CSPINE, TSPINE, TMJ Flashcards
typically, where is referred non radicular px in relation to Cspine
surrounding the medial border of scap (C3/4 starts at sup angle, then count all the way around and C7/T1 are at inf angle)
cap like HA is referred/non rad px from C
5 or 6 disc
in C spine, protrusion appears with what sx
arm pain in partial dermatome pattern
in C spine, prolapse appears with what sx
arm pain is worse than the back pain, follows dermatome pattern
in C spine, extrusion presents with what sx
arm pain worse than back pain, poly dermatome pattern
with severe HA, you have to R/O
ischemic (blood supply) issues
if you have a case that none of your tests are conclusive and they have neuro sx, you may need to refer out for
tumor
nerve root pain usually exists at what segment
if it’s C3-C4 it will exist at C4
meaning the lower segment
C2/C3 radicular px is where
side of head or neck (ant/lat)
C3/C4 radicular px is where
above the upper trap (C4 is supraclavicular)
C4-C5 radicular px is where
lateral arm
C5-C6 radicular px is where
thumb
C6-C7 radicular px is where
middle finger
C7-T1 radicular px is where
hypothenar and 5th finger
where is facet px for C3-C4
side of neck
where is facet px for C4-C5
side of lower neck
where is facet px for C5-C6
entire upper shoulder area
where is facet px for C6-C7
entire scapula
where is facet px for C2-C3
around ear (behind ear)
bilateral neck pain sx (but one side worse) spreading to medial scapula (staying around c spine)
DDD of Cspine
bilateral neck pain Sx (but one side worse) spreading to medial scapula, also having lateral neck px or shoulder px or post back px (around scapula)
DDD of C spine with possible DDD of facet
differentiate btwn clowards sign and disc with nerve root involvment (body chart)
clowards is just referred px (non neural or non radiating), nerve root involvement also has stiffness and px in the neck as well as neural sx in the arm
Deep unilateral neck pain with stiffness, then sharp or deep px somewhere around medial scapula
discogenic (IDD/EDD) (there is an issue within the disc but it’s contained and not radicular px)
clowards sign (disc referral) is or is not radicular
is not - referred from disc only
neck pain, arm pain, bilateral, multiple dermatome patterns, extension hurts so they come in flexed, sensory and motor loss, neuro tests pos probable diminished reflexes (all describe)
cervical stenosis
simultaneous NT is bad, think
cord issues
body chart with ear dot
00-01 facet
02-03 disc
temporal band body chart would be __ or __
01-02 or 02-03 facet
whole head px is what body chart
T4
what 6 areas can 02-03 facet body chart px be
eye socket jaw temporal band occipital area (coming up and around to eye) ant neck behind ear (post, medial cranium)
If it’s just a scapular dot, what test must you do
modified spurling towards pxful side
(retraction/extension/ipsi SB/ipsi rotation)
this puts load on the post/lat disc
which levels of facet do you do testing with pro/retraction
00-01
01-02
other ones you do rot, then ipsi sb
what are some differences btwn Cspine and Lspine (IVJ)
the intervertebral joint takes less load in the Cspine and the vertebral body is smaller. also, the load is 50/50 btwn the facet and the IVJ.
