Vetebral Column Flashcards
Neurophysiological Effect of Joint Mob
Firing of articular mechanoreceptors proprioceptors
Firing of cutaneous/muscular receptors
Altered nociception
Mechanical effect of joint mob
Stretching of joint restrictions
Breaking of adhesions
Altered positional relationships
Diminish/eliminate barriers to normal motion
Psychological effect of joint mob
Confidence gained thru improvement
Positive effects from manual contact
Response to joint sounds
Total vertebra
Cervical
Thoracic
Lumbar
29
7
12
5
Sacral
coccygeal
5
4
Three separate joints in vertebral motion segment
2 facets, IVD and Vertebral bodies
How many pairs of facet joints?
What type of joints are facets?
24
Planar
Upper cervical facet orientation
Lower cervical
horizontal
45 degrees
Z-joints/uncovertebral made of what process?
Uncinate process
Thoracic facet joint orientations
Lumbar
Almost vertical (Facilitates rotation/resist anterior displacement)
Vertical with J-shaped structures (resists rotation and anterior shear)
Three sub-systems contribute to stability
Passive: Anatomical structures
Active: muscles, source of active stiffness
CNS: Feedforward and feedback
Absolute contraindications
Joint hypermobility/instability Joint inflammation/effusion Hard end-feel Medically instable Acute pain that worsens with repeated attempts Acute radiculopathy Bone disease/fractures Spinal Arthropathy Deteriorating CNS pathology Status post joint fusion Blood clotting disorders
Variables affecting spinal motion
Disc-vertebral height ratio Compliance of fibrocartilage Dimension/shape of adjacent endplates Age Disease Gender
Coupling
Two or more motions coupled when one motion is always accompanied
Opposite of each other in UPPER cervical
Same side in LCS
Facet joints
Glide up and forward or down and back if occur in same directions, flexion/extension occurs
If movements occur in opposite direction, side-bending occurs
Rotation ALWAYS coupled with SB (LOWER CS)
Fryette’s first law
When you stand neutral and you side bend right, spine will rotate to the left
Fryette’s second law
When you flex or hyperextend your spine and you side bend to the right, your spine will rotate to the right (SAME SIDE)
Fryette’s third law
If motion in one plane is introduced to spine, any motion occurring in other direction is restricted
When you flex, you can’t move as much in other planes
“Can’t Close”
Restriction of Ext/SB/Rot to SAME side of pain
**Articular
“Can’t open”
Restriction of flex/SB/rot to OPPOSITE side of pain
**Capsular
Cervicoencephalic
Atlanto-occipital
Atlanto-axial
Cervicobrachial
C0-C1
C1-C2 (rotation)
C3-C7
Most rotation occurs here
Occipital Atlanto region
Injury to area can cause
Cognitive dysfunction, CN dysfunction, Sympathetic system dysfunction
Atlanto-occipital joints
Yes and maybe joint
Ellipsoide
Flex/ext 15 to 20 degrees
side flexion of 10 degrees
Atlanto-axial
No joint
Flexion/ext 10 degrees
Side flexion 5 degrees
Rotation 50 degrees (primary motion)
Cervicobrachical Region
C3-C7
Symptoms in area: Neck or arm pain Headaches Restricted ROM Paresthesia Altered myotomes/dermatomes Radicular signs
Buffers axial compression by distributing compressive forces
Withstands tension in disc
NP
AF
Vertebral Artery
Passes thru transverse
Supplies 20% of blood supply to brain
Can be compressed (osteophyte formation or injury to facet joint)
Stress by rotation, extension, and traction
VBA System
Three vessels
two VA
one Basilar
Four portions to VBA
Proximal, Transverse, Suboccipital, Intracranial
Proximal Portion
From origin of subclavian to entry to Cspine through Transverse of C6
Transverse portion
C6 to C2
Suboccipital Portion
Exit at C2 to penetration into cord
Divided into 4 parts
- within Transverse of C2
- Between C2 and C1
- In transverse of C1
- Between posterior arch of atlas and entry into foramen magnum
VA most vulnerable to compression and stretching
C1-C2 with cervical rotation
Transverse forearm of C1 is more ____than that of C2 VA
Lateral
Intracranial portion
IC runs from foramen magnum to formation of basilar artery at lower border of Pons
ICP is more prone to obstructions
Branches of VA
- Meningeal branches: supply bone and dura mater
- Anterior Spinal Artery
- Posterior Spinal Artery
- Muscular branches
- Posterior inferior cerebellar artery
VA insufficiency
Occur because of close proximity of VA and bony structures of Spine
or
RA, sickle cell, etc.
Manifestations of VBI
Dizziness, Drop Attacks, Diplopia, Dysarthria, Dysphasia, Nausea, Numbness, Nystagmus, Tinnitus Headache Wallenberg/Horner syndromes Paresthesia/Hemi Scotoma/Vision obstruction Periodic LOC Lip/Perioral Anesthesia Hemifacial Paralysis Hyperreflexia Babinski, Clonus Gait Ataxia
Risk factors for Arterial Damage (Stroke)
BP >140/90 Hypercholesterolemia Hyperlipidemia Diabetes Family history of MI Smoking BMI >30 Repeated or recent injury Upper Cervical Instability
Subdural Hematoma
Worse Headache of life
Imaging
Conventional Angiography: Gold Standard
MRA (Stenosis/Occlusions)
Doppler Sonography (assesses blood flow velocity)
Five D’s And the N’s
Dizziness, Diplopia, Drop attacks (Drop foot, drooping of face/eyes), Dysarthria, Dysphagia, Dysphasia
Ataxia
Nystagmus, Numbness, Nausea
Absolute contraindications to Manual Therapy
Infection, Acute circulatory, Malignancy, Open wounds, Recent fracture, Hematoma, Hypersensitivity to skin, Poor end feel, Advance diabetes, Cellulitis, severe pain, Extensive radiation of pain
Examination of VA
Maintain Immediate pre-mobilization position for a minimum of 10 seconds to test system
STOP when signs noted
Observe for Nystagmus, Changes in pupil, assess quality of speech, have pt reports changes in symptoms
Common issues
Worse headaches (Thunder headache) Different headache than I have ever had
Dizziness and headaches/neck pain! (Two most common for stroke)
Be conservative
To assess comorbidities look at
RBP
Upper cervical spine instability testing
BMI
Avoid prior to SMT on Cspine
Only if you observe proper evaluation techniques
ONLY IF YOU GAIN CONSENT
Excessive rotation, Non physiological movements in joints, aggressive forceful maneuvers
Through history, quality observation skills
Relative precautions to joint mobilization
Malignancy, Joint replacement, bone disease, CT disorders, Pregnancy or immediately post partum, Recent trauma (radiculopathy, cauda equina), early healing phase of CT injury, People unable to community, Psychogenic patients, corticosteroids, skin rashes/open wounds, Elevated pain levels that make palpation unreasonable
Neutral zone
Defines a region of laxity around neutral resting position of segment
Minimal loading occurring in passive structures and active
Spinal motion produced with minimal internal resistance
Two roles of Meniscoid
Fill space during joint displacement
Actively assist in dispersal of synovial fluid
