Cervical Spine Flashcards

Question

Torticollis (congenital or acquired) | Description & Intervention

Answer 1

Unilateral shortened **Sternocleidomastoid** (SCM) muscle causing: - **Ipsilateral side flexion** and **contralateral rotation** of the C-spine - DEC AROM & PROM in **opposite direction** (side flexion away & rotation towards the affected side) - Rx: Stretch the affected side SCM Strengthening exercises to improve balance b/t both sides Positioning/ handling to simulate symmetry (ex also holding the baby on the same side - Tx: switch sides II Crib - move it to the center so the baby will look both ways) Congenital Torticollis: - Etiology unknown but believed to be due to trauma during birthing process (delievery) or intrauterine malpositioning - **Positional plagiocephaly** (flattened head syndrome) may develop as a result of uneven pressure distribution for porlonged periods when lying in positions Cranial remodling orthosis (baby helmet) & frequent repositioning may help prevent plagiocephaly Interventions: - Repositioning - Stretch tight SCM mm

Answer 2

Forward head posture (chin poking) may result in adaptive shortening of the lower cervical flexions (SCM & anterior/middle scalene mm) Upper cervial extensors (suboccipital mm & capitis mm) may lead to deep neck flexor weakness UCS = Weak: deep neck flexors Tight: Upper trap & levator scapula Weak: Lower trapezius, rhomboids & serratus anterior Tight: Pectorals **May lead to alignment changes in the c-spine leading to increased stress on the psoterior structures (ie facets & posterior disc) Interventions: 1. Postural correction - go to answer 2. Strengthen weak & elongated mm 3. Stretch tight structures

Answer 3

Excessive motion between 2 adjacent vertebra - D/t ligament damage, fracture, dislocation, joint damage (stenosis, dehydrated discs - period before osteophytes are formed leading to stiffness) - May be caused by trauma, congenital malformations, long-term corticosteriod use (weaken tissues), or secondary to pathologies (RA, DS, osteoporosis) **IF instability is suspected mobilizations &/or manipulations should not be performed** (contraindicated)

Answer 4

1. Dizziness 2. Lip or facial paresthesia 3. Lump in throat 4. Nausea/ vomitting 5. Nystagmus 6. Patient is hesitant to move head or neck (especially into flexion) 7. Pupil change 8. Severe headache (especially w/ mvmt) 9. Severe mm spasm 10. Soft end-feel SCI S/S - Quadrilateral paresthesia *Paresthesia down all 4 limbs* - Cord compression S/S

Answer 5

Tests the integrity of supporting anterior ligaments & capsular tissues Procedure: - Patient in supine, head in neutral - Therapist stabilizes the vertebra by placing both thumbs over the anterior aspect of the TPs - Therapist applies an **anterior force** on the adjacent vertebra above the stabilized vertebra *May apply force through SP or bilaterally through the posterior arch (lamina)* (+) = Excessive motion &/or S/S of cervical instability

Answer 6

Tests the integrity of the contralateral alar ligament Procedure: - Patient in supine, head in neutral - PT stabilizes C2 with wide pinch grip around SP & lamiina - PT side flexes C1 & head (+) = excessive side flexion **An intact alar ligament results in a strong capsular end-feel**

Answer 7

Tests the integrity of lateral ligaments & capsular tissue Procedure: - Patient in supine, head in neutral - Forwarn patient that test may cause pain and discomfort ** - PT places the radial aspect of the 2nd MTP joint of one hand aginst the TP of one vertebra & the radial aspect of the 2nd MTP joint of the other hand on the TP of an adjacent vertebrae on the other side of the neck - PT hands are then pushed together carefully creating a **shearing** force of one vertebra over the other (+) = Excessive motion or sumptoms of instability, spinal cord, or vascular pathology - Minimal motion and no symptoms should be produced with intact ligaments & capsular tissue **NEED to refer patient - at risk for numerous adverse events (stroke)**

Answer 8

**Should be performed with extreme caution** Test to determine subluxation of C1 (atlas) on C2 (axis) - Transverse ligament helps maintain position of th eodontoid process of C2 relative to C1. If the transverse ligament is torn, C1 will sublux by translating forward relative to C2 in flexion - **Patient may be hesitant or reluctant to perform forward flexion** Procedure: - PT places one hand over the patient's forehead & the thumb of the other hand is placed over the C2 SP in order to stabilize C2. - Patient is asled to slowly flex head forward, while the PT applied pressure against the patient's forehead. *May hear a clunk - could possible reduce the subluxation* (+) = PT feels the head slide backwards during the movement - Indicates relocation of subluxed atlas. May be accompanied by a clunk

Answer 9

Indicates C1-C2 dysfunction **Validated as a diagnostic test for C1-2 related CERVICOGENIC headache** Procedure: - Patient in supine - PT fully flexes the patient's c-spine (chin-chest) & proceeds to rotate the patient's head to the RT & LT (while maintaining full c-spine flexion) to assess ROM *FULL FLEX: locks C3-7) to evulate how much rotation is at C1-2* (+) = - Increased or decreased ROM 45 degrees upper c-spine rotation ROM indicating a C1-2 dysfunction - Reproduction of headache indicating C1-2 cervicogenic headache False (+) if you do not lock the pt C/S well

Answer 10

Clinical Stability - will not see this on radiograph compared to the other instabilities **Related to how well the inner unit mm are working - stabilizing mm - are they coordinatde & have appropriate timing** Inner unit mm: - Attach segmentally - Function as stabilizers (tonic mm - constantly on) NOT prime movers *Analogy - stabilizers = marathon runners - can go a long time BUT are not very strong. Prime mover = sprinters* - Includes: Deep neck flexors Deep neck extensors Suboccipitals - Can become weak - after a traumatic injury (MVA - inhibited by pain) Dysfunction in these mm can lead to segmental (clinical) instability, potentially leading to **aberrant movement** (Not moving smoothy - clunk into place) b/t segments or at certain ROM causing pain May also lead to increased recruitment of superficial global mm in an attempt to maintain stability causing overuse of global musculature (TONIC contractions - can get fatigued which leads to pain - INC lactic acid - lead to area becoming sensitized) Intervention: 1. Deep Neck Flexor (DNF) Training - Coordination & timing - Analgesic effect - slight mvm when other mvmt is tolerated - helps with pain

Answer 11

Procedure: - Test deep neck flexor mm function - Patient positioned in supine in crook-lying with c-spine in neutral (place towels under head to achieve neutral c-spine if necessary) - Place inflatable pressure sense (BP cuff) under the upper c-spine - Inflate presure device to a base level of 20 mmHg - Instruct the patient to perform upper c-spine flexion by nodding the head slowly & gently in order to reach a pressure grade of **22 mmHg & hold for 10 seconds** *If actication of SCM occurs = pt is doing it wrong* - This is repeated at increasing pressure grades (22, 24, 26, 28, and 30) - Most young & middle-aged patients can successfully perform test at 26 & hold for 10 seconds (+) = - Patient is unable to increase pressure to at least 26 mm Hg - Unable ot hold contraction at given pressure for 10 secs (or it teters) - Inability to raise pressure in small increments (2 mm Hg) - Uses compensatory patterns: Uses superficial neck mm (SCM) Extends the head *Overacitivty of global mm & underactivity of deep mm