Ortho 2 (special tests/glides): Cx Spine Flashcards
Cx spine - observation
Posture spine: Ax in standing & in sitting
-FHP remember may cause different dysfunction/condition
-Head neutral position, tilted, rotated to one side
Shoulder levels: Often dominant arm slightly lower, Rounded ↔ FHP
- Height of shoulder (R handed = typically R side lower)
- looks for ms bulk
- creases at back from forward head posture
Posture normal versus FHP
From the front: The chin should be in line with the manubrium
From the side: The ear should be in line with the shoulder & forehead vertical
Hypermobility
- May see cutaneous creases
Lateral stenosis
- May have a neck position that open the IVF (flex/contralateral SF)
Disc pathology
- May look like a torticollis
Cx spine - ROM
**make sure for oske that you do AROM only first them apply your OP!
- PROM
- Side rotation: Stabilize w forearm and grip occiput from front for OP
- Side flexion: One hand on shoulder (stabilize) other push head away
- Forward flex: 1 hand at C7/T1, 1 on head
- Extension: 1 hand on sternum (stabilize), other hand on forehead – don’t spend too much time there and be very gentle
Cx spine - RISOM and R/O LE
Cx spine - compression and traction
Cx spine - dermatomes
Ax superficial TACTILE sensation = Light touch
- Using cotton ball, Kleenex or finger
- Touch lightly the skin (avoid pressure)
Ax superficial PAIN sensation = sharp/dull touch
- Using a new paperclip
1/ Light touch on an unaffected area of your pt’s skin, demonstrate what you will be doing
- Pt supine, eyes close
- Ax distal aspect of dermatome first (more pure dermatome)
- If (+)ve, then Ax distal to proximal
- Compare side to side then if (+)ve → across one side
- You should ask:
1) Does it feel the same? As you touch both side
2) Do you feel anything? As you Ax affected dermatome
2/ Superficial PAIN sensation
Should be Ax after light touch on the area that had decreased sensation
- Pht should touch pt’s skin with curve & prickly sides
- Pt should say if the pht touched with the curve or prickly part
- Should wait 2 sec in between each stimulus to avoid summation
Grading
0 = no sensation 1 = decreased sensation 2 = Normal sensation
Cx spine myotome
- Pt in sitting position
- Pt’s ms should be in a shortened position, close to resting position
- Pht use an isometric contraction
- Compare side to side (at the same time or one after the other)
- The command should be “don’t let me move you”
- Hold 5 seconds
- Testing for weakness & fatigue (fading/progressive weakness with reps contractions)
- Repeat 5 times to confirm fatigability
- if (+)ve use an alternative muscles
Grading:
0 = No contraction
1 = Ms contraction without movt 2 = Movt without gravity
3 = Movt with gravity
4 = Movt against resistance
5 = Normal ms strength
Cx spine - reflexes
- Pt should be relax
- Pt’s tested limb should be well supported
- Pht should hold reflex hammer with a weak/floppy handling (to allow reflex hammer to balance freely)
- The stimulus should be quick & brisk & directly on the tendon
- Can use the Jendrassik manoeuvre
- Clench teeth/press hands together as you stimulate the tendon
Grading
0: Absent
1: Diminished
2: Average
3: Exaggerated
4: Clonus, very brisk
Hyporeflexia = Lesion of spinal n root or peripheral n (PHTH-623)
Hyperreflexia = UMN lesion
Abnormal deep tendon reflexes are not clinically relevant unless they are found with sensory or motor abnormalities
Cx spine - how to test for UMN lesions
Cx spine - Upper Limb Neurodynamic Tension (ULNT1)
Normal (negative) result:
Deep ache or stretch in cubital fossa
Deep ache or stretch into ant & radial aspect of F/A & radial aspect of hand
Tingling to the fingers supplied by appropriate nerve
Stretch in anterior shoulder area
Above responses increased with contralateral Cx SF
Above responses decreased with ipsilateral Cx SF
Pathological (positive) result:
Production of patient’s symptoms (but not always)
A sensitizing test in the ipsilateral quadrant alters the symptoms
Different symptoms btw right & left (contralateral quadrant)…important
Cx spine - PA
In prone or supine:
Facet joints: They form the articular pillar q1 inch (2.5cm) to SP
Cx spine - shoulder abduction test
Cx spine - what are the 4 radiculopathy screening tests?
