HVLA LECTURE 2 FINISHED Flashcards
CERVICAL ARTERY DYSFUNCTION: What arteries does it involve Definition Causes What are the 3 most common sites for external impingement:
Vertebral artery and carotid artery
DEFINITION: Compromise of the blood flow through the cervical and vertebral artery system leading to hypoxia of the tissues the system supplies (brain).
CAUSES:
Intrinsic: conditions that narrow the artery lumen e.g. atherosclerosis.
Extrinsic: compromise or impingement upon the external wall of the artery.
3 MOST COMMON SITES FOR IMPINGEMENT:
- Level of vertebral foramen at C6 by contraction of the longus colli and the anterior scalenes
- Within the foramen transversarium between C6-C2
- At the level of C1-C2 as it enters the skull
What does VBI stand for?
Vertebral Basilar Insufficiency
What are 3 signs of VBI?
Nystagmus
Gait disturbance
Horner’s Syndrome
VBI Symptoms
Dizziness Vertigo Tinnitus Nausea Drop attacks Dysarthria (inability to speak properly) Dysphagia (inability to swallow) Occipital headaches Facial paraesthesia Tingling in the upper limbs Pallor and sweating Blurred vision Light headedness Blackouts and fainting
What are the KEY SYMPTOMS of VBI? (3)
Sudden severe cervical pain and/or headaches
Dizziness
Nausea and/or vomiting
What are the 5 ABSOLUTE contraindications to HVLA?
1) BONE: Any pathology that weakens bone
2) NEUROLOGICAL
3) VASCULAR
4) LACK OF DIAGNOSIS
5) LACK OF PATIENT CONSENT
What are the 5 most common tumours that metastasise to bone?
Lung Thyroid Kidney Prostate Breast (sometimes GI)
What bone conditions would be mean an absolute contraindication?
Tumour Infection eg TB Metabolic eg osteomalacia Congenital eg dysplasias Iatrogenic e.g. long term corticosteroid use, asthma, skin conditions Inflammatory eg severe RA Traumatic e.g. bone fractures
What neurological conditions would mean an absolute contraindication?
Cervical myelopathy
Cord compression
Cauda equina compression
Nerve root compression with increasing neurological deficit
What vascular conditions would mean an absolute contraindication?
Diagnosed VBI
Aortic aneurysm
Bleeding Diathesis eg severe haemophilia
What are relative contraindications for HVLA?
Adverse reactions to previous HVLA Inflammatory arthritdes Pregnancy - esp first trimester Osteoporosis Disc herniation and prolapse Spondylolysis Spondylolisthesis Spondylosis Vertigo Psychological dependence on HVLA Ligamentous laxity - pregnancy, downs syndrome Arterial calcification
Spinal locking types:
Type 1 motion - rotation and sidebending to the same side
Type 2 motion - rotation and sidebending to opposite sides
What are fryettes laws of coupled motion:
Law 1) neutral side bending produces rotation to the other side
Law 2) non neutral (vertebra hyper flexed or extended) causes rotation and side bending to the same sides, individual joints acting as one.
Law 3) introducing motion to a vertebral joint in one plane automatically reduces its mobility in the other 2 planes.
What type of spinal locking/coupled motion is produced in C2-T4?
Type 2 - rotation and side bending occur to the same sides of the joint, e.g. side bending right causes the vertebra to also rotate to the right
What type of spinal locking/coupled motion is produced in T4-L5 vertebra when the patient is in a neutral position?
Type 1 - rotation and side bending occur on opposite sides of the joint, e.g. side bending to the right causes the vertebra to rotate to the left
