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Osteopathy > Cervical region > Flashcards

Cervical region Flashcards

1
Q

Adson’s test

Thoracic outlet syndrome tests (TOS)

A

Patient seated.

Locate pulse and monitor.

Practitioner externally rotates and extends patients 90 degree abducted arm.

Patient actively ipsilaterally rotates and head with c-sp flexion whilst deeply inhaling.+ve = neurological symptoms

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2
Q

Brachial plexus compression test

A

Practitioner stands behind seated patient.

Apply compression through the trapezius and mid-clavicle to compress the brachial plexus towards the 1st rib.

Pain in shoulder or UEX is a + test.

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3
Q

Spurlings A test

diagnosis of cervical radiculopathy

Specifiy but poor sensitivity

A

Patient seated.

practitioner behind patient.

Stabilise one shoulder and places other hand on the top of the patient’s head.

Practitioner then introduces passive side-bending of C-sp towards the side being tested, and applies caudal compression directed towards the facets joints on this side.

+ ve = neurological symptoms/ pain in the arm, not just the neck.Can be performed segmentally to increase dermatomal accuracy (supine position).

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4
Q

Spurlings B test

Often used in conjunction with C-Sp distraction test and Valsalva testBi-lateral symptoms - possibly cord compression

A

Practitioner stands behind patient.

Stabilises, introduces passive side bending then rotates C-sp contralaterally.

Examiner applies caudal compression.+ ve = Reproduction of dermatomal symptoms.

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5
Q

C-sp Distraction test.

Often used with Spurlings tests, Quadrant Csp Compression test, and Valsalva test to indicate Csp radiculopathy.

Non-provocative . +ve is indicated by relief of symptoms

A

Supine or seated.Supine test

Apply a superior traction force using a firm handhold on the occiput and chin.

Seated test ; practitioner stabilises patient, assumes a firm handhold cradling the occiput with the thumbs approximately midway between the mastoid process and the inion. Apply upward traction.

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6
Q

C-Sp Quadrant Compression test

  • test used to assist diagnosis of various C-sp conditions including; facet irritation and dysfunction, spondylosis. Bi-lateral symptoms is a red flag
A

Patient seated.

Practitioner passively flexes and sidebends the c-sp to each side, then extends, sidebends and contralaterally rotates Csp to each side.

Practitioner applies gradual caudal compression at the end of each of these 4 movements.

+ve = reproduction of local C-sp symptoms

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7
Q

Valsalva test

  • general test to assist diagnosis of radicular symptoms in Csp, Tsp, and Lsp. Many causes.
A

practitioner instructs patient to take a deep breath, and hold it whilst bearing down as if the moving the bowels.

+ve = reproduction of dermatomal symptoms or localised symptoms

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8
Q

Lhermitte’s sign

  • test for cervical myelopathy and radiculopathy
A

Patient seated or supine.

Examiner passively flexes C-sp to end of range

.+ ve = Sharp spinal or dermatomal pain

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9
Q

VBI test

A

Patient supine or seated.

Examiner supports head and passively extends, sidebends, and rotates patient’s head to one side.

Examiner holds position for 15 seconds.

Repeat on opposite side.

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10
Q

Where is TP of C1?

A

Between mastoid process and angle of mandibular

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11
Q

what level is the hyoid bone?

A

C3

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12
Q

What level is the thyroid cartilage?

A

C4-C5

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13
Q

what can be felt between the thyroid cartilage and the SCM muscle?

A

carotid pulse

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14
Q

Scalenus anterior attachments and actions

A

Origin : C3-C4 Insertion : first rib

Action ; elevates 1st rib, laterally flexes the cervical vertebrae.

Inn. ventral ramus C5, C6

Phrenic nerve accompanies this muscle

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15
Q

What are the O & I of Splenius capitis, nerve Inn., and actions?

A

O: SPs C07-T03 I: mastoid process & lateral aspect of occipital bone

Inn. Dorsal rami of middle cervical spinal nerves

Actions. Draws head to one side and slightly rotates it

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16
Q

Splenius capitis innervation

A

C3, C4

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17
Q

Splenius capitis action

A

bilaterally - head extensionunilaterally - rotation to the same side

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18
Q

Rectus capitis posterior major : O and I

A

O : Spinous process of axis (C2)I: lateral part of the inferior nuchal line of the occipital bone

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19
Q

Rectus capitis posterior major : actions

A

extends and rotates the head

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20
Q

Rectus capitis posterior major : innervation

A

posterior primary division of the spinal nerves (dorsal ramus of C01)

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21
Q

what two deep occipital muscles originate from the SP of C2?

