Things I can't remember Flashcards
ROM opening for TMJ
35-50 mm
Lateral Deviation for TMJ ROM
10-15 mm
Protrusion TMJ ROM
3-6 mm
Acute phase Treatment of TMJ
Patient Education Postural Retraining Modalities Biofeedback E-Stim Massage
What are the 2 components of TMJ opening?
Rotation 25mm
Glide 15 mm
C-curve TMJ opening demonstrates
Hypomobility, internal derageent of the manidble which deviates toward involved side midrange of opening.
S-Curve is due to what
Muscle imbalance, lateral excursion with mouth open
Reciporical Clicking is a sign for
Anterior Disc Displacement with reduction
Type of pain:
Cramping, Dull, Aching
Muscle
Type of pain:
Dull, ache
Ligament or capsule
Sharp, shooting pain
nerve root
Burning, pressure like, stinging, aching
Sympathetic nerve
Deep, nagging, ache
BONE
Sharp, severe, intolerable
Fracture
Throbbing, diffuse
Vasculature
Action of SCM
Unilaterally; cervical rotation to opposite side, cervical lateral flexion to same side
Bilaterally; cervical flexion, raises the sternum and assists in forced inspiration.
-Spinal Accessory nerve
Decorticate Posturing disruption of what tract?
Lateral Corticospinal tract (supplies flexor muscles in the LEs)
Decerbrate is brain stem damage below what level
red nucleus, disruption of the Rubrospinal and Lateral Corticospinal.
Responds to shaking and loud voice
obtunded
Responds to painful stimulation, groans, reflex acitivty
Stupor
Sleeps when not stimulated, inattentive, responds to name
Lethargy
Memory impaired, disoriented
confusion
Contraindication for Cervical Thrust techniques
- Cranial Nerve Sign
- Loss of bowel or blader control (specific in lumbar)
- Painful movements in all joint direction
- Bilateral or multisegmental neurologic signs or symptoms
- UMN signs
- Emotional disorders
- Anticoagants consumption or steriods for long time
- Inexperienced clinician
Weight Bearing Axis in the spine
C1, 7, T10 and S2
Normal Spine ROMS
C0-C1
10-15 deg of flexion/extension
8 deg of SB
Limited SB in C-spine due to the
Uncovertebral Joints
C1-2 ROM
ROTATION GREATEST: 45 deg
C3-C7 ROM
64 deg Flex
24 deg Ext
40 deg lateral flex
40 deg rotation
Facet Joint Alignment for
Cervical
Thoracic
Lumbar
Cervical: 45 deg to vertical in sagittal plane at C2-7
Thoracic: 60 deg to the vertical in sagittal plane
Lumbar: vertically oriented (90) little rotation and flexion
The Dorsal Primary Ramus innervates?
Paraspinal Muscles and Facet joints( medial branch of DPR especially important in facet joint innervation)
In C-spine, each nerve root is named for the vertebra ______?
Below, for example C5 nerve root exists between C4 and C5
In the rest of the spine, each nerve root is named for the vertebra _____?
Above, for example L4 nerve root exists between L4 and L5
However, with P/L disc herniation in Lumbar spine, what nerve root would be affected if there was an L4/5 herniation?
L5. and L5/S1 –>S1 would be affected.
Grades and Joint Status 0 1 2 3 4 5 6
0-Ankylosed 1-Very Hypomobile 2-Slight Hypomobile 3-Normal 4-Slight Hypermobile 5-Very Hypermobile 6-Unstable
Alar ligament resists
Flexion, C/L SB and Rotation of the neck
Co-C1 Arthrokinematics
Convex-Concave
C1-C2 arthrokinematic
Convex-on Convex (AA)
Below C2
Concave on Convex
Capuslar pattern for TMJ
Limited opening
Capsular pattern for Upper Cervical
Forward Flexion more limited than extension
C1-C2 capsular pattern
restricted rotation
Lower Cervical/Upper T-spine/Lumbar capsular pattern
SB and R equally limited
Hangman’s Fracture
Bilateral fracture of the pedicles of C2
Jefferson’s Fracture
Bilateral fracture of the arches of the Atlas
Restriction define
cannot go into a certain position
Movement Restriction in C-Spine
Flexion and R SB
Left hypombolility
Extensor muscle tightness
Posterior capuslar adhesion
Left Joint Dysfunction (into extension)
Movement Restriciton in C-spine
Extension and Right SB
Right extension Hypomobility
Left flexor muscle tightness
Anterior Capsular adhesion
Right joint dysfunction (into flexion)
Alar Ligament Stress test how is it performed?
