Cervical Practical mostly from Website and Pictures Flashcards
Cervical Exam: AROM Flexion
Practice/Describe/Think it through
○ Flex
■ The patient is asked to look down & bring her chin to her chest (Figure 6-16). During flexion & extension observe for initiation of motion from the lower C-spine. Hypertonicity of cervical extensor muscles may be a protective response to limit flexion or loss of deep cervical extensor control. On return to neutral from flexion, excessive craniocervical extension suggests dominant superficial extensors & loss of deep craniocervical flexor control.
■ The inclinometer is centered on top of the patient’s head in line with the external auditory meatus and zeroed. The patient performs flexion/extension and the amount is recorded
General information:
○ Observations of altered segmental mobility must be confirmed by passive segmental mobility tests and muscle performance tests. Keeping in mind severity and irritability, the patient is asked either to move as far as she can or only to the onset or increase of baseline symptoms. The clinician determines which motions should be tested and makes the assessment in a standardized manner.
Cervical: CCFT
Practice/Describe/Think it through
● CCFT (craniocervical flexion test)
○ Patient supine with the neck and the face horizontal to the table. A neutral neck position without a pillow is desired, but some patients with excessive cervicothoracic kyphosis need a towel under occiput. The un-inflated biofeedback pressure unit (Stabilizer, Chattanooga, USA) is placed under the neck and slipped superiorly so that it is next to the occiput and inflated to 20 mm Hg. The pressure should be stabilized. Inform the patient that this is a test of precision and control, not strength. Asked to nod slowly and gently as if to say “yes” and hold the position.
Cervical: AA Rotation Self SNAG
Practice/Describe/Think it through
○ In sitting upright neutral posture for a right rotation limitation, the patient places the strap on the posterior aspect of C1 on the left & pulls horizontally across the face. The strap facilitates C1-C2 rotation in the direction that is limited. While pulling horizontally, the head is actively rotated toward the involved side & sustained at end range for 3 sec. Performed in the pain free range with no symptoms other than stretching. The horizontal pull is maintained on the return to neutral position.
Cervical: PAIVM C3-7 CPA
Practice/Describe/Think it through
○ CPA: Using pressure through the thumb pads against the spinous process (SP) of the cervical and upper thoracic regions, each segment is gently moved in a PA direction. Elbows are straight allowing the clinician’s sternum to be directly over the SP. Assessment is performed superficial to deep in a progressive oscillatory manner to assess symptom response and quality of movement through range and at end range. The clinician does not push on the spine, but instead leans forward translating the weight of the trunk through the arms to the spine.
Cervical Exam: AROM Extension
Practice/Describe/Think it through
○ Ext
■ The patient is asked to look up to the ceiling and look back along along the ceiling with her eyes. (Figure 6-16) A hypothesis of poor eccentric control during extension is determined by unwillingness to allow the head to move posteriorly behind the frontal plane of the shoulders with a dominant upper cervical extension pattern. Another suggestion of poor eccentric control of extension is observed when the head drops or translates backward and may be painful or described as feeling a loss of control. On return from extension a poor control strategy is initiated by the SCM and anterior scalene muscles, resulting in lower cervical flexion, but not upper cervical flexion. Recovery from extension is poor when upper cervical flexion is absent or delayed.
■ The inclinometer is centered on top of the patient’s head in line with the external auditory meatus and zeroed. The patient performs flexion/extension and the amount is recorded.
General Information
○ Observations of altered segmental mobility must be confirmed by passive segmental mobility tests and muscle performance tests. Keeping in mind severity and irritability, the patient is asked either to move as far as she can or only to the onset or increase of baseline symptoms. The clinician determines which motions should be tested and makes the assessment in a standardized manner.
Cervical: PPIVM C3-7 Rotation
Practice/Describe/Think it through
○ Rotation: For rotation, the palpation finger is on the side opposite the rotation (i.e., left side for right rotation) to monitor opening of the motion segment. Assess the segment as hypomobile, normal, or hypermobile. Monitor for symptoms.
Cervical Exam: AROM Lateral Flexion
Practice/Describe/Think it through
○ LF
■ The patient is asked to bring her left or right ear toward her shoulder (Figure 6-16). Restriction of lateral flexion may be due to segmental dysfunction or muscular restriction of several segments often associated with short scalenes or neural tissue sensitivity. In patients with chronic neck disorders extension and rotation deficits are greater than lateral flexion deficits.
