Cervical Spine Exam & Intervention Flashcards
Factors associated w/ development of chronic neck pain
- less baseline pain and disability intensity
- age (> 40)
- headache
- bicycling
- worse QoL
upper cross syndrome
- Inhibited neck flexors and inhibited rhomboids and serratus anterior
- tight upper trapezius and levator scapula and tight pectorals
C1 myotome
capital flexion
C2 myotome
capital extension
C3 myotome
neck lateral flexion
C4 myotome
shoulder (scapular) elevation
C5 myotome
shoulder abduction
C6 myotome
elbow flexion and wrist extension
C7 myotome
elbow extension and wrist flexion
C8 myotome
thumb abduction
T1 myotome
finger adduction
biceps DTR
C5
brachioradialis DTR
C6
triceps DTR
C7
special tests for ruling out cervical arterial dysfunction (CAD)
- end-range rotation test
- VBI test
- Modified VBI test
upper cervical stability ruling out tests
- modified sharp purser test
- upper cervical flexion test
- A-O membrane test
- tectoral membrane test
- alar ligament stability test
How to perform modified sharp purser test
- slightly flex neck
- palpate C2 spinous process
- provide posterior force through forehead with contralateral hand
- if symptoms produced during neck flexion and reduced with posterior force on forehead
What test is good for confirming upper cervical instability but not good for screening?
modified sharp purser test
How to perform tectoral membrane test
- stabilize spinous process of cervical spine and under occiput
- provide traction and posterior translation force
- test is excessive motion
How to perform posterior A-O membrane test
Stabilize cervical spine at transverse process of C1 and under occiput to provide translation force
- Excessive motion is + test
How to perform alar ligament stability test
Palpate spinous process of C2 and rotate head and lateral flex head until feel C2 spinous process moving
If no movement occurs = + test
Repeat in slight flexion and extension
The alar ligament stability test is good for _______ but not as good for ________
good for confirming but not as good for screening
ruling out test for cervicogenic headaches
cervical flexion-rotation test
ruling out test for radicular pain/radiculopathy
upper limb tension test
How to perform cervical flexion rotation test
- full neck flexion and maintain chin tuck
- rotate R and L
- test if symptoms produced or difference of 10 deg ROM from side to side
CPA testing aka spring testing
- find spinous process and provide anterior force
- want to have snot drip straight down
- looking for provocation of radicular symptoms
UPA testing
- same as CPA but done on articular pillars
cervical tests for confirming
- spurling’s compression test
- cervical distraction test
- valsava maneuver
- brachial plexus compression test
- cervical compression test
- Wainner’s test item cluster
items in Wainner’s test item cluster
- spurling’s test
- cervical distraction test
- ULTT
- c-spine rotation AROM < 60 deg
MDC for neck flexor muscle endurance test
17.8 sec
Grade 1 mobilization
small amplitude at beginning of range
Grade 2 mobilization
large amplitude within range but not end range
Grade 3 mobilization
large amplitude performed up to the limit of the range
Grade 4 mobilization
small amplitude performed at the limit of the range
manual therapy absolute contraindications for PROM and manipulations
- malignancy of targeted region
- cauda equina syndrome
- red flags - neoplasm, fracture, or systemic disturbance
- rheumatoid collagen necrosis
- upper c-spine instability
- concern for CAD (dizziness, nausea, hearing disturbances, unsteadiness)
relative contraindications for PROM and manipulations
- acute nerve root irritation
- blood clotting disorder
- acute inflammation, stiffness, systemic disease, irritability, osteoporosis
absolute contraindications for manipulations
same as PROM as well as:
- practitioner lack of ability
- spondylolisthesis
- gross foraminal encroachment
- children/teenagers
- pregnancy
- fusion
- psychogenic disorders
- immediately postpartum
cervical thrust and non-thrust techniques for mechanical neck pain are part of which POC?
acute, subacute, and chronic neck pain
cervical mobilization/manipulation in combo w/ exercises is good for what diagnosis?
cervicogenic headaches
- evidence for pain reduction and functional improvement
Thoracic thrust and non-thrust techniques for mechanical neck pain are better for ________ results
short-term
mobilization and manipulation of c-spine w/ targeted neck strengthening is good for which muscles?
cervical deep flexors
cervical mobilization with movement for which diagnosis?
cervical dysfunction
- cervicogenic headaches and dizziness
