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Practice topics Exam 6 > Cervical Manipulation > Flashcards

Cervical Manipulation Flashcards

1
Q

To keep it safe

A

Small amplitude
Mid range
Localization
Low force

Force
Contact point
Localized
Direction
Amplitude
Speed
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2
Q

Indications for manipulation - Mechanical

A 
Hypomobility/Motion restriction
Joint fixation/acute joint locking
Somatic dysfunction
Restore bony alignment
Meniscoid entrapment/displaced disc fragment/adhesions
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3
Q

Indications for manipulation - Physiological

A 
Pain modulation
Reflex relaxation of muscles
Reprogramming of the CNS
Muscle facilitation 
Release of endorphins
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4
Q

Strength changes with cervical manipulation - study showed

A

Scapulothoracic muscle strength changes following a single session of manual therapy and an exercise program in patients with neck pain

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5
Q

Clinical practice guidelines - evidence supports that it helps in those with

A

Neck pain with mobility deficit (cervicalgia, pain in thoracic spine)
Neck pain with headache (HA, cervicocranial syndrome)

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6
Q

Absolute contraindications - highlighted ones

A

Bone pathology - ligamentous laxity (alar, transverse, tectorial membrane)

Neurological - cervical myelopathy (cord compression - BB changes, B symptoms, ataxic gait)

Vascular - vertebral artery insufficiency (5Ds And 3Ns), carotid artery dysfunction

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7
Q

Relative contraindications

A 
Adverse reaction to previous MT
Disc herniation
Spondylolysis, listhesis, advanced DJD
Anticoagulants or corticosteroids
Psych dependence
Lig laxity
Pregnancy
Arterial calcification
Worsening condition
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8
Q

Adverse effects of thrust and non thrust manipulation

A 
Neck pain/soreness
Radiating pain
Fatigue
HA
Dizziness
Blurred vision
Ringing in the ears
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9
Q

Adverse effects of thrust and non thrust manipulation - highlighted ones

A

Neck pain/soreness (27.7% T, 22.3% NT)
HA (15.6% T, 15.8% NT)

They are both about the same with these side effects

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10
Q

Safety/Prevention - study - Are adverse events preventable and are manipulations being performed appropriately?

A

If all contraindications and red flags were ruled out:

  1. 8% of adverse events could be avoided (they had an abs contra)
  2. 4% inappropriate (it wasn’t indicated)
  3. 4% unpreventable suggesting some inherent risk
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11
Q

One of the risk factors has to do with anatomy - explain

A

Vertebral and Carotid arteries

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12
Q

One of the risk factors has to do with anatomy - explain Vertebral artery

A

11% of cerebral blood flow
Supplies post cranial circulation
Greater stress with upper cervical rotation
(we are never in end range rotation)

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13
Q

One of the risk factors has to do with anatomy - explain Carotid artery

A

89% cerebral blood flow
Supplies ant cranial circulation
Greater stress with mid cervical extension
(we aren’t putting our patients into ext)

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14
Q

Vertebral artery dissection

A

Tunica intima can be peeled away from tunica media

Tunica intima itself might occlude blood flow

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15
Q

Thrombus

A

Thrombus might be formed at site awaiting to release - and then gets released by some cervical motion into the circle of willis

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16
Q

Is it the manipulation that injures the arteries?

A

Pt example of having the severe arthritis and then osteophyte that hit the artery

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17
Q

Mechanism of VBI - stats

A 
Arterial dissection/spasm
Brain stem lesions 
43% spontaneous
31% cervical manipulation
16% trivial trauma
10% major trauma
18
Q

Mechanism of VBI - info

A

Manipulation might have been administered to pt with a spontaneous dissection in progress

Initial symptoms of acute neck pain and HA for which they seek treatment

Almost 70% of VBI is caused by something other than the manipulation

19
Q

The risk of serious complications

A

6/10 million

risk of death 3/10 million

20
Q

Risk factors - major risk factors for stroke or artery problems

A 
Hypertension
Hypercholesterolemia
Hyperlipidemia
Diabetes
Family hx of MI, angina, TIA, CVA, PVD
Smoker
BMI over 30
Repeated/recent injury
Upper cervical instability
21
Q

Risk factors - minor risk factors for stroke or artery problems

A 
Vit B12/folate deficiency 
Estrogen based contraceptive
Infections
Poor diet
RA
Blood clotting disorders
Fibromuscular dysplasia
Hypermobility (marfans, EDS)
Erectile dysfunction
BMI 25-29
22
Q

Screening for VBI in pts with neck pain - MT decision making in presence of uncertainty - Spinal fractures