facets in the Cspine are arranged how
frontal plane, 45 degrees (facilitates rotation)
difference in discs of cspine and Lspine
the cspine discs degenerate quicker
the cspine discs nucleus and annulous blend
there is no disc at co/c1 and c1/c2
UVJ only occurs after
WB has occured, we aren’t born with it (it gets stronger and stiffer as we walk)
Vert A goes in the
transverse foramen
where spinal N exits in Cspine
foramenal gutter (aka IV foramen)
in the facet joint of Cspine, the capsule is strongest where
stronger ant, weaker post
where is there more degeneration upper or lower cspine
lower
C spine nerve roots exist where
above the vertebrae (they are named by their level)
compression on nerve root can be either ant or post, if it is ant it is dt ___ if it is post it is dt
ant - HNP
post- articular surface or ligg
in c spine, with flexion there is increased load on the
disc (for C spine not upper)
decreased load on facet
in c spine, with extension there is increased load on the
facet
decreased load on disc
retraction of the neck is flexed ___ spine and ext ___ spine
flexing the upper and ext the lower
with rotation, the facet of the side you are rotating towards is __ and the opp side is __
closing, opening
in c spine, SB and rotation are ____, which is opp of lumbar
coupled (ipsi)
in combined mvmt of cspine, SB and Rot are
contra (remember combined means not natural)
how to test the ventral capsule (00-02)
they are seated protract with post cranial tilt you L grip and scoop hand rotate towards your body and take a big breath (SB away) Your L grip is at C1/C2
how to test dorsal capsule
seated
retract with ant cranial tilt
rotate away
SB towards
for facet issues, if you are doing traction and they have px, what can you do
rotate them away to open the facet
when you are doing cervical traction of the c spine (not upper) explain your placement of hands and body
use first finger of cradle hand to stabalize the segment (left)
other hand is on top of that hand (right)
you lean in towards the stabalizing hand side so that your armpit area is on their forehead (stabalizing hand is the armpit side)
you do a slight distraction with your other hand
when a pt sidebends to one side, that side ___ glides or ___
that side down glides or closes (other side opens)
local pain could be (cspine)
facet, non neuro disc, UVJ, ligg, muscle
cap HA px is usually
referred, non radicular C5-C6
main sx of DDD, DJD
limited ROM (rot and sb) PAs are stiff, flexion may be limited too
with discogenic c spine issues, what motion is most pxful
flexion
why (general) would you do PIVMS
unilateral sx
with a rotational PIVM, how to choose which way to rot
rotate away from pxful side (for tx)
main difference btwn seated distraction and supine traction is
seated distraction is for 00 -01/02 only
if you are doing unilateral PAs and you have them rotate to the side you are working on, and rotation in general is stiff for them. what may this indicate
01-02 issue
vascular, fat filled intra articular tissue that acts as a space filler in the facet jt
meniscoid
functions of UVJ
protect disc from lateral prolapse
aid in flexion and ext
reduce SB
what joint wears out the quickest
UVJ (you will hear crepitus)
what ligg helps control motion (most) in c spine, if weak then central prolapse can occur
PLL
largest nerve root
C7
axis of rotation in upper C spine is
away from disc (more translation)
axis of rotation of lower C spine is
tight to the disc
with DDD (spondylosis) there is increased load on
facet and UVJ bc they pick up the slack
B sx of deep ache in neck. One side greater issue. May have some medial scapula aching. dx?
DDD
with disc/nerve root involvement, if there is immediate sharp shooting px in the arm, think ___
DRG
with disc/nerve root involvment, if there is sx that start in the neck and progress to the arm, think ___
actual nerve root itself
with nerve root irritation or neuro claudication, if the sx are worse distally it’s a ___ issue
chronic, if sx are worse proximally it’s acute
neck and arm px that is bilateral, with many segments of derma/myotome issues you have to rule out
stenosis
UVJ is ___ px
local unilateral
facet joint issue is ___ px
local unilateral
lateral neck, local (unilateral) px…think ____
C3-C5 facet
with nerve root involvement of c spine, what motions are very pxful and limited
ext and SB rotation towards
central stenosis px, what motion is worse
ext
facet, there is more px with ____ vs ____
more px with standing vs sitting
px with turning head to look over shoulder, think
facet
with nerve root irritation, what motion feels good (cspine)
flexion of spine
list myotomes and actions of c spine
C1— cervical flexion
C2— cervical extension AND resisted cervical spine rotation
C3—cervical lateral flexion - SB
C4—shoulder shrug
C5—Deltoids
C6—Biceps; resist elbow flexion with wrist supinated
C6—ECRL; Thumb up,elbow flexed, resist wrist extension/ radial deviation
C7—Triceps; resist elbow extension with wrist in neutral
C7—Wrist flexion
C8—EPL; thumb extension
C8—Flexor digitorum profundus; DIP flexion
reflexes for C spine
Biceps (C5-6)
Brachioradialis (C6)
Triceps (C7)
dermatomes for c spine
C2—side of head C3—anterior and lateral neck C4—supraclavicular area—over trap C5—lateral arm C6—pad of thumb C7—middle finger C8—hyperthenar eminence and fifth finger T1—medial forearm
what AROM will be limited with EDD/IDD
flexion
congenital shortening of the SCM usually under 12 yrs of age
torticollis
axns of SCM
flexion and contra rotation
axns of scalenes
flexion, contra rotation, ipsi SB
how to rule out muscle tightness vs true neural tension in the upper ext neuro test
have them flex neck towards test side, if that decreases sx then it is prob not neural
scalene length test (explain)
they are supine, rest their head in your hand, other hand goes parallel (runs 1st finger right on the side of the neck until you hit the shoulder) go just slightly lateral to your landing spot and that should be the 1st rib. SB away and feel when the first rib raises, shouldn’t happen right away.
