complete range of motion w/ gravity and full resistance

8

C5-C8 dermatome and myotome

C5
- dermatome (sense function) = lateral upper arm
- myotome (motor function) = deltoid
- reflex = biceps

C6
- dermatome (sense function)= lateral forearm, thumb and index finger
- myotome (motor function)= biceps and wrist extensors
- reflex = brachioradialis

C7
- dermatome (sense function) = middle finger
- myotome (motor function) = triceps, wrist flexors and finger extensors
- reflex = triceps

C8
- dermatome (sense function) = ring and little finger, medial forearm
- myotome (motor functions) = finger flexors, thenar muscles
- NO REFLEX

9

Reflex grading

0/4 = absent

1/4 = decreased but present

2/4 = normal

3/4 = brisk without clonus

4/4 brisk w/ clonus

10

Spurring maneuver

Foraminal compression test

Done by placing the head in extension, side being and rotation toward the shoulder and then adding axial compression

(+) = pain or numbness that radiates down ipsilateral arm
- not sensitive (30%) but is specific (93%) for some sort of cervical radiculopathy

**test narrows intervertebral foramina leading to radicular symptoms**

11

What are considerations in OMM for pediatric patients and elderly

Pediatrics
- have decreased muscle and bone tone
- dont use direct articulatory techniques


Elderly
- have variety of degenerative processes that alter the ability to modify structure
- dont use direct techniques and focus on small amounts of OMT in frequent intervals

12

Signs of vertebrobasilar insufficiency (cervical spondylitis)

Nausea

Vomiting

Visual disturbances

Vertigo

**if this is present = CONTRAINDICATION**

13

Types of ME

Post-isometric relaxation

Joint mobilization using muscle force

Respiratory assistance

Reciprocal inhibition

Crossed extensor reflex

Isokinetic strengthening

Isolytic lengthening

14

Common errors in ME

Wrong diagnosis

Initial position for treatment is not localized

Not monitoring motion at the involved joint

Too forceful of matching muscle contraction

Too short of duration for muscle contraction

Not allowing patient to fully relax before repositioning to new restrictive barrier

Forgetting to retest

15

Contraindications for ME

Fracture

Dislocation

Rheumatolgic conditions

Painful tissue damage (tears, hematoma)

Infections of tendons, ligaments and/or muscle tissue

Centrally mediated muscle spasms

Compromised vasculature

Uncooperative or non consenting patient

Evocation of neurological symptoms

16

Most common complication for ME

Muscle stiffness or soreness that is self-limiting and generally resolves in 24-36 hrs

17

Oculocervical and oculocephalic reflexes

Oculocervical: using eye movements to activate or inhibit muscles of the neck

Oculocephalic: using eye movements to activate or inhibit muscles of the head

Can be used alternatively in ME when the patient is matching the force by having them look towards the neutral position

18

What stops AA joint movement anteriorly and posteriorly w/ flexion and extension

The transverse ligament
- stops anterior grinding of the atlas on the axis and limits gaping superiorly and inferiorly w/

19

AA biomechanics

Major motion is rotation (50% of the cervical spine rotation occurs at this joint)

20

How is cervical rotation split about the cervical spine?

60 degrees is in the upper cervical complex

30 degrees is in the lower cervical complex

21

What does the term elaboration mean?

Describes rotation of the vertebrae to the same side as lateral flexion

22

Normal degrees of motion in the cervical region

Flexion
- 45

Extension
-90

Rotation
- 80-90

Side-bending
- 35-45

23

How does lateral flexion of the occiput work?

Right lateral flexion:
Left side alar ligament wraps around the dens and tightens it
- causes translation of the right occipital condyle to the left in dueling right lateral flexion

*vise versa on left lateral flexion

24

How does the AA joint move?

Rotates along the axis dens with the transverse ligament stoping any anterior movement

Major motion is rotation
- 50% of cervical spine rotation is here

**there is almost no sidebending/flexion/extension occurring here

25

What are the borders of all “cervical triangles”

Submandibular
- inferior border of mandible
- anterior belly of digastric
- posterior belly of digastric

Submental
- hyoid bone
- anterior belly of digastric
- midline

Muscular
- hyoid and superior belly of omohyoid muscle
- anterior border of SCM
- theoretical midline of the neck

Carotid
- superior belly of the omohyoid
- stylohyoid and Posterior belly of the digastric
- anterior border of the SCM

26

What type of mechanics does C2-C7 show?

Type 2-like except that F/E or N doesnt change that rotation and sidebending are always on the same side
- often also shows multiple segments

*example NSRRR is a possibility*

27

Common indications for cervical ME

Sprains/strains

Cervicalgia

Headaches

Arthritis

Upper respiratory and HEENT infections

Dysphagia

Speech disorders

Thyroid disorders