Cervical Spine Flashcards
(93 cards)
1
Q
Neurophysiological Effects of Mobilization
A
- Firing of mechanoreceptors, proprioception
- Firing of cutaneous and muscular receptors
- Altered nociception
2
Q
Mechanical Effects of Mobs
A
- Stretching of joint restrictions
- Breaking adhesions
- Altered positional relationships
- Diminish/eliminate barriers to normal motion
3
Q
Psychological Effects of Mobs
A
- Confidence gained through improvement
- Positive effects from manual contact
- Response to joint sounds
4
Q
Ther Ex Strategies
A
Williams Flexion McKenzie Exercises Core stabilization Lumbar stabilization Yoga/Pilates based strengthening and flexibility
5
Q
OMPT Techniques
A
Manipulation Mobilization Snag NAGs Mulligan mobs with movement Maitland Paris Australian Canadian Osteopathic McKenzie Nordic Cyriax
6
Q
Soft Tissue Techniques
A
Myofascial release
Trigger point release
Dry needling
7
Q
Neuro Approaches
A
PNF
Postural Restoration
Strain-Counter Strain
Neurodynamics
8
Q
Contraindication to Joint Mobs
A
Joint hypermobility or instability
Joint inflammation or effusion
Hard end feel
Medically unstable
Acute pain that worsens with repeated attempts
Acute radiculopathy
Bone disease or fracture detectable on radiograph
Spinal arthropathy (ankylosing spondylitis, DISH, spondy)
Deteriorating CNS pathology
Status-post joint effusion
Blood clotting disorder
9
Q
Precautions to Joint Mobs
A
Malignancy (>50, failure to respond, unexplained weight loss, prior history)
Total joint replacement
bone disease not detectable on radiograph (osteoporosis, osteopenia, osteomalaci, etc.)
Systemic connective tissue disorders (RA, Down’s syndrome, Marfan’s, Ehrlos-Danlos syndrome, lupus)
pregnancy or immediately after, oral contraceptives, anticoagulant therapy
Recent trauma, distal radiculopathy, cauda equina
Early healing phase
Individuals unable to reliably communicate or respond to intervention
Psychogenic patients exhibiting dependent behaviors
Long term corticosteroid use
Skin rashes or open wounds in region
Elevated pain levels
10
Q
Total Vertebrae
A
29
11
Q
Cervical Vertebrae
A
7
12
Q
Thoracic Vertebrae
A
12
13
Q
Lumbar Vertebrae
A
5
14
Q
Sacral Vertebrae
A
5
15
Q
Coccygeal Vertebrae
A
4
16
Q
Number of facet joints
A
24
17
Q
Classification of facet joints
A
Planar
18
Q
Upper cervical facet joints are orientated in what direction?
A
Horizontal
19
Q
Lower cervical facet position?
A
45 degrees
20
Q
Z joints/uncovertebral joints made up of what?
A
Uncinate processes
21
Q
Thoracic facet joints oriented?
A
Near vertical
22
Q
Lumbar facet positions?
A
Vertical with J-shaped surface
23
Q
What positions are major stressors to IVD?
A
Axial compression, shearing, bending, twisting (especially in combination)
24
Q
What are the 3 sub-systems that contribute to stability?
A
Passive
Active
Central Nervous System
25
Passive stability system
Anatomical structures
26
Active system
Muscles
27
Central nervous system
Feedforward and feedback control
28
Neutral zone of spine
Region of laxity around normal resting position of spinal segment
Involves minimal loading of passive and active structures and spinal motion is produced with minimal internal resistance
29
What produces movement in spine?
Agonist and synergistic muscles
30
What controls and modifies movement?
Antagonistic muscles
31
What affects the amount of motion available at each region of the spine?
```
Disc-vertebral height ratio
Compliance of fibrocartilage
Dimension/shape of adjacent vertebral endplates
Age
Disease
Gender
```
32
What are the two types of coupling in the cervical spine?
Opposite in Upper
| Same in Lower
33
What happens to the facet joints in flexion/extension and side-bending?
Flexion/extension- up&forward/down&back in same direction
Side-bending- movement in opposite directions
34
Fryette's First Law
In neutral, side-bending and rotation occur in opposite direction
35
Fryette's Second Law
In flexion or extension, side-bending and rotation occur in same direction
36
Fryette's Third Law
When put in one position, movement in other positions becomes limited
37
Restriction of Ext/SB/Rot to same side of pain indicates?
Can't Close issue
| Articular problem
38
Restriction of Flex/SB/Rot to opposite side of pain indicates?
Can't Open
| Capsular issue
39
Disease causing altered structural alignment in skull?
Arnold Chiari Syndrome/Malformation
40
Where does the majority of cervical rotation occur?
Atlanto-occipital region
41
Injury to atlanto-occipital/cervicoencephalic areas can lead to?