how to length test upper trap
supine, cradle head, push down on shoulder of test side, SB head away and rotate towards
how to length test levator scap
supine, cradle head, push down on shoulder of test side, SB head away, and rotate away
the “yes” joint
OA
primary stabalizers of UCS
ligg
sx of vertebral A issues
dizziness, tinnitus, nystagmus, NV
ON
occipital neuralgia (enrapment of nerve)
HA like no other, rule out
CAD (cervical artery dysfunction)
what motions may create sx from CA dysfunction
rotation and extension (contra side rotation)
how to rule in CAD
do cranial nerve exam and go by their sx, don’t do the old position testing
one of the most common causes of ICA trauma
the sink at the hairdressers
Main types of HA
then 3 main subtypes of one of them
Vascular: migraine, cluster, tension
Cervicogenic - typically isn’t just a HA (has specific referred px locations - T4, C5/6)
vagal nerve ischemia sx
NV
only type of HA that has B sx
tension
posture of most UCS pathos
foreward head
what motions will you assess with UCS issues of 00-02
protraction and retraction
What motion will you assess if you suspect UCS disc patho
flexion
what palpation will you do for any facet issue
unilateral PA
what motion is often the most damaging with WAD
whiplash associated disorder = extension
how to do a gross assessment of the dorsal capsules of UCS
retract and flexion
how to do a gross assessment of the ventral capsules of the UCS
protract and extend
protraction/retraction with SB vs protraction with rotation (provocation tests)
If you just do protraction with SB you are trying to rule in 00-01 facet (you SB to right and left)
if you just do protraction with rotation you are trying to rule in 01-02 facet (you rotate right and left)
How to test 02-03 facet
Rotate with SB (rotate towards side of px)
ipsi SB vs contra SB (capsule vs articular surfaces)
SB then rotation tests what
UVJ
ipsi rotation is capsule
contra rotation is art surfaces
Rotation then SB tests what
facet
Biceps reflex is what segment
C5-C6
Brachioradialis reflex is what segment
C6
Triceps reflex is what segment
C7
what motion will be pxful with nerve root involvment
extenstion
if you suspect IDD/EDD of cspine what test could you do
they AROM protract, Extension, SB ipsi and rotate ipsi
for the UCS provocation tests, explain how to test ventral vs dorsal and 00-01 vs 01-02
Remember, this is different than Sue’s rotation mobilization tx
ventral: protract
dorsal: retract
OO-01: SB
01-02: rotation
when you would you do the UCS provocation tests
when you suspect facet issues anywhere btwn 00-02
Explain Sue’s UCS rotation (mobilization of 00-02) tx for ventral capsule
this is a tx
This one is for 00-02 only
seated, lumbrical grip, scoop hand under their occiput, your scoop hand arm is in front of pts face, have them post cranial tilt and protract, rotate towards you, and SB away
Explain Sue’s UCS rotation mobilization of 00-02 tx for dorsal capsule
for 00-02 only
seated, lumbrical grip, scoop hand under their occiput, have them ant cranial tilt and retract, rotate away and SB towards (this is a tx)
So UCS seated rotation for ventral details
P
P
RT
SBA
CS not UCS seated SB PIVM (explain)
palpate pretty low under the ear for the transverse process. Grip around post part of neck and feel with 1st and 2nd finger as you use other hand (on top of their head) to SB towards side you are palpating. You are feeling for restrictions.
if protraction is an issue, what should be a go to tx
tiny yes’s (for 00-01)
how to stretch the SCM
drop head of table down
extend the neck and rot away
the seated distractions (breathing one) is only for what segments
00-02
How would you do a PIVM for SB while supine (for CS not UCS)
Marcies way: have them supine, use your index finger to locate the segment. then with other hand (test side) locate the joint line, SB away from joint line hand to feel if it opens, compare sides. (do the same for rotation= those are rotational PIVMS)
test you put your fist above their shoulder
upper ext tension test
explain components of the upper ext tension test
90 degrees abd and ER, fully ER them, fully supinate them, extend wrist and fingers, extend elbow and sb away
how to test T lig
seated
flex neck slightly to find C2
lumbrical grip at C2 (stabalize)
as you push forehead posteriorly
how to test alar lig
seated
find C2
palpate lateral to C2
as you SB R you plapate to the left of the SP
as you SB L you palpate on the R of the SP
explain how to downglide for tx
they are supine,
you palpate for the segment and hook your 1st finger
you SB towards and rotate towards that side
slight ext
and your line of force goes to their opp hip
explain the 2 ways to do PIVM rotations for C spine (not UCS)
Seated - Sue’s way rotate away (pillow)
Supine- Marcie’s scoop way
there is no disc at what levels of c spine
00-02
protraction and retraction are done to test what
FACETS of 00-02
the whole ventral/dorsal capsule thing only applies to
00-02
Pain located anterior to the tragus and referring to the ear, the mandible, the eye, or temple is strongly correlated to
TMJ pain.
