Cervical Spine Competency

Question 1

a. Perform the evaluation for the OA joint for modified Type 1 somatic dysfunction and document appropriately.

Answer 1

• Student notes the joint has modified Type I mechanics meaning primary motions are flexion/extension, but rotation and side bending are opposite (atypical cervical vertebrae).

LATERAL TRANSLATION TEST:
- Patient supine.

• Examiner seated at head of table.
• Examiner contacts head with both hands, with tips of fingers 2 and 3 over occipital articulation
• Examiner then translates OA joint to right and left with head in neutral, noting any restriction of translational motion.
• Examiner notes that if there is restriction of translation to the right then the OA prefers to side bend to the right thus by definition it would be rotated to the left.
• Student places the OA segment in flexion and performs same technique as above noting if translational end feel becomes more symmetric in flexion. Thus, a Flexion Dysfunction with side bending and rotation in opposite directions based on the translational findings (Ex: OA F RLSR).
• Student places the OA segment in extension and performs same technique as above, noting if translational end feel becomes more symmetric in extension. Thus, an Extension Dysfunction with side bending and rotation in opposite directions based on the translational findings (Ex: OA E RLSR).

ROTATIONAL TEST:
- Patient supine.

• Examiner seated at head of table.
• Examiner contacts head with both hands, with tips of fingers on the occipital ridge and the joint in neutral position.
• Examiner by lifting anterior on the right ridge, with the right hand, the OA joint rotates to the left noting any restriction of rotational motion.
• Examiner then by lifting anterior on the left ridge, with the left hand, the OA joint rotates to the right noting any restriction of rotational motion.
• Examiner notes that if there is preferred rotation to the right, then the OA, by definition, prefers to side bend to the left.
• Examiner notes that if there is preferred rotation to the left, then the OA, by definition, prefers to side bend to the right.
• Student places the OA segment in flexion and performs same technique as above, noting if rotational end feel becomes more symmetric in flexion. Thus, a Flexion Dysfunction with side bending and rotation in opposite directions based on the translational findings (Ex: OA F RLSR).
• Student places the OA segment in extension and performs same technique as above noting if rotational end feel becomes more symmetric in extension. Thus, an Extension Dysfunction with side bending and rotation in opposite directions based on the translational findings (Ex: E RLSR).
• The OA somatic dysfunction diagnosed would be noted in the objective portion of the SOAP note.

Question 2

b. Perform the evaluation for the AA joint for rotation somatic dysfunction and document appropriately.

Answer 2

• States the atlas primary motion is rotation in relation to the axis and can become restricted in rotation.
• Patient supine.
• Examiner sits at the head of the table.
• The student grasps the head with fingertips contacting lateral masses of the atlas bilaterally.
• Student flexes the C‐spine FULLY which locks C2‐7, isolating rotation to the atlas.
• Student rotates head and neck right then left, assessing for restriction and freedom of motion.
• Greater rotation to the right implies restriction of left rotation defined as an AA rotated right.
• Greater rotation to the left implies restriction of right rotation defined as an AA rotated left.
• Flexion, extension, and side bending are not tested at this segment.
• This would be documented in the objective portion of the chart (Ex: AA RL or AA RR).

Question 3

c. Perform the lateral translation evaluation for the typical cervical spine segments for Type 2 somatic dysfunction and document appropriately.

Answer 3

• Student notes the joint has modified Type 2 mechanics meaning primary motions are flexion/extension with rotation and side bending are to the same side (typical cervical vertebrae).

LATERAL TRANSLATION TEST:
- Patient supine.

