Upper Cervical And TMJ Flashcards by Connor Davis

Secondary curves

Cervical, lumbar lordosis

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Early phase of opening

Condyle rolls posteriorly

Body of mandible moves posterior and inferior

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Later phase of opening

It is a gliding jt.
Anterior slide of disc and condyle
Move from rotation to translators motion
Maximal anterior stretch on the disc

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Closing phase is _____ of opening phase

Opposite

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Intermediate part of the disc is located where

On top of the mandibular condyle

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Vertebral artery goes through

The transverse foraminae of the the cervical spine

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Atlas (C1) arthrokinematics

Superior articulate facet is concave
Superior moving on inferior when we are talking arthrokinematiccs
Convex on concave

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AO jt primary movement

Flexion and extension (nodding)

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T/F atlas always moves with the head

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Total ROM at AO jt

15 (Flex 5, ext 15)

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AA jt primary motion

Rotation

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35-40 degrees

Axial rotation at AA jt

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AO jt arthrokinematics

Flex - Ant roll, post slide

Ext - post roll, ant slide

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One motion around one plane is associated with another motion around a different plane

Spinal coupling

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T/F spinal coupling occurs in the upper cervical spine

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AO and AA jt spinal coupling

Lateral flex is coupled with contra lateral rotation

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Primary curves

Thoracic and sacral kyphosis

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When palpating the TMJ where is the therapist posisitoned

Patient is sitting
Therapists behind patient
Palate lateral poles of the mandible condyle a by placing index fingers in the ears-external auditory meatus
You may also perform this test externally by placing index fingers on lateral poles of the mandible condyle a
Ask patient to open mouth (depression) and assess for symmetry, willingness to move, quality of movement

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When in front of patient, measure the distance of __________ from the bottom of the top _________ an the top of the _______ .
Normal active motion in an adult is ______mm

Mouth opening
Central incisors
Bottom central incisors
40-50

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Mandibular depression is considered WNL if _______

The PIP jts of 3 fingers can be inserted between the teeth

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Normal active ROM in an adult of lateral deviation of the mandible

10-12 mm

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Normal active protrusion of the mandible in an adult

6-9 mm

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When palpating the muscles of mastication, patient is in ______ and therapist is ______
Palpate the extra oral musculature ____ ____ _____
Palpate the Intra oral musculature _____ _____

Supine
At the head
Masseter, temporalis, suprahyoids
Lateral and medial pterygoids

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Where does most rotation occur in the cervical spine

C1C2 AA jt

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1st step of sub-occipital active ROM

OA nodding

In forward and backward nodding (OA nodding) patient is ____ with therapist ____ and ask patient to ______ and then ______ slightly. This is a small movement with ______ total ROM. No _______ is applied in this area as you have not yet tested ligaments.

``` Sitting To the patient's side Actively tuck his chin down and in Back bend slightly 15 degrees Over pressure ```

In AA rotation, patient is ______ and therapist is standing ______. Ask patient to _______ and then _______ to test _____. If tight muscles are preventing full side bend ROM to the right, _______. Repeat to the other side. There is _____ of AA rotation per side

``` Sitting In front Bring their right ear to their right shoulder Rotate their head to the left AA left rotation Unweight the left arm 35-40 degrees ```

Palpating of the upper cervical region (8)

``` Sub occipital muscles Mastoid process TP of C1 Posterior tubercle of atlas SP of C2 TP of C2 Hyoid bone Digastrics, infrahyoids, suprahyoids ```

Perform prior to any other passive testing

Ligament testing

Test assesses the integrity of the transverse ligament

Sharp-purser test (Saginaw plane stability)

Therapist stands to the side of the patient places palm of one hand on the patient's forehead and uses the other hand to stabilize the SP of C2 using a pinch grip of the thumb and fingertip pads

Sharp-purser test

Therapist slightly flexes the patient's head and neck about 20-30 degrees, then applies a posterior pressure on the forehead to posteriorly translated the occipital and atlas

Sharp-preset test

Sharp purser test is considered positive if

Symptoms (Cardinal signs/symptoms of spinal cord compression) occur during Flexion and are relieved when posterior pressure is applied to the forehead. Excessive translation is also considered a positive test

Continuation of the posterior longitudinal ligament from the posterior body of the atlas to wrap around the posterior tip of the dens to the gutter in the basic input of the for amen magnum posterior to the atlantal axial ligament

Tectorial membrane

Restricts OA Flexion and gives longitudinal stability

Tectorial membrane

When testing tectorial membrane, patient is ____, and therapist is _____. Depress the patient's ________ with forearms and firmly hold the _____ while performing light _____ to the upper cervical spine and gentle passive ____.

``` Sitting Behind Shoulders Occiput Traction Upper cervical Flexion ```

Tectorial membrane test is positive if

``` Nystagmus Facial paraesthesias Profuse sweating Nausea, vomiting Difficulty swallowing ```

Controls axial rotation and side bending

Alar ligament

Posterior superior aspect of the dens laterally to the no articulate medial aspect of the occipital condyle a on either side with variable position in relation to the dens and occipital. It also runs from the dens to the atlas

Alar ligament

The alar ligament restricts

Side-bending and rotation of the axis to the opposite side

To test the alar ligament, patient is _____. Palpate _____ on the left and passively __________._______ should Conde into contact with finger on the _____. This is and indication of an intact _____ alar ligament. How much motion?

