Cervical Spine Treatment

Question 1

Brachioradialis DTR

Answer 1

Brachioradialis tendon at distal radius

C6 with some C5

Question 2

Triceps DTR

Answer 2

Triceps tendon where it crosses at olecranon fossa

C7 with some C8

Question 3

Spurling’s Maneuver

Answer 3

Compress head in neutral
Congress with head in extension
Sidebend away from affected side then towards affected side and add compression

Positive test = pain down arm in distribution of nerve root indicating nerve root compression

Question 4

OA Joint

Answer 4

Modified Type I mechanics

Patient supine
Doc at head of table at occiput
Translate left and right
Rotate left and right

Question 5

AA Joint

Answer 5

Rotation only

Grasp lateral mass of atlas
Fully flex C-spine
Rotate left and right

Question 6

C2-7

Answer 6

Type 2 Mechanics

Localize segment
Translate left and right
Rotate left and right
Add flexion and extension

Question 7

OA Articulation ME

Answer 7

Patient supine
Doc at head of table
Contact occiput
Extend/flex, sidebend, rotate THROUGH occiput
Pull chin toward chest for flexion dysfunction; push head back for extension dysfunction
Hold 3-5 secs
Relax

Question 8

AA Articulation ME

Answer 8

Patient supine
Doc at head of table
Contact AA joint
Fully flex C-spine
Rotate THROUGH barrier
Patient tries to rotate to side of ease of motion
Hold 3-5 secs
Relax

Question 9

C2-7 ME

Answer 9

Patient supine
Doc at head of table
Flex head
Contact transverse process on both sides with thumb and index finger
Extend/flex, sidebend, rotate THROUGH segment into barrier
Patient tries to return to neutral
Hold 3-5 secs
Relax

Question 10

OA Articulation HVLA

Answer 10

Patient supine
Doc at head of table on side of posterior occiput
2nd MCP joint contact posterior occiput
Cradle head and neck
Flex/extend, sidebend, rotate THROUGH occiput toward barrier
End of exhalation thrust up towards top of head/eyes

Question 11

AA Articulation HVLA

Answer 11

Patient supine
Doc at head of table
Contact AA joint
Fully flex c-spine
Go through ME
End of ME rotate into barrier
End of exhalation rotational thrust

Question 12

C2-7 Rotational HVLA

Answer 12

Patient supine
Doc head of table on side of PTP
Contact PTP with 2nd MCP joint
Cradle head and neck
Rotate to barrier THROUGH segment
Sidebend in direction of ease of motion TO segment
Add flexion/extension (don’t hyperextend)
End of exhalation rotational thrust at level of segment
- upper segment up towards eyes
- middle segment straight across
- lower segment down toward opposite axilla

Question 13

C2-7 Translational HVLA

Answer 13

Patient supine
Doc at head of table opposite PTP
Contact PTP with 2nd MCP joint
Cradle head and neck
Sidebend to barrier THROUGH segment
Rotate to side of ease of motion TO segment
Flex/extend (don't hyperextend)
Sidebending thrust towards sternalnotch

Question 14

Documenting DTRs

Answer 14

0 = no response; usually abnormal
1+ = a slight response; may or may not be normal
2+ = a brisk response; normal
3+ = a very brisk response; may or may not be normal
4+ = a repeating reflex (clonus); always abnormal

Question 15

Bicep DTR

Answer 15

Biceps tendon

C5 with some C6