C-spine Flashcards
How do you motion test for OA joint?
- rotate C2-7 maximally, then nod actively
- passively for coupling pattern: supine, flex upper cervical, apply traction, rotate 30 degrees, should see L flex occur opposite side
- Flexion and extension is assessed; flexion restrictions most common
What is the coupling pattern for upper cervical spine?
Rotation and lat flex occur in opposite direction
How do you perform MET for OA joint?
Flex upper cervical spine, apply traction, rotate 30 to one side
- look up and toward SS rotation for agonist
- look down and toward contralateral side of rotation for antagonist
- hold 5s, then mob into further rot/ lat flex
How do you motion test for the AA joint?
- look at full cervical rotation; Max flex to lock out C2-7, rotate; should see at least 50% rotation ROM
- Passive segmental mobility: translate C2 anterior
How do you do HEP MET for the AA joint
- Max flex and rotate, with resistance for agonist or antagonist m’s provided by hands
- opening on contralateral side to rotation
- Closing on SS to rotation
How do you mob the CO-1 segment?
anterior force over CO-1 joint with pt in prone
- push until 1st pt of pain; hold; then push beyond pain
How do you mob the C2-3 segment?
find C2 SP, move laterally, push soft tissue medially; apply anterior force to articular pillars
- push until 1st pt of pain; hold; if tolerable, push past pain and mob
How do you mob the C1-2 segment?
find C2 SP and move laterally, push soft tissue medially; have pt rotate towards affected facet to lock out C2-3; apply anterolateral force (directed towards mouth) to articular pillars
- push until 1st pt of pain; hold; if tolerable, push past pain and mob
How do you mob for HA into upper cervical flexion or lower cervical extension?
pt seated; chin tuck either passively by PT or actively by pt; PT blocks level below targeted segment
- opposite fore upper cervical flexion and lower cereal extension
What are S and S of cervical myelopathy?
- Headache and head pain
- Sensory disturbance of the hands
- Muscle wasting of hand intrinsic muscles
- Unsteady gait
- Positive Babinski’s sign
- Hyperreflexia
- Multisegmental weakness and/or sensory changes
- Muscle spasms
- Easy fatigability
What are the special tests for ligamentous instability?
- Sharp-purser - resistance over forehead and thumb over C2 SP; pt slowly flexes head; + = head slide backward (injury to transverse lig)
- Lat Flex alar lig stress test - palp C2 SP; SB head; SP should move contralateral direction of SB; + = delay in SP movement
What are S and S of VA insufficiency?
- Drop attacks
- Dizziness or lightheadedness related to neck movement
- Dysphasia
- Dysarthria
- Diplopia
- Malaise and nausea
- Vomiting
- Severe headaches
- Unsteadiness in walking, incoordination
- Weakness in extremities
- Sensory changes in face or body
- Hearing difficulties
- Facial paralysis
What is the screening position for testing for VAI?
Rotation and extension; hold 10s
- can be done passively by PT or actively by pt in prayer position
What are the TBCs for neck pain?
- pain control
- centralization
- mobility
- Conditioning and increase exercise tolerance
- reduce headache
What are the examination findings for pain control TBC?
- Very recent onset of symptoms
- Symptoms precipitated by trauma
- Referred or radiating symptoms extending into the upper quarter
- Poor tolerance for examination or most interventions
What are the proposed interventions for pain control TBC?
- Gentle active ROM within pain tolerance
- ROM exercises for adjacent regions
- Physical modalities as needed
- Activity modification to control pain
What are the examination findings for centralization TBC?
- Radicular/referred symptoms in the upper quarter
- Peripheralization and/or centralization of symptoms with ROM
- Signs of nerve root compression present
- May have diagnosis of cervical radiculopathy
What are the proposed interventions for centralization TBC?
- Mechanical/manual cervical traction
2. Repeated movements to centralize symptoms
What are the examination findings for mobility TBC?
- Recent onset of symptoms
- No radicular/referred symptoms in the upper quarter
- Restricted ROM with rotation and/or discrepancy in lateral flexion ROM
- No signs of nerve root compression or peripheralization in the upper quarter with cervical ROM
- can have degenerative or traumatic hx
What are the proposed interventions for mobility TBC?
- Cervical and thoracic spine mobilization/manipulation
- Active range of motion exercises
- PA mobs as well as selective ROM for AA and OA
What are the examination findings for conditioning and increased exercise tolerance TBC?
- Lower pain and disability scores
- Longer duration of symptoms
- No signs of nerve root compression
- No peripheralization/ centralization during ROM
What are the proposed interventions for conditioning and increased exercise tolerance TBC?
- Strengthening and endurance exercises for the muscles of the neck and upper quarter
- Aerobic conditioning exercises
What are the examination findings for reduce headache TBC?
- Unilateral headache with onset preceded by neck pain
- Headache pain triggered by neck movement or positions
- Headache pain elicited by pressure on posterior neck
What are the proposed interventions for reduce headache TBC?
- Cervical spine manipulation/ mobilization
- Strengthening of neck and upper quarter muscles
- Postural education