A

Major trauma - MVA, fall from height, direct blow to C spine w/o imaging
Severe limitations during neck AROM in all directions

23
Q

Screening for VBI in pts with neck pain - MT decision making in presence of uncertainty - Cervical myelopathy

A 
Sensory disturbance of hands
MM wasting of intrinsics
Unsteady gait
Hoffman's reflex
Hyperreflexia
B/B changes
Multisegmental weakness and/or sensory changes
24
Q

Screening for VBI in pts with neck pain - MT decision making in presence of uncertainty - Neoplastic conditions

A 
Age over 50
Prior history of CA
Unexplained weight loss 
Constant pain - not relieved with bed rest
Night pain
25
Q

Screening for VBI in pts with neck pain - MT decision making in presence of uncertainty - cervical ligamentous instability

A

Occipital HA and numbness
Cervical mm spasm
Severe limitation in AROM
Signs of cervical myelopathy

26
Q

Screening for VBI in pts with neck pain - MT decision making in presence of uncertainty - artery insufficiency

A 
Drop attacks
Dizziness
Dyphagia
Diplopia
Dysarthria
Nausea
Numbness
Nystagmus 
Lightheadedness
Perioral altered sensation
Loss of visual acuity
Impaired sensation of face
Altered taste
Acute anxiety
27
Q

Screening for VBI in pts with neck pain - MT decision making in presence of uncertainty - Inflammatory or Systemic disease

A 
Temp over 100
BP over 160/95
HR over 100 
RR over 25
Fatigue
28
Q

Examination of at risk pateints

A

Vascular check - BP, atherosclerosis risk factors, baseline data, pulse check

Neuro eval - CNs, UMN tests (Clonus, Hoffmans, Rhomberg, Babinski)

BMI, Eye tracking, Ligamentous instbaility, Pre positional testing, Functional pre screening

29
Q

Transverse ligament

A

Stabilize C2

Extend backward

30
Q

Alar ligament

A

Stabilize C2

LF or Rot

31
Q

Tectorial membrane

A

Stabilize C2

flexion and distraction

32
Q

Evidence - Manipulation for neck pain - long and short term results in thrust and non thrust and with combined interventions - Thoracic vs. Cervical manip for those with neck pain — People we know benefit from thoracic manipulation

A 
Symptoms less than 30 days
No symptoms distal to shoulder
Looking up - no aggravates
Low FABQ (less than or equal to 12)
Dec kyphosis at T3 - T5
Ext ROM is less than 30 deg

So took these people - manip thoracic and they do well - already proven

Then they did same criteria for people but manipulated their neck

Both groups got same HEP

NDI score improved for both - but better for those that had cervical manipulation - going straight to where problem is
Functional and pain scales better too

33
Q

Key points to the thoracic vs cervical study

A

Pts treated with C spine TJM and Ex showed greater improvement in pain and disability compared to T spine TJM and ex

They also experienced fewer transient post treatment side effects

34
Q

Can we predict who is likely to benefit from neck joint manipulations - clinical prediction rule

A

If pts meet 4 criteria = 100% prob of success
3 criteria = 90%
2 criteria = 68%
1 criteria = 43%

35
Q

If pt doesn’t meet clinical prediction rule?

A

Does not mean it is contraindicated - just means that you cannot predict success

36
Q

Can we predict who is likely to benefit from neck joint manipulations - clinical prediction rule - what are the predictor variables

A

1 Symptoms duration less than 38 days
2 Positive expectation that manipulation will help
3 Side to side difference in cervical rot is 10 degrees or more
4 Pan with PA to mid c spine

37
Q

Continuous reassessment

A

During history
During physical exam
During intervention
Following intervention

38
Q

Norm for coupled movements

A

Occ/CI = OPP

Below C2 = SAME

39
Q

Facet apposition locking below C2

A

Norm is SAME

So to lock will be opp

40
Q

Upslope - in the direction of

A 
Rotation
Inferior facet of the superior vertebrae is moving up - UPSLOPE
Primary = rotation
Secondary = sidebending
PALPATE on opp side of rotation!
41
Q

Downslope - in the direction of

A 
SB
Superior facet of the inferior vertebrae is sliding inferiorly - DOWNSLOPE
Primary = SB
Secondary = rotation
PALPATE on same side of SB
42
Q

Vertebral artery testing

A 
End range rot 10 sec
Neutral 10 sec
Other rot 10 sec
Neutral 10 sec
Ext 10 sec
Neutral 10 sec

Practice topics Exam 6 (3 decks)

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