Biomechanical Evaluation of the Upper Cervical Spine Flashcards
When do you perform a biomechanical evaluation of the upper cervical spine?
Following a negative stability, circulatory (VBI, etc) and neurological examination.
When do you perform a combined movements test during active physiological movement evaluation?
When planar movements are negative and/or when a regular or irregular motion pattern is to be confirmed.
How do you test OA flexion and extension (Kaltenborn)?
pt. position: sitting
hand 1: palm stabilizing lower c-spine with index finger placed between transverse process of C1 and mastoid of skull.
hand 2: on top of skull, moving head back-and-forth to produce movement at OA joint.
COMPARE BOTH SIDES
How do you test AA Rotation (Edwards)?
pt. position: sitting
hand 1: over back of neck with index finger on C2 spinous and thumb over articulation between C1 & C2
hand 2: around skull grabbing occiput with little finger over arch of C1 holding against therapists body. rotates head to side of therapist.
negative: C2 felt moving at approx. 30-50° of total head rotation
How do you test OA combined side-bending and rotation?
Same as OA flex and extension except instead of flex-ext with hand 2, you do side bending and rotation
How do you perform OA Flexion and Extension with Traction?
pt. position: sitting
hand 1: palm stabilizing lower c-spine with index finger placed between transverse process of C1 and mastoid of skull.
hand 2: around skull grabbing occiput with little finger over arch of C1 holding against therapists chest. Traction with this hand and body working together, then flexion/extension evaluated.
TELL PT TO BREATHE IN DEEPLY THEN BREATHE OUT. APPLY TRACTION WHEN BREATHING OUT.
How do you do a CPA glide?
UPA glide?
pt. position: prone
both hands: thumbs in ext. over the spinous processes (CPA) or lateral masses/transverse processes (UPA), pushing into spinous processes with movement from elbow and body weight (not small thenar muscles).
What are PA glides assessing?
pain/symptom reproduction, spasm, mobility.
How do you perform transverse pressures on C2?
What is an important thing to do with it?
pt. position: prone
both hands: thumbs on spinous process pushing prallel to coronal plane (parallel to floor).
Always evaluate TO the side of pain as well as AWAY from it.
How do you perform Maitland Side-gliding of the Atlas?
pt. position: lying prone with head rotated 30-40°
Therapist standing at head of table.
both hands: incline thumbs on pt’s “top” side of the Atlas and direct UPA toward opposite ear (straight down pretty much).
How do you perform Kaltenborn lateral glide with caudal fixation?
If there is too much movement then what?
pt. position: lying supine
Therapist standing at head of table
hand 1: radial border of index finger stabilize lateral aspect of C2
hand 2: radial border of index finger performing lateral glide of C1
If excessive motion, mobilization is contraindicated and may also need eval of vertebral artery.
What is the difference between Type 1 coupling and Type II coupling? What cervical vertebrae do each type?
Type 1, aka Neutral, sidebending in one direction causes vertebral rotation in OPPOSITE direction. C0-C2
Type 2, aka Non-neutral, sidebending in one direction causes vertebral rotation in SAME direction. C2-C7
When there is pain when rotating one direction, how do you differentiate between lower and upper cervical spine?
- Sidebend to opposite side of pain
- Then rotate to same side of pain
If pain with #2, then it is UPPER c-spine.
If NO pain with #2, then it is lower c-spine.
If you have confirmed upper c-spine pain, how do you differentiate between OA and AA pain?
- Rotate to restriction
- Therapist fixates head against chest and places hand around C1.
- C1 is rotated further to side of restriction while head is fixed.
An INCREASE in symptoms implicates AA
A DECREASE in symptoms implicates OA - Rotate C1 to opposite side to confirm findings.
How do you perform AA Rotation in Supine?
pt. position: supine (duh)
Therapist standing at head of table
both hands: holds occiput and flexes cervical spine into full flexion and rotates in each direction
Positive: LESS THAN 45° rotation OR 10 degree difference in rotation implicates AA rotation restrictions.
