Test 1*- Motion Palpation Occiput-T3 Flashcards
What is the primary listing componext in the sagittal plane of occiput?
X axis rotation (0 theta)
P-A glide restricted
Palpation should match what?
the listings on the Xray
What if palpation findings don’t match the films?
did I palpate correctly?
was the patient helping or hindering me?
has the patient had some form of stress that could have affected the spine?
When palpating, what should you make sure the patient is doing?
make sure they are relaxed as possible and they are at your working height
What do you compare the segment you are questioning to?
the segment below and assume there is a stable base
Where should the patient be when performing an occipital P-A glide?
patient seated relaxed at doctor’s center of gravity, neck in neutral position
Where should the doctor be when performing an occipital P-A glide?
doctor’s thumbs/thenars on superior lateral aspect of the patient’s head
How do you perform an occipital P-A glide?
press gently down to engage the condyles on the lateral masses and rock the occiput forward while maintaining pressure
then challenge each side by laterally bending to the right and left and gently pressing and gliding on both sides
What does it mean if there is unilateral fixation of the occiput?
the occiput is stuck in flexion, the posterior aspect is stuck superiorward
What is the listing is there is unilateral decreased P-A glide of the occiput?
PS
What does it mean if there is bilateral fixation of the occiput?
occiput is POSSIBLY stuck in extension, anterior aspect is stuck superiorward
What must you do if you palpate and you think the occiput has an AS listing?
verify it on the lateral cervical film. the FML and APL would be converging to the posterior (or diverging to the anterior)
Is there a motion palpation associated with the sagittal plane of atlas?
no
What is the primary listing component of atlas?
AS or AI
How do you find the primary listing of atlas?
must look at the APL and the OPL on the lateral cervical film
Which way is the anterior tubercle of atlas stuck if the atlas is stuck superior?
AS
Which way is the anterior tubercle of atlas stuck if the atlas is stuck inferior?
AI
What is the second component of the occiput listing?
transverse plane (theta z-axis), laterality
How do you perform the motion palpation to find laterality of the occiput?
fingertips on the anterior inferior tip of mastoid and C1 TVP, bend the head to the side of the fingers
How do you determine normal/abnormal motion of occiput laterally?
normal- when bending, the fingers should come together
abnormal- when lateral bending, the fingers wouldn’t come together as much
What does it mean if there is an RS on the occiput listing?
decreased right laterality
occiput has moved to the right and superior
tip of mastoid and C1 TVP won’t approximate
What does it mean if there is decreased left lateral bending for the occiput?
it has an LS listing, occiput has moved to the left and superior, the tip of mastoid and C1 TVP won’t approximate
What is the double check for occiput laterality?
we could find decreased P-A occipital glide on the side of laterality
(ex: will have found restricted P-A occipital glide if the head was bent to the left for LS)
What is the second compoent of the atlas listing?
transverse plane (theta z-axis), laterality
How do you check for laterality of C1?
place fingertips on C1 and C2 TVPs to check for normal/abnormal motion
What is the normal motion for atlas lateral bend?
the fingers on the C1 and C2 TVPs should come together when you bend the head to that side
What is abnormal motion for atlas lateral bend?
the fingers don’t approximate well on the side you bend the head to
When you have decreased right lateral flexion, what has happened to atlas?
it has moved to the right and superior, tips of C1 and C2 TVPs won’t approximate
When the third letter of your atlas listing is an L, what does that mean?
atlas has decreased left lateral bend, C1 has moved to the left and superior and the tip of C1 and C2 TVPs won’t approximate
What is the tertiary listing for occiput?
coronal plane (theta y-axis), rotation
What is rotation named according to for occiput?
which way the nose goes
How do you determine if there is a rotational component of occiput?
fingertips on the anterior inferior aspect of C1 and C2 TVPs
rotate the head to the opposite side of your fingers
What is normal motion for occipital rotation?
fingers should separate apart at the end of the range of motion
When determining left rotation, which way did you rotate the head?
to the right
If you have decreased left rotation, what does that mean for occiput?
the right side is posterior
When determining right rotation, which way did you rotate the head?
to the left
If you have decreased right rotation, what does that mean for occiput
the left side is posterior
What is the double check for occipital rotation?
tissue prominency over the posteiror arch on the side OPPOSITE posterior rotation of occiput
If you have a PS-RS-RP, where would you find tissue prominency if you were double checking the rotational component?
