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MSK basics > cervical 2 - interventions and patterns > Flashcards

cervical 2 - interventions and patterns Flashcards

1
Q

capsular pattern - diagram

A

everything is limited excluding flexion

multiple segments are involved

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2
Q

capsular pattern is associated with what diagnosis

A

an arthritis pattern

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3
Q

Treatment of the Capsular Pattern

A

address the irratblity

generalized mobilization with traction

controlled ROM exercises

flexability exercises

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4
Q

should you do thrust mobilzation with a capsular pattern

A

no they do not line up well

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5
Q

what pattern do we see with acute synovistis/trauma

A

global limitation

trauma - something happened and they are now limited in all directions

synovitis - 72 hours issue, mechanical problem
- active rest

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6
Q

slept on it wrong pattern

A

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

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7
Q

Arthrosis pattern

A

restriction in everything expected flexion

SB on both side is the most restricted

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8
Q

Arthrosis pattern - can this pattern be changed

A

no this is a permenent change

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9
Q

Arthrosis general presentation

A

Not acute, older individuals, have a history of prolonged neck issues

Rotation preserved: atlanto-axial is fine

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10
Q

what can cause a restriction in flexion

A

Acute trauma synovitis

Painful discogenic structure

Mechanical dysfunction in the CT upper thoracic spine

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11
Q

painful discogenic struture - flex pattern

A

Pain will peri (scapula) – high level of pain
Does not respond to manual therapy

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12
Q

Mechanical dysfunction in the CT upper thoracic spine - flexion pattern

A

 Pain in the axial skeleton – middle of neck

 Most prevalent presentation

 Intervention: manual therapy

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13
Q

what are the interventions for flexion pattern - Mechanical dysfunction in the CT upper thoracic spin

A

CT distraction

seated throacic distraction

mid throacic thrust

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14
Q

what region is CT distraction good for

A

C7 - T2

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15
Q

Seated thoracic distraction - region

A

T1-T4

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16
Q

Mid-thoracic thrust - region

A

T4 -T8

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17
Q

follow up exercises after flexion lmitation thrusts

A

Anything that promotes thoracic extension

Cervical retraction and protraction

Wing armed breathing

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18
Q

what causes a extension/closing pattern

A

the facets cannot move down and back

left sided extension issue - ext, rot, SB to the left side, with segment or localized pain

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19
Q

what testing do we do for an extension pattern

A

CPU/UPAs

osteopathic side gliding

response to motion

20
Q

what does response to movement look like with the extension pattern

A

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

21
Q

what are the interventions for an extension pattern:

A

positional release

Mid-cervical/Direct extension mobilization

CPU/UPA

22
Q

what does Positional release look like

A

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

23
Q

Mid-cervical/Direct extension mobilization - what does this look like

A

chin kick, lift, shift, shove

Ext head with side bending to issue side

2nd MCP over the articular pillar
 Apply an inferior medial glide

24
Q

follow up for extension pattern

A
  • Retraction cervical
  • 3 finger exercise
  • Hand collar self-mob
  • Mob C movement (towel)
25
Q

what pattern does cerivcal radiulopathy look like

A

the extension restrion pattern with radiating symptoms

26
Q

what is the presentation of cervical radiculopathy

A

Upper extremity symptoms with the origin from the cervical spine

Associated paraesthesia

Head movement produces the radiating symptom

27
Q

cervical radiculopathy does it follow a dermatonal pattern

A

yes

 C5, C6, C7 most common

28
Q

what is included in Wainner’s cluster

A

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

29
Q

what is a good treatment option for radiculopathy

A

traction

  • if there is a bad response to traction referr the patient out
30
Q

what is the CPR for traction

A
  • Age > 55
  • shoulder abd test
  • Symptoms peripheralize with central post-ant motion testing at the low cervical spine (C4 -C7)
  • Neck distraction
    • ULTTA
31
Q

what does a positive shoulder abd test look like

A

C6 - oppsite shoulder

C7 - arm on head

C5 - rest the arm on the abdomen

32
Q

openinng/flexion restriction presentation

A

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

33
Q

treatment options for flexion pattern

A
  • Upper ribs
  • Breathing pattern
  • CT/upper thoracic spine
  • Mid C-spine flexion mobility
  • Anterior neck flex activation
  • Shoulder/shoulder girdle
  • Soft tissue mobilization
34
Q

which rib do we mobilze first

A

the 2nd rib to get it out of the way

35
Q

why do we mobilze the ribs for a flexion pattern

A

the scalenes are hypomobile and therefore are pulling the ribs up

36
Q

bretahing pattern and flexion pattern

A

diaphramic breathing
- want the stomach and not the chest to move

37
Q

AA presentation pattern

A

RSB and LR is limited wiht left sided pain

38
Q

AO presentation

A

ext and LSB are limited with left sided pain

SB is limited towards athe limited side

39
Q

what screening should you do in cervical patients

A
  • CN testing
  • Ligament Stress test
  • Blood pressure
40
Q

what are the ligamentous test

A

sharps pursure - transverse

shear - alar

kick - alar

tectorial membrane

41
Q

what does the flexion rot test test fo

A

AA probelm

AO/C2-C3 pattern: palpation and then this test

42
Q

what does the Flexion rotation test look like

A

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)

43
Q

what is a positive felxion rot test

A

Positive: asymmetry in rotation

44
Q

what is the intervention for AA issues

A

AA moblizations

45
Q

what does AA mobilzation look like

A

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

46
Q

what test do we do for AO pattern

A

AO/C2-C3 testing

Gliding nodding mobilization on AO - intervention

Sub-occipital release

47
Q

what is Gliding nodding mobilization on AO - intervention

A

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

MSK basics (20 decks)

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