Cervical summary Flashcards
What motions are coupled in the cervical spine?
SF and ROT
what portion does more SF ?
mid
What drys up faster cervical or lumbar disc ?
Cervical
Where does the mid cervical refer to ?
medial boarder of scap
What is a major contra to cervical Rx
RA do not dot MOBS on RA pt’s
Do you need to scan everyone with neck pain?
Yes
What has a better prognosis immediate pain or insidious
immediate worse prof.
When can you do a passive test overpressure on the c spine
ONLY if painfree active ROM and no neuro or log or vascular damage
What is indicative of serious path in the neck?
Painful weakness of short neck flexors could mean instability or #
** Do NOT overpressure if 5d’s are there***
Pt presents with weakness of hand intrinsics what are your concerns?
T1 tumor
**NOT associated with disc issues **
What do PAVMs tell u?
if a jt is stiff/hyper/ and end feel
Contraindications for PA Pressure in the neck?
Local fracture local inflam active neo infection acute trauma local instability vascular patho of the carotid or vert arteries
PRECAUTIONS
Osteoporosis
Anti-coagulatns
what is the most common degenerative spot in teh c spine
c5/6
Where and what does the alar ligament do?
Runs from Dens on C2 to the tubercles on the medial occipital condyle
*“check ligament” checks side to side movements
What does the transverse lig of the atlas do?
It runs like a cruciate lig and keeps the dens held anterior in the arch of the axis
What are common outcome measures for the neck
Neck disability index (NDI) (50 pts or 100% is pt rated MAX disability
*CIChange is 5 pts
What do NDT’s test when is it ++?
nerve mobility - see if restriction b/w interfaces its passes (IVF, muscle, Facet jt.)
- if it reproduces sympt. or restriction in mobility its ++ Vs other side
- if ++ use 1-3 graded tech (watch irritability)
Pt presents and is very irritable and their condition is worsening what are these indications of and would you use NDT
- ## they are contra along with neuro SIGNS, undiag condition, spinal cord or CE compromise
What are the NDT tests?
ULNT 1= Median nerve bias (abduction) ULNT 2 = Median nerve (Depression) UNLT 3 = Radial nerve bias UNLT 4 = Ulnar nerve (know what directions increase/dec tension)
What is the normal response of the Median nerve bias?
stretch sensation in the antecubital fossa, tingling in thumb and first 3 fingers
What is the normal response for the Radial nerve.
stretch pain sensation in lateral forearm &/or stretch P in lateral upper arm
Ulnar nerve bias normal response?
stretch P hypothenar eminence and med 2 fingers or pins/needles same distribution
WHat is the standardized position for NDT?
supine legs straight opps . arm at side (pt could be on diagonal as well )
What are the known positions of vert artery compromise?
Ext, rotation, traction
What are S & S of vert art compromise? WHAT arteries do these include?
5D's Nystagmus Perioral numbness ataxia nausea vomiting tinnitus 5D's (carotids and opposite vertebral artery) NEVER DO EXT/ROTATION AND TRACTION TOGETHER !!!
What are positive tests for the craniovertebral region of the neck?
soft end feel w. p or spasm
lump in throat/shortness of breath (could be d/t swelling post MVA or haematoma, retropharyngeal)
- spinal cord signs
- ver artery signs
ANY OR ALL OF THESE ARE ++ TESTS PT PUT INTO A HARD COLLAR REFER BACK TO DOC FOR POSSIBLE MRI
* Positives are rare though
What structures are tested in the anterior (Shap purser/supine anterior shear) tests?
Transverse lig/dens
What is tested in the vertical stability test?
Tectorial mem., AO, AA, ant and post membr
What is tested with the kinetic test/stability test
alar ligament/jt. capsule
What are the stability tests in the CV regions
1) anterior shear, sharp pursar
2) vertical stability of AA/AO
3) Rotational kinetic test/stabilty test
When performing the sharp purser test your patient gets symp *& signs w flex which is made better post test. What does this mean?
This is indicative of a positive test and means that the C1 vert on flex was ant subluxed on C2 and the posterior pressure on c1 put it back into place and decreased the signs
YOu think you pt has a stiff segment in the neck while doing a Flex PIVM what do you do next?
WHat if there was excessive mobility?
Test it with PAVM to confirm
- excessive = need to do stability tests!
- PIVMS = you can then grade appropriately to decrease pain via mechanorecpetor effect or vascular pumping
WHat are the:
History
Signs & Rx
FOr postural neck pain?
Hx - grandual onset/bilat Sympt local or referred
Agg - prolonged postures (sitting/lying)
Ease - by moving
Signs - FHP, poor T-spine posture, decreased CV flex, painful ext, P/A tender W. spasm
Rx–> exs postural/ergo advice/ soft tissue
WHat are the:
History
Signs & Rx
For Spondylosis/DDD (degenerative disc disease)
Hx - >problems, c/o stiffness wtih static postures better with some motion
Agg: static postures
Ease - with motion
Signs - Xray = OA and osteophytes , cap pattern
P/A - stiff +/- pain
END FEEL - hard capsular/bony (osteophytic)
Rx- PAs, exs, postural /ergo advice/soft tissue rx.
