L11/12/14 CT Interventions Flashcards
Cervicothoracic Biomechanics
- motion of cervical spine involves motion of thoracic spine, possibly down T7-T8
- Rotation of cervical spine in pts with neck pain, have reduced T1-3 and increased C5-7
- Retraction occurs at C7-T4
- Protraction occurs at T5-T12
Graded mobilizations and extension exercises
significant improvements in shoulder function for pts with subacromial pain syndrome
Thoracic mob and manip both…
improved pain and cervical AROM in patients with chronic neck pain
Absolute contraindications to performing thrust jt manip to thoracic spine
- Bony
- Neuro
- Vascular
Vascular issues (contraindications to manips)
- diagnosed vertebrobasilar insufficiency or cervical artery abnormalities
- aortic aneurysm
- bleeding diatheses
- angina pectoris
- untreated cardiac insufficiency
- acute abdominal pain
Bony issues (contraindications to manips)
- tumor
- infection
- metabolic (osteoporosis)
- congenital
- iatrogenic (surgical fusion, surgery)
- inflammatory (RA)
- Traumatic injury
Neurological Issues (contraindications to manips)
- acute cervical, thoracic, or lumbar myelopahty
- spinal cord compression
- cauda equina syndrome
- nerve root compression with increasing deficit
- sudden vomiting/vertigo
Cervicothoracic Junction
- transition point from very flexible neck to more supportive and protective thoracic region
- 1st rib attaching on anterolateral portion of T1
- lower incidence of disc pathology than segments above
Clay shoveler’s fracture
- rare and important fx of spinous process, most commonly at C7, can occur at C6-T3
- traumatic or cumulative avulsion stress into flexion or extension
- risk factors include laborers, sports, MVA
- localized swelling and tenderness, crepitus
- typircally managed conservatively with brace, rest
- has high union rates with good clinical outcomes
Association with 1st Rib Dysfunction
- tight scalene muscles
- apical breather
- lateral neck, shoulder, CT junction pain
- thoracic outlet syndrome
Assessment of 1st Rib Dysfunction
- palpation with spring test in supine
- cervical flexion and lateral rotation rest –> lateral flexion will be limited b/c 1st rib is blocking C7 motion
Upper Cervical Assessment and Treatment
- joint mobility/play assessment with the intention to treat occurs IF AND ONLY IF there is not concern of instability or red flags
- METs as effective and safer than mob and manip techniques
- strong but small muscles, altered motor control immediately after increasing mobility is common
- transition into AROM and proprioceptive exercises ASAP after mobility
Upper cervical dysfunction can contribute to
- contribute to neck pain
- contribute to headaches
- contribute to TMJ dysfunction
- be concordant with mid/lower cervical dysfunction
ROM interventions following manual therapy
deep flexor necks
cat-cow with neck flexion
Rotation of neck
stretching
Soft tissue mob techniques
positional release
active release
manual stretch
