CBL Entrapment Flashcards
What is double crush syndrome?
Compression of peripheral nerves along the course of the nerve, at two or more locations
Can coexist or synergistic on each other
common in carpal/cubical or radial tunnel patients
Spurling maneuver review
1) physician stands behind the seated patient
2) physician passively moves the patients head into
- extension
- sidebending and rotate to one side (same side)
3) physician adds axial compression down the cervical spine through the top of the head
* positive test = pain or paresthesia down the ipsilateral arm to which the head is sidebent and rotated towards.
A positive spurling maneuver can signify what etiologies?
Cervical disc degeneration
Cervical disc bulge/herniation
Cervical arthritis
Osteophytes
Anterior cervical counterstrain points
AC1:
- location = posterior aspect of ascending Ramus at earlobe level
- treatment position = Rotate away with minor flexion
AC1 Lat:
- location = transverse process of C1
- treatment position = rotate away with slight sidebending
AC2-6
- location = anterolateral aspect of the corresponding anterior tubercle of the transverse process
- treatment position = FSARA
AC7
- location = clavicular attachment of SCM
- treatment position = FSTRA
AC8
- location = sternal attachment of SCM
- treatment position = FSARA
Posterior cervical counterstrain points
PC1
- location = inferior nuchal line later to inion
- Treatment = marked flexion
PC1-occiput
- location = immediately inferior to nuchal line midway between iron and mastoid
- Treatment = marked extension
PC2- occiput
- location = inferior nuchal line between PC1/ PC1-occiput (location fo semispinalis capitis)
- treatment = marked extension
PC2-8
- location = inferior lateral aspect of the corresponding process (except for C2/C3 where it is superior aspect of spinous process and inferior aspect of C2 spinous process respectively)
- treatment = ESARA (except C3 which is FSARA)
Thoracic outlet syndrome
Name for a group of disorders resulting from compression of nerves and/or blood vessels between the following
- 1st rib
- clavicle
- scalenes
- pec major
Etiology of pain can be the following
- repetitive activity
- poor posture
- tumors
- cervical ribs
- pregnancy
Upper crossed syndrome
Pain and paresthesia caused by an imbalance between the posterior and anterior musculature
Almost always due to poor posture
Symptoms:
- headache and neck pain
- chest tightness
- upper back/shoulder pain
- fatigue
- jaw pain
- low back pain
What muscles are hypertonic/facilitated in upper crossed syndrome?
Upper traps
Levator scapulae
Suboccipital musculature
SCM
Pectoralis major/minor
What muscles are inhibited in upper crossed syndrome
Deep cervical flexor musculature
Middle and lower traps
Serratus anterior
What tests can be used to test for thoracic outlet syndrome
Wrights
- (+) = pectoralis minor hentrapment
Adsons
- (+) = scalene or cervical rib entrapment
Roos test
- (+) = any reason for entrapment
Halstead test
- (+) = cervical rib entrapment
Upper limb tension test
Another test for TOS
1) bilaterally abduct arms to 90 degrees with elbows fully extended
- (+) - strongest positive
- entrapment is on ipsilateral side
2) dorsiflexion of wrists bilaterally while in #1 position
- (+) - strong positive
- entrapment is on the ipsilateral side
3) sidebend head and neck toward one shoulder and then repeat to the other while in position #2
- (+) - weak positive
- entrapment is on contralateral side
Facilitated positional release
Modified technique for indirect myofascial release
Advantages:
- ease of application
- speed of response
1) Patient is usually supine or prone
2) physician places involved joint into neutral position and then applies an activating force towards the articulation point
- this shortens the involved muscle(s) by releasing tissue tension and joint restriction
3) region is then placed into the directions of the somatic dysfunction and then held for 3-5 seocnds
Cubital tunnel syndrome
Compression or irritation of the ulnar nerve as it passes through the cubical tunnel over the medial epicondyle
Etiology:
- repetitive flexion of elbow
- prolonged flexion of elbow
- leaning on the elbow for prolonged time
Symptoms:
- pain/paresthesia in medial 1.5 fingers
- weakened grip
- altered finger dexterity
- muscle wasting of the hypothenar eminence
How does the radial head move?
Posteriorly with pronation of the forearm
Anteriorly with supination of the forearm
Carpal tunnel syndrome
Compression or irritation of the median nerve as it passes underneath the flexor retinaculum
Etiology:
- increased BMI
- diabetes
- prolonged extreme posture o the wrist
- high repetitive movements of wrist or fingers
- prolonged exposure to vibration
- pregnancy