• Examiner seated at head of table.
• Examiner contacts head with both hands, with tips of fingers 2 and 3 over transverse process in the midcoronal line.
• Examiner then individually translates C2‐7 to right and left with head in neutral, noting any restriction of translational motion.
• Examiner notes that if there is restriction of translation to the right then the segment prefers to side bend to the right thus by definition it would be rotated to the right.
• Student places the OA segment in flexion and performs same technique as above, noting if translational end feel becomes more symmetric in flexion. Thus, a Flexion Dysfunction with side bending and rotation in same direction based on the translational findings (Ex: C3 F RRSR).
• Student places the OA segment in extension and performs same technique as above, noting if translational end feel becomes more symmetric in extension. Thus, an Extension Dysfunction with side bending and rotation in same direction based on the translational findings (Ex: C4 E RRSR).
• The typical cervical somatic dysfunction diagnosed would be noted in the objective portion of the SOAP note.

Question 4

d. Perform the rotational evaluation for the typical cervical spine segments for Type 2 somatic dysfunction and document appropriately.

Answer 4

• Student notes the joint has modified Type 2 mechanics meaning primary motions are flexion/extension with rotation and side bending are to the same side (typical cervical vertebrae).

ROTATIONAL TEST:
- Patient supine.

• Examiner seated at head of table.
• Examiner contacts head with both hands, with tips of fingers on the posterior aspect of the transverse
  process (articular pillar) of C2‐7 (one at a time) in neutral position.
• Examiner by lifting anterior on the right transverse process, with the right hand, the segment rotates to
  the left noting any restriction of rotational motion.
• Examiner then by lifting anterior on the left transverse process with the left hand, the segment rotates
  to the right noting any restriction of rotational motion.
• Examiner notes that if there is preferred rotation to the right, then the segment, by definition, prefers to side bend to the right (Type 2 mechanics).
• Examiner notes that if there is preferred rotation to the left, then the segment by definition prefers to side bend to the left (Type 2 mechanics).
• Student places the segment in flexion and performs same technique as above noting if rotational end
  feel becomes more symmetric in flexion. Thus, a Flexion Dysfunction with side bending and rotation in same direction based on the rotational findings (Ex: C4 F RRSR).
• Student places the segment in extension and performs same technique as above noting if rotational end feel becomes more symmetric in extension: thus an Extension Dysfunction with side bending and rotation in same direction based on the translational findings (Ex: C6 E RRSR).
• The typical cervical somatic dysfunction diagnosed would be noted in the objective portion of the SOAP note.

Question 5

Neurological Testing

Answer 5

1) Bicep: C5
2) Brachioradialis: C6
3) Triceps: C7

Question 6

Spurling’s Maneuver

Answer 6

• Physician is standing behind the seed patient
• Test is done in three stages, each of which is more Provocative. If symptoms are PRODUCED, one does not proceed to the next stage
  1) Compression of the Head in NEUTRAL
  2) Compression of the Head with Head in EXTENSION

3) Sideband AWAY from the affected side then TOWARD the affected side and ADD COMPRESSION
- Positive test is indicated by pain down the arm in the distribution of the Nerve Root indicating Nerve Root Compression!!!!

Question 7

Spinal Mechanics

Answer 7

1) OA: Modified Type I
2) AA: Rotational ONLY
3) C2-7: Modified Type II

Question 8

OA Joint

Answer 8

Lateral Translation Test:
- Grasp head with both hands, with tips of fingers 2 and 3 over OCCIPITAL ARTICULATION

Rotational Test:
- Grasp head with both hands. pale tips of miners on the OCCIPITAL RIDGE and the Joint in Neutral Position

Question 9

AA Joint

Answer 9

• Have to FULLY FLEX the C Spine (This locks C2-7, Isolating the ROTATION of the ATLAS)

Question 10

C2-7 Motion Testing

Answer 10

Lateral Translation Test:
- Support patients head with your hands while palpating LATERAL BORDERS of the Articular Pillars

Rotation Test:
- Rotational movement force should follow the planes of the Facets

**Testing for is directed up towards EYES for UPPER CERVICAL VERTEBRAE, and towards OPPOSITE ASIS for LOWER CERVICAL VERTEBRAE (Not in Horizontal Plane)

• Support patients head with palms, with fingertips contacting the Posterior Surface of the ARTICULAR PILLARS!!!!!