Cognitive dysfunction
Cranial nerve dysfunction
Sympathetic system dysfunction
42
Atlanto-occipital joints
Principal motion=15-20 degrees of flex/ext
| 10 degrees of side-bending
43
Atlanto-axial joints
Principal motion= 50 degrees rotation
10 degrees flex/ext
5 degrees SB
Most mobile articulations in spine
44
Cervicobrachial Region injury symptoms
```
Neck/arm pain
Headaches
Restricted ROM
Paresthesia
Altered dermatomes and myotomes
Radicular signs
```
45
What do IVDs do in cervical spine?
Make up 25% height
| Give lordotic curve to spine
46
Purpose of nucleus pulposus?
Buffer axial compression
47
Purpose of annulus fibrosis?
Withstand tension
48
What are the 4 parts of the vertebral artery?
1. Proximal
2. Transverse
3. Suboccipital
4. Intracranial
49
Path of proximal portion of VA
Origin at subclavian artery to point of entry into C-spine at ~C6
50
Transverse Path
entry into C-spine up through transverse foramen of C2 through transverse canal
Prone to compression from osteophytes, subluxation from facet joints
51
Suboccipital Path
From exit of C2 to penetration into spinal canal
Divided into 4 parts:
1. Within transverse foramen of C2
2. Between C2 and C1
3. Within transverse foramen of C1
4. Between posterior arch of C1 and entry into foramen magnum
Vulnerable to impingement from extension, excursion of transverse mass of C1, ossification of atlanto-axial membrane
52
Intracranial Path
from foramen magnum to formation of basilar artery at lower pons
Following penetration, VA goes medially to oblongata, then up to medulla to meet up with other VA to become basilar artery
This portion is prone to atherosclerotic plaques and stenosis
53
Branches of VA
1. Meningeal branches-supply bone and dura mater
2. Anterior Spinal
3. Posterior Spinal
4. Muscular branches- supply deep suboccipital muscles
5. Posterior Inferior Cerebellar Artery
54
Vertebrobasilar Insufficiency
```
Damage and occlusion of VA due to:
Atherosclerotic involvement
Sickle Cell
RA
Arterial fibroplasias
Arteriovenous fistula
Congenital syndromes
```
55
External causes of VBI
Extra-cranial Compression
Neck hyperextension
Vertebrobasilar infarction (extra-cranial dissection)
56
Internal causes of VBI
Atherosclerosis
Thrombosis
Arterial fibrodysplasia
Arteriovenous fistulas
57
What is Klippel-Trenaunay Syndrome?
Condition affecting development of blood vessels, soft tissues, and bones
58
Clinical Manifestations of VBI
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Dizziness/Vertigo
Drop attacks
Diplopia
Dysarthria
Dysphagia
Nausea
Numbness
Nystagmus
Tinnitus
Headache
Wallenberg, Horner Syndrome
Paresthesia/ Hemi
Scotoma/vision obstruction
Periodic LOC
Lip/perioral anesthesia
Hemifacial paralysis
Hypereflexia (Babinksi, Hoffman, Oppenheim)
Clonus
Ataxia
Dysphaisa
```
59
Imaging Studies for VBI
Conventional Angiography- shows lumen
MRA- less invasive, highly sensitive and specific
Doppler Sonography- allows direct visualization of vascular tree
60
What should clinician do throughout treatment?
Observe for nystagmus, Observe for pupil size changes
Assess quality of speech
Require pt to report any change in symptoms, regardless of seeming insignificance
61
5 D's And 3 N's
```
Dizziness
Diplopia
Drop attacks
Dysarthria
Dysphagia
Ataxia
Nystagmus
Numbness
Nausea
```
62
Horner's Syndrome
Decreased pupil size
Drooping eyelid
Decreased sweating on affected side of face
63
Proper training techniques include avoiding
Excessive Rotation
Non-physiologic movements in the joints
Aggressive, forceful maneuvers (instead gradually build from gentle mobs to higher amplitude and velocity
64
3 things necessary for doing cervical mobs
1. Proper training
2. Proper evaluation
3. Gain consent
65
Contraindications for VBI treatment
```
Infection
Acute circulatory problems
Malignancy
Open wounds
Recent fracture
Hematoma
Hypersensitivity
Inappropriate end feel
Advanced diabetes
Cellulitis
Severe pain
Extensive radiation of pain
```
66
Precautions for VBI treatment
```
Joint inflammation
RA
Neurological signs
Osteoporosis
Pregnancy
Dizziness
Steroid/anticoagulant therapy
```
67
Canadian C-spine Rules
```
Cognitively in tact
Under 65
>45 degree rotation
No crazy injury circumstances (High speeds, distraction)
No pain at rest in midline
No paresthesia in arms
```
If yes, no X-rays
68
3 tests to check ligament integrity in UCS
Modified Sharp-Purser
Alar Ligament Stress Test
Transverse Ligament of Atlas Test
69
Signs and Symptoms of Cervical Instability
```
Severe muscle spasms
Resistance and apprehension to movement
Lump in throat
Lip or facial paresthesia
Severe HA
Dizziness, nausea, vomiting, nystagmus, pupillary changes, other VBI indicators
Empty end feel
```
70
Sharp-Purser Test
Push anteriorly on C2 and posteriorly on forehead