Cx spine - spurling A test
Cx spine - Muscle flexibility Upper Trap
Cx spine - Muscle flexibility levator scapula
Cx spine - Muscle flexibility scalene
HEP:
Pt: Seated
- Stab 1st/2nd rib(Ant scalene – do slight Cx ext (Cr-vx flex)
- Add contralateral SF & ipsilateral rotation
Cx spine - Muscle flexibility SCM
Cx spine - Muscle flexibility lat dorsi
Cx spine - Muscle flexibility pec major
Cx spine - Muscle flexibility pec minor
HEP
- Pt seated
- Hand behind head (HBH)
- Combined with breathing out
Cx spine - ms strength middle and lower traps
Cx spine - ms strength rhomboid
Cx spine - ms strength serratus anterior
Cx spine - stability test of IU ms (short flexors ms)
Short neck Flexors:
- Longus Colli
- Longus Capitis
*Can use PBU to have an objective measure
HEP:
Similar principles as for the lumbar spine
Train tonic endurance of deep neck flexors
Exercise should be pain free
Incorporate in functional activities
Cx spine PPIVM flex
Cx spine PPIVM ext
Cx spine PPIVM rot
Cx spine PPIVM SF
Cx spine AP/PA glides (and post-sup/post-inf glides)
- review lecture on surface anatomy!
Cx spine hypermobility biomechanical Ax - test 1
Pt:
- Supine, crook-lying position
- Cx spine in neutral/towel under head as needed
- Front 1/3 of tongue on the roof of the mouth, lips together, teeth slightly apart
Pressure Biofeedback Unit (PBU):
- Placement: behind the suboccipital spine
- Inflate to 20 mm Hg
Look/palpate for any compensations…
- Substitution outer unit: SCM, anterior scalene
- Lost of Cx spine neutral position
- If cannot talk or swallow while holding the contraction
- Look for any rigidity (can do some wiggle!!!)
Cx spine hypermobility biomechanical Ax - test 2
Pht:
Look for any compensations
-Outer Unit muscle substitution
- Suboccipital muscle substitution
- Lost of Cx spine neutral position
- Look for any rigidity (can do some wiggle!!!)
TOS Adson
Cx spine hypermobility biomechanical Ax - test 3
Pht:
Look for any compensations
- Outer Unit muscles
- Flexor ms will be activated but should not dominate
- Substitution: SCM, Scalene
Progression:
- Can change the head angle….be as functional as possible…
- Can be given as an exs…
Cx spine hypermobility biomechanical Ax - test 4
Pht:
Look for any compensations
- Outer Unit muscles
- Extensor ms will be activated but should not dominate
- Substitution: Levator scapulae
- Ext Cx, Tx or Lx spine
Progression:
- Can change the head angle….be as functional as possible…
- Can be given as an exs…
Cx spine objectuve exam, rep movements - pt guided retraction and extension lying supine
Cx spine retraction in supine with clinician OP
- Is the essential procedure for the reduction of posterior derangements in the lower Cx
- Also used for the treatment of extension dysfunction in the lower Cx
- Is an essential precursor to other movements required to effectively treat the Cx
- Treats cervical headaches and flexion dysfunction of the upper Cx
Cx spine retraction with extension and clinician OP
Extension principle
Retraction and extension
- Retraction and extension in sitting
- Retraction and extension with rotation in sitting
- Retraction and extension with rotation in supine
- Retraction and extension with rotation and clinician traction in supine
TOS - ROOS
TOS - hyperabduction
Hyperabduction for symptoms
Hyperabduction for pulse
TOS - Tinels sign