A

Rectus capitis posterior majorObliquus capitis inferior

22
Q

Shoulder abduction test

Test is used to assist diagnosis of C-sp radiculopathy. Good specificity when used in conjunction with Csp Compression/Distraction tests. (Malanga et al 2003)

A

Patient seated or standing.

Patient abducts symptomatic arm, flex elbow and place hand on top of head.

In this position the tension may be taken off the cervical nerve roots and parts of the Brachial plexus.

Reduction or elimination of symptoms is a positive test.

23
Q

Head shifted forwards is called…

A

protraction

24
Q

head shifted backwards is called….

A

retraction

25
Q

what muscle covers most of the scalenus anterior, and where is the best place to palpate the scalenus anterior?

A

(a) s.c.m.
(a) insertion on 1st rib is found directly lateral to the clavicular insertion of s.c.m.

NB. isometric ipsilateral contraction will make muscle prominent. Or deep inhalation.

26
Q

How is the CSp functionally divided? (2)

A
  1. C0/C1 and C1/C2 segments
  2. C2/3 to T3/T4 segments
27
Q

why is the lower cervical spine not very good for lateral flexion?

A

because they have a wide lateral base

(LSp has less distance between the facet joints)

28
Q

what do the tubercles in the cervical vertebrae represent?

A

the anterior tubercle of a rudiment of a rib

the posterior tubercle is the actual transverse process

29
Q

What is used to fix a vertebrae doing HVT manoeurves?

A

the laminae since they are at the same level of the spinous processes.

30
Q

what is required for lateral flexion in the CSp?

A

coupling movement of rotation

31
Q

what happens with rotation in the CSp?

A

inevitably coupled with lateral flexion and the axis of rotation is tilted.

Eg. Rotation to the right is accompanied by lateral flexion to the right

32
Q

Diagram of uncovertebral joints during lateral flexion

A
33
Q

what inserts at the inion?

A

ligamentum nuchae

34
Q

what muscles are located directly below superior nuchal line?

A

semispinalis cervicis

splenius capitis

descending part of the trapezius

(the large intrinsic muscles)

35
Q

where is the inferior nuchal line and what attaches to it?

A

one finger-width inferior to the inion.

the deep neck muscles (rectus and obliquus muscles)

36
Q

Which SPs does the ligamentum nuchae directly attach to?

A

C5-C7 SPs

37
Q

What is the role of the alar ligaments? (3)

A

They control central biodynamics of the cervical region.

  1. help move the dens during CSp Flex and Ext
  2. limit atlantoaxial rotation
  3. pass lateral flexion of the head onto the axis by rotating C2
38
Q

What is the main movement of the C0/C1 joint?

A

It is an extensor (20% gross movement)

(flexor 7%)

39
Q

Rotation is the main movement at C1/C2. How much does the range of movement increase when C2 is free to move?

A

Goes from 20% to 40%

40
Q

Diagram showing tensing of alar ligaments during lateral flexion, causing posterior side of dens to move and axis rotates to the left

A

* strong form of coupling in the musculoskeletal system

(SP of C2 moves to the right)

* movement of C2 is used to assess stability of alar ligaments

41
Q

What are the extrinsic muscles of the cervical spine? (4)

A

descending fibres of trapezius

lev. scap.

scaleni

s.c.m.

(supplied by ventral rami of the spinal nerves)

‘muscles that are no longer found in their original positions’

42
Q

Levator Scapulae - origins and insert

A

C1- C4 transverse processes

to

superior angle of scapula

43
Q

Diagram of posterior superficial muscles of CSp (3)

A
44
Q

Which muscle lies between the CSps and the vertebral laminae?

A

Semispinalis

(half of width is covered by descending part of trapezius)

45
Q

The Splenius capitis is a strong muscle that does what?

A

strong rotator and extensor of the CSp

46
Q

This is something important about the occipital insertion of the scm…

A

It attaches posteriorly to the mastoid process, as well as to the mastoid process

47
Q

What is the relationship of C1-C3 tps to the scm?

A

C1 transverse process is anterior to scm

C2 transverse process is directly posterior to scm

C3 transverse process is also the posterior border of the scm

48
Q

what is the 3rd organ of balance?

A

mechanoreceptors in C0/1 to C2/3 joints, muscle spindles in deep, short suboccipital muscles (rectus and obliquus muscles)

49
Q

Why do the scaleni muscles originate at the anterior tubercle of the cervical vertebrae?

A

Because they are an extension of the intercostal muscles in the cervical region, therefore they originate from rudiments of the cervial ribs.

50
Q
A
51
Q

Scalenus medius

A

C3-C7 transverse processes down onto 1st rib

(NB. Scalenus anterior originates from C3-C4)

Osteopathy (12 decks)

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