L3: Skills Prac 1-2 Flashcards
(20 cards)
What are 6 surface anatomy landmarks?
- TV process C1 and arch of atlas
- Spinous processes C2-7
- C2 spinous process: C1-2 facet joint; C2-3 facet joint
- Zygapophyseal joints C2-3 -C7-T1
- Spinous processes T1-12
- Spine of scapula, inferior angle, medial border of scapula
What are 4 postural assessment to examine?
- Habitual sitting posture
- Correction of spinal posture, facilitation of correct posture, effect on ROM
- Scapular posture
- Correction of scapular posture, effect on ROM (rotation), muscle tenderness
What are 3 practical activities for the beginning?
What is the surface anatomy of the upper cervical spine?
What is the surface anatomy of the cervical spine from C1-7?
What does the zygapophseal joint look like in the cervical spine?
What are the bony landmarks for finding T2-3, T3-4, T7-9?
What is postural analysis for the cervical spine?
What does cervical and thoracic angle look like during a 10min mouse task?
What are the 6 steps of a dnamic postural analysis (analysis of postural strategies and muscle use) for sitting?
Correct posture requires a neutral lumbo-pelvic, thoracic, cervical and shoulder girdle position
- What is the patients habitual sitting posture
- Neutral pelvic/spinal posture
- Flexed pelvic/spinal posture
- Extended pelvic/spinal posture
- What is the patient’s perception of an ideal sitting posture?
- Look for a predominant use of thoraco-lumbar erector spinae (poor pattern)
- Facilitate a correct upright posture
- Check for upright pelvis and normal lumbar lordosis
- Check thoracic spine
- need for slight sternal lift if still too flexed
- need for slight sternal depression if still too extended
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Assess effect of change in posture on (TDT):
- Resting pain
- Cervical range of movement (Upright posture can increase cervical ROM)
- Palpable tenderness in levatorscapulae or upper trapezius
- Can the patient replicate an ideal sitting posture once taught and if not what is the reason?
- kinesthetic ability
- poor active control
- loss of passive mobility
What is an anatalgic posture? C6/7?
Anatalgic posture relieves pain - do not correct
C6 - hand over opposite shoulder
C7- HBH
What is the assessment of shoulder girdle dysfunction?
Assess scapular orientation relative to thorax:
- 3 rotations:
- upward/downward
- anterior/posterior
- internal/external
- 2 translations:
- superior/inferior
- protraction/retraction
What are the 2 characteristics of a normal or ideal shoulder girdle?
- the scapula should sit flush on the chest wall
- smooth curve of the neck and shoulder
What are 5 common scapular positional faults in neck pain patients?
- Downwardly rotated and protracted scapula ±anterior tilt, internal rotation
- Poor control of upward rotator synergy (trapezius, serratus anterior)
- Overactive levator scapulae, rhomboids, pec minor
- Poor upward rotation with arm movement
- Poor scapular orientation worsened under load
- Often immediate improvement in cervical motion and tenderness of shoulder girdle muscles when scapular position corrected
- Caution with subtle elevation of shoulder posture
- Protective ‘overactivity’upper trapezius
- Check
- neural mechanosensitivity
- scalene hypertonicity
- elevated first rib
What are 6 characteristics of scapular posture?
- assess in standing and sitting
- make pattern of muscle imbalance fit
- position scapula in optimal position
- NOTE: Deviation from the ideal is not uncommon
- assessthe effect on symptoms and cervical ROM
- assess patient’s pattern of control to reposition the scapula
What are 6 aims of analysis of cervical motion in sitting?
-
Pain and other symptoms:
- reproduction of patient’s presenting symptoms
- where in range it occurs
- intensity of symptoms
- Analyse pattern, control of movement (neck and upper thoracic area)
-
Range of movement
- measure with inclinometer?
-
Overpressure
- apply only when there is apparent full ROM and no pain to ‘clear’ the direction of movement
- Recording: Direction, Range, Pain response, comment on pattern or √√ if full range and painfree
- Nominate: which direction (s) will be outcome measures *
What are 4 observations of cervical flexion?
- flattening of cervical curve
- movement of upper thoracic region
- extension of chin (Neural tissue protection)
- initiate return from the cervico-thoracic region, head neutral (returning using upper cervical extension could indicate predominant use of head rather than neck extensors)
What are 3 observations of cervical extension?
-
Position of head relative to the line of the shoulders.
- The mass of the head should move posterior to the shoulders with increasing lordosis
- Should be able to get pass shoulders
- Inability to do so could be protection of a painful segment or indicate weakness of cervical flexors
- The mass of the head should move posterior to the shoulders with increasing lordosis
- observe rhythm –a ‘slide’ indicates poor control and weakness of cervical flexors; or possible segmental instability
-
Initiate return from extension with craniocervical flexion
- Return with CC region in extension indicates weakness of deep cervical flexors
What are 3 observations of cervical rotation?
-
Regional movement:
- Movement of head predominantly (C1-2 = 40°) could indicate hypomobility in lower cervical region
- Lack of free movement of head with movement forced to lower cervical region could indicate hypomobility in the upper cervical region
- Palpate movement of upper thoracic region during head rotation
- Check effect of scapular posture correction–indicates potential role of axio-scapular muscles in movement dysfunction
What are 3 observations of cervical flexion?
Observe for smooth lateral curve in the neck
- Analyse any movement restriction
- Segmental: loss of movement in section of the curve
- Neural tissue restriction: differentiate NT by repeating lateral flexion with the arm in the BPPT position
- Muscle: restricted by a lengthened muscle (eg Upper trapezius) –repeat while supporting the shoulder in slight elevation
