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
What is the spinal segment of the ulnar nerve?
C7-T1
What is the innervation of the ulnar nerve?
Motor:
Vast majority of intrinsic hand mm, flexor carpi ulnaris & medial half of flexor digitorum profundus
Sensory:
Skin covering the hypothenar eminence, dorsal ulnar aspect of hand, dorsal aspect of fifth digit, and half of fourth digit
What is the common compression site of the ulnar nerve?
Cubital tunnel, tunnel of Guyon
What is the spinal segment of the radial nerve?
C5 – C8
What is the innervation of the radial nerve?
Motor:
Posterior muscles of the arm and forearm
Radio
Sensory:
Skin of the posterior arm, radial aspect of dorsum of hand and dorsal surface of first four digits skin over first interosseous
What are the common compression sites of the radial nerve?
Axilla, arcade of frohse (supinator)
What are the steps of cozen’s test?
Stabilize the patients elbow with your thumb on the lateral epicondyle. Ask the patient to make a fist, pronate the forearm and radially deviate and extend the wrist while you resist this motion. A positive would be sudden severe pain in the area of the lateral epicondyle of the humerus.
What are the steps of Mill’s test?
While palpating the lateral epicondyle, passively pronate the patients forearm, flex the wrist fully and extend the elbow. Pain over the lateral epicondyle of the humourous indicates a positive.
Which nerve neuropathy can also be an issue with golfers elbow?
Ulnar nerve neuropathy due to its close proximity to the common flexor tendon in the cubital tunnel.
What is a colles fracture?
Fracture of the distal radius commonly caused by a “foosh”
What is dequervain’s Tenosynovitis?
RSI of the tendon sheath of abductor pollicis longus and extensor pollicis brevis
Which fingers are most commonly affected by Trigger finger?
The 3rd & 4th digits
What is dupuytren’s contracture?
Contracture of the palmar fascia that pull the fingers into a permanently fixed position making it difficult to perform simple tasks
Which digits are most commonly affected by dupuytren’s contracture?
The 4th & 5th digits
What are the treatment goals for treating dupuytren’s contracture?
Promote CT mobility, maintain ROM, and maintain soft tissue and joint health
Lumbar myotomes
L1 - L2:
L3:
L4:
L5:
S1:
S2:
L1 - L2: Hip flexion
L3: knee extension
L4: ankle Dorsiflexion
L5: big toe extension
S1: ankle eversion, plantar flexion, hip extension
S2: knee flexion 
Lumbar dermatomes
L1:
L2:
L3:
L4:
L5:
L1: lower back, hips, groin
L2: lower back, front and inside of thigh
L3: lower back, front and inside of thigh
L4: lower back, front thigh, and calf, area of knee, inside of ankle
L5: lower back, front and outside of calf top and bottom of foot first four toes
Deep tendon reflexes
L4:
S1:
L4: Patellar reflex
S1: Achilles reflex
What are some special test for nerve root compression in the L-spine?
- Valsalva maneuver
- SLR (test dural tension & disc herniation)
- Slump test (test dural tension, disc herniation)
Where does spondylosis commonly occur?
L5
What is spondylolysis?
Defect or fracture of the pars interarticularis
What are some symptoms of spondylosis?
- Beltline pain across the low back
- Hyper lordotic posture often coupled with hamstring restriction or spasm - Initially sharp quality becomes achy overtime
- may radiate into glutes
- rest alleviates pain
- extension aggravates, as well as rotation
What are the assessment findings of spondylosis?
- A ROM extension will aggravate
- positive lumbar instability test
- step deformity in lumbar spine
- prone BL hyper extension test
- x-ray/MRI
Where are compression fractures of the L spine most common
At the L1 segment
Why do compression fractures occur?
As a result of osteoporosis or trauma
What are some assessments for compression fracture?
- Heal drop test
- compression aggravates
- traction alleviates
- x-ray/MRI
What is the difference between compression fracture and spondylosis in the L spine? Why do they happen?
Compression fractures usually occur as a result of osteoporosis or trauma and spondylosis usually occurs in active children or adolescence
Osteokinemativ movements of the shoulder: w/ GH flexion, scaption and abduction how do the SC, AC, ST & T-spine move?
Sc: inferiorly, posteriorly
Ac: moves w/ scapula (superiorly w/posterior rotation)
ST: upward rotation, protraction, posterior tipping
Osteokinematic movements of the shoulder: w/ GH Extension how do the SC, AC, ST & T-spine move?
Sc: superiorly, anteriorly
Ac: moves w/ scapula anteriorly & inferiorly
St: downward rotation, retraction, anterior tipping
T-spine: flexion
What is the function of the rhomboids with scapular movement?
Downward rotation, retraction
What is the function of UFT with scapular movement?
Elevation, upward rotation
What is the function of MFT with scapular movement?
Retraction
What is the function of LFT with scapular movement?
Depression, upward rotation
Which upward rotating muscle is usually long and weak with thoracic hyperkyphosis, forcing the other upward rotators to overwork?
Lower traps
What is the function of serratus with scapular movement?
Protraction, upward rotation
This muscle keeps the scapula fixed to the rib cage weakness can result in winging
Serratus
What is the function of levator scapula with scapular movement?
Elevation, downward rotation
What is the difference between structural winging and functional winging?
Structural winging is winged at rest and movement
Functional winging is winged at rest not winged with movement
Which structures that reside under the hook of the acromion are vulnerable to impingement?
- Supraspinatus tendon
- subacromial bursa
- biceps LH tendon
What degree does scapular movement start at?
30 degrees
An external (subacromial) impingement is an impingement of…
Soft tissue structures (bursa/tendons) between the humeral head & acromial arc.
