Cervical Spine Somatic Dysfunction Flashcards
Where do the nerves exit in the cervical, thoracic, and lumbar vertebrae?
Cervical: nerves exit above the vertebral body
Thoracic/Lumbar: nerves exit below the vertebral body
a 16 y/o male presents to the clinic after going helmet to helmet with another football player. He states he has been having headaches and numbness and tingling in the first 3 digits on his palmar side. On exam you find that his C6 dermatome seems to be affected. Which of the following spinal segments is likely affected?
C5-C6 or C6-C7
C5-C6 because nerves exit above the spinal segment
Describe the atlas (C1)
No vertebral body; rotates around the dens of C2; bounded anteriorly on the dens by the anterior arch and posteriorly by transverse atlantal ligament (part of the cruciform ligaments)
Describe the axis (C2)
Vertebral body of C2 extends superiorly to form the dens (odontoid process)
What is the myodural bridge?
True connection between the rectus capitis posterior major and dura mater; contains neural component; may have function aside from anchoring the muscle; monitor dural tension; role in cervicogenic pathologies
For C2-C7, what is the relationship between rotation and sidebending?
Occur usually in the same direction
A 42 y/o female comes to your clinic with right neck pain after waking up with a kink in her neck 3 days ago. On PE, you note restriction to cervical extension and rotation to the right. After doing ST/MFR, you find C4 is rotated left, restricted to extension, and prefers left to right translation. Which of the following is the correct named somatic dysfunction?
A. C4 E RLSL B. C4 F RLSL C. C4 E RRSL D. C4 E RRSL E. C4 F RLSR
B. C4 F RLSL
A 19 y/o female presents to your clinic complaining of headaches. She states that she has been having these headaches since she was 17 y/o after a car accident whiplash injury and finds they are worsened by stress. OSE findings includes an OA preference to right rotation and restriction from R to L translation. These findings worsen in extension. How would you name this patient’s somatic dysfunction?
OA F RRSL
What are the major motions for the occiput (C1; OA)?
Flexion and extension
What is the primary motion for the AA joint (C1-C2)?
Rotation; atlas rotates about the dens; almost no sidebending or flexion/extension
A 27 y/o male football player presents with a subtle headache and neck pain after being thrown to the ground due to an excessive endzone celebration on Sunday. He denies numbness or tingling. On PE, he has no signs of nerve impingement or concussion symptoms. OSE reveals restriction of rotation to the right at the AA. Which of the following is the correct direction or the patient’s activating force during muscle energy treatment?
A. Rotating right
B. Rotating left
C. Side bending right
D. Side bending left
B. Rotating left
For the cervical segmental exam, how do you induce left rotation? Right rotation?
Left Rotation: induced by anterior pressure on posterior aspect of right lateral mass
Right Rotation: induced by anterior pressure on posterior aspect of left lateral mass
What are the contraindications for soft tissue techniques?
Fractures, open wounds or surgical site, infection (bony or soft tissue), DVT, coagulopathy, neoplasm
What are the contraindications for MET?
Undiagnosed joint swelling, severe osteoporosis, neoplasm, infection, hematoma, rheumatoid arthritis, fracture, dislocation
What are the contraindications for HVLA in the cervical area?
Advanced rheumatoid arthritis, down syndrome, vertebral artery disease, advanced carotid disease, acute radiculopathy, Klippel-Feil syndrome, achondroplastic dwarfism, osteogenesis imperfecta, malignancy
