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OSPE Practical > HVT > Flashcards

HVT Flashcards

1
Q

What to say

A

Going to perform a HVT
Potetnial risks, including stroke for Csp (1/100,000)- examination + Hx= not in risk category

Position may feel tight but shouldnt be uncomfortable, if it is let me know and I will stop
I will apply a quick impulse which may result in a cavitation (click sound), this is just CO2 and N2 leaving the Jt space, not bone on bone

The aim is to restore normal functioning + ROM

Happy?

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2
Q

Point of HVT

A

Speed to overcome muscle contraction not produce a clicking sound

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3
Q

Cautions

A

Hypermobility- cant feel bind
Hesistance

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4
Q

Contras

A

Lack of consent
Undiagnosed/previous disc injury
High blood pressure
P on set up

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5
Q

HVT v Mob

A

Quicker + same outcome
Lower amplitude- at end range for less time

Inc time- Pt may feel in more control

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6
Q

Chemical repsonse to HVT

A

May feel spaced out after, increase in +ve androgens
Inc ROM= Inc BF

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7
Q

Neurological response

A

Balances proprioceptive reflex

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8
Q

Psycholgical response

A

Audible sound may make Pt believe something has happened
Highlights importance of explaining what happens

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9
Q

Csp contact

A

Contact is 2nd MCP on articular pillar, other hand is supporting= not moving, moving superior segment. Flx/SB/Rot= accumulating bind

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10
Q

Csp considerations

A

Consider age (60+), if normal blood pressure (exercise caution if medicated), cervical clearing test

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11
Q

Csp impulse

A

Impulse= rotation away
Lower segments- 2-3, thrust more towards axilla
Middle- thrust more in line with mouth
Upper- more in line with eyes

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12
Q

Csp set up

A
  1. Couch high- able to rest elbows on pillows
  2. Pt supine, head close to you
  3. Flx/SB/Rot with nose still in line with sternum
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13
Q

Csp What is happening

A

Moving superior on inferior

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14
Q

CT Lift

A
  • Pt hands on their head
  • Place your hands linked over C5/6
  • Ask them to place their hands over yours
  • Squeeze your elbow into their lats
  • Ask them to squeeze their elbows together
  • Relax stomach, breathe in/out, look up
  • Pull back and up
  • Direction- thrusting C7 away from T1. C7 moves anteriorly
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15
Q

CT What is happening

A

C7 anterior on T1

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16
Q

Tsp Risks

A

Soreness 24-48 hours

17
Q

Tsp prone

A
  1. Start with harmonic, whilst palpating to find area of Rx
  2. Springing to identify further
  3. Closest hand in line with TPs closest
  4. Other hand perpendicular
  5. Breathe in, breathe out, then thrust down towards floor
  6. Contact on TP above, pisiform on TP below which will cavitate
18
Q

Tsp prone What is happening

A

Pisiform on inferior TP= cavitation

19
Q

Tsp dog

A
  • Contact- SP above sits in gutter of hand
  • Direction- straight down
  • Accumulation of bind- rotation and flexion
20
Q

Tsp dog What is happening

A

Contact on TPs below to move one above ant-post

21
Q

Ribs

A
  • Contact medial to angle of rib, just off TP, thumb almost touching SP
  • Direction- ribs 3-6 pressure more up. 6-9 more straight down
  • Prone:
    o Bring contact out laterally to be on rib head
22
Q

Lsp contras

A

o Cauda equina
o Fracture- would have been screened
o Lack of consent
o P on set up
o Undiagnosed/previous disc injury (worsens symptoms- would need to consider CHx)
o Anky spon
o Osteoporosis/osteopenia

23
Q

Lsp cautions

A

o Hypermobility- cant feel bind
o Hesitant- may be due to previous bad experience

24
Q

Lsp set up

A
  1. Forearm over iliac fossa, other arm is gapping= rotate thorax using rib cage
  2. Knee on couch + leg straight
  3. Other knee into popliteal fossa
  4. Looking towards the head
  5. ASIS ASIS, leg forward
  6. Thrust= rotational- downwards
  7. Ipsilateral facets are gapping (may cavitate both facets)
  8. Accumulation- opposing rotational forces
  9. Contact- between SPs
25
Q

SIJ

A
  • Palpate sulcus
  • Increase the rotation (compared to Lsp) + add SB
  • Contact on PSIS
  • Thrust goes through ASIS
  • Gapping posterior aspect of SIJ
26
Q

Chicago technique

A
  • Anteriorised innominate
  • Push down on ASIS, find which side moves less
  • Whichever side is Rx= crossed over other leg, initiates posterior rotation
  • Move legs away from you, allows quadratus femoris to slack
  • Side bend upper body
  • Cross arms over, bring your contact over shoulder
  • Hand contact on ASIS (thrusting hand)
  • Accumulation- rotation
  • Thrust- down towards couch in posterior direction

OSPE Practical (5 decks)

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