Cervical HVLA Flashcards
OA joint characteristics (3)
- type 1 spinal mechanics (SB & rotation to opposite sides)
- 15 degrees flexion/extension, limited side bending, no rotation
- condyles angled antero- medial>postero- lateral
AA Joint characteristics
- primarily rotation 55-85% of total rotation of Cx spine
- ligamentous structures stabilise odontoid process against the anterior arch of C1 and the occiput
Characteristics of lower cervical region
- C2/C3 through to C7/T1 joints
- Type 2 spinal mechanics (SB & Rotation coupled to the same side
*plane of facet changes from 35 degrees to the horizontal in the upper Cx to 65 degrees to horizontal in lower Cx
The role of C5
C5/6 has the most flexion/extension and is the region of most mechanical strain
Mechanical loading of Cx
1/3 of the compressive load is transmitted by z joints, 2/3 by vertebral bodies and joints
Compressive load on Cx joints found to be 10kg higher when the head position changed from 15 degrees of flexion to 40 degrees
Cues for TMJ involvement in neck pain
Observable mouth breathing
Anterior head carriage
Waking with neck pain
Signs of stress and anxiety
HVLA sequence
Diagnosis
Initial consent
Localising the joint
Articulation
Final consent
Practitioner final check
Deliver thrust
Patient history for HVLA looking for (6)
Age
Migraine headaches
Smoking
Oral contraceptives
Family history of cardiovascular disease
Ischemic signs & symptoms (dizziness)
HVLA precautions risk management physical examination
Blood pressure
BMI
Signs of cardiovascular disease
Upper cervical spine integrity tests
HVLA precautions VBI signs and symptoms
Dizziness/vertigo/light headedness
Drop attacks &loss of consciousness
Dislopia -double vision
Dysarthria-difficulty with speech
Disphagia - difficulty swallowing
Ataxia
Nausea
Numbness in one side face/body
Nystagmus- radio uncontrolled eye movements
Contraindications to HVLA (7)
Rheumatoid arthritis of cervical spine
Carotid or vertebrobasilar vas. disease
Presence/possibility of bony metastasis
Severe osteopenia
History of pathological fractures
Connective tissue disorders (scleroderma)
Abnormal development of osseous or ligamentous structures
Artherosclerosis risk factors
*Hypertension
*Diabetes
*Family history of atherosclerosis
*Smoking
*High LDL (hypercholesterolemia)
*Hyperhomocysteinemia
*Infection by escherichia coli, helicobacter pylori etc
*Mechanical trauma to vessel
HVLA Premanipulativ we testing
*case history +BP + 5Ds &3Ns
*informed consent
* cranial nerve screen
* active seated ROM
* ORTHOPEDIC TESTING
Spurlings
Compression
Distraction
Alar ligament
In Australia for negligence to have occurred what three factors must be proven
Absence of duty of care
Breach of standard of care
Damage or loss caused by breach of standard of care
Informed consent must include information of
The diagnosis and prognosis
Explanation of the treatment
Risks of procedure and side effects
Possible complications
Details of the treatment
Options to treatment
Cost of treatment
Option to defer treatment
Right to withdraw consent
Symptoms of C A D for carotid artery pathologies (arthrosclerosis, stenotic thrombosis aneurysmal
Carotidnyia
Neck pain
Facial pain
Headache
Cranial nerve dysfunction
Horners Syndrome
Transient Ischemic Attack
Stroke
Symptoms of C A D for carotid artery pathologies (hypoplasia)
Commonly silent rare cerebral ischemia
Symptoms of C A D for carotid artery pathologies (dissection)
Neck pain
Facial pain
Headache
TIA
Cranial Nerve Palsied
Horners Syndrome
Symptoms of C A D for vertebral artery pathologies (arthrosclerosis)
Neck pain
Occipital headache
TIA
Stroke
Symptoms of C A D for vertebral artery pathologies (dissection)
Neck pain
Occipital headache
TIA
Cranial nerve palsy
Symptoms of C A D for temporal/ vertebral/ occipital/ carotid arteries pathologies (giant cell arteritis)
