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CS6 > HVLA > Flashcards

HVLA Flashcards

1
Q

Cervicothoracic spine C7 - T3 Rotation Gliding (push)

A

Myofascia ligamentus

same side head and thrust

Apply sidebend and tuck chin

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2
Q

Thoracolumbar spine T10 - L2 - neutral positioning

A

Neutral

coupled motion type 1

Facet apposition type 2

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3
Q

Thoracolumbar spine T10 - L2 - flexion positioning

A

Flexion

Coupled motion Type 2

facet apposition Type 1

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4
Q

Lumbosacral Joint L5 to S1 - Neutral positioning

A
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5
Q

Cervicothoracic Spine C7 to T3 - Rotation gliding

(scissor)

A

myofascia ligamentus

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6
Q

Cervicothoracic C7 to T3 - Extension Gliding

A

myofascia ligamentus

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7
Q

Atlanto Axial Joint C1 to C2 - chin hold

A

AA coupled motion primary rotation

Rotation thrust

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8
Q

Atlanto occipital joint C0 to C1 - contact occiput

A

OC joint coupled motion Type 1

Facet apposition Type 2

thrust is C-scoop

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9
Q

Thoracic Spine T4-T9 - extension gliding

(seated)

A

Ligamentous myofascial

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10
Q

Thoracic Spine T4-T9 - Rotation gliding

(“Dog” - Supine)

A

Ligamentous myofascial

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11
Q

Cervical C2-C7 - Upslope chin hold

A

coupled motion type 2

facet apposition type 1

Primary leaver rotation secondary side bending

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12
Q

Cervical C2-C7 upslope cradle hold

A

coupled motion type 2

fascet apposition type 1

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13
Q

Cervical spine C2-C7 Downslope chin hold

A

Type 2 normal

type 1 lock up

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14
Q

Cervical spine C2 - C7 downslope cradle

A

Normal Type 2

Coupling Type 1 - opposite rotation and side bending

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15
Q

Lumbar L1 - L5 - flexion

A

Coupled motion Type 2

facet apposition Type 1

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16
Q

Lumbar L1 - L5 - neutral

A

Coupled motion Type 1

facet apposition Type 2

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17
Q

What are red flags for HVLA?

A

Fracture
Tumour
infection
Neurological condition
Aneurism
Haemorrhage
Other serious condition

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18
Q

What are the absolute contraindications for HVLA?

A
  1. Bone: weakening, osteoporosis, tumour
  2. Neurological: cord compression, myelopathy
  3. Vascular: cervical dissection, aneurysm
  4. Lack of diagnosis
  5. Lack of patient consent
  6. Patient positioning can’t be achieved due to pain or ROM
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19
Q

What are the relative contraindications to HVLA?

A
  1. Averse reactions to previous treatment
  2. Disc herniation or prolapse
  3. pregnancy
  4. vertigo
  5. Osteoporosis
  6. Psychological dependance to HVLA
  7. inflammation
  8. Spondylolisthesis / spondylosis
  9. Corticosteroid therapy
  10. Degenerative joint disease
  11. ligamentous instability
  12. Arterial calcification
20
Q

What are the risks of HVLA to each spinal segment?

A
  • *Cervical:** Low (when the practitioner is well trained and the patient is well screened)
  • *Thoracic:** Not documented
  • *Lumbar:** Rare (when the practitioner is well trained and the patient is well screened)
21
Q

What are the four classifications of HVLA complications?

A
  • Transient effect < 48-72h
  • Substantive reversible impairment (take longer to recover)
  • Substantive non-reversible impairment (wont recover)
  • Serious non reversible impairment (adverse events - permanent damage)
22
Q

What are transient effects?

A

Local pain or discomfort
Stiffness
A headache
Tiredness/fatigue
Radiating pain or discomfort

23
Q

What are some Substantive reversible impairment to each spinal segment?

A

Cervical: Disc herniation, spinal compresion, Cs strain

Thoracic: Rib fracture, VB compression fracture, Posterior fracture, shoulder and rib cage strain.

Lumbar: VB compression fracture, posterior fracture, Disc herniation, nerve root compresion, strain

24
Q

What are some non-Substantive reversible impairment to each spinal segment?

A
  • *Cervical:** unresolved disc herniation and radiculopathy
  • *Thoracic:** Significant VB fracture, Post fracture with spinal canal disruption.
  • *Lumbar**: unresolved disc herniation and radiculopathy, Significant VB fracture, Post fracture with spinal canal disruption.
25
Q

What are some serious non-reversible impairment?

A
  • *Cervical:** stroke, Spinal cord compression = cervical myelopathy.
  • *Thoracic:** Spinal cord compression
  • *Lumbar:** Spinal chord compresion = cauda equina
26
Q

What are the causes for complications on HVLA relating to a patient selection?

