Cervical Muscle Energy Flashcards
Major motions of OA joint
Flexion and extension
- occurs along a transverse axis
Rotation
- occurs along a vertical axis
Lateral flexion (sidebending) - occurs along an AP axis
Is type 1-like since rotation and sidebending are opposite directions, but can still be flexed or extended
- rotation one way will induce opposite side-bending
- note the alar ligament causes natural lateral flexion of the occiput to the right (2-3mm)*
Alar brake (ligament)
ligament that Originates at the posterior lateral aspect of the dens of C2 and angles over the atlas (C1) inserting into the medial tubercles of the occipital condyle
- prevents sidebending of the AA
Also takes help from the dens
Why is there fewer cervical radioculopathies vs lumbar?
Cervical vertebrae have uncovertebral joints on the lateral surface of the vertebral bodies in conjunction w/ facet joints
- provides additional stability and processes articular pillars for the nerves and vertebral foramen for the vertebral artery
Articular pillars
Transverse processes fro the cervical vertebrae
Superior facet orientation in each section of the spine
cervical spine (BUM) - Backward Upward and Medial
Thoracic spine (BUL) - Backward Upward and lateral
Lumber spine (BUM) - Backward Upward and medial
How does the rotation/sidebending ratio change in the cervical spine?
gradual cephalocaudal decrease in rotation and increase in sidebending
- this is due to the increasing in the angle of incline of the facet joints as you go down the cervical spine
Ex:
- C2 = 2 degrees rotation/ 3 degrees sidebending
- C7 = 1 degree rotation/7.5 degrees side being
Motor strength recording
0/5 = no motor strength at all
1/5 = Trace amounts of contraction/ strength w/ no joint motion
2/5 =. Complete range of motion w/ no gravity
3/5 = complete range of motion w/ gravity but no resistance
4/5 = complete range of motion w/ gravity and some resistance
5/5/ = complete range of motion w/ gravity and full resistance
C5-C8 dermatome and myotome
C5
- dermatome (sense function) = lateral upper arm
- myotome (motor function) = deltoid
- reflex = biceps
C6
- dermatome (sense function)= lateral forearm, thumb and index finger
- myotome (motor function)= biceps and wrist extensors
- reflex = brachioradialis
C7
- dermatome (sense function) = middle finger
- myotome (motor function) = triceps, wrist flexors and finger extensors
- reflex = triceps
C8
- dermatome (sense function) = ring and little finger, medial forearm
- myotome (motor functions) = finger flexors, thenar muscles
- NO REFLEX
Reflex grading
0/4 = absent
1/4 = decreased but present
2/4 = normal
3/4 = brisk without clonus
4/4 brisk w/ clonus
Spurring maneuver
Foraminal compression test
Done by placing the head in extension, side being and rotation toward the shoulder and then adding axial compression
(+) = pain or numbness that radiates down ipsilateral arm
- not sensitive (30%) but is specific (93%) for some sort of cervical radiculopathy
test narrows intervertebral foramina leading to radicular symptoms
What are considerations in OMM for pediatric patients and elderly
Pediatrics
- have decreased muscle and bone tone
- dont use direct articulatory techniques
Elderly
- have variety of degenerative processes that alter the ability to modify structure
- dont use direct techniques and focus on small amounts of OMT in frequent intervals
Signs of vertebrobasilar insufficiency (cervical spondylitis)
Nausea
Vomiting
Visual disturbances
Vertigo
if this is present = CONTRAINDICATION
Types of ME
Post-isometric relaxation
Joint mobilization using muscle force
Respiratory assistance
Reciprocal inhibition
Crossed extensor reflex
Isokinetic strengthening
Isolytic lengthening
Common errors in ME
Wrong diagnosis
Initial position for treatment is not localized
Not monitoring motion at the involved joint
Too forceful of matching muscle contraction
Too short of duration for muscle contraction
Not allowing patient to fully relax before repositioning to new restrictive barrier
Forgetting to retest
Contraindications for ME
Fracture
Dislocation
Rheumatolgic conditions
Painful tissue damage (tears, hematoma)
Infections of tendons, ligaments and/or muscle tissue
Centrally mediated muscle spasms
Compromised vasculature
Uncooperative or non consenting patient
Evocation of neurological symptoms
Most common complication for ME
Muscle stiffness or soreness that is self-limiting and generally resolves in 24-36 hrs
Oculocervical and oculocephalic reflexes
Oculocervical: using eye movements to activate or inhibit muscles of the neck
Oculocephalic: using eye movements to activate or inhibit muscles of the head
Can be used alternatively in ME when the patient is matching the force by having them look towards the neutral position
What stops AA joint movement anteriorly and posteriorly w/ flexion and extension
The transverse ligament
- stops anterior grinding of the atlas on the axis and limits gaping superiorly and inferiorly w/
AA biomechanics
Major motion is rotation (50% of the cervical spine rotation occurs at this joint)
How is cervical rotation split about the cervical spine?
60 degrees is in the upper cervical complex
30 degrees is in the lower cervical complex
What does the term elaboration mean?
Describes rotation of the vertebrae to the same side as lateral flexion
Normal degrees of motion in the cervical region
Flexion
- 45
Extension
-90
Rotation
- 80-90
Side-bending
- 35-45
How does lateral flexion of the occiput work?
Right lateral flexion:
Left side alar ligament wraps around the dens and tightens it
- causes translation of the right occipital condyle to the left in dueling right lateral flexion
*vise versa on left lateral flexion
How does the AA joint move?
Rotates along the axis dens with the transverse ligament stoping any anterior movement
Major motion is rotation
- 50% of cervical spine rotation is here
**there is almost no sidebending/flexion/extension occurring here
What are the borders of all “cervical triangles”
Submandibular
- inferior border of mandible
- anterior belly of digastric
- posterior belly of digastric
Submental
- hyoid bone
- anterior belly of digastric
- midline
Muscular
- hyoid and superior belly of omohyoid muscle
- anterior border of SCM
- theoretical midline of the neck
Carotid
- superior belly of the omohyoid
- stylohyoid and Posterior belly of the digastric
- anterior border of the SCM
What type of mechanics does C2-C7 show?
Type 2-like except that F/E or N doesnt change that rotation and sidebending are always on the same side
- often also shows multiple segments
example NSRRR is a possibility
Common indications for cervical ME
Sprains/strains
Cervicalgia
Headaches
Arthritis
Upper respiratory and HEENT infections
Dysphagia
Speech disorders
Thyroid disorders
