C-Spine, Elbow & Wrist,SI, L-spine, Shoulder Flashcards
From c2 - c7 lateral flexion is coupled with ____ in the same direction
- axial rotation
When the neck rotates the facets close by gliding ….
Downwardly & posteriorly
To improve flexion of the c-spine at a particular segment you would…
Perform an anterior glide of the superior vertebrae of the motion segment while stabilizing the inferior
To improve extension at a motion segment of the c-spine you would…
Perform an anterior/superior glide of the inferior vertebrae of the motion segment while stabilizing the superior segment
To improve rotation of a spinal segment in the c-spine you would…
Perform a lateral glide using the SP towards the contralateral side or perform an anterior glide of the contralateral facet
Thoracic outlet syndrome is compression of the …
Brachial Plexus
What are some test that can be used to test for TOS
- Travell’s (scalene compression)
- Adson’s (scalene compression)
- Military (1st rib-clavicle)
- Hyperabduction (pec minor)
What are some tests to test for peripheral entrapment?
- Tinnel’s along nerve pathway
- Pronator teres activation (median nerve)
- Phalen’s / reverse phalen’s (median nerve at carpal tunnel)
- Nerve tension test (generalized mf restrictions along nerve pathway)
What are the jt referral patterns of the C-Spine?
C2-C3:
C3-C4:
C4-C5:
C5-C6:
C6-C7:
C2-C3: back of head
C3-C4: back of neck
C4-C5: back of neck
C5-C6: suprascapular
C6-C7: scapula/thorax
What is the trp pattern for scalenes?
Back of arm, dorsal finger (1st & second phalanges) , front of arm, front of chest, front of shoulder, mid-thoracic back, upper thoracic back
Trp referral pattern of lev scap…
Back of shoulder, stiff neck, upper thoracic back, medial border of scapula
Trp referral pattern of UFT
(Looks like question mark), Back of head pain, back of neck pain, cheek pain, headaches or migraines, mid-thoracic back pain, temple and eyebrow pain, temporal headache, tmj disorder, angle of jaw, upper thoracic back pain
Trp referral pattern of splenius capitis
Posterior neck, above the ear, at the top of the head, headaches or migraines
Trp referral pattern of splenius cervicis
Headaches, migraines, posterior neck, above the ear, top of the head, back of head
Trp referral pattern of SCM
Back of head pain, cheek pain, mastoid process, dizziness when turning, headaches or migraines, temple and eyebrow pain, tmj pain, sinus issues
Trp referral pattern of suboccipitals
Headaches or migraines, back of head, temple & eyebrow, occiput to eye & forehead area
Trp referral pattern of longissimus capitis
Around the ear, posterior neck, behind the eye
Trp referral pattern of semispinalis capitis
Back of head, frontal headache, temporal headache, headache or migraines
What are the STI classifications of whiplash disorders
Grade 1:
Grade 2:
Grade 3:
Grade 4:
Grade 1: no physical neck/upper back signs
Grade 2: neck/upper back musculoskeletal signs
- decreased ROM
- Point tenderness
Grade 3: neck/upper back neurological signs
- decreased reflexes
- decreased sensation
- decreased strength
Grade 4: neck/upper back fracture/dislocation
What posterior structures that limit flexion are prone to traction/strain/sprain injuries?
Discs, UFT, nuchal ligament, transverse ligament, posterior longitudinal ligament, Splenius cap & cerv, subocc, errector spinae,
What anterior structures may be injured in a compression injury after a front impact whiplash injury?
Discs, longus colli, hyoid, longus capitis, mandable, wind pipe
What contralateral structures that limit side bending are prone to traction/strain/sparin injuries?
Scalenes, UFT, SCM, nerves, brachial plexus, arteries, lev scap
What ipsilateral structures are prone to compression injuries with whiplash injuries?
Tvps, TMJ, nerves, arteries, scalenes, lev scap, UFT, SCM
Which whiplash impact has a greater risk of injury?
Rear impact (hyperextension)
- there are not many tissues that can limit this movement.
What anterior structures are prone to traction/strains/sprain injury with rear impact?
Hyoid, longus capitus, longus colli, rectus capitis anterior and lateralis
What posterior structures are prone to compression injury with rear impact?
UFT, lev scap, sub ox, posterior longitudinal ligament, splenius cap & cerv, erector spinae,
What are some ways of non surgical management of cervical disc herniation?
- normalizing neck posture
- mobilizing thoracic spine to offload cervical spine, reducing hyper kyphosis
- traction
- Joint mobilization - C-spine, T-spine
- Ther ex - chin tuck, traction, thoracic mobilization
Which impairment is C4 - C7 commonly affected by?
Degenerative Disc Disease
Mild Degenerative disc disease may present as…
Asymptomatic, mild stiffness
Moderate degenerative disc disease may present as…
Increased muscle tone, occasional episodes of muscle spasm
Severe degenerative disc disease may present as…
- Increased tone/episodes of spasm
- IVF stenosis and neurological symptoms can present as disc space lessons
- boney changes occur to stabilize
Why doesn’t degenerative disc disease affect C1 to C2
There is no disc between C1 to C2 segment
What are the treatment highlights of DDD?
- Traction
- Normalizing head posture
- Strengthening deep neck flexors
What can facet irritation be described as…?
- unilateral pain with associated stiffness/spasm
- ‘catching’, local pain
- associated muscle and CT restrictions
What three special tests could be used to assess for facet irritation in the C – spine?
- Spurlings
- Upper & Lower quadrant Test
What are the treatment highlights for treating facet irritation in the C– spine?
- Reducing cervical hyper lordosis (lengthen superficial neck flexors and extensors)
- strengthen deep neck flexors (chin tucks)
- traction
- traction with passive contralateral flexion, and rotation
- joint mobilization to facilitate flexion, contralateral flexion & rotation
This impairment is stiff neck associated with contralateral, rotation, and ipsilateral side bending of the cervical spine it affects SCM
Torticollis a.k.a (wry neck, cervical scoliosis)
What are the three types of torticollis?
- Acquired/acute
- Congenital
- Spasmodic/cervical dystonia
How does torticollis present?
- Ipsilateral lateral flexion with contralateral rotation
-Increased tone in the muscles that do these actions
-Usually pain in the associated muscles - joint restrictions
What are some interventions for torticollis in the acute/acquired stage?
- Reduce spasm/pain cycle - mx, spasm techniques, hydro
- Address/correct causative factors
-Meds: mm relaxants, analgesics
Is congenital torticollis a spasm of SCM?
No, there is no clear cause
What are the interventions for congenital torticollis?
- Stretch
- Teach parents to stretch
Referral to Physio
-May require surgery
What are the interventions for spasmodic (aka cervical dystonia, aka intermittent torticollis)?
- Reduce stress
- Botox
- Central nervous system medication
What is upper cross syndrome? What does it look like?
- Head forward posture
- Hyper kyphotic thoracic spine
- Internally rotated GH joint
- Protracted scapula
- Anterior tipped scapula
What is the common compression site of the median nerve?
- Pronator Teres
- Carpal tunnel
What are the spinal segments of the median nerve?
C6 - T1
What does the median nerve supply?
Most of the superficial and deep flexors in the forearm, thenar & lumbrical mm except flexor carpi ulnaris