What is the cap pattern of the neck?
bilateral= SF/Rot/painful ext / full flexion
WHat are the:
History
Signs & Rx
FOr cervical disc lesion
Hx- acute onset/ interscapu.ar pain +/- radicular pain (trauma or poor positioning)
Agg- with specific mvot. , compression ** Flexion***
Ease - lying down. traction
Signs - deformity, neck held in flexion or side flexion
- reduced motion part. flex/rotation/SF to the side of P
- +/- nerve root signs
- +/- dural signs
Rx - traction, soft tissue, exs.postural /ergo info
WHat are the:
History
Signs & Rx
For cervical radiculopathy ?
Cause - dis, Z jt swelling/ thickening, degen. changes - osteophytes, UV Jt degen. (anything that can compress nerve root)
Hx - acute could be slow to progress
Signs - decreased motion - ext/sf/rot same side d/t P and + spurlings,
- opposite move. may be tight (Flex, contra sf/rot)
- neuro sign +/- nerve root +/- dural signs
P/A - painful and stiff; unilateral stiff /painful
Rx - traction, PA (Rx pP and stiff, soft tissue, exs, ergo educ
WHat are the:
History
Signs & Rx
For Isolated Z jt dysfunction
Hx - onset - acute; could be gradual
- pain uni & local +/- referred to arm, scap hd
Agg: motion
Eased: rest
Signs: restriction motion - stretch pattern - F/SF/Rot away
compression pattern = Ext/SF/Rot towards
- segmental muscle guarding
Rx - Educa., soft tissue, PA’s unilateral,
What is the stretch and compression patterns of an effected Z jt dysfunction/
F/SF/ Rot away
compression = ext/SF/Rot towards
WHat are the:
History
Signs & Rx
For Cervical instability?
Hx - trauma/repeat episodes/consistently inconsistent / posture
- local +/- referred P
Agg - static postures / sleep positions
Signs -poor posture, HF, flattened C curve d/t spasm/ guarding decreased ROM
- Segmental multifidus spasm
- weak deep neck flexors
P/A’s reactive spasm +/- P or increased translation (may be hypo segment around this one)
Rx - stab program, strengthening, soft tissue, exs post educe.
WHat are the:
History
Signs & Rx
FOr generalized mechanical dysfunction?
+/- postural imbalance
+/- muscle imbalance
+/- segmental dysfunction - restriction or hyper mobility
Rx - per findings
WHat are the:
History
Signs & Rx
for acceleration /deceleration injury.
also called WAD, cervical sprain/strain
Management: early motion key ** pt participation and self management
- foundation to rehab early intervention by pt effective at decreasing P imp mobility
Goals to Rx:
- base off Ax/ occupt./sport change depending on response
What are the quebec WAD’s scale
Grade I - neck P, stiffness, tenderness only no physical signs
Grade II - neck complaint, and MSk signs (decreased ROM, Pt tenderness)
Grade III- neck complaint, neurologicla signs (weakness, sensory deficit, decreased reflexes)
Grade IV - neck complaint and fracture or dislocation
What are some aspects of Rx for WAD injuries
exercises: ROM (want ot stim healing)
Man therapy: joint mob/manipulation/myofasical
mechanical forces - traction/ supports
What are the major components to Rx a WAD Injury
1) Application of controlled forces
2) optimize physical performance (jt rom, strength, flexibility…)
3) Pain management techniques
4) Client education
5) Ongoing evaluation
** prevent a soft tissue impairment from becoming a soft tissue disability**
What are the components to therapeutic exs. program for the neck? What can alter the mechanics of the neck?
1) mobility
2) stability
3) strength
4) Specificity
- muscle imbalance which causes some to shorten others to lengthen then changes relationship
What muscles are typically tight in cervical region?
Pecs upper traps lev scap SCM Rectus capitis major and minor superior and inferior obliques
What muscles tend to be weak in the neck?
Deep neck flexors rhomboids mid and and lower traps suprahyoids mylohyloid longus coli
how would you instruct someone on deep neck flexor strengthening?
tongue to roof of mouth
lips together teeth apart dont clench jaw
hold 10sec
- start with 10 reps x1 daily progress up
What are your Rx principals for DNF as per prescription?
- st. w. core stability and DNF
- P in neck inhibits DNF alters movt patterns
- Cerviocognic headaches –> type 1 - type 2 fibers
- Scapular stability for cervical posture and pain syndromes
- Assess their DNF stg. and ability in diff positions
- st. with DNF (inner unit) work to outer unit (arm movt. scap stability)
- Longus coli and capitis
When you are starting your cervical Ax what anterior stability test should you start with and why?
st. with sharp pursur b/c its active and safe
