HVT Flashcards
What to say
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?
Point of HVT
Speed to overcome muscle contraction not produce a clicking sound
Cautions
Hypermobility- cant feel bind
Hesistance
Contras
Lack of consent
Undiagnosed/previous disc injury
High blood pressure
P on set up
HVT v Mob
Quicker + same outcome
Lower amplitude- at end range for less time
Inc time- Pt may feel in more control
Chemical repsonse to HVT
May feel spaced out after, increase in +ve androgens
Inc ROM= Inc BF
Neurological response
Balances proprioceptive reflex
Psycholgical response
Audible sound may make Pt believe something has happened
Highlights importance of explaining what happens
Csp contact
Contact is 2nd MCP on articular pillar, other hand is supporting= not moving, moving superior segment. Flx/SB/Rot= accumulating bind
Csp considerations
Consider age (60+), if normal blood pressure (exercise caution if medicated), cervical clearing test
Csp impulse
Impulse= rotation away
Lower segments- 2-3, thrust more towards axilla
Middle- thrust more in line with mouth
Upper- more in line with eyes
Csp set up
- Couch high- able to rest elbows on pillows
- Pt supine, head close to you
- Flx/SB/Rot with nose still in line with sternum
Csp What is happening
Moving superior on inferior
CT Lift
- 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
CT What is happening
C7 anterior on T1
Tsp Risks
Soreness 24-48 hours
Tsp prone
- Start with harmonic, whilst palpating to find area of Rx
- Springing to identify further
- Closest hand in line with TPs closest
- Other hand perpendicular
- Breathe in, breathe out, then thrust down towards floor
- Contact on TP above, pisiform on TP below which will cavitate
Tsp prone What is happening
Pisiform on inferior TP= cavitation
Tsp dog
- Contact- SP above sits in gutter of hand
- Direction- straight down
- Accumulation of bind- rotation and flexion
Tsp dog What is happening
Contact on TPs below to move one above ant-post
Ribs
- 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
Lsp contras
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
Lsp cautions
o Hypermobility- cant feel bind
o Hesitant- may be due to previous bad experience
Lsp set up
- Forearm over iliac fossa, other arm is gapping= rotate thorax using rib cage
- Knee on couch + leg straight
- Other knee into popliteal fossa
- Looking towards the head
- ASIS ASIS, leg forward
- Thrust= rotational- downwards
- Ipsilateral facets are gapping (may cavitate both facets)
- Accumulation- opposing rotational forces
- Contact- between SPs
SIJ
- Palpate sulcus
- Increase the rotation (compared to Lsp) + add SB
- Contact on PSIS
- Thrust goes through ASIS
- Gapping posterior aspect of SIJ
Chicago technique
- 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
