L24: Skills Prac 17-18

Question 1

What are the 6 tasks for management?

Answer 1

Question 2

What are the 3 examination of a cervicogenic headache (CGH) patient

Answer 2

1. Loss of upper cervical ROM
2. Cervical muscle dysfunction
3. Upper cervical joint dysfunction

• Nb. Also consider thoracic or CT junction stiffness and postural influences
• Key drivers?
• Flexion/extension problem, rotation, postural control/muscle system, stiff adjacent regions

Question 3

What are the 3 main assessment of cervicogenic headache (2/3/2)?

Answer 3

1. ROM:
   
   1. upper cervical spine ROM
   2. flexion–rotation test (in lying)
2. Muscle dysfunction:
   
   1. CCFT
   2. Scapula hold
   3. Extensors
3. Joint dysfunction:
   
   1. Upper cervical PAIVMs
   2. Upper cervical PPIVMs

Question 4

What are 4 steps of Flexion-rotation test (C1-2) for CGH? What is the normal range?

Answer 4

1. In lying
2. Get patient to look at their heels
3. Support head with your body and hold head around zygomatic arch
4. Rotate to each side until reach bony block

• Note range (<44° or >10° difference between sides
• Sensitivity 91%, specificity 90% for CGH and dizziness

Question 5

What are the 3 palpations for the cervicogenic headache?

Answer 5

1. Palpation of upper cervical soft tissues
2. PAIVMs C1, 2 central, unilateral
3. Transverse C1 (side lying)
   
   • Gapping technique (press on non-painful side)

Question 6

What is the surface anatomy of the upper cervical spine?

Answer 6

Question 7

What are upper cervical PPIVMs used for?

Answer 7

differentiate between C0-1, C1-2 and use for treatment

Question 8

What are the 3 movement types of upper cervical PPIVMs?

Answer 8

1. C0-1flexion-extension
2. lateral flexion
3. rotation

Question 9

What are the 3 procedures of the 3 movement types for C0-1 in upper cervical PPIVMs?

Answer 9

Cradle the head in both hands, place thumbs between mastoid and C1 TP

1. Flex-ext nod head down and back (feel movt of mastoid past C1)
2. LF-tilt head sideways
3. Rotation- rotate head until feel mastoid come up to thumb

Question 10

What are the 2 procedures for C1-2 rotation in upper cervical PPIVMs?

Answer 10

1. Hold C2 spinous process
2. Rotate from chin to limit of range

Question 11

What are PAIVMs as treatment?

Answer 11

Question 12

What are PPIVMs as treatment?

Answer 12

Question 13

What are 3 steps of Mulligan self SNAG (C1-2)?

Answer 13

1. Using a strap or selvage edge of a towel
2. Place at the level of C2, holding horisontally
3. Pull with contralateral hand, other hand pulls down to stabilise

• NB: Can use towards OR away from side of pain depending on irritability of condition

Question 14

What are 2 steps of Mulligan headache SNAG (C0-1)?

Answer 14

1. Stabilise C2 with thenar eminence
2. Cradle head with little finger under occiput and glide head posteriorly on C2 with a slight cephalad scoop
   
   • Gapping posterior and slight craniocervical flexion

Question 15

What is the diagnosis?

Answer 15

Sudden onset Z joint wry neck

Question 16

What are your 5 options for treatment?

Answer 16

1. Heat
2. Traction (in line of restriction) progress to neutral
3. PAIVMS
4. PPVIMs
5. Progression: Manipulate

Question 17

What are the 4 clinical pointers for ↶ C 3-4 III for Technique C2-C7 LF Gr III, IV and V?

Answer 17

1. Take skin from the lateral side of the neck to assist index finger locking in on the laminar of C3
2. Support hand is on opposite side of the head and neck, movement is performed with forearms and body
3. Think of a pivoting action to slide the facet of C3 down the slope of the superior facet of C4, to induce the localised C3-4 lateral flexion
4. GrV is part of the continuum of graded techniques
   
   1. Take joint to the limit range for that segment
   2. (slightly rotate the head away to lock off segment)
   3. apply a small rapid downslope thrust with slight medial direction

Question 18

What are the 3 types of grades for treatment?

Answer 18

Question 19

What are the 2 preparation for cervical manipulation?

Answer 19

1. Revise LF PPIVMs techniques Gr III, IV
2. Demonstration of procedure for Gr V

Question 20

What are 2 requirements for cervical manipulation?

Answer 20

1. Informed consent
2. VBI test (No dizziness)
   
   1. sustained rotation
   2. Pre-treatment position

Question 21

What are 4 statements/explanation to the patient for cervical manipulation?

Answer 21

1. What the treatment involves
2. Potential benefits and risks of the proposed treatment
3. Risk may be minor and transient eg increased pain, or rarely serious eg. stroke or neurological compromise
   
   • ​But there is a small risk (legal obligation)
4. Alternatives to the proposed treatment discussed
   
   • Or continue with the PAIVM techniques

A really small but fast thrust on the neck to try and open the joint on –> let out the bit of tissue that stuck in there