Temporal pain
Scalp tenderness
Jaw and tongue claudication
Visual symptoms
Symptoms of C A D for cerebral vessels pathologies ( reversible cerebral vasoconstriction syndrome
Severe Thunderclap headaches
Symptoms of C A D for subarachnoid pathology (heammorage)
Sudden severe headache
Stiff neck
Visual disturbance
Photo phobia
Slurred speech
Sickness
Unilateral weakness
Symptoms of C A D for jugular vein pathologies (thrombosis)
Neck pain
Headaches
Fever
Swellingariund neck/angle of jaw
Risk factors for CAD (dissection vascular events)
Recent Trauma
Vascular anomaly
Current or past smoker
Migraine
High total cholesterol
Recent infection
Hypertension
Oral contraception
Family history of stroke
Risk factors for CAD (non dissection vascular events)
Current or past smoker
Hypertension
High total cholesterol
Migraine
Vascular anomaly
Family history of stroke
Oral contraception
Recent infection
Recent trauma
Recent symptoms for dissection events
Headaches
Neck pain
Visual disturbance
Parathesia (upper limb)
Dizziness
Parathesia (face)
Parathesia (lower limb)
Signs of VBA dissection
Unsteadiness/ataxia
Dysphasia/ dysarthria/ aphasia
Weakness (lower limb)
Weakness (upper limb)
Dysphagia
Naesea/vomiting
Facial palsy
Dizziness/ disequilibrium
Ptosis
Loss of consciousness
Confusion
Drowsiness
Exam of blood pressure points
Pulse pressure (systolic - diastolic) indicator of cardiovascular health. Pulse pressure 《40 is normal
Pulse pressure 》60 refer to GP
Cranial nerve examination if
Pt presents with symptoms involving face/ head
Presents with new / unfamiliar headache
Presents with signs of vascular involvement
Occipital-atlanto/OA + Atlanta Axial/AA joint collectively provides ROM…
In all planes
Origin and insertion of Longus Colli
Transverse processes and anterior bodies of C3 -T3 vertebrae
To the
Transverse processes and anterior bodies of C2-C6 and anterior arch of C1
OA structure and function: describe with attachments, function
- Paired synovial condyloid joints
- no dosc
- no spinal process
- tubercles, anterior & posterior
Anterior tubercle attaches to Longus Colli muscles and ALL
Posterior tubercle attaches to ligamentum nuchae and Rectus Capitus Posterior Minor - Motion is flexion & extension (50% of the cervical spine ROM)
What are the two parts of the AA joint-
What is the motion
- Transverse ligament
- Fibrocartilagineous snyovial joint
50% of Cx rotation
Posterior occipital membrane is closely associated with the ….. and blends with the…
Vertebral artery
Dura
What are the four suboccipital muscles and the attachments of each
*Rectum capitus posterior minor (posterior tubercle of C1 to occiput)
- rectus capitus posterior major (spinous process of C2 to occiput)
- obliquus capitus inferior
(Spinous process of C2 to transverse process of C1) - obliquus capitus superior
(Transverse process of C1 to occiput)
Suboccipital anatomy: what nerves activate the suboccipital muscles?
Rectus capitus posterior major: suboccipital nerve
Dorsal ramps of C1
Rectus capitus posterior minor :
The suboccipital nerve
Dorsal ramus of C1
Obliquus capitus inferior
The suboccipital nerve
Dorsal ramps of C1
Obliquus Capitis Superior
The suboccipital Nerve
Dorsal ramps of C1
The C2 nerve (Greater Occipital Nerve) is vulnerable to impingement at what three points
- crosses the AA joint
- around Obliquus Capitus Inferior
As it pierces the semispinalis capitis and trapezium muscles
The vestibulospinal tract are…
Bundle of nerve fibres that carry information from. The higher centres of the brain to the peripheral parts of the brain
What does the lateral vestibulospinal tract do
Helps adjust and maintain posture and balance by changing the muscle tone and increasing activation of anti-gravity extensor muscles, thus maintaining an upright posture in response to changing orientation of the head.
