Cervical Spine OSCE Flashcards
1
Q
C Spine Supine Cradling
A
- place fingers on articular pillar at the level of the dysfunction.
- engage cervical tissue using a ventral force
- move the tissue cephalad and caudad, induce circumferential rotation to the right and left, and determine where there is ease of motion and restriction of motion
- you can either apply an indirect treatment by moving in all the directions of ease of motion, or apply a direct treatment in the direction of the restriction of motion
2
Q
C Spine Soft Tissue Technique
A
- supine position for all cervical treatments
- forces directed more deeply into the tissue in a rhythmic alternating fashion
- parallel and perpendicular traction
- engage the tight soft tissue elements/barriers
- apply treatment technique
- wait for tissue to release, then reengage barrier and reassess
3
Q
C Spine Traction, Supine
A
- one hand cradles occiput
- other hand grasps gently below chin
- exert cephalad traction with both hands (help head neutral or slightly flexed. Avoid extension)
4
Q
C Spine Forward Bending (Unilateral fulcrum), supine
A
- use one hand to flex patient’s neck in order to slide the other arm under patient’s head with hand palm down on opposite shoulder.
- keeping neck in flexion, rotate the patients head toward elbow of arm that is under patient’s head
5
Q
C Spine Forward Bending (Bilateral fulcrum), supine
A
- arms are crossed under patient’s head, hands placed palm down on patient’s shoulders.
- flex patient’s neck, giving a longitudinal stretch of paravertebral muscles
6
Q
Contralateral Traction, Supine for C Spine
A
- physician stands at side of table opposite side being treated
- cephalad hand rests on patient’s forehead to stabilize head
- caudad hand reaches across and contacts paravertebral muscles on side opposite of where you are standing (make sure to be lateral to spinous processes, not on them)
- engage tissue with ventral force and continue to apply traction moving ventrally and slightly laterally creating a perpendicular stretch
7
Q
C Spine Cradling with Traction, Supine
A
- fingers placed under patient’s neck bilaterally on paraspinal muscle,s just lateral to the spinous process.
- engage soft tissue with ventral and lateral force
- longitudinal traction exerted by moving cephalad along the soft tissues
8
Q
Suboccipital release
A
- finger pads placed in sub occipital region
- apply upward pressure into tissues and hold
9
Q
OA Muscle Energy
A
- flex or extend head through occiput into barrier
- rotate and sidebend head to restrictive barrier
- patient attempts to pull chin back to neutral against your resistance in an isometric contraction
- after 3-5 seconds, patient relaxes while physician engages the new barrier (post-isometric relaxation) by increasing F/E, rotation and side bending
- repeat this process 3-5 times, or until no new barriers are encountered.
- reassess
10
Q
AA Muscle Energy
A
- fully flex the cervical spine (this locks out motion at the AA)
- rotate head to barrier through atlas
- patient attempts to pull chin neutral against your resistance in an isometric contraction
- after 3-5 seconds, have patient relax while physician engages the new barrier (post-isometric relaxation) by increasing rotation
- repeat this process 3-5 times, or until no new barriers are encountered
- reassess
11
Q
C2-C7 Muscle Energy
A
- flex or extend head through involved segment into barrier
- rotate and sideband head into barrier through involved segment.
- patient attempts to pull chin back to neutral against your resistance in an isometric contraction
- after 3-5 seconds, have patient relax while physician engages the new barrier by increasing the F/E, rotation and SB.
- repeat this process 3-5 times, or until no new barriers are encountered
- reassess
12
Q
OA Joint HVLA
A
- grasp patient’s head with thrusting hand on occiput, MCP joint just inferior to sulcus (thrusting hand is whichever side rotation is to)
- place other hand on patient’s chin/lateral jaw, with palm on zygomatic process
- extend slightly (at OA joint), using MCP of thrusting hand as fulcrum (don’t hyperextend)
- rotate and SB occiput into barriers, taking up all slack in soft tissues to lock out all 3 planes
- have patient inhale deepening, then as they are exhaling, continue to take up slack and engage the barrier.
- at end of exhalation, apply a high velocity and low amplitude thrust.
- force directed at patient’s eye, combined SB and rotation.
- reassess
13
Q
AA Joint HVLA
A
- flex cervical spine fully
- rotate cervical spine through the atlas.
- apply muscle energy principles
- apply a rotational thrust at end of muscle energy treatment
14
Q
Typical Cervicals Sidebending HVLA
A
- rotational barrier has a harder end feel
- physician’s right MCP placed behind the right articular pillar of C6 to restrict that segment.
- physician supports patient’s head with left hand
- head is sideband right until C5 begins to move, then flexed until motion is felt at C5.
- physician carefully rotates the head to the left, maintaining the original right side bending.
- with the patient relaxed and not guarding, the physician uses rapid acceleration and supinates the left hand and wrist to direct a left rotational arc-like thrust.
- reassess
15
Q
Typical Cervicals Rotational HVLA
A
- sidebending barrier ahs a harder end feel
- physician supports the patient’s head with the pads of the index fingers on the articular pillars of the dysfunctional vertebra (C5).
- physician gently flexes the patient’s head and neck until C5 moves
- physician, while monitoring at C5, rotates the patient’s head and neck to the right until motion is felt at C5.
- physician sidebends patient’s head and neck to the left, engaging the side bending barrier.
- physician’s right MCP placed behind the right articular pillar of C5.
- physician adjusts flexion or extension as needed to localize all 3 planes
- with the patient relaxed and no guarding, the physician’s right second MCP directs an arc-like thrust caudally, across the midline in the oblique plane of C5, engaging the right side bending barrier.
- reassess