■ The inclinometer is placed in the frontal plane on top of the patient’s head in line with the external auditory meatus and zeroed. The patient performs lateral flexion and the amount is recorded.
General Info
○ Observations of altered segmental mobility must be confirmed by passive segmental mobility tests and muscle performance tests. Keeping in mind severity and irritability, the patient is asked either to move as far as she can or only to the onset or increase of baseline symptoms. The clinician determines which motions should be tested and makes the assessment in a standardized manner.
Cervical: Manual Traction
Practice/Describe/Think it through
○ WEB: Grasp the chin and occiput in slight flexion while applying an unloading force of 14 lbs. The test is positive if symptoms are reduced. In patients suspected of cervical radiculopathy or carpal tunnel syndrome, the reliability is substantial, ĸ = .88.246. As a single test item, diagnostic accuracy is Sn 0.44, Sp 0.90, -LR .62, and +LR 4.4.
- Class Notes:
- Can put hand under occiputand on forehead or under chin
- Can put towel under occiput if it feels like sliding and wrap around headto hold at forehead (with other hand under occiput on top of towel).
Cervical Exam: Flexion OP
Practice/Describe/Think it through
■ With OP: One hand stabilizes at the cervicothoracic junction while other hand on the posterior aspect of the head gently guides the cervical spine into flexion while asking for a change in symptoms.
Cervical Exam: Neck torsion nystagmus test
Practice/Describe/Think it through
○ Neck torsion nystagmus test
■ To perform the test, the head is held stationary while the neck and trunk are rotated. If symptoms are provoked, cervicogenic dizziness is considered because keeping the head still minimizes the vestibular system while stimulating the neck structures (somatic & vascular). However, specificity of this test for cervicogenic dizziness has not been demonstrated.
Can do part two, where person turns body with head. If dizziness results, it is likely a vestibular problem
Cervical: AA (atlanto-axial) Self MET
Practice/Describe/Think it through
■ In sitting, the patient actively flexes the head & neck by moving the chin toward the chest & then rotating to the involved side toward the end of range. The patient then isometrically resists rotation to the opposite side with the hand on the zygoma for 5 sec. The patient then relaxes for up to 10 sec prior to engaging the new barrier. Any slack or increase in length present in the soft tissues following the relaxation is taken up to a new rotation barrier. Repeat 3-5 times.
Cervical: AA (atlanto-axial) MET
Practice/Describe/Think it through
○ Flexion, rotation: pt try to rotate head out of rotation
■ Patient supine, cradle the occiput with both hands & flexes the head & neck to end range. For a left rotation motion deficit, passively add left rotation up to the first barrier while maintaining head and neck flexion. Ask the patient to lightly turn the head to the right in 5-sec isometric contraction or simply look to the right against controlled resistance for 5sec. Relax for up to 10 sec prior to engaging the new barrier. Any increase in length in the soft tissues following relaxation is taken up into left rotation to a new barrier. Repeat 3-5 times. Reassess muscle length and cervical mobility to determine if a change in length, tissue texture, or mobility has occurred.
Cervical: Compression
Practice/Describe/Think it through
■ With the patient seated the examiner stands behind the patient and places both hands on top of the head and gradually exerts a downward pressure while assessing for a change in baseline symptoms. In 100 patients with neck and/or shoulder pain, reliability of compression is poor (ĸ = .34) without knowledge of history and increases to fair (ĸ = .44) with knowledge of the patient’s history.
Make sure pt is not protruding chin
Cervical: Closing/downglide (therapist mob)
Practice/Describe/Think it through
Closing/downglide (therapist mob)
Patient supine, head neutral on pillow; use either a cradle or chin hold. Cradle (shown here), both hands support the posterior occiput/neck. To perform at C5-C6 on right, the mobilization or manipulation hand contact is the right C5 articular pillar with radial border of the proximal or middle phalanx of index finger. Introduce right lateral flexion until tension is felt at the right contact point followed by left rotation to C4-C5, leaving C5-C6 free to move. Make slight adjustments to achieve firm barrier. Direct a graded oscillation or HVLA thrust along the plane of the facet downward & caudally toward the patient’s left axilla using minimum force necessary. If the patient feels pain, alter hand position or use an alternate procedure. Reassess.