Attempt to SB the patient’s head while stabilizing C2, can also rotate in seated at C2.
IF ligamentous tissue damage of intra-articular lesion the safest intial step
is to unload the joint and control movement with a soft collar.
In the lower C-spine the most flexion and extension, SB and R occurs at what level?
C5-6
Increasing ROM into extension where is the stabilizing hand and where is the mobilizing hand (cranial glide)
Stablizing hand is on the superior segment
Manipulating hand is on the inferior segment
Manipulation C0-2 neck is in
extension
Manipulation for C3-4 neck is in
neutral
Manipulation for C5-7 neck is in
slight flexion
MYOTOME C1-2 C3 C4 C5 C6 C7 C8 T1 L2 L3 L4 L5 S1
Neck flexion/Extension SB Shoulder Elevation Shoulder ABD Elbow FLexion and wrist extension Elbow Extension and wrist flexion Finger extension (THUMB) Finger Abduction Hip Flexion Knee Extension DF Big toe extension PF
Patient presents with ptosis, smaller pupil, constriction of pupil, decrease sweating, conjuctiva
Horner’s Syndrome (can relate to pancoast tumor) due to a sympathetic nervous system problems. Ipsilateral to site of lesion
Disc Displacement with out reduction (key features)
-persistent limited opening
-Deviation of mandible to afffect side with opening and protrusion
-Limited condylar translation, condyle never assumes a normal position with the disc.
no clicking
In chronic closed lock episodes what happens?
the condyle may steadily push the disc forward to achieve almost normal ROM of mouth opening despite the presence of a non-reducing disc.
TMJ disc attaches anteriorly to ______and posteriorly to _______
Lateral pterygoid, condyle
Superiorly lateral pterygoid pulls disc_____and inferior lateral pterygoid pulls disc ______
anteriorly and inferiorly
When the disc stays in anterior position with jaw closed, the disc is displaced posteriorly to condyle when opened with 1-2 clicks. Then is displaced anteriorly again with 1-2 clicks as jaw closes this is defined as
open lock, disc displacement with reduction
Biomechanics of TMJ
Rotation
GLide
25 mm rotation, lower compartment
15 mm glide, upper compartment
Opening and protrusion of TMJ involves what action?
Ant/inferior/lateral glide
It is important to normalize what before referring patients to get any permanent dental procedure or appliance?
Normalize c-spine posture
Capsular pattern for SIJ
pain when joints are stressed
Closed Pack and open pack for SIJ
nutation and counternutation
Whiplash injury typically involves what ligament
Anterior long. Ligament (Hyperextension)
MOI: Penetration wounds, Stab, GSW
Loss of pain, temperature, light tough on OPPOSITE SIDE
Loss of motor function and vibration, position sense, deep touch on SAME SIDE
Brown-Sequard
MOI: Flexion Injury to cervical spine, damage to anterior spinal cord.
Loss of motor function and Pain an temp
with preservation of position, vibration, and touch sense
Anterior cord SYndrome
MOI: Hyperextension cervical spine or degenertive narrowing of spinal canal (spinal Stenosis)
CENTRAL CORD SYDROME
UE> LE
MOTOR>Sensory
MOI: late stage syphilis, wide steppage gait is what SCI?
Posterior cord syndrome, loss of position sense, vibration and touch sense.Preservation of motor, pain and temperature.
Bakody’s sign
test is used to test for radicular symptoms, especially inolving C4/5. decrease in symptoms is a positive test.
Grade 1 nerve injury, nerve sheath and axons intact
Neuropraxia
Grade 2 nerve injury, nerve sheath intact some axons torn
Axonotomesis
Grade 3 nerve injury, nerve sheath and axons cut (may be partial or complete)
Neurotmesis
Brachial Plexus Injury, ERB’s PALSY MOI: Forceps delivery of a newborn, or falling on neck at angle. What is involved and what does it result in?
Upper trunk C5-C6
cause from excessive lateral neck flexion, away from shoulder
Loss of Lateral Rotators (Rcuffs of shoulder), arm flexors and hand extensors)
-at birth-infants show recovery usually within 2-3 mothns.
Brachial Plexus injury, Klumpe’s. Cause from upward pulling on ABD arm grabbing something when you fall. Results in?
claw hand. Lower trunk injury C8 and T1. Weakness shown in tricpes. Sensory loss on ulnar side.Paralysis of hand instrisnic muscles and flexors of the wrist and fingers.
Palsy vs. Polio?
Polio-viral infection disease affecting the grey matter of the spinal cord, muslce weakness mostly affecting the LEs.