left posterior arch of atlas
If you have a PS-RS-RA where would you find tissue prominency if you were double checking the rotational component?
right posterior arch of atlas
What are the motion palpation findings for PS-RS-RP?
decreased P-A glide, decreased right lateral bend, decreased left rotation
What are the motion palpation findings for PS-RS-RA?
decreased P-A glide, decreased right lateral bend, decreased right rotation
Do you need all 3 components of an occiput listing in order to have a complete listing?
no
What is the tertiary listing for atlas?
coronal plane (theta y-axis), rotation
How do you find the rotational component of atlas?
fingertips on C1 and C2 TVPs and rotate the head to the opposite side of the fingers
What is normal rotational motion of atlas?
fingers should separate at the end of the ROM
What is abnormal rotational motion of atlas?
fingers wouldn’t separate as much at the end of ROM
When you have decreased left rotation of atlas, what side is posterior? Which way did you turn their head?
right side posterior, turn head to left
When you have decreased right rotation of atlas, what side is posterior? Which way did you turn the head?
left side posterior, turn head to right
What is the double check for atlas rotation?
tissue prominency over the posterior arch on the side of posteriority
If you have an ASRA, where would you find tissue prominency fro rotational component?
over the left posterior arch
What are the motion palpation findings for ASRP
AS- found on film
R- decreased right lateral bend
P- decreased left rotation
What are the motion palpation findings for ASRA?
AS- on film
R- decreased right lateral bend
A- decreased right rotation
Do you need to have all 4 letters of an atlas listing for it to be complete?
no
What is the primary component of the C2-L5 listings?
sagittal plane (X-axis), P-A is restriction
How do you perform extension for C2-L5?
contact the inferior tip of the spinous and induce P-A motion of the segment and challenge the segment at the end of the ROM
When there is decreased P-A motion, the spinous has gone ___.
posterior
What is the secondary motion of a C2-L5 listing?
rotation
How do you perform rotation for C2-L5?
turn the body to the same side you want to challenge, then challenge the segment at the end of ROM
What does it mean when a segment has decreased left rotation?
the spinous has gone to the left
What is the double check for rotation of a lower vertebrae?
tissue prominency over the opposite side of spinous laterality
What causes the tissue prominency of the rotational component?
cervical- lamina pedicle
thoracic- TVP
lumbar- mammillary
What if you have scoliosis and the rotation of a segment is on the side of the curve? What is the listing?
if there is no wedge indicated, you still need to avoid thrusting into the curve, since the spinous is on the same side of the curve, the listing is still considered a PR
What if you have scoliosis and the rotation of a segment is on the opposite side of the curve? What is the listing?
if there is no wedge indicated, you still need to avoid thrusting into the curve, since the spinous is on the opposite side of the curve, the listing is PR-L
When and how is a disc wedge found?
found when you lateral bend/circumduct
the side of decreased motion will be the side of the open wedge
If you have facet motion on the right side, which side is considered restricted?
left
How do you find disc wedging?
contact the lateral inferior tip of the spinous and take the patient into lateral bending or circumduction
How do you know which side has decreased lateral bending?
the spinous moves easily to the open wedge and it won’t move well to the closed wedge
What is the double check for disc wedge?
circumduction and straight lateral bending double each other when trying to determine the wedge
If you have a PLI-T, what are the motion palpation findings?
decreased extension, decreased left rotation, decreased right lateral bend
What are the possibilities for cervical syndrome?
bilateral, right, left, no
What does it mean if there is a bilateral cervical syndrome?
then there is possibly an occiput, you need to palpate over the posterior arch of C1 for tissue prominency
What does it mean if you have a right/left cervical syndrome?
you need to palpate over the oppostie side for posterior body location
What if there is no cervical syndrome?
you should search elsewhere for the cause of the short leg (pelvis first)
What does it mean if there is an AD?
the patient has an anatomically deficient leg
PLS C5. What are the Spinography findings?
C5 & C6 DPLS cross each other on the lateral film,spinoUs to the left and wedge to the left On me A-P cervical film
TI &T2 DPLS cross On the lateral film. Pedicle shadow is Smaller on the rightand thewedge is opento the right.What are the palpation findings?
tissue prominency on the right) decreased extension, decreased right rotation & decreased left lateral bend
decreased flexion, decreased bilateral extension,decreased left lateral bend&posterior arch Ofatlas is more prominent on the right.
Occiput, AS-LS-LA
You run a nerveoscope and a break was found at the C4 level. What level should you check for subluxation?
C5
