cervical 2 - interventions and patterns Flashcards
capsular pattern - diagram
everything is limited excluding flexion
multiple segments are involved
capsular pattern is associated with what diagnosis
an arthritis pattern
Treatment of the Capsular Pattern
address the irratblity
generalized mobilization with traction
controlled ROM exercises
flexability exercises
should you do thrust mobilzation with a capsular pattern
no they do not line up well
what pattern do we see with acute synovistis/trauma
global limitation
trauma - something happened and they are now limited in all directions
synovitis - 72 hours issue, mechanical problem
- active rest
slept on it wrong pattern
The neck got held in a certain position of sometimes and the facet joints/capsules are now holding you in that position
this pt is very inflammed
Active rest with palliative measures
Arthrosis pattern
restriction in everything expected flexion
SB on both side is the most restricted
Arthrosis pattern - can this pattern be changed
no this is a permenent change
Arthrosis general presentation
Not acute, older individuals, have a history of prolonged neck issues
Rotation preserved: atlanto-axial is fine
what can cause a restriction in flexion
Acute trauma synovitis
Painful discogenic structure
Mechanical dysfunction in the CT upper thoracic spine
painful discogenic struture - flex pattern
Pain will peri (scapula) – high level of pain
Does not respond to manual therapy
Mechanical dysfunction in the CT upper thoracic spine - flexion pattern
Pain in the axial skeleton – middle of neck
Most prevalent presentation
Intervention: manual therapy
what are the interventions for flexion pattern - Mechanical dysfunction in the CT upper thoracic spin
CT distraction
seated throacic distraction
mid throacic thrust
what region is CT distraction good for
C7 - T2
Seated thoracic distraction - region
T1-T4
Mid-thoracic thrust - region
T4 -T8
follow up exercises after flexion lmitation thrusts
Anything that promotes thoracic extension
Cervical retraction and protraction
Wing armed breathing
what causes a extension/closing pattern
the facets cannot move down and back
left sided extension issue - ext, rot, SB to the left side, with segment or localized pain
what testing do we do for an extension pattern
CPU/UPAs
osteopathic side gliding
response to motion
what does response to movement look like with the extension pattern
Retract and extend - Try to see if this leads to change in pain movement diagram
Retract and rotate - same
if these do not cause a change then move onto manipulation
what are the interventions for an extension pattern:
positional release
Mid-cervical/Direct extension mobilization
CPU/UPA
what does Positional release look like
2nd MCP apply pressure at limited joint
Extension and side bend to the level
Rotate the head left and right
See what side of rotation makes things better – hold that for 30secs
Mid-cervical/Direct extension mobilization - what does this look like
chin kick, lift, shift, shove
Ext head with side bending to issue side
2nd MCP over the articular pillar
Apply an inferior medial glide
follow up for extension pattern
- Retraction cervical
- 3 finger exercise
- Hand collar self-mob
- Mob C movement (towel)
what pattern does cerivcal radiulopathy look like
the extension restrion pattern with radiating symptoms
what is the presentation of cervical radiculopathy
Upper extremity symptoms with the origin from the cervical spine
Associated paraesthesia
Head movement produces the radiating symptom
cervical radiculopathy does it follow a dermatonal pattern
yes
C5, C6, C7 most common
what is included in Wainner’s cluster
ULTTA, Medial nerve tension test
Rotation – likely to be an asym, the rot will cause pain
Distraction – when we apply distraction to the spine this might relieve some the of the radiating sym, unloading the cervical spine
Spurling – slight ext, SB left, overpressure with axial compression and this reproduces the feature of the pt pain
what is a good treatment option for radiculopathy
traction
- if there is a bad response to traction referr the patient out
what is the CPR for traction
- Age > 55
- shoulder abd test
- Symptoms peripheralize with central post-ant motion testing at the low cervical spine (C4 -C7)
- Neck distraction
- ULTTA
what does a positive shoulder abd test look like
C6 - oppsite shoulder
C7 - arm on head
C5 - rest the arm on the abdomen
openinng/flexion restriction presentation
stretch pain
- when I turn to left I feel pain on my right
RSB, RR, RF leads to left sided pain
SB is not the predominent feature
treatment options for flexion pattern
- Upper ribs
- Breathing pattern
- CT/upper thoracic spine
- Mid C-spine flexion mobility
- Anterior neck flex activation
- Shoulder/shoulder girdle
- Soft tissue mobilization
which rib do we mobilze first
the 2nd rib to get it out of the way
why do we mobilze the ribs for a flexion pattern
the scalenes are hypomobile and therefore are pulling the ribs up
bretahing pattern and flexion pattern
diaphramic breathing
- want the stomach and not the chest to move
AA presentation pattern
RSB and LR is limited wiht left sided pain
AO presentation
ext and LSB are limited with left sided pain
SB is limited towards athe limited side
what screening should you do in cervical patients
- CN testing
- Ligament Stress test
- Blood pressure
what are the ligamentous test
sharps pursure - transverse
shear - alar
kick - alar
tectorial membrane
what does the flexion rot test test fo
AA probelm
AO/C2-C3 pattern: palpation and then this test
what does the Flexion rotation test look like
Pt supine
PT – HOB, rest pt head on abdomen
Maximally flex pt neck
From flexed position – rotate the pt’s head R and L
Capsular end feel (if we do not get this you are not doing something correct)
what is a positive felxion rot test
Positive: asymmetry in rotation
what is the intervention for AA issues
AA moblizations
what does AA mobilzation look like
right sided issue stand on the rught side
ID C2 – use a key grip
Other hand – tuck head on PT chest grabbing under occiput (touching the other hand)
Forearm – on the zygomatic arch
Turn head into rotation (side that is the issue)
Open the jar
Can ask pt to activate muscles
what test do we do for AO pattern
AO/C2-C3 testing
Gliding nodding mobilization on AO - intervention
Sub-occipital release
what is Gliding nodding mobilization on AO - intervention
Pt supine
PT – table at mid-thigh height
Hand 1 opp – fixating hand, placed posterior to C1 (atlas) posterior arch
Weight of the patient’s head presses hand into the table
Hand 2 same – mobilizing hand, grasps the patient’s occiput
nodding motion (flexion of the occiput on C1)
Shoulder same - placed on the patient’s forehead
Shoulder glides the occiput posteriorly