A

Incorrect diagnosis
Inadequate palpatory assessment
lack of awareness
lack of patient consent

27
Q

What are the causes for complications on HVLA relating to poor technique application?

A

Excessive Force, amplitude and leverage
an incorrect plane of thrust
Wrong leverage
Poor patient positioning
Poor operator
lack of patient feedback

28
Q

What are the principles of HVLA

A

Exclude contraindications
•Obtain informed consent
•Ensure patient comfort
•Ensure operator comfort and optimal posture
•Achieve spinal positioning by either facet apposition locking or the utilisation of ligamentous myofascial tension
•Identify appropriate pre-thrust tissue tension
•Apply HVLA thrust

29
Q

Elbow traction thrust

A

Joint: gapping/restriction at humero-radial joint

One hand applies compression to shoulder/humerus

Other hand compresses over wrist/hand

Thrust is downwards and slightly outwards

30
Q

Elbow Humero-Ulnar gap

A

Joint: humeroulnar

locate one hand on the humerus and the other on the forearm.

Find a neutral position with arm extended apply

thrust on the direction of the cubital fossa line.

31
Q

Overview of the osteopathic test for the shoulder

A
32
Q

What are the shoulder impingment tests

A
  1. Hackings Kenedy: Supra pushed against coracoid ligament
  2. Neers: Supra jams greater tuberosity on anterior inferior acromion space
  3. Tests Supra for inflamation or injury
33
Q

When do I perform a upper limb neuro test?

A

An osteopath may perform a neurological exam when a patient has changes in;

  • Sensory system: Changes in sensation in the arms and/or hands
  • Motor system: muscle wasting, involuntary movements, weakness in arms or hands
  • Coordination: difficulty with fine motor tasks of hands
34
Q

Wrist whip

A

Lunate on radius – plane synovial joint

take patients wrist prone

create tension by expanding the thenar and hypothenar immanence

use the thumbs to find a restricted carpal joint

articulate and then apply thrust in a down and towards me

35
Q

Thumb CMC HVLA

A

joint: Trapezium on 1st Met – saddle synovial joint

  • Restriction: gliding of CMC joint or Intercarpal joint (trapezium on scaphoid)
  • Contact affected bone (e.g. 1st met or trapezium) with thrust hand
  • Other hand stabilises wrist and hand
  • Thrust is a distraction/traction thrust along line of thumb
36
Q

Thoracic Rotation - short leaver

A

Patient prone

apply hypothenar eminence on TP on each side of the spine

take up the slack by rotating contact point on opposite directions

apply downward thrust

37
Q

Thoracic supine flexion thrust (DOG for T1/2)

A

T1-T4 (usual technique but add steps below)

Place your applicator across SP/TPs of the level BELOW the joint you are aiming to thrust (e.g. T2 for T1/2)

Manoeuvre the patients crossed elbows towards their head (allows you to direct the thrust straight down towards T1/2) while maintaining tension

Thrust down towards your contact hand

38
Q

Lower Thoracic supine flexion thrust

(DOG T10-T11)

A

T9-T12 (usual technique but add steps below)

Place your applicator across SP/TPs of the level BELOW the joint you are aiming to thrust (e.g. T11 for T10/11)

Manoeuvre the patients crossed elbows towards their feet (allows you to direct the thrust straight down towards T11) while maintaining tension

Might be useful to increase ligamentous tension by asking the patient to bend their knees up

Thrust down towards your contact hand

39
Q

Thoracic rotation adapted to ribs

A

Patient supine

One hand on TP closer to the practitioner

the other hand before Rib angle on the opposite side

thrust is down and outward

40
Q

FIbular thrust

A

Patient supine

internally rotate fibular head under knee line from posterior to anterior in a clockwise direction.

Externally rotate leg above ankle joint

flex the knee

thrust is amplifying flexion

41
Q

Talar tug

A

patient supine

interlock fingers and apply contact of 5 digit on talus

lift leg

lean back

thrust down and out towards practitioner

42
Q

SIJ tug

A

patient supine

grab leg above ankle joint

elevate adduct and internally rotate leg

lean back

short sharp tug towards the practitioner

43
Q

Hip tug

A

patient supine

grab leg above ankle joint

elevate abduct and externally rotate leg

lean back

short sharp tug towards the practitioner

44
Q

Metatarsal thrust (toes)

A

Condyloid joint

apply pressure on the sole of the foot over the metatarsal-phalangeal joint.

contact proximal phalange toes 2-5

apply downward thrust

45
Q

Navicular/cuneiform thrust

A

Medcuneiform-navicular - gliding synovial joint

move the patient foot of the table

patient supine

Isolate ankle joint over navicular

second contact over middle cuneiform

apply downward thrust - shear motion

46
Q
A

CS6 (10 decks)

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