what is bruxing
grinding or clenching of teeth
her stance on treating C spine with TMJ
If CS signs and symptoms are not addressed, attempts to treat the TM joint will not be successful
Clicking during opening and closing protrusion limited deviation toward the involved side lateral deviation limited toward the uninvolved side. palpable crepitus
these all describe what TMJD
articular disc displacement
list the palpation synovials for TMJD
#1 anterior inferior synovial pain #2 anterior superior synovial pain #3 lateral collateral ligament pain #4 temporomandibular ligament pain #5 posterior inferior synovial pain #6 posterior superior synovial pain
ISLTIS
list synovials that correspond with stages of articular disc displacement
stage 1: synovials 1 and 2
Stage 2: pain with #1, #2, #3 synovials
Stage 3: pain with #3, 5, 6 synovials
Stage 4: pain with #3, #5, #6
most common area of px for tmjd
pariauricle (around the ear)
explain stages of ant displacement tmjd (sx)
Stage1: no joint sounds
Stage 2: early opening/ late closing
Stage 3: late opening/ early closing
Stage 4: no joint sounds
list the provocation tests for TMJD
#4 Inferoposterior glide – temporomandibular ligament
#7 Bilaminar zone -Superior movement of condyle on posterior ligament
#8 Retrodiscal area --from #7, add protrusion (with patient assist)
- Encroachment of condyle on posterior discexplain provocation tests for TMJD
4 -inf/post glide of lower jaw
7- pushing on the mandible (at the curve) and compressing the disc
8 - same as 7 but they protrude jaw
Soreness in the jaw in the AM if clenching or bruxing; may be better in AM but worse after eating breakfast
what do you need to rule in/out
TMJD
pain with palpation and pain with forced biting, what TMJD
systemic inflammation
Large indentation palpable posterior to condyle when mouth opened, think what patho for TMJD
instability/hypermobility
what provocation test do you do for hypermobility of TMJD
4
Behavior of Sx – joint noise – crepitus at the same points in ROM (TMJD)
degenerative issue
inf facet in C spine are oriented how
ant and downward
the sup facet of the c spine are oriented how
post and upward
meniscoids are typically only found in
children
area of Tspine (segments) with a ton of articulations
T2-T9
compared to cervical and lumbar, the stability of the Tspine is ___
increased - dt the increased articulations and ribs
what is lost due to the increased stability of the TSpine
ROM
functional regions of thoracic spine
CT junction (C7-T3) mid thoracic spine (T4-T9) thoracolumbar junction (T10-L1)
explain vertebral placement/position in kyphosis of tspine
the vertebral bodies and discs are higher post than anteriorly in the Tspine, which increases load ventrally = thoracic kyphosis
(meaning: there is an angle of the orientation of the alignment, higher in the back)
typical vs atypical vertebrae Tspine
typical- segments T2-T9
atypical- segments T1, T10 - T12
each typical Tspine vertebrae articulates with what (that the atypicals dont)
ribs
the typicals have 2 pairs of demi facets
explain articulation of ribs with T spine level, for typical vertebrae
each rib will articulate with it’s corresponding vertebral segement and then also the segment above.