Class Notes:
- He is putting his radial side of index finger against articular pillar (like PPIVMs except we were using pulp instead of the dip or pip)
- Can use as a manip as well
- Ipsilateral lateral flexion at the level you have your index finger against. That is where you are creating motion.
- Ipsilateral lateral flexion, contralateral rotation, oscillate towards axilla (her left axilla in this picture)
Cervical: Spurling’s Test A and B
Practice/Describe/Think it through
■ A: Spurling’s test A (Figure 6-33a) is performed by applying 7 kg of pressure with the patient sitting and neck laterally flexed to the tested side, reliability ĸ = .60.
■ B: Spurling’s test B (Figure 6-33b) is performed by applying 7 kg of pressure with the patient sitting & the neck extended, laterally flexed and rotated to the tested side, reliability ĸ = .62.
Picture: Spurling’s A
Cervical: Opening/upglide (therapist) (can use as a manip as well)
Practice/Describe/Think it through
○ Patient supine, head on pillow. Cradle the posterior head & neck and contacting the articular pillar with the lateral aspect of the MCP or the proximal or middle phalanx of the IF. Direct the mobilization or manipulation hand & forearm laterally to apply translation. For C2-C3 left-sided opening deficit, a apply force to the left through the right hand contact on the C2 articular pillar until the motion barrier is felt. The craniocervical spine and head move in the same lateral direction. Perform HVLA thrust or graded oscillation directed at the target segment in the appropriate right or left lateral translation direction using minimum force necessary. Also performed in neutral or slight flexion.
○ Treating left side
○ Looks like PPIVM, using same radial border of index finger
○ He is laterally translating her (not flexing)
Cervical: Traction/Distraction
Practice/Describe/Think it through
- In Sitting: Axial traction is performed in sitting to decrease symptoms. The examiner stands behind the patient and gently lifts the head with the hands under the maxilla and the thenar eminences under the occiput while assessing for change in baseline symptoms. The reliability of traction in sitting is fair without and with knowledge of the patient’s history, ĸ =.56 and ĸ = .41, respectively.
- In Supine: Grasp the chin and occiput in slight flexion while applying an unloading force of 14 lbs. The test is positive if symptoms are reduced. In patients suspected of cervical radiculopathy or carpal tunnel syndrome, the reliability is substantial, ĸ = .88.246. As a single test item, diagnostic accuracy is Sn 0.44, Sp 0.90, -LR .62, and +LR 4.4
**watch out for earrings
Cervical Exam: Sharp Purser Test
Practice/Describe/Think it through
○ Sharp-Purser: The Sharp-Purser test (Figure 6-40) assesses the stability of C1 on C2. If the transverse ligament is lax or no longer intact, C1 is able to translate forward on C2 in flexion. Patient sitting with flexion of the head on neck. Stabilize SP C2 with pincer grip & place other hand on the forehead. Apply a posterior force through the forehead. A positive test is when the head & C1 complex slide posteriorly hitting the dens indicating a reduction of the subluxed atlas on axis or when a firm end feel is not appreciated. Symptoms present at baseline may also be relieved.
Cervical Exam: VBI Test
Practice/Describe/Think it through
■ Supine, end range neck extension, hold for 10 seconds while looking at pt’s eyes (make sure they keep them open) and asking about and looking for change in s/s the entire time. If symptom-free at 10 seconds, add rotation to end range and assess the same way for 10 seconds.
Cervical: OA MET (therapist)
Practice/Describe/Think it through
○ The same procedure [as the suboccipital muscle length test] can be used to perform a MET to lengthen the posterior suboccipital muscles and improve upper cervical flexion. In neutral with one hand cupping the posterior occiput and one hand on the patient’s forehead, the clinician introduces upper cervical flexion to the first barrier. Ask patient to look up or gently push the occiput isometrically toward the table against a controlled resistance for 5 secs. Engage the new barrier after relaxation for up to 10 sec. Any increase in length in the soft tissues following the relaxation is taken up into flexion to a new barrier. Repeat 3-5x. Reassess muscle length and cervical mobility to determine if a change in length, tissue texture, or mobility has occurred.