Name the corresponding vertebral level Hyoid Bone Thyroid Cart. First cricoid ring Carotid tub
C3
C4
C6, lateral to to first criocoid ring.
Pronated Feet resutls in–>
Medial rotation at the tib (tib abduction)
Genu Valgum at the knee (knocked knee)
Coxa Vara -hip muscle weakness
can all affect lumbar spine and SIJ.
What view would you need to see the Unicovert. joints in the C-spine?
Oblique
Left lateral trunk flexion is limited primarily by
due to the rib cage?
During opening of the mouth a palpable and audible click is discovered in the Left Temporomandibular joint. The physician informs the therapist that the patient has an anteriorly dislocated sick. This click most likely signifies that
The condyle is sliding anterior to obtain a normal relationship with the disc
the lumbar spine because of horizontal plane facet limit
rotation
With spinal column injuries, the spine is considered stable
the spine is considered stable when at least 2 columns of the spine are intact. (total of 3).
Superior Facet orientation for Cervical, Thoracic and Lumbar
BUM, BUL, BUM
Referred Pain (name the visceral organ) Shoulder Blade-gallbladder Shoulder from undersurface of diaphragm Abdomen Epigastrium Left chest Umbilicus Testis
- gallbladder (t3-5)
- diagphragm
- abdomen
- heart
- spleen
- umbilicus
- ureter
Pectus carniatum (pigeon chest)
ribs under the sternum and pushing and pushing sternum out, Impairs the effectivess of breathing by restricting ventilation volumen.
Pectus excavatum (funnel chest)
Sternum being pushed posteriorly, decrease A-P dimension, heart may also be displaced, reduces RESPIRATION. seen in teenagers.
LandMarks Spine of Scap Xihopid process Inferior Lateral Angle Iliac crest
T3
T10
T7
L4-5
FACET JOINT OPENING RESTRICTION
Stuck closed, opening problem
Deviation to same side during forward flexion
Difficulty side bending to oppposite side
Prominence of affected TP during extension
Rule of thumb for scolosis
0-20 degrees
20-40
Over 40
observe
brace
surgery
Which of the following ligaments are not important in the lumbar spine?
- Ligamentum Flavum
- PLL
- ALL
- Transforaminal
Transformainal (not important)
Which muscles are primarily used for stability and if weak can shift load on disc?
Transversospinal group
The outer half of the IVD is innervated by
sinuvertbral nerve and grey rami commincans
External oblique action
rotation to the opposite side
Extension Bias: Extension Approach
Patient usually presents with flexed posture, a lateral shift may also be present
Extension test decrease or centralize symptoms.
Dx: Disc lesion, impaired flex posture, fluid statsis.
-So can present with a flexed posture but they feel better when they go into extension
Extension Bias-Extension Syndrome
The patient’s symptoms decrease in extension (lordosis)
Flexed postures or repetitive flexion load posterior or P/L intervertebral disc lesions or injury to PLL.
When extension motions relieve symptoms it is called extension bias.
Management for Extension Bias
Patients would benefit from early interventions that emphasize extension of the involved segments.
AVOID isometrics and dynamic exercises during acute phases to preven an increase in disc pressure.
Contraindications after Spinal Sx
- Joint manipulations at the level of fusion
- Extension excercises including prone press up for laminectomy
Spondylosis
Spondylolysis
Spondylolisthesis
- Degeneration of Intervertbral Disc
- A defect of the Pars interarticulars or arch of the vert.
- A forward displacement of one vertebra on another
Compression of L5 nerve as it passes under the _____ligament can become irritated
iliolumbar ligament
Isthmic Type 2 Spondilo?
age?
due to?
5-50
most common
due to predisposition to weakness leading to fracture of pars L5 on S1.
Degenerative Type 3 Spondilo?
age
due to?
Older adults 50+
Facet arthrosis leading to subluxation of L4 on L5
High grade is more than 50% of slippage.
If you are performing Hoover’s test and you hold patients legs and tell patient to lift leg. What is a positive test?
If the patient lifts one leg without downward pressure on the other leg, it is considered positive.
What two ligaments in the spine are prone to ossifying?
Iliolumbar ligament leading to sacralization of L5
and Ligametum Flavum.
What is the closed packed position of the SIJ?
Nutation
Sacrotuberous and Sacrospinous ligaments both limit what motions?
Nutation and posterior innominate rotation
Which muscle can develop trigger points that can underdetected and is a key lateral stablizer?
Quadratus lumborum
Lumbopelvic Rhythm
-During flexion of the lumbar spine the lumbar spine will first flex ________then ________to allow more movement followed by hip flexion.
60-70 degree, then pelvis will rotate anteriorly
