Cervical Spine, Thoracic Spine, Lumbar Spine

Question 1

C1

Answer 1

does not have TP, therefore first process palpated below occiput is C2

Question 2

most prominent SP?

Answer 2

C7

Question 3

TP palpated posterior to angle of mandible?

Answer 3

C1

Question 4

hyoid bone

Answer 4

anterior to C3

Question 5

thyroid cartilage

Answer 5

anterior to C4/C5

Question 6

cricoid cartilage

Answer 6

anterior to C6

Question 7

atypical vs. typical cervical vertebrae?

Answer 7

atypica = OA and AA joint
typical = C2-7

Question 8

OA joint

Answer 8

occiput on atlas movment

• major motions: extension and flexion with
• minor motions: s/b and rotation are coupled and occur in opposite dxns
• ** somatic dysfunction is found in minor motions ***

example ddx: OA ESLRR

Question 9

AA joint

Answer 9

describes motion of C1 (atlas) on axis (C2)

• major motion is rotation which accounts for 40-50% of rotation in cervical spine
• motions in saggital and coronal plane (flexion/extension and sidebending) are minor and do NOT typically contribute to somatic dysfunctions of the AA joint

To ddx: flex lower C-spine to limit rotation of these joints then test for rotation

example ddx: AA RR

Question 10

C2-7

Answer 10

• rotation and s/b are coupled motions, usually occur to same side
• coupled motion is due to BUM (backward, upward, medial) orientation of superior facets

Question 11

type I

Answer 11

neutral - segment, ocurring in same direction

Question 12

Type II dysfunction

Answer 12

extension/flexion, of single segment dysfunction

Question 13

where are thoracic landmarks?

Answer 13

C7 = most prominent
T2 SP = at level of superior angle of scapula
T3 SP = level of scapular spine
T7 SP = level of inferior angle of scapula
L4 SP = level of superior aspect of iliac crest

Question 14

rule’s of threes?

Answer 14

T1-3: spinous process at same level as TP
T4-6: SP is half step below
T7-9: SP is full step below
T10: full step below
T11: half step below
T12: same level

Question 15

Kirksville crunch

Answer 15

for T5 FRSR

• stand on left side of patient
• instruct patient to cross arms over chest, with arm on same side as posterior transverse process on top
• flexion acheived by bending pt. body toward you, extension by keeping shoulders flat on table
• flex up patients head and neck towards you

Question 16

MET for OA?

Answer 16

for OA FRRSL:

use oculocephalogyric reflex to tx, looking toward position of ease

Question 17

MET for tx of AA?

Answer 17

ddx: AA RR
- flex patients neck up until motion is palpated at C2, rotate patients head to left to feather edge, instruct patient to return to position of ease

Question 18

MET for typical cervical dysfunction?

Answer 18

ex ddx: C3FRRSR
- gently flex pt head and neck until motion is palpated at C3, apply anterior force over pillars to extend segment, rotate and sidebend C3 to the left to restrictive barrier

Question 19

anterior lumbar tenderpoints?

Answer 19

L1 = medial to ASIS
L2 = medial to AIIs
L3 = lateral to AIIS
L4 = inferior to AIIS
L5 = anterior aspect of pubic symphysis

Question 20

on-side HVLA for type 1 Lumbar dysfunction?

Answer 20

ddx: L2-4 NSLRR

stand in front of patient, lay patient in lateral recumbant with sidebending side down

Flex patients hips until motion is palpated at C3, straighten out left leg and flex upper leg.

• pull patients left arm to enduce right sidebending
• place forearm lateral to SI ijoint, medial to greater trochanter

localize SB and Rotation by applying anteriorly and superiorly directed force to pelvis from forearm

• final corrective force is anteriorly, superiorly directed to pelvis from caudad forearm

Question 21

on-side HVLA for type II lumbar?

Answer 21

ddx: L3, FRSL
- lay patient sidebending side down
- flex patients hips until motion is palpated, straighten out lower leg, let upper leg drop anteriorly
- pull patients arm to induce right sidebending
- translate patients shoulders posteriorly until extension is felt at L3
- pull patients shoulder to ceiling to induce right rotation
- final corrective force = anteriorly and superiorly

Question 22

walk-around technique?

Answer 22

xddx: L2 FRSR

• place heel on right transverse process
  have pt. interlace fingers and clasp hands behind neck, then reach beneath patients left arm with your left armand contact their right humerus
  instruct patient to slump forward
  extend pt. until motion is palpated
  then sidebend patient to left by translating shoulders to right
  rotate patient to left by pulling arm

final corrective force is anterior and lateral