Exam 2 Flashcards
Angle of the middle and lower facets of the cervical spine
45 degrees upward and forward
Angle of the facet joints for C1/C2
More horizontal than lower and middle facet
How are movements coupled in cervical spine
Upper cā spine - opposite
Lower cā spine - same
Common causes of cervical radiculopathy
Space occupying lesions: disc herniation, spondylitic spurs, or cervical osteophytes
Most common cause of cervical radiculpathy
Foraminal encroachment from decreased disc height and degenerative changes to uncovertebral and zygapophyseal joints
Movement of ribs occurs at which joints
Costotransverse and costovertebral
How much forward bending is available at the thoracic spine
30-40
Superior and slightly anterior gliding of inferior facet of superior vertebrae moving on superior facet of inferior vertebrae
How much backward bending is available at the thoracic spine
20-25
Inferior and slightly posterior sliding of inferior facet of superior vertebrae moving on superior facet of inferior vertebrae
How much rotation is available at the thoracic spine
30-35
How much lateral bending occurs in the thoracic spine
25-30
Serious conditions that can result in pain in thoracic spine
Infection Fracture Neoplastic disorder Inflammatory disorder Disc protrusion
Somatic conditions that cause thoracic spine pain
Facet joints
Muscles
Intervertebral discs
Visceral conditions that cause thoracic spine pain
MI Dissecting thoracic aortic aneurysm Peptic ulcer Acute cholecystitis Pancreatitis Renal colic Acute pyelonephritis
Cervical radiculpathy cluster
ULTT 1
Spurlings A
Distraction
IL cervical rotation of 60 degrees or less
Patients likely to respond to cervical traction and exercise
Peripheralization with lower cervical spine PA mobility Positive shoulder abduction test Age >55 Positive ULTT 1 Positive neck distraction test
Predictors of short term outcomes with cervical radiculopathy
Multimodal treatment
Younger age (less than 54)
Looking down does not worsen symptoms
Dominant arm is not affected
Likely to respond to thoracic manipulation
Symptoms less than 30 days No symptoms distal to shoulder Looking up does not aggravate symptoms FABQ less than 12 Diminished upper thoracic spine kypohsis Cervical extension ROM less than 30
MDC of NDI
5 in patients with neck pain
Up to 10 in patients with cervical radiculopathy
MCID of NDI
Greater than 5 if musculoskeletal
Greater than 7 when pain is neural
Contraindications of cervical manipulation
Post-partum Anti-coagulant therapy RA Downs syndrome Trauma Fracture/dislocation Ligamentous instability Unexplained weight loss History of cancer Severe night pain Pain worse when lying down Fever IV drug use Steroid use
Patient education for cervical patients
Posture correction
Pain control
Decreased stress
Correct body mechanics
Muscles for OA
Upper trap
Suboccipitals
SCM
Muscles for AA
CL levator scapulae
Muscles for opening
Levator scapulae
Spinalis cervicis
Posterior scalene
Muscles for closing
Middle scalene
Anterior scalene
CPR for good response to cervical manipulation
Symptoms less than 38 days
Positive expectation manipulation will help
Side to side difference in cervical rotation ROM greater than 10 degrees
Pain with PA spring testing of middle cervical spine
Supine progression - max protection
Flex arms to 90
Abduct arms to 90
ER arms at side
Supine progression - mod to min protection
Flex to full range
Abduct to full range
PNF D2
Prone progression - max protection
Scapular squeeze with shoulder ER with arms at side
Scapular squeeze in 90/90
Prone progression - mod to min protection
Elevate shoulders to full flexion
Scapular adduction with arms at 90
Diagonal pattern
Postural sequence exercise
Chest lifts Axial extension Chin tucks Shoulder roll Lumbar roll