Cervical: Repeated Retraction in lying (include progression)
Practice/Describe/Think it through
○ Retraction in lying
○ Retraction in lying w/pt OP
○ Retraction in lying off End of Table. The patient or clinician supports the patient’s head with the head and neck off the treatment table to the level of T3-T4. The patient first performs repeated retraction. The effect on symptoms is noted.
Progress through everything the pt can do by themselves before adding therapist assist.
Can put pillow under head if FHP is a problem
Cervical: Closing/downglide (self mob with fingers and towel)
Practice/Describe/Think it through
■ Using fingers: For a right-sided restriction in extension, right lateral flexion, & right rotation, the patient uses a towel or hooks the left index or middle finger over the articular pillar of the inferior vertebra of the involved segment on the right. The patient looks up and to the right while applying a slight PA pressure with the left index or middle finger. The patient then performs a gentle chin retraction followed by right rotation and slight extension until a stretch or tension is felt at the motion segment.
■ Towel version: For a right-sided restriction in extension, right lateral flexion, & right rotation, the patient uses a towel or hooks the left index or middle finger over the articular pillar of the inferior vertebra of the involved segment on the right. The patient looks up and to the right while applying a slight PA pressure with the left index or middle finger. The patient then performs a gentle chin retraction followed by right rotation and slight extension until a stretch or tension is felt at the motion segment.
Cervical Exam: Extension OP
Practice/Describe/Think it through
■ With OP: One hand stabilizes at the cervicothoracic junction while the other hand placed under the mandible gently guides the head and neck further into extension.
Cervical: Flexibility Tests: Pectoralis Major
Practice/Describe/Think it through
WEB: Page describe 3 test positions for portions of the pectoralis major. Patient supine & arm to be tested at the edge of the table & scapula on the table. Stabilize the sternum with the forearm. Different portions (i.e., lower sternal, midsternal, and clavicular) of the pectoralis major are tested by changing the amount of shoulder abduction. Lower sternal fibers are tested by abducting the arm to 150° with slight external rotation. With slight overpressure the arm should be able to reach the horizontal plane. Inability to reach the horizontal suggests a short Pec Maj and symptoms of stretch or pull in the muscle region should be noted. The midsternal fibers are tested by abducting the arm to 90° with external rotation. Normal length is noted by the arm resting below the horizontal with slight overpressure. The clavicular fibers are tested by placing the arm close to the body and moving into extension. Normal length is observed by the arm resting below the horizontal with slight overpressure. Kappa values, percent agreement, and prevalence of positive findings for the right and left Pec Maj as ĸ = 0.90, 95%, 41% and ĸ = 0.50, 86%, 23%.
- Class Notes:
- Only will test the mid-fibers in lab (demonstrated in video)
- Stabilizing on sternum with forearm, flex shoulder to 90, horizontal abduction to 90/90 position.
Cervical: Flexibility Tests: Levator Scapulae
Practice/Describe/Think it through
WEB: Patient supine. Flex the patient’s head & neck, laterally flex, & rotate away from tested side. Maintain this position, depress & upwardly rotate with the hand at the superior medial angle of the scapula to further lengthen the LS. Assess resistance to motion, end feel, and response. Patient feels a stretch along the LS. The splenius cervicis and posterior scalenes are most likely also lengthened.The test may also be performed in sidelying. Kappa values, percent agreement, and prevalence of positive findings for the right and left LS as ĸ = 0.61, 81%, 32% and ĸ = 0.54 , 77%, 45%.
- Class Notes:
- Supine on table
- Passive
- Flexion (stabilized scapula), contralateral lateral flexion, contralateral rotation, upward rotation of medial side of the spine of the scapula (dr mincer says depression) - stretching levator
Cervical: PPIVM C3-7 Flex/Ext
Practice/Describe/Think it through
○ Flex/Ext: In supine, physiological movement of each cervical segment from C2 to C7 are examined passively in each plane of movement: flexion, extension, lateral flexion, & rotation. Cradle the patient’s head and palpate at the posterior lateral margin of the z-joint using the pad of the index or middle finger. For the C2-C3 motion segment flexion and extension, the palpation finger is on the articular pillar at joint line between the 2 segments. Produce flexion or extension at each segment palpating on both sides moving only to the end of motion for that segment and not beyond. The cervical spine and each segment are returned to neutral for each test.
