C-Spine and TMJ Flashcards
PT
The Cervical Spine is broken into:
Upper Cervical:
C0-C1 (atlanto occipital joint)
C1-C2 (atlanto axial joint)
Lower Cervical:
C2-C3 to C7-T1
How much does the upper C spine contribute to the motion of the neck
50%
What is the primary movement of C0-C1?
C0-C1 Atlanto Occipital Joint performing flexion and extension (30% total)
What is the primary movement of C1-C2?
C1-C2 Atlanto-Axial Joint performing rotation (45% each side)
What are the deep ligaments of the c spine?
Transverse Ligament of Atlas
Alar Ligaments (holds Dens)
What type of motion happens in the lower c spine?
Primarily Type II
rotation and side-bending happen on the same side
Actions of upper trap
Extension
SB
Contra Rotation
Action of Levator Scapula
Extension
SB
Ipsi Rotation (to C spine, not scapula)
Action of Scalenes
SB
Contra Rotation
Action of SCM
Bilateral Flexion of the Neck with extension of Upper C Spine
Unilateral SB
Contra Rotation
Action Sub-Occipital Group
Extend the Occiput on the cervical spine
Muscles of Deep Cervical Flexors
Longus Colli, Longus Capitus
What is TMJ
Articulation between condyle of the mandible and the temporal bone
(disc attached to lateral pterygoid)
Muscles and Motion of Opening/Closing TMJ
Opening: Lateral Pterygoid
Closing: Temporalis, Masseter, Medial Pterygoid
Muscles and Motion of Lateral Deviation TMJ
Ipsilateral temporalis and masseter
Contralateral Pterygoids
Muscles and Motion of Protrusion/Retrusion of TMJ
Protrusion: pterygoids (jaw forward)
Retrusion: Posterior fibers of temporalis and anterior fibers of the neck
Resting Position of the mouth
mandible slightly retracted and teeth slightly apart
Acute Phase of Cervical Sprains and Strains
Protecting healing tissue, decrease inflammation and pain, minimize loss of ability
Modalities: E Stim, Cold Pack, Non-Thermal US, Laser
Manual: STM
Therex: AROM in pain-free ROM
PT Education: Posture Ed, Activity Modifications
Types of Cervical Collars
Soft
Tynor Hard Collar
Miami J Collar
Sub Acute Phase of Cervical Sprains and Strains
decrease inflammation and pain
regaining mobility
Modalities: CP/HP E Stim, US, Laser, Intermittent Traction
Manual: STM, gentle manual cervical traction
Therex: AROM, light stretching, postural exercise, gentle ISO strengthening in pain free position
Education: Posture Ed, HEP
Chronic Phase of Cervical Sprains and Strains
restore full mobility, posture re-ed, regaining full strength, training postural muscle endurance
Modalities: HP/CP
Manual: STM to restore full mobility, sub occipital release, manual cervical traction, manual stretching, joint mob
Therex: stretching spinal stabilization, upper extremity strengthening, ISO exercises for cervical strength, re-ed of deep cervical flexor
Education: HEP, slow return to pre-injury activity
What is cervical Spondylosis?
chronic degenerative condition that involves either
Disc (DDD), Joints (DJD), or BOTH
(theres no space)
What tissues can cervical spondylosis possibly have an impact?
Neural tissues in spinal canal or intervetebral foreamen
What are the symptoms of Cervical Spondylosis?
Stiffness
Pain
Loss of Mobility
Crepitus
Radiculopathy
Myelopathy leading to weakness
What is the chronic long term adaptations of cervical spondylosis?
Connective Tissue shortening
Chronic Muscle Tightness
Joint OA
Capsular Tightness restricting segmental mobility
What can you use to decrease pressure on joint/disc/connective tissue by decreasing tightness of c spine?
STM
Traction
Stretching
What is Cervical Disc Disease
a result of wear and tear or trauma
What should treatment be focused on for radiculopathy?
decreasing neural compression and patient education to avoid movements that close on the IV foreamen
*because of nerve damage treatment should not go for extended periods without signs and symptoms improving
(May require surgery)
Thoracic Outlet Syndrome
Condition where there is compression of the artery, nerve, or vein in the thoracic outlet
A result of trauma, overuse, or mechanical dysfunction
What are common areas of compression in thoracic outlet syndrome?
Scalenes
Between the clavicle and 1st Rib
Under Pec Minor
What is the goal when treating TOS?
decrease tightness in the anterior lateral cervical musculature and the axilla, and ensure there are normal mechanics for the upper quarter
What is Cervical Facet Joint Dysfunction
“crick in the neck” (somatic or segmental)
Overfacilitation of the nervous system at a particular cervical segment which leads to local muscle guarding and impaired mobility
What is an acute episode of Cervical Facet Joint Dysfunction
sleeping wrong, moving too quickly, trauma
Cervical Posture Dysfunction
Chronic adaptations (long periods) of poor posture on in response to previous trauma that was not rehabilitated properly
Requires restoration of proper length to tight structures and strengthening to inhibited muscle groups
What is the typical presentation of Cervical Posture Dysfunction
tight sub-occipital muscles, SCM, scalenes, pectoral muscles, hypertonic levator scap and/or upper trap
Weakness in deep neck flexors and interscap muscles
What is TMJ dysfunction?
Develops due to muscle imbalance from grinding, chewing on one side, chewing gum, sleeping position, or compensation for cervical spine dysfunction
What are signs and symptoms of TMJ dysfunction?
pain (usually one sided)
worse with opening
popping, limited ability to open mouth, difficulty chewing