- supraspinatus tendon
- subacromial bursa
- biceps LH
W/ an external impingement pain will be felt at ____ to ____ degrees and ____ & _____ tests would be positive
- 170 - 180 degrees
- neers
- hawkings kennedy
Which type of impingement happens at the rotator cuff tendons and/or labrum b/t the humeral head and glenoid rim? (With Pain felt in the back if the shoulder)
Internal impingement
Pain with an internal impingement will commonly be felt at ___ to ___ degrees. ____ test may be positive w/ Pain in the ____ shoulder. ____ and ____ test may be positive as well.
- 80-120 degrees
- Apprehension
- Posterior
- Jerk
- Scour
Describe a primary (structural) impingement
Structural changes that mechanically decrease the space/narrow the subacromial space. Structural issue inside the joint bony change.
Describe a secondary (functional) impingement
Secondary to the problem by a mechanical change due to another issue. A functional disturbance of where the humeral head is positioned in the GH joint, potentially leading to internal or external impingement.
When can a Therapist start to do more work with a client that has frozen shoulder?
When they are in the “thawing” phase.
Detachment of the anterior capsule and glenoid labrum is called a…
Bankart lesion (may involve the inferior GH ligament)
(Generally a traumatic mechanism with force against the arm, and a position of abduction and external rotation)
Tear of the superior labrum anterior to posterior is called a…
SLAP lesion (may also include the biceps long head tendon)
What is a reverse Bankart lesion?
Tearing of the posterior inferior labrum, and often the posterior band of the inferior GH ligament.
What is a hill-sachs lesion?
Compression fracture of the posterior aspect of the humeral head occurs, during anterior dislocation, usually accompanies a Bankhart labrum lesion.
An anterior dislocation of the humerus may be accompanied by…
Bankart labral lesion, as well as a hill sachs fracture
What test can you do for an anterior shoulder instability? How are they performed? What are the positives?
Apprehension test:
Patient is supine their arm is abducted and externally rotated with the elbow bent, using the forearm as a lever. A positive is apprehension or pain. This also tests for a posterior impingement of supra & infra
Anterior drawer test
The patient is supine. The therapist hand is in the axilla, other hand distracts and pulls the humeral head anteriorly. A positive is click/apprehension/excessive movement.
How do you test for inferior instability of the shoulder what are the positives? How is it performed?
Sulcus sign:
Standing therapist pulls distally on forearm with patient arm in neutral
Positive is presence of sulcus sign (step deformity) and pain
What are the tests for posterior instability of the shoulder? How is it performed? What are the positives?
Jerk test: patient is high, seated, mediately rotate and flex arm to 90 degrees, then push posteriorly maintaining axial load, horizontally adduct the arm.
A positive is sudden clunk/jerk of arm as it subluxes
What is the test for an anterior (subacromial) impingement of the shoulder? How is it performed? What are the positives?
Hawkins - Kennedy impingement test:
Flex patient arm to 90, bend elbow, internally rotate, using forearm as lever, ✨to test impingement at acrimon ✨
positive is local pain
✨To test impingement at coricoid process✨ flex arm to 90, bend elbow, internally rotate using forearm as lever & adduct
positive is local pain
Neer impingement test:
Internally rotate GH and elevate arm in scaption
positive is local pain
What is a SLAP lesion?
Superior labrum tear from anterior to posterior
What is the test for a slap lesion or rotator cuff lesion? How is it performed ?What are the positives?
Labral tear test (a.k.a. clunk test):
Have patient supine, apply fist under patient’s head of humerus, abduct and externally rotate GH, hold humerus above elbow, push further into external rotation, while pushing anteriorly with fist.
Positive is a clunk or grinding sound (indicates a torn labrum )
What is the test for arthritic changes in the GH joint? How do you perform this test? What are the positives?
Elman’s compression rotation:
Patient is Sidelying, affected side up, press down with reinforced palms on humeral head while patient internally and externally rotates the shoulder.
Positives are pain/tenderness/stiffness of arthritis
What is the test for a torn transverse humeral ligament? What is the positive?
Yergason’s test
positive is biceps tendon popping out during resisted motion.
What is the test for bicipital tenosynovitis/tendinitis/tendinosis? What is the positive? How is it performed?
Speed test:
Flex arm to 90 degrees, therapist applies pressure into extension, patient resists but allows therapist to overcome patient’s resistance, thus performing eccentric contraction of biceps
A positive is pain localized in the bicipital groove . This can also be a positive for a labral tear .
How do you test for a super spinatus muscle pathology? What is the positive?
Empty Can test (also jobe):
Shoulder flex to 90, put patient into scaption plane, internally rotate arms so thumbs are down, and therapist applies downward force while patient resist
positive is weakness/pain
Which test will be positive for an external subacromial impingement? Where will the pain be felt?
Jobe (empty can)
NEER
Hawkins
Apprehension
Pain will be felt anterior
Which test would be positive and which would be negative for an internal posterior superior glenoid impingement?
Negative:
- Jobe (empty can)
- Hawkins
Positive:
- NEER (pain felt posterior)
- Apprehension (pain felt posterior)
If the relocation and release test are positive with pain, is this a secondary or primary impingement?
Secondary
If the relocation test is negative this is a ____ impingement
Primary
The full can test is positive for…
Rotator cuff pathology
If the SAT and SRT test are positive This is for
Scapular dyskinesis
Which test would be positive for instability?
- Laxity test
- Apprehension
- Relocation
Which test would be positive for biceps-SLAP pathology?
- Speed’s
- Biceps load
Which test would be positive for GIRD
IR ROM