Cervical: Thoracic Manip: Distraction – sitting p. 395 (Seated mid-thoracic spine distraction thrust manipulation)
Practice/Describe/Think it through
■ WEB: Patient sitting with arms crossed over the chest or hugging upper body. Stand in a walk stance knees flexed position & use the sternum, towel, or mobilization wedge as a fulcrum against the T6 SP or mid-T-spine. Grasp the patient’s elbows & passively bring the patient backwards while maintaining a compressive force at T6 & a distraction force through the patient’s arms. As tension is achieved, apply a HVLA distraction force through the clinician’s hands in an upward direction against the T6 SP using the sternal contact.
Cervical Exam: AROM Rotation
Practice/Describe/Think it through
Sitting (goniometer):
- The patient is asked to look & turn her head to the left or right (Figure 6-16) Mobility deficits in rotation may occur in the upper cervical, lower cervical or upper thoracic regions. Observation of the quality of motion assists in locating the region. Upper thoracic restrictions may present as a loss of end-range motion. Lower cervical motion loss may be noted when the head turns easily on the neck, but motion remains limited. Upper cervical motion loss is suspected when rotation occurs mainly through the lower region with little head on neck rotation observed.
- Using a standard goniometer, the stationary arm is in line with the acromioclavicular joint and the movable arm with the nose. The patient rotates and the amount is recorded.
Supine (inclinometer):
- For rotation in supine, the inclinometer is centered on the forehead in line with the nose and zeroed. The patient rotates to one side and the amount is recorded.
Cervical Exam: Dix-Hallpike (did not practice in lab)
Practice/Describe/Think it through
■ Inform the patient that this test is provocative and may produce vertigo and nystagmus. Patient seated upright legs extended on a table, the examiner rotates the patient’s head 45° to the side to be tested. While maintaining the head & neck position, quickly move the patient into supine & then slightly extend the patient’s neck about 20° below the horizontal plane. The patient’s chin points slightly upward with the eyes open & head hanging off the edge of the table supported by the examiner. While observing the eyes, note the presence or absence of nystagmus & vertigo and duration, latency, and direction if nystagmus is present. In most cases nystagmus and vertigo are produced in a few seconds, however, in some patients the response is delayed. The test should be held for at least 30 sec. Any vertigo & nystagmus should be allowed to resolve before returning the patient to upright. If the nystagmus does not resolve, return to the upright position & allow to resolve. The test is repeated on the other side.
Cervical Exam: Rotation with OP
Practice/Describe/Think it through
■ With OP: The clinician stands on the side of rotation.The forearm stabilizes the trunk while both hands are placed on the lateral side of the head or at the zygoma of the mandible. The hands gently guide the head and neck further into rotation. Symptoms are assessed during overpressure as well as after completion of the procedure.
Picture: note forearm on back
Cervical Exam: Lateral Flexion with OP
Practice/Describe/Think it through
■ With OP: One hand stabilizes the trunk through the acromion process while the other hand placed on the lateral aspect of the head gently guides the head and neck further into right or left lateral flexion.
Cervical: OA flexion self mobilization
Practice/Describe/Think it through
○ To self-mobilize the left OA in supine or sitting, the patient rotates the head about 30° to the left and adds slight upper cervical lateral flexion to right. A towel or the fingers clasped behind the neck to stabilize at C2 assists with localizing motion to the upper C-spine. The patient actively performs upper cervical flexion with an imaginary axis through the external auditory meatus while adding a gentle upper cervical retraction. The reverse procedure addresses flexion mobility deficits at the right OA joint. Keeping the head and neck in neutral, the patient actively performs upper cervical flexion to address both sides simultaneously (Figure 6-72).
Cervical: Flexibility Tests: Scalenes (Anterior/Middle)
Practice/Describe/Think it through
WEB: Patient supine head & neck supported off the table. One hand under occiput with the shoulder over the patient’s forehead. Other hand stabilizes 1st & 2ND ribs. Retract or posteriorly translate the head & neck toward the floor to create extension in the typical C-spine keeping the upper C-spine flexed or in neutral. Maintain retraction, laterally flex away & rotate toward the tested side; assess resistance to motion, end feel, & response. The patient should feel a stretch along the scalenes or the SCM. Kappa values, % agreement, & prevalence of positive findings for the right and left scalenes as ĸ = 0.81, 90%, 37% and ĸ = 0.62, 81%, 59%.