rib 2 articulates with T1 and T2
rib 3 articulates with T2 and T3
(the atypical’s don’t follow this rule)
ratio of disc ht of Tspine, C spine, L spine (compared to the vert body ht)
Lspine 1:3
Tspine is 1:5
(cspine is 2:5)
disc height vs vert body ht
Ratio between the vertebral body height and the disk height will dictate the mobility between the vertebra –
Highest ratio in cervical region allows for motion
Lowest ratio in thoracic region limits motion
with a protrusion in the Tspine, what part of the disc protrudes
typically annulus is the protruding part bc nucleus is so small
main lig of Tspine
ALL
spinal canal in tspine is largest at what areas
CT juncton
thoracolumbar junction
explain orientation of transverse processess in Tspine
T1-T3 the TP’s are directly lateral to their corresponding segments
T4-T9 they are superior to the SP
explain the finger width rule for t spine palpation
(1) T1/T2: 1 finger cranial to SP
(2) T3/4: 2 fingers cranial to SP
(3) T5-T8: 3 fingers cranial to SP
(4) T9-T10: 2 fingers cranial to SP
(5) T11-T12: 1 finger cranial to SP
Rib articulation: The costovertebral joint (CVJ) is formed by what 3 things
the articulation between the head of the rib, the intervertebral disc and the vertebral body at the same level and the level above
3 main parts to ribs (anteriorly)
manubrium
sternum
Costo cartilige
ribs ___-____ are typical
3-9
they have 2 articular facets to art with the vert body above AND below
atypical ribs include
1,2
10-12
these only articulate with one vertebra via 1 facet (their own corresponding level)
true vs false ribs (list segments and describe differences)
true ribs: 1-7 (they attach directly to chest plate)
false ribs: 8-12 (they blend with the costo cart)
mvmt of ribs during breathing
(1) Upper ribs: pump
(2) Lower ribs: bucket
2 main joints of articulation of the ribs with the tspine vertebrae
costovertebral
costotransverse
explain orientation of the facets in upper, mid and lower t spine
60
90
0
coronal
Tspine flexion, ribs rotate___
Tspine ext, ribs rotate___
ant
post
one way to implicate ribs as the source of px
SB to side of px and have them inspire big
how can body misinterpret an issue in the lungs as a Tspine issue
message sent to DRG (sympathetic afferent), message goes to brain; brain tells T2-T5 that they have pain in this region because the afferents from the lungs converged with somatic afferents and traveled together to the brain. Brain tricks the body and has pain in TS rather than in the organ.
armpit px is often what
referred T2
whole head px with temporal dot is often what
referred T4
right UQ px (big circle on upper right chest and shoulder) is often what
referred T9
lower abd dot is often what
referred T11/12 or L4
groin px (line at groin region, under crease) is often what
T12 or L1
neural sx that go to medial aspect of upper arm and medial elbow area is often (radicular)
T2 nerve root
single line under inf border of scapula is often (radicular px)
T8 nerve root
which c spine facet px is over the entire scapula
C6-C7
where does T2-T3 facet px occur
under the scapular spine
(then count all other segments of Tspine as you advance down the back, ending above the iliac crest for T10-T11_
if the Tspine facet area of px is at mid spine and then lateral on the iliac crest it is
T9-10
herniation of disc substance through cartilaginous plate of disc into body of the adjacent vertebra
schmorles nodes
Compression syndrome involving the subclavian artery or vein and/ or brachial plexus as it passes from neck to axilla (an upper rib dysfunction)
TOS
is T4 syndrome radicular px
no
it is referred non radicular
sharp, stabbins, severe burning along intercostals describe what patho of Tspine
nerve root issue
what motions create sx for flattened upper TS disorder
pain with loaded ext,
will have limited flexion capability- so make sure to observe
pulling and pushing activities are agg factors for what tspine disorders
general hypomobility and T4 syndrome
if you suspect general hypomobility of tspine, other than doing pushing/pulling what else should you have them to do
sustained flex or extension to see if they can hold it
thoracic disc agg factors
prolonged sitting
physical labor
rotation (remember-tspine disc issues are different agg factors than any other part of the spine)
what hx is often common with general hypomobility of tspine
work hx of prolonged positions (ex: desk jobs or surgeons )
with general hypomobility of tspine, what goes on with their UE movement
UE mvmt is limited and usually are muscle imbalances
T4 syndrome is thought to maybe be caused by
a sympathetic reaction to a hypomobile segment
big issue with flat upper tspine dysfunction
they are resistant to tx
what posture accompanies general hypomobilty
kyphosis
what posture accompanies t4 syndrome
forward head, kyphosis, protracted shoulders
generalized disc issue will have what posture
increased tspine kyphosis
the only t spine pathology that would have a pos beevor sign
nerve root involvement
explain beevors sign
