Cervical Spine Practical Flashcards
how is muscle length of the levator scapula assessed
Stabilised: Scapula depression
Applied: Contralateral cervical sideflexion, rotation and flexion
how is muscle length of the upper trapezius assessed
Stabilised: Scapula depression
Applied: Contralateral cervical sideflexion, ipsilateral rotation and flexion
how is muscle length of the pectoralis minor assessed
Observe space between shoulder (acromion) and plinth in supine. Can assess
unilaterally by passively retracting at coracoid process and assess end feel
how is muscle length of the latissimus dorsi assessed
Stabilised: Thoracic spine on plinth in crook lying – may need to ask patient to
activate Transversus to prevent spinal extension.
Applied: Shoulder elevation in full lateral rotation
how is muscle length of the anterior scalene assessed
Stabilised: 1st rib
Applied:
Anterior scalene: cervical extension, contralateral sideflexion AND ipsilateral
rotation
how is muscle length of the middle scalene assessed
stabilised - 1st rib
Middle scalene: cervical extension, contralateral sideflexion.
how is muscle length of the posterior scalene assessed
stabilised - 1st rib
Posterior scalene: contralateral sideflexion AND contralateral rotation.
how is muscle length of the sub occipital extensors assessed
Fix C2 with lumbrical grip (caudal direction) and perform occipital roll with other
hand.
what is required to conduct cranio-cervical flexion test
Criterion – unrestricted craniovertebral flexion is required for an accurate test, so
test this first
what movement is wanted for cranio-cervical flexion test
The motion you are looking for is an upper cervical nod, not retraction, to activate longus colli & capitus.
what is the patient to do in the craniocervical flexion test
place towel on occiput
place pressure biofeedback in 3rds
aim patient to nod target - 22, 24, 26, 28, 30 mmHg
observe any compensatory behaviours - retraction, SCM, scalene activity
determine the pressure the patient can hold steady with no palpable superficial muscle activity
measure enurace - 10secs hold, 10 reps
normal pressure patients can maintain in cranio cervical flexion test
26-30 mmHg 10 secs x 10reps
describe patient position, therapist position and movement of side flexion PPIVM
patient - supine, head of table,
physio - supporting weight of patients with abdomen, palpate articular pillar between C2/C3, other hand support head, compare findings
movement - lateral flexion, feel for the opening and closing of the joint
positive findings of cervical spine side flexion PPIVM
increased resistance through motion,
muscle spasm,
decreased opening or closing of the joint,
pain provocation.
describe patient, therapist positioning and movement of rotation PPIVM
Physio - Palpate contralateral articular pillar, reinforced index finger, as joint opens during rotation, other hand support weight of occiput,
patient - supine, head lying off edge of bed
movement - on same hand while index finger on lamina produce produce cervical rotation away from palpating hand
describe patient and therapist positioning and movement of flexion/extension PPIVM
Patient - side lying with head cradled in physios forearm, head on bed
therapist - facing patient, back elbow contacts front of facem forearm contacts side of head, palmar surface of hand contacts back of head one hand supporting head, other hand palpate C2 spinous process, forearm stabilise vertebral column, palpate interspinous space C2-C3
Movement - guide head into flexion
not as clinically useful
what nerve roots make up median nerve
C5,6,7,8 T1
Method of ULNT of median nerve
lie patient in supine
stand facing patient
grasp pt hand,
extend wrist and fingers fully straighten out thumb and fingers
abduct shoulder
supinate forearm
LR of shoulder
lateral cervical flexion
extend elbow
radial nerve ULNT 2
Patient positioning - supine
physio - depress scapula with thigh,
extend elbow
Glenohumeral IR, elbow pronation
flex wrist - w/ patients thumb grasp in hand
positive test result for median nerve ULNT
Reproduces neck / arm pain.
Asymmetrical ROM
Different to expected normal response.
Normal response for median nerve ULNT
Deep stretch or ache in cubital fossa (99%) extending down anterior & radial
aspect of forearm into radial side of hand
Tingling in thumb and first 3 fingers
Anterior shoulder stretch.
Ipsilateral cervical sideflexion decreases
responses.
list sensitising manoeuvres that add further longitudinal stress on neural tissue for median nerve ULNT
Cervical side flexion
Scapula depression
what DEsensitising manoeuvre can be used median nerve ULNT
Release individual components
what is the normal response to radial nerve ULNT
stretch pain in –
Lateral aspect of upper arm.
Biceps
Dorsal aspect of hand
What is an abnormal response to radial nerve ULNT
Reproduces neck / arm (elbow)
pain.
Asymmetrical ROM
Different to expected normal
response
What desensitising manoeuvres can be used for radial nerve ULNT
Cervical spine ipsilateral
sideflexion
Shoulder abduction
what patient and therapist positioning and movement is needed for ulnar nerve ULNT
Patient in supine
cusp scapula with one hand, other hand on elbow
flex elbow
abduct shoulder
lateral rotate shoulder
pronate forearm
extend wrist and fingers - to face side of face
normal response to ulnar nerve ULNT
stretching discomfort in hypothenar eminence & medial 2 fingers
tingling in same region.
Positive response to ulnar nerve ULNT
Reproduces neck / arm pain.
Asymmetrical ROM
Different to expected normal response
List desensitising manoeuvres for ulnar nerve ULNT
Release individual components
what treatment MT for lumbar unilateral cervical pain
PAVIMS - transverse, unilateral PA
PPIVM - rotation, side flexion
treatment option of MT for bilateral cervical pain
central PA
longitudinal movement
rotation PPIVM
Biomechanical basis of transverse and rotation
transverse to spinous process to the right create segmental rotation to left
exercise treatment options
archery exercise - CT regions
self PROM side flextion - hand behind back - stretch Levator scapula, upper traps, sub-occipital, pec major, pec minor
