Coupling/ Types of Movement Flashcards
What are some causes of Upper Cx instability?
1) Incompetence of odontoid process
2) Incompetence of Transverse Atlantal Ligament
What are some Congenital factors that could lead to Cx Instability?
Odontoid Process:
- Anatomical variance: seperate odontoid
- Free apical segment
- Agenesis of: base, apical segment or whole odontoid process
In medicine, agenesis refers to the failure of an organ to develop during embryonic growth due to the absence of primordial tissue.
Transerve Atlantal Lig:
- Downs Syndrome
- Idiopathic (spontaneous disease of unknown origin)
What are some Neoplastic factors that could lead to Cx Instability?
Odontoid Process:
- Primary Tumor of the bone
- Secondary Metastasise
What are some Traumatic factors that could lead to Cx Instability?
Odontoid Process:
- Acute bone injury (#)
- Chronic Bony Change
Transvere Atlantal Lig:
- Acute ligament damage associate with #
- Chronic Ligamentous Damage (head flicks)
What are some Inflammatory factors that could lead to Cx Instability?
Odontoid Process:
- Osteomyelitis
Transvere Atlantal Lig:
- Bacterial/Viral Infection
- Rheumatoid Arthritis
- Ankloysing Spondylitiis
What are the four cardinal signs of Upper Cx Instability?
- Overt loss of balance due to head/neck movements
- Upper or Lower Limb Paraesthesia, either constant or reproduced by passive/active neck movements
- Facial Lip Paraesthesia, reproduced by passive or active neck movements
- Nystagmus in relation to active/passive neck movements
What are the two tests that you can perform for Upper Cx Instability?
1) Sharp-Purser: Transverse Atlantal Lig
2) Alar Lig Stress Test
What are you looking for in these tests?
1) Any of the four cardinal signs
2) Feeling for lax end-feel
What is the normal coupling motion of C0-C1?
Type 1
What is the facet apposition locking of C0-C1?
Type 2
What is the normal coupling motion of C1-C2?
Complex: Primarily Rotation
What is the facet apposition locking of C1-C2?
Not applicable
What is the normal coupling motion of C2-C7?
Type 2
What is the facet apposition locking of C2-C7?
Type 1
What type of HVLA is the OA joint?
Myofascial Ligamentous
You facet apposition lock C1 and below
What type of HVLA is the AA joint?
Myofascial Ligamentous
You facet apposition lock C2 and below
Where is the direction of thrust for the AA joint?
Towards the patient corner of the mouth (Pure rotation)
What is the normal coupling motion of C7-T3?
Type 1 or 2
What type of HVLA is the CT joint?
Myofascial Ligamentous
Where is the direction of thrust for the prone CT joint?
Towards the patients opposite shoulder
Where is the direction of thrust for the prone head-of-the-table CT HVLA?
Towards the patients axilla
What is the normal coupling motion of Thoracolumbar Junction?
Type 1
What is the facet apposition locking of Thoracolumbar Junction?
Type 2
Where is the direction of thrust for the Thoracolumbar Junction?
Downwards towards the table whilst exaggerating Pelvic Rotation
What are some general considerations when palpating the abdomen?
- consent
- legs bent to relieve abdominal mm
- warm hands to reduce mm guarding
- can place the head up too
- arms across the chest or by the side
- asking if the patient has emptied their bladder
- asking the patient (if female) if they’re menstrating
- palpating light –> deep
- watch for patients face for feedback
What are some absolute contraindications for HVLA?
- No Consent
- Lack of a working DD
- Patient positioning cannot be achieved due to pain
- Weak bone: ie long steroid use, osteoporosis, parathyroid issues, metastasises, iatrogenic
- Neurological conditions: cervical myelopathy, cauda equina, nerve root/cord compression
- Vascular insufficiencies: CAD, AA, blood thinners
What are some relative contraindications for HVLA?
- Pregnancy, especially in first trimester
- Previous adverse reaction
- Disc herniation or prolapse
- Inflammatory arthritis
- Spondylolythesis
- Vertigo
- Hypermobility
What are the common transient side effects?
- Local pain/discomfort
- Stiffness
- Headache
- Tiredness/ Fatigue
- Radiating pain or discomfort
What are the substantiative reversible complications possible from Cx HVLA?
- Disc herniation/ prolapse
- Nerve root compression
- Cx and upper Tx spine strain
What are the substantiative non-reversible/serious complications possible from Cx HVLA?
- unresolved disc herniation/ prolapse
- unresolved radiculopathy
- spinal cord compression
- damage to the integrity of the neck arteries leading to stroke
What are the substantiative reversible complications possible from Tx HVLA?
- Rib #
- # to the bones in the spine (vertebrae)
- Shoulder girdle, rib and Tx spine strain
What are the substantiative non-reversible/serious complications possible from Tx HVLA?
Significant # to the spine causing disruption or compression of the spinal canal, leading to pain stemming from the spine
What are the substantiative reversible complications possible from Lx HVLA?
- Minor # of the spine
- Disc herniation/ prolapse
- Nerve root compression
- Shoulder, rib cage, sacral or spinal strain
What are the substantiative non-reversible/serious complications possible from Lx HVLA?
- Significant # +/- disruption of the spinal canal
- Unresolved disc herniation/ prolapse
- Unresolved radiculopathy
- Caudua Equina
Absolute and relative contraindications related to abdomen treatment
Absolute: - Acute abdomen pain (needs to be medically examined) - Recent abdominal/pelvic surgery Relative: - Pregnancy (especially 1st trimester) - Post-abdominal surgery with reasonably stable scars - Adverse responce to treatment - IUD's - Pelvic inflammatory conditions