have them do a sit up or SLR and watch their umbilicus, if it goes to one side and not up or down, it’s pos.for weakness or lack of neural connection on the side opp of the deviation
the only t spine pathos that would have pos neural tests
disc or nerve root
hypomobility or t4 syndrome might have neural tension, but not true neural sx with pos neural tests
hypomobility of tspine can have what 3 px generators
facet
disc
rib
general hypomobility, what ROM test will you always do
UE motions
what ROM tests
would you do for tspine disc
TS rotation
flexion
Flexion with inhalation
what ROM testing will you do for tspine nerve root involvement
rotation
SB
(it’s different than cervical)
when might you do babinskis and what is pos test
if they have B N/T or neuro sx
pos is when the GT extends
landmarks for t spine
spine of scapula is t4
inf angle of scapula is t8
does flattened tspine always accompany hypomobility and visa versa
no, you can have the same body chart for either, but look at the spine to determine whether it is flat or kyphotic. it may be flat with hypomobility, or just hypomobility
HA with glove like distribution of px into the hand, think
T4 syndrome
trunk movements bothersome, think what part of the spine
mid to low tspine
if you suspect facet issue in tspine, what motions should you do (handprint px)
flexion with rot/sb
(closing the joint)
then take them prone and do pavms
thumbprint px is typically (in tspine)
CTJ
nocturnal UE px with “pins and needles” may be
upper rib issue
where is CTJ or CVJ often located (pain)
local px 3 cm from rib articulation at TP
vague epigastric px, increased px after eating, cannot lean against lower ribs
slipped rib (costal arch syndrome)
if you suspect any form of rib pathology, what tests would you do
ROM:seated SB with deep breath
Lindgrens for rib 1 (PROM cervical rotate away from test side, then contra SB)
Spring test
with any Tspine suspected patho, always check
shoulder ROM
Rotation pxful (tspine) what pathos most likely
neural sx: disc with nerve root
non neural sx: facet or disc
sensation tests location for tspine
T8: area just below xiphoid process
T10: the umbilicus
T12: lower abdominal region, level with ASIS
reflex testing tspine
observe umbilicus with a cough (does it move in a normal pattern-not diagonal)
Flower pedals drawing with reflex hammer
motor testing for tspine (myotome)
resist sit up, then diagonal sit ups
with tspine disc issue (general) what motion with inspriation hurts
ext plus inspiration
in tspine, the flexion or ext with sb/rot implicates
facet issue
in tspine, pure rotation by itself impicates
disc or possibly facet too
Inflammation of the costochondral cartilage
Tietze’s (costochondritis)
disc slides medially during opening (no pain) describes what phase of disc displacement of TMJD
phase 1
bilaminar tissues lengthen allowing disc to migrate med. and ant. Reciprocal clicking starts. describes what phase of TMJD
2
Post. Lig. overstretched completely
Disc deformed
Mandibular head deforms
describes what phase of TMJD
IV - most severe
symptoms of ischemia (CAD)
5 d's 3 N's 1 a dizziness, diplopia, dysarthria, dysphagia, drop attaack nausea, numbness, nystagmus ataxia
which thoracic spine dysfunction is closely related to occupations that use their hands in a manner that the shoulder is not really flexed (hands at waist level)
hypomobility
what should be the focus of therex tx for T4 syndrome pts
pulling the scap back
scap pinches or all 4s exs
5 nerve tests for T spine
Dermatomes Beevors ULNT Myotomes Slump
for tspine, disc and disc with nerve root involvement, this motion is always pxful
rotation
tmj body chart can also look like what body chart
01-02 facet
in the LUMBAR spine, what motions are coupled but contra
SB and rot are contra/coupled
the Lspine facilitates what motion more compared to Cspine
lspine facilitates flexion/ext more
cspine falitates rotation more
In the C spine, the disc is taller on the ___ side
ant
only part of spine with UVJ
CSpine
Cspine , what motions are coupled
SB and rotation (ipsi)
education for suspected TMJD
limit hard foods
limit over opening
modify sleep position
limit parafuncitional activities
Avoid foods that require excessive opening of the mouth (e.g. hamburgers).
Avoid eating hard foods. Do not bite into ice.
When yawning, place and hold your tongue against the roof of your mouth.
Avoid clenching your teeth, as when chewing gum.
Sleep with one pillow.
Maintain correct sitting posture.
how to describe ex for TMJD
Restore cervical lordosis and strengthen in that position;
if you suspect UCS facet, you must do what tests, and then what tx would you want to do
You stand on opp side of px
after reg ROM, do the provocation tests (pro/ret)
then for dorsal do seated pivm (DAT-dorsal, rotate away from you, sb towards you) or for ventral do seated pivm (VTA) ventral- rotate head towards you and SB away
right rotation and left sb (of UCS) at occiput results in what
all vertebrae from c2 down to rotate right and sb right
UCS innervation
dorsal and ventral rami of 1-3
explain cervicogenic HA
these cause specific referred px, (not like vasculo HAs that typically stay in/around the head)
