L3: Skills Prac 1-2

Question 1

What are 6 surface anatomy landmarks?

Answer 1

1. TV process C1 and arch of atlas
2. Spinous processes C2-7
3. C2 spinous process: C1-2 facet joint; C2-3 facet joint
4. Zygapophyseal joints C2-3 -C7-T1
5. Spinous processes T1-12
6. Spine of scapula, inferior angle, medial border of scapula

Question 2

What are 4 postural assessment to examine?

Answer 2

1. Habitual sitting posture
2. Correction of spinal posture, facilitation of correct posture, effect on ROM
3. Scapular posture
4. Correction of scapular posture, effect on ROM (rotation), muscle tenderness

Question 3

What are 3 practical activities for the beginning?

Question 4

What is the surface anatomy of the upper cervical spine?

Answer 4

Question 5

What is the surface anatomy of the cervical spine from C1-7?

Answer 5

Question 6

What does the zygapophseal joint look like in the cervical spine?

Answer 6

Question 7

What are the bony landmarks for finding T2-3, T3-4, T7-9?

Answer 7

Question 8

What is postural analysis for the cervical spine?

Answer 8

Question 9

What does cervical and thoracic angle look like during a 10min mouse task?

Answer 9

Question 10

What are the 6 steps of a dnamic postural analysis (analysis of postural strategies and muscle use) for sitting?

Answer 10

Correct posture requires a neutral lumbo-pelvic, thoracic, cervical and shoulder girdle position

1. What is the patients habitual sitting posture
   
   1. Neutral pelvic/spinal posture
   2. Flexed pelvic/spinal posture
   3. Extended pelvic/spinal posture
2. What is the patient’s perception of an ideal sitting posture?
3. Look for a predominant use of thoraco-lumbar erector spinae (poor pattern)
4. Facilitate a correct upright posture
   
   • Check for upright pelvis and normal lumbar lordosis
   • Check thoracic spine
     
     • need for slight sternal lift if still too flexed
     • need for slight sternal depression if still too extended
5. Assess effect of change in posture on (TDT):
   
   • Resting pain
   • Cervical range of movement (Upright posture can increase cervical ROM​)
   • Palpable tenderness in levatorscapulae or upper trapezius
6. Can the patient replicate an ideal sitting posture once taught and if not what is the reason?
   
   • kinesthetic ability
   • poor active control
   • loss of passive mobility

Question 11

What is an anatalgic posture? C6/7?

Answer 11

Anatalgic posture relieves pain - do not correct

C6 - hand over opposite shoulder

C7- HBH

Question 12

What is the assessment of shoulder girdle dysfunction?

Answer 12

Assess scapular orientation relative to thorax:

• 3 rotations:
  
  1. upward/downward
  2. anterior/posterior
  3. internal/external
• 2 translations:
  
  1. superior/inferior
  2. protraction/retraction

Question 13

What are the 2 characteristics of a normal or ideal shoulder girdle?

Answer 13

1. the scapula should sit flush on the chest wall
2. smooth curve of the neck and shoulder

Question 14

What are 5 common scapular positional faults in neck pain patients?

Answer 14

1. Downwardly rotated and protracted scapula ±anterior tilt, internal rotation
   
   1. Poor control of upward rotator synergy (trapezius, serratus anterior)
   2. Overactive levator scapulae, rhomboids, pec minor
   3. Poor upward rotation with arm movement
   4. Poor scapular orientation worsened under load
2. Often immediate improvement in cervical motion and tenderness of shoulder girdle muscles when scapular position corrected
3. Caution with subtle elevation of shoulder posture
4. Protective ‘overactivity’upper trapezius
5. Check
   
   1. neural mechanosensitivity
   2. scalene hypertonicity
   3. elevated first rib

Question 15

What are 6 characteristics of scapular posture?

Answer 15

1. assess in standing and sitting
2. make pattern of muscle imbalance fit
3. position scapula in optimal position
4. NOTE: Deviation from the ideal is not uncommon
5. assessthe effect on symptoms and cervical ROM
6. assess patient’s pattern of control to reposition the scapula

Question 16

What are 6 aims of analysis of cervical motion in sitting?

Answer 16

1. Pain and other symptoms:
   
   1. reproduction of patient’s presenting symptoms
   2. where in range it occurs
   3. intensity of symptoms
2. Analyse pattern, control of movement (neck and upper thoracic area)
3. Range of movement
   
   • measure with inclinometer?
4. Overpressure
   
   • apply only when there is apparent full ROM and no pain to ‘clear’ the direction of movement
5. Recording: Direction, Range, Pain response, comment on pattern or √√ if full range and painfree
6. Nominate: which direction (s) will be outcome measures *

Question 17

What are 4 observations of cervical flexion?

Answer 17

1. flattening of cervical curve
2. movement of upper thoracic region
3. extension of chin (Neural tissue protection)
4. initiate return from the cervico-thoracic region, head neutral (returning using upper cervical extension could indicate predominant use of head rather than neck extensors)

Question 18

What are 3 observations of cervical extension?

Answer 18

1. Position of head relative to the line of the shoulders.
   
   • The mass of the head should move posterior to the shoulders with increasing lordosis
     
     • Should be able to get pass shoulders
   • Inability to do so could be protection of a painful segment or indicate weakness of cervical flexors
2. observe rhythm –a ‘slide’ indicates poor control and weakness of cervical flexors; or possible segmental instability
3. Initiate return from extension with craniocervical flexion
   
   • Return with CC region in extension indicates weakness of deep cervical flexors

Question 19

What are 3 observations of cervical rotation?

Answer 19

1. Regional movement:
   
   • Movement of head predominantly (C1-2 = 40°) could indicate hypomobility in lower cervical region
   • Lack of free movement of head with movement forced to lower cervical region could indicate hypomobility in the upper cervical region
2. Palpate movement of upper thoracic region during head rotation
3. Check effect of scapular posture correction–indicates potential role of axio-scapular muscles in movement dysfunction

Question 20

What are 3 observations of cervical flexion?

Answer 20

Observe for smooth lateral curve in the neck

1. Analyse any movement restriction
2. Segmental: loss of movement in section of the curve
3. Neural tissue restriction: differentiate NT by repeating lateral flexion with the arm in the BPPT position
4. Muscle: restricted by a lengthened muscle (eg Upper trapezius) –repeat while supporting the shoulder in slight elevation