- Class Notes:
- Supine Off table
- Passive
- Retraction, contralateral lateral flexion, ipsilateral rotation, ipsilateral shoulder depression
Cervical: Seated Repeated Retraction (including progression)
Practice/Describe/Think it through
- Retraction In sitting: For retraction in sitting, the patient is asked to slide or draw the head backwards while tucking in the chin and keeping the head horizontal or facing forward and return to neutral.
- Retraction w/ pt OP: In sitting with pt OP: The patient presses the chin with the fingers at the end range of movement. Overpressure may also be performed through the maxilla rather than the mandible to protect the temporomandibular joint.
- Retraction w/ PT OP: Clinician overpressure may also be performed through the mandible and maxilla.
- Retraction and ext: The test movement is retraction followed by extension. The patient performs retraction as described above and the slowly tips the head back as far as able and returns to neutral.
Cervical: Palpation (supine)
Practice/Describe/Think it through
Supine
- Spinous processes (similar to lumbar - two hands, top hand adds the pressure, bottom hand feels the spinous processes)
- Articular pillar: move laterally over muscle belly, move muscle out of the way and feel under it.
- Mastoid process
- Soft Tissue
- Scalene muscles are especially important (may be tight)
- Palpate all muscles in the cervical area and thoracic area. Palpate across the direction the muscle runs in order to feel ropiness, etc.
- Be careful palpating anterior structures (mostly SCM); pt may feel like they are choking even with very little pressure.
Pictures of anatomy to see if you remember the muscle directions properly
Cervical: Thoracic Manip: Upper, Mid T AP p 394, 395. Supine Thrust (pistol)
Practice/Describe/Think it through
■ WEB: Patient in supine, arms hugging the upper body and/or towel & the away arm on top forming a “V”. Stand on patient’s right side & reach the lower hand across to locate and the inferior segment at the TP of T5.Keeping the right hand in place, roll the patient back into supine. Use the left hand & forearm to support the patient’s head, neck, and upper T-spine. Flex the patient’s head, neck and upper thoracic spine until tension is felt at the T4/T5 segment. Rest your sternum or upper abdomen on the patient’s elbows. Apply an AP thrust through the patient’s arms & chest toward T4-T5.
■ Assess until find fulcruming over hand.
■ Alternative patient position: the patient may interlock their hands behind the neck keeping the elbows together.
■ Keep chin tucked!
Cervical: Opening/upglide self mob
Practice/Describe/Think it through
○ For a right-sided restriction in flexion, left lateral flexion, and left rotation in sitting, the patient hooks the left index or middle finger over the articular pillar of superior vertebra of the involved motion segment on the right & performs active flexion, left lateral flexion, & left rotation. The index or middle finger guides motion at the articular pillar & applying overpressure at end of available range. A towel can be used in place of the fingers as needed.
○ Can do with towel?
Cervical: NDT’s: 1 Median
Practice/Describe/Think it through
NDT’s
- WEB: (general) The uninvolved side or least painful side is tested first. Resting symptoms are established prior to starting the series of movements. During each step in the procedure, the clinician notes the quality, range of movement, resistance through the range and at the end of each movement, and the symptom response. The test is considered positive if all or some of the patient’s symptoms are reproduced, range of motion is limited compared to the uninvolved side, and symptom reproduction occurs with a sensitizing maneuver - movement of a body segment away from the site of symptoms. If symptoms are produced, most likely the patient will be unable to complete all of the test components. A sensitizing maneuver is necessary to assist in structurally differentiating between a somatic and neural source of symptoms. A positive test does not indicate the site of injury, but does suggest increased neural tissue sensitivity.
1 Median (only one we will be doing in lab)
- WEB: Face the patient’s head with the near hand pressing into the table stabilizing not depressing the superior aspect of the patient’s shoulder & the other hand holds the patient’s hand in neutral with the elbow flexed to 90° & supported on the examiner’s thigh. Add the following sequentially & assess response to each component: glenohumeral abduction up to 90°- 110°, if available wrist/finger extension & forearm supination glenohumeral external rotation elbow extension. With the onset of patient’s symptoms or new symptoms, structural differentiation is necessary.
- Class Notes:
- Should be about the same as last year
- Could be a couple of differnt things
- Watch carefully what PT does with right hand before abductin pt’s arms
- Persnickety alert!! Dr. Mincer wants us to be very very careful to put our hand all the way across the ends of the pt’s fingers, don’t let fingers be out here (showed the fingers being able to flex a bit at the tips).
