L6: Skills Prac 3-4 Flashcards
What are 3 examinations of the articular system in a patient with a neck disorder?
- Assessment of combined movement in the cervical region
- Passive Physiological Intervertebral Movements (PPIVMS C2-C7-LF)
- Passive accessory intervertebral movements (PAIVMS –cervical segments C0-1 -C7-T1)
What are 3 characteristics of scapular posture?
- Influence of correction on pain, ROM, muscle activity
- Assessment direction-go to muscle or articular system next?
- Treatment direction
What are 2 characteristics of cervical ROM? What are 2 things that decrease cervical ROM?
- Does direction match history?
- Does direction implicate particular structures ie. articular, muscle, neural
Decreased range:
Motor control
Articular (joint)
What are 6 characteristics in the analysis of cervical motion when in sitting?
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Assessment of pain and other symptoms:
- reproduction of patient’s presenting symptoms
- where in range it occurs
- intensity of symptoms
- Analyse pattern, control of movement (neck and upper thoracic area)
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Range of movement
- measure with inclinometer
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Overpressure
- apply only when there is apparent full ROM and no pain to ‘clear’ the direction of movement
- Recording: Direction, Range, Pain response, comment on patternor √√ if full range and painfree
- Nominate:which direction (s) will be outcome measures
What are 3 observations of cervical rotation?
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Regional movement:
- Movement of head predominantly (C1-2 = 40°) could indicate hypomobilityin lower cervical region
- Palpate movement of upper thoracic region during head rotation
- Check effect of scapular posture correction–indicates potential role of axio-scapular muscles in movement dysfunction
What are 4 observations of cervical lateral flexion?
Observe for smooth lateral curve in the neck
- Analyse any movement restriction
- Segmental:loss of movement in section of the curve
- Neural tissue restriction: n/a
- Muscle: restricted by a lengthened muscle (egUpper trapezius) –repeat while supporting the shoulder in slight elevation
What are the 2 uses of combined movements of cervical region?
- To assist in understanding the mechanical dysfunction at the cervical segment
- To aid selection of the most appropriate treatment movement and position of the patient
What are the 2 most commonly used combined movements for cervical region?
The movements most commonly used in combination are:
- EXT and LF
See which combination is the worse EXT <—> LF (coronal or saggital plane = PAIVM or PPIVM)
When should combined movements for cervical region be used?
Apply to patients with mild to moderate pain (not severe)
What are 3 steps of combined movements of cervical region?
- Test each combinationie Ext + LF; LF + Ext
- Take 1stmovement to P1
- Determine which combination most accurately reproduces the patient’s pain
- See which combination is the worse EXT <—> LF (coronal or sagittal plane = PAIVM or PPIVM)
- Direction of treatment + progression
- Usually when test combined movement = will get both pains
What are 2 indications for…?
- Upper cervical flexion and extension
- Upper cervical rotation in neck flexion (C1-2 rotation)
- Pain in occipital, sub-occipital region
- Headaches
What are 2 movements for…?
- Pain in occipital, sub-occipital region
- Headaches
- Upper cervical flexion and extension
- Upper cervical rotation in neck flexion (C1-2 rotation) + overpressure
- Ensure that the cranio-cervical area is not flexed to allow full rotation at C1-2
- Quick check to see if the problem is cervical?
What are 2 specific movements in the examination of Cervico-thoracic region?
Examined with movements of the cervical region
Specific movements
- Retraction action with neutral cranio-cervical region for C/Th extension
- Cervical rotation
- the physiotherapist simultaneously performs transverse pressures on the upper thoracic spinous processes to palpate/produce the segmental movement
What are 4 clinical pointers for Passive Physiological Intervertebral Movements (PPIVMS C2-C7-LF)?
- Hands must be relaxed and cause no local tenderness
- PPIVMs are a motion test at each segment, no force
- Movement is produced by non palpating hand
- Palpating hand feels for the slide down of the inferior facet of the vertebra above on the superior facet of the vertebra below
How can you assess for loss of glide in Passive Physiological Intervertebral Movements (PPIVMS C2-C7-LF)?
Have good perception of laminae in the C2-4 region, need to perceive motion through muscle tissue in the lower articulations
What are 6 clinical pointers for passive accessory intervertebral motion (Central PAs C2; Unilateral PAs C2-3)?
- there must be no tenderness produced by thumb contact
- The gentle force of the technique must be produced by elbow movement
- Grip the side of neck (region of TV processes) with the flat of middle or index fingers
- This grip supports the gentle placement of the thumb tips on the spinous processes (central PAs) or articular pillars (unilateral PAs)
- Grip the segment and then concentrate on ‘springing’ the segment via elbow movement and assessing the motion, resistance to the induced movement and pain response
- Poor handling provides false positive results
What are clinical pointers for the examination of C0-1; C1-2?
- C0-1: the technique is performed via the arch of the atlasand must be directed towards the eye to account for the orientation of the joint
- C1-2: the technique is performed either on the arch of the atlas or over the joint line and is directed vertically to the floor.
Note the joint line of C1-2 is readily palpable
What is the interpretation of processes underlying Jo’s condition?