``` Supine C2 SP Rotate cervical spine to the right C2 SP Left Left 15-20 degrees ```

Positive alar lig test

C2 SP does not move with cervical movement. Look for spasm of sub occipital muscles in presence of alar lig tear.

Stability in the sagittal plane

Transverse cruciate ligament

Posterior to the dens attaching to the posterior aspect of the anterior arch of the atlas bilaterally to hold the dens forward against the anterior arch o the atlas

Transverse cruciate ligament

The transverse cruciate ligament restricts

Anterior glide of the atlas in Flexion of C1 on C2 (it holds the dens in place)

If the transverse cruciate ligament is torn

The dens will move posteriorly onto the spinal cord

When testing the transverse cruciate ligament, patient is _______, Palpate ______. Gently ___ on ______. Hold this position for ______. Note if symptoms present before this timeframe, _____ as this is a positive test.

``` Supine C1 TPs Lift up (glide anteriorly) C1 TPs 15-20 sec Release your hold ```

The transverse cruciate ligament test is positive if

``` Nystagmus Facial paraesthesias Profuse sweating Nausea, vomiting Difficulty swallowing *refer back to physician immediately. Transverse lig laxity may be present in individuals with Rheumatoid arthritis and Down syndrome ```

When assessing sub occipital nodding (mostly OA), patient is ____. Hold the head with a hand on each side, with the head in slight _____; gently _____ the head on the neck. Assess both ______ nodding of the head feeling for _____. Once the slack is taken up, move gently to ______. Assess the ______. This is the quality of resistance to the movement at the end range of the movement.

``` Supine Flexion Nod Left and right nodding The willingness of the head to move End ROM End feel ```

Passive ROM of AA rotation. Patient is ____. Hold the patient's head with a hand on each side, _____ the patient's mid cervical spine ______ to the right (purpose is to downslide all ______). In full right side bend, rotate the head to the _____.once the slack is taken up, move gently to the end of the rom. Assess the ____. Repeat of right AA rotation

``` Supine Side-bend As far as possible Right cervical facets to lock out mid cervical spine Left End feel ```

Passive combined motions

OA (Flexion with side bending) | OA (extension with side bending)

you must be careful doing passive combined motions. OA jt flexes and extends ____ if you see movement into the neck it is ____ movement

Around 15 degrees | Too much

OA (Flexion with side-bending). Patient is _____. Perform OA ____, adding ______ to right and left. During OA Flexion, occipital condyle a roll _____ and slide ____ on both sides (convex on concave). When right side bending is added, there will be coupled ____ rotation. The ____ condyle will glide further ______. This tests __________

``` Supine Flexion Side bend Anteriorly Posteriorly Left Left Posteriorly Left occipital condyle posterior glide AAROM ```

OA (extension with side-bending) patient is ______. Perform OA extension, adding a side bend to right and left. During OA extension, occipital condyle a roll ____ and slide _____ on both sides. When right side bending is added, there will be coupled ____ rotation. The right condyle will glide further ____. This tests _____

``` Supine Posteriorly Anteriorly Left Anteriorly Right occipital condyle anterior glide AAROM ```

Osteokinematics of OA jt in four motions

Flex - 5 Ext -10 Lat flex 5 Rotation negligible

Arthrokinematics of OA jt in 4 motions

Flex - ant roll, post slide Ext -post roll, ant slide Lat flex - slide opposite of roll Rotation - restricted motion

Osteokinematics of AA jt four motions

Flex - 5 Ext -10 Lat flex - negligible Rotation - 35-40

Arthrokinematics of AA jt four motions

Flex - follows OA - ant tilt Ext - follows OA - post tilt Lat flex - tilt Rotation - spin

What clinical test would you use with a patient who me you suspect has instability in the upper cervical spine

Sharp-purser Longitudinal ligament stability Alar ligament Transverse cruciate ligament

List four Simmons suggestive of a CNS compromise

Nystagmus Facial paraesthesias Profuse sweating Nausea

A of suprahyoids

Depress mandible

A of lateral pterygoid

Protracts mandible

A of medial pterygoid

Protracted and deviates mandible

A of masseter

Elevates, abducts, protrudes mandible

A of temporalis

Elevation, retraction of mandible (chewing)

Normal measurements for Opening Protrusion Lateral deviation

40-50 mm 6-9 mm 10-12 mm

Describe muscle and jt interactions during opening and closing of the mouth

Opening of the mouth- posterior rotation, ant. Translation, followed by more posterior rotation. Muscles involved are Lat pterygoid, infra and suprahyoids. Closing the mouth - ant rotation, posterior translation and then more ant rotation. Musc involved - temporalis, masseter, medial pterygoid.

Upper Cervical And TMJ Flashcards

(67 cards)