Midterm Flashcards
What are the effects of joint mobilization?
Neurphysiological
Biomechanical
Psychological
What are the three sub-systems that contribute to stability in the spine?
passive
active
central nervous system
Passive system:
anatomical structures contributing to stability
Active system:
muscles, source of active stiffness
Central nervous system:
feedforward and feedback
Neutral zone:
region of laxity around the neutral resting position of a spinal segment
position of the segment in which minimal loading is occurring in the passive structure and active structures
Total vertebrae:
29 total
5 sacral
4 coccygeal and 3 joints and 2 facets
Alignment of upper cervical spine?
horizontal and 45 degrees in lower
Fryette’s First Law
when any part of the spine is in neutral position the side bending of the vertebrae will be to the opposite side as the rotation of the spine
Fryette’s Second Law
when any part of the spine is in a position of flexion or hyperextension the side bending of the vertebrae will be to the same side as the rotation of the spine
Fryette’s Third Law
If motion in one plane is introduced to the spine any motion occurring in another direction is thereby restricted
Can’t open restriction:
restriction of Flex/SB/Rot to the opposite side of pain
Can’t close restriction:
restriction of Ext/Sb/Rot to the same side of pain
Where does the majority of cervical rotation occur?
occipital atlanto region
Occipital atlanto flexion
15-20 degrees
Occipital atlanto side flexion
10 degrees
Atlanto-axial flexion/extension:
10 degrees
Atlanto-axial side flexion
5 degrees
Atlanto-axial rotation
50 degrees (primary motion)
4 parts of vertebral artery:
proximal
transverse
suboccipital
intracranial
4 parts of suboccipital portion of vertebral artery:
within transverse foramen of C2
between C2 and C1
in the transverse foramen of C1
between the posterior arch of atlas and its entry into the foramen magnum
5 D’s And 3 N’s
dysarthria Dysphagia Drop attacks Dizziness Double Vision Ataxia Nausea Numbness Nystagmus
Clinical prediction rule for patients with neck pain likely to benefit from TJM to Cspine:
symptom duration less than 38 days
positive expectation that manipulation will help
side to side difference in cervical rotation ROM of 10 degrees or greater
pain with posteroanterior spring testing of the middle cervical spine
Trauma patient order:
VBI and trauma hx C-spine rules and AROM screen Progress to eval if clear AROM, ROM, MRS functional movement screen special test
No hx of trauma order:
VBI screen AROM, PROM, MRS hypermobile vs. hypomobile functional movement screening special test treatment
C-spine:
Cognitively intact? Under 65? 45 d of rotation? injury circumstances? pain at rest in midline? paresthesia in arms?
Positive findings for cervical instability clearing tests:
movement felt during passive translation
clunk
symptoms that were present during forward flexion are relieved
Priority tests for cervical instability:
sharp purser
membrane test
alar ligament test
Where does nodding occur?
upper C-spine C0-C1 during flexion
What muscles are commonly implicated with headaches?
SCM
Upper trap
superior obliqus capitus
Shoulder abduction relief test
C4-C5 or C5-C6
Bakody sign
ULTT 1
median nerve, anterior interosseous C5-C7
ULTT 2
median nerve, axillary musculocutaneous
ULTT 3
radial
UlTT 4
ulnar C8-T1
Radiculopathy cervical prediction rule:
+ spurlings
+ ULTT median nerve (1)
+ cervical distraction
less than 60 degrees rotation in c-spine
Clinical prediction rule for radiculopathy:
spurlings jackson's MFCT distraction ULTT assymetrical
Clinical prediction rule for neck pain and cervical traction:
peripherlization with lower c-spine mobility \+shoulder abduction test age older than 54 \+ ULTT A \+distraction
Cervical Facet syndrome:
mild/moderate neck pain that is often long standing neuro symptoms into arm
not dermatomal
Treatment of cervical facet syndrome:
Joint mobs, HVLA
traction
core strengthening with balance exercises
thoracic mobility
Clinical prediction rile for cervical spine manipulation
inital scores on NDI less 11.50
presence of bilateral pattern of involvement
not performing sedentary work for more than 5 hours each day
feeling better when moving neck
not worse when extending neck
spondylosis without radiculopathy
Alternative CPR for cervical manipulation:
symptoms for less than 38 days
positive attitude
side to side difference 10 degree or more cervical rotation
pain with PA spring test of mid cervical spine
Cervical myelopathy, cervical stenosis, severe cervical arthritis
muscle weakness, possible muscle wasting at end stages
decreases reflexes or possible hypertonic reflexes
walking difficulity
Cervical myelopathy, cervical stenosis, severe cervical arthritis treatment:
nerve glides thoracic spine mobility segmental mobs for decreased mobility postural re-ed soft tissue/core strengthening for logus coli
WAD
hyperflexion/hyperextension injury
stiffness/loss ROM in all planes
guarding
WAD grade 1:
mild strain
WAD grade 2:
neck pain and decreased ROM
WAD grade 3:
neurological + msk
WAD grade 4:
fracture/dislocation
WAD treatment:
neuro exercises
gentle mobs
soft tissue/core strengthening and balance
Myofascial disorders/Fibromyositis
hypermobility
lack of neuro symptoms
trigger points
repetitive trauma
Myofascial disorders/Fibromyositis treatment:
trigger point
joint mobs
postural re-ed
thoracic spine mobility
Adult torticolis:
painful SCM spasm with movement restricted in one plane worse than other
Pseudotorticolis:
limited in all ROM, typically seen upon waking (no trauma)
Treatment torticolis:
strain-counterstrain gentle mobs trigger points modalities HVLA
Cervicogenic HA:
worse with movement, cervical flexion/rotation test positive C1-C2 segment
HA treatment:
soft tissue Joint mobs trigger point postural re-ed stability
CPR for patients who will respond to thoracic manipulation:
duration of symptoms less than 30 days no symptoms distal to shoulder looking up does not aggravate symptoms FABQ less than 12 diminshed upp t-spine kyphosis at T3-5 cervical extension ROM less than 30 d excluded stenosis pts, red flags, WAD less than 6 weeks, CNS disorder, nerve root compression
T-spine flexion/extension
20-45 degrees
T-spine rotation:
35-50 degrees
T-spine lateral flexion
20-40 degrees
Wells Criteria:
clinical S/S DVT PE is as likely or more than alternative pulse greater than 100 previous hx of DVT or PE immobilization or major surgeries in past 4 weeks hemophysis active cancer within last 6 months less than 2 =low, 2-6 moderate, greater than 3=high
Compression or spinal fracture:
more common in those osteoporosis age greater than 70 steroid use trauma common in T11-L1 increased kyphosis supine sign and percussion test
Scoliosis rehab:
stretch concavity
strengthen convexity
strengthen rotation to opposite side of rib hump
Sites of compression for thoracic outlet:
interscalene triangle
costoclavicular space
thoraco-coraco-pectoral space
Onset for thoracic outlet:
repetitive trauma
insidious
unilateral or bilateral
Thoracic outlet intervention:
cyriax release 1st rib mobilization mobility for scalene/1st rib mobilize AC and GH joints pec stretching scap muscle strengthening