- Don’t hold them there for long. Get out of the uncomfortable position before asking more stuff
- Helpful to instruct in head movement before doing the test.
- Go sloooooooowly! (will light them up if they are positive and don’t want to hurt them)
- She always looks for students to not change any of the previous steps when adding a new step!!
- Class Notes:
Cervical: Flexibility Tests: Upper Trap/SCM
Practice/Describe/Think it through
- Upper Trap/SCM
- WEB: With the patient in supine, flex the patient’s head & neck, laterally flex away from the tested side, & rotate toward the tested side. Maintain this position, gently depressed the shoulder girdle through the acromion & assess resistance to motion, end feel, & symptom response. The patient should perceive a stretch in the area of the muscle. To facilitate more SCM lengthening add & maintain a chin nod or upper cervical flexion during the test. Kappa values, percent agreement, & prevalence of positive findings for the right UT & left UT as = 079, 90%, 73% and = 0.63, 82%, 68%.
- Class Notes:
- Supine
- Passive
- Flexion, contralateral lateral flexion, ipsilateral rotation, depression of ipsilateralshoulder
- Close to being off the table
Cervical: Flexibility Tests: Suboccipitals (muscle length test, MET)
Practice/Describe/Think it through
- Suboccipitals (passive stretch and MET)
- WEB: Patient is supine, the examiner supports the occiput with one hand & provides upper cervical flexion through the forehead with the other hand. The suboccipital muscles are biased to one side by rotating the head 30° and adding upper cervical flexion; left rotation lengthens the left suboccipitals.364 Resistance to motion, end feel, and response are noted. The patient should feel a stretch in the region of the suboccipital muscles. Kappa values, % agreement, & prevalence of positive findings for the right & left subocciptals as ĸ = 0.63, 86%, 23% and ĸ = 0.58, 86%, 18%, respectively.The initial video show the muscle length test and continues as a muscle energy technique.
- Class Notes:
- Retraction can be used as a suboccipital stretch (would be held longer instead of repeated motions)
- One hand behind and one hand on forward.
- He moves into MET: she tries to resist him, relax, further into nodding motion
Cervical: Thoracic Manip: Mid T PA p .393 (what we did last year) Cross Hand PA Thrust
Practice/Describe/Think it through
■ Patient is prone with head and neck in a comfortable neutral position. Clinician on the patient’s left side. At T8- T9, place left hypothenar eminence on the left TP of T9 the hypothenar eminence of the right hand on the right TP of T8. Obtain a skin lock, lean your body weight over your hands. Apply a PA force to achieve tension toward the end of available range & apply a high velocity low amplitude (HVLA) thrust against the TP using the minimum force necessary. This procedure is also used as a mobilization.
■ PT did not do the skin lock separately
■ We are allowed to use the same hand grip we learned last year
Cervical: PPIVM C3-7 Lateral Flexion
Practice/Describe/Think it through
○ Lateral Flexion: For lateral flexion the palpation finger is on the side of the lateral flexion (i.e., right side for right lateral flexion) to monitor closing. Assess the segment as hypomobile, normal, or hypermobile based on perception of the mobility at each spinal segment relative to those above and below the tested segment and based on the examiner’s experience and perception of normal mobility. Monitor each segment for symptom reproduction.
Cervical: Repeated Protrusion
Practice/Describe/Think it through
■ In Sitting: Establish baseline resting symptoms and explain the procedure. Assess the response to one repetition and ask for 10-15 repetitions. For protrusion in sitting the patient is asked to poke or extend the chin forward as a far as possible keeping the head horizontal and return to neutral.
Cervical: PAIVM C3-7 UPA
Practice/Describe/Think it through
○ UPA: In the same position as described for central PA PAIVM, the clinician uses both thumbs to produce the passive accessory movement in a PA direction over the articular pillar at each level. Video: Thumbs placed tip-to-tip or one on top of the other. The thumbs are placed in the area of the z-joints 1.3-2.5 cm (0.5 – 1.0 inches) lateral to the SP beginning on the uninvolved side making side-to-side and level above and below comparisons. Inclination of the CPA or UPA may be varied medially, laterally, superiorly or inferiorly. Dr. Mincer had us stand on the side of pt.