| Feel for clunk and look for reproduction of symptoms
71
Transverse Ligament Test
Pt lying supine
| Pull anteriorly on occiput and hold for 15-20 seconds
72
Anterior Shear Test/Sagittal Stress Test
Same as Transverse Ligament Test
73
Alar Ligament Stress Test
Pt sitting with your hands on C2 spinous process and forehead
Rotate pt head side to side and SB to each side
74
Longitudinal Ligament/Tectorial Membrane (Pettman's Distraction Test)
Pt supine
Fixate C2 and distract occiput until end feel
Positive test= reproduction of symptoms or >1mm distraction
75
Atlantoaxial Lateral Shear Test
Pt supine
| Stabilize C1 and pushes C2 over, then repeats in opposite directions
76
Jefferson's Fracture/Odontoid Fracture Test
Pt supine with head and neck neutral
One hand supports occiput, other hand contacts lateral mass
Apply medial force through atlas
77
Vertebral Artery Torsion Test
Pt sitting
| Stand in front of pt and shake pt head, observe eyes
78
Wallenberg's Position
Pt sitting with neck extended and rotated to one side
| Hav pt count backwards from 20
79
What directions of ROM do you screen
ALL
| Flex, ext, SB, rotation
80
UE Myotomes, test actions, and muscles involved
C1-C2- Neck flexion (rectus lateralis and capitus anterior, longus capitis, coli, and cervicis, and sternocleidomastoid)
C3- Neck side flexion (longus capitis and cervicis, trapezius, and scalenus medius)
C4- Shoulder elevation (diaphragm, traps, levator scap, anterior scalene, middle scalene)
C5- Shoulder abduction (rhomboids, deltoid, supraspinatus, infraspinatus, teres minor, biceps, anterior ad middle scalene)
C6- Elbow flexion and wrist extension (serratus anterior, lats, subscap, teres major, pec major, biceps, coracobrachialis, brachialis, brachioradialis, supinator, extensor carpi radialis longus, anterior, middle, and posterior scalene)
C7- Elbow extension and wrist flexion (serratus anterior, lats, pec major, pec minor, pronator teres, flexor carpi radialis, flexor digitorum superficialis, extensor carpi radialis longus and brevis, extensor digitorum, extensor digiti minimi, middle and posterior scalene)
C8- Thumb extension and ulnar deviation (pec major, pec minor, triceps, flexor digitorum superficialis and profundus, flexor pollicis longus, pronator quadratus, flexor carpi ulnaris, abductor pollicis longus, extensor pollicis longus and brevis, extensor indicis, abductor pollicis brevis, flexor pollicis brevis, opponens pollicis, middle and posterior scalene
T1- Hand intrinsics (flexor digitorum profundus, intrinsic muscles of the hand except extensor pollicis brevis, flexor pollicis brevis, opponens pollicis
81
Myelopathy is a form of?
UMN lesion
82
What are forms of LMN lesions?
Nerve root and peripheral nerve lesion
83
Reflexes
Biceps= C5-C6
Brachioradialis= C6
Triceps= C7-C8
Hoffman- flick middle finger and watch thumb
84
What are the 2 types of special tests and describe them
Provactive- Upper limb tension tests, foraminal compression tests, cervical flexion rotation tests
Symptom relief- distraction tests, shoulder abduction test
85
Key Tests for Cervical Neurological Symptoms
Brachial Plexus tension test
Distraction test
Foraminal compression test
Upper limb neurodynamic tension test
86
Spurling's Compression
Pt sitting with head flexed to uninvolved side, examiner press down
Repeat on involved side
87
Jackson's Compression Test
Same as Spurling's with rotation
88
Maximal Foraminal Compression Test/ Spurling's Upper/Lower Quadrant
Pt sitting with neck passively placed in extension, ipsilateral side-bending, and ipsilateral rotation for lower quadrant
Pt sitting in cervical protraction and the other positions
Apply gentle compression with triplanar overpressure
89
Distraction Test
Lift or distract head from neck and look for improvement in symptoms
90
Shoulder Abduction (Relief) Test
Pt has arm elevated with forearm and hand on head
| Positive if pt has decrease in symptoms
91
Cervical Flexion Rotation Test
Pt supine, then moves into active flexion
Examiner applies forceful rotation to both sides and inquires about symptoms
Positive= pain provocation or >10 degree loss in ROM
92
Cervical Muscle Strength
Pt supine, examiner places pt head into retraction and pt holds head 1 in. off table
See how long pt can hold head in position
93
Upper Limb Nerve Tension Tests
```
Median 1- (anterior interosseous nerve) shoulder, wrist, and elbow extension, finger extension, shoulder ER
Median 2 (axillary and musculocutaneous)- shoulder abduction to 90, elbow, wrist, and finger extension, downward force on shoulder
Radial- shoulder and elbow extension, wrist flexion, finger flexion, downward force on shoulder
Ulnar- "3-point goggles"
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