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384 Cards in this Set
- Front
- Back
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What are the two main components of the Craniocervial-mandibular system?
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Stomatognathic system and cervical region
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What is a parafunction?
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Everything that is not functional...AKA Habits...such as biting the tip of a pen or finger nails
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Components of the Stomatognathic system
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TMJ ***
MASTICATORY MUSCLES *** Maxilla and mandible Dental Arches Soft tissues (salivary glands, nervous and vascular supplies) |
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What is the function of the stomatognathic system?
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Mastication
Phonation (Speech) Deglutition (Swallow) Breathing |
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How many times a day does your TMJ move?
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2,000 times per day
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Parafunction Examples (Stomatognathic System)
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Grinding (Bruxism)
Clenching |
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Function of Cervical Region
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To support the head
To allow movements of the head in many directions and adjust its position To connect nerves from the brain to the sacrum |
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What type of joint is TMJ
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Ginglymoarthrodial joint
Ginglymo -> hinge jt rotation arthrodial -> gliding/translation |
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What type of cartilage cover the TMJ? Why?
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Fibrocartilage...B/c they are stronger thus providing more support
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Anatomy (Components) of TMJ include
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Bone Components:
Articular eminence of temporal bone Mandibular condyle Glenoid fossa/mandibular fossa Soft Tissue Component: Articular Disc Capsules Ligaments |
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TMJ resting position
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Mouth slightly open, lips together, teeth not in contact
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TMJ close packed position
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Teeth tightly clenched
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TMJ capsular pattern
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Limitation of mouth opening
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Three cardinal features of TMD are?
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Orofacial pain
Restricted jaw motion Joint noise |
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Which movement occurs in the upper cavity of the TMJ?
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Gliding, Translation, or sliding movement
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Which movement occurs in the lower cavity of the TMJ?
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Rotation or hinge
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Tongue Resting position
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Tip of tongue is behind the front teeth up against your palate (no pushing forward)
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Forward head posture is a parafunction for your ____
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Head
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Biconcave structure interposed between the condyle and the temporal bone
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Articular Disc
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Disc gives _____ to the joint movement
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Stability
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Without the articular disc:
Condyle/eminence articulation |
Convex-convex
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Convex-convex articulation describes (in respect to TMJ)
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The articulation b/w eminence and condyle if articular disc wasn't there
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Articular Disc (Characteristics)
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Divides the joint in superior (large) and inferior (smaller)
Thinner in the center (1mm) compared with anterior and posterior band (2-3mm) Centre area is avascular Structure inbetween condyle and temporal bone |
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When you open your mouth the condyle (movements and direction)
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Condyle rotates anteriorly and translates until the eminence of temporal bone
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Temporalis will attach to the _____
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Coronoid process
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Right and left TMJ are connected by the ____
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Mandible
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Anatomically the condyle is inclined (anteriorly or posteriorly?)
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Anteriorly
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True or False. Dental problems don't influence your TMJ
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False. Dental problems CAN influence your TMJ
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Components of Disc
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Posterior Band
Intermediate zone Anterior Band |
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Which band/part of the disc is innvervated and vascular?
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Posterior band
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Which band/part of the disc is avascular?
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Intermediate zone
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Which lamina allows translation at the beginning but restricts anterior movement-gliding?
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Superior lamina
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Which lamina restricts anterior rotation of the disc on the condyle
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Inferior lamina
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Superior lamina allows ____ but restricts ____
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Allows translation at the beginning but restricts anterior movement-gliding
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Inferior lamina restricts
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Anterior rotation
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Describe what happens with the disc as the mandible moves forward on opening
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The disc moved medially and posteriorly until the collateral ligaments and lateral pterygoid stop its movement. The disc is then seated on the head of the mandible, and both disc and mandible move forward to full opening
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_______ is the mandibular jaw position in which the head of the condyle is situated as far anterior and superior as it possibly can within the mandibular fossa/glenoid fossa.
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Centric Relation
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How many permanent teeth in mouth
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32 permanent teeth
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What are the three main ligaments in TMJ
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Collateral (discal)
Capsular Temporomandibular |
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Name the two accessory ligaments
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Sphenomandibular
Stylomandibular |
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What are the ligament functions in the TMJ
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Guide and limit movements
Stability Protection Passive restraining to limit movement |
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Centric Relation -> _____ band of disc on top of condyle
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Posterior band
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Measurement of the free way space
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1.5 - 5 mm
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How can you measure the free way space?
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Measure by two points...take the chin and nose in closed and resting positions and difference give you free way space
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This ligament attaches disc to condyle medially and laterally
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Collateral (Discal) Ligament
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Collateral (Discal) ligament
(Characteristics) |
Allows the disc to move with the condyle anteriorly and posteriorly
Restrict movement of the disc (medial and lateral) Stabilize intracapsular structures during the mandibular movements |
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Capsular ligament is reinforced laterally by the
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TM ligament
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Capsular ligament
(Characteristics) |
Covers all the joint from temporal bone (borders of articular surface to the neck of condyle)
Resist to any medial, lateral and inferior forces Helps to retain the synovial fluid Reinforced laterally by TM lig Highly vascularized/innervated |
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Capsular ligament resists _____ forces
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medial, lateral and inferior forces
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TM ligament prevents compression _____ (directionally)
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posteriorly and inferiorly
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TM ligament (Characteristics)
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Reinforcement of capsule
Has 2 parts: oblique & horizontal...One extends from base of zygomatic process downward and oblique to the neck of the condyle; posterior/horizontally to the condyle and disk Prevents compression posteriorly and inferiorly |
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Function of accessory ligaments
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Limit excessive protrusive (chin forward) movements
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What is the main muscle that closes mouth?
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Masseter
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Name the Masticatory Muscles
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Masseter
Temporalis Medial Pterygoids Lateral Pterygoids |
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Which portion of the masseter muscle's fibers run down and backward?
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Superficial portion
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Which portion of masseter muscle's fibers run predominantly vertical?
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Deep
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Masseter (Characteristics)
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From the zygomatic arch downward to the lateral aspect of the lower border of the ramus and angle
Has 2 portions: Superficial (fibers run down and backward) and Deep (fibers run predominantly vertical) |
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Temporalis
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Closing muscle
From the temporal fossa and extend downward to form a tendon that inserts in the coronoid process Divided in 3 portions (fiber directions): Anterior (vertical; elevate mandible vertically)...Medial (oblique; elevate mandible vertically); Posterior (almost horizontal; retrude mandible) |
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Closing mouth muscles
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Temporalis
Medial Pterygoids |
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These fibers of Temporalis are vertical and elevate mandible
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Anterior
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Medial fibers of Temporalis
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Oblique; elevate and retrude mandible
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Posterior fibers of Temporalis
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almost horizontal; retrude mandible
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Medial Pterygoids
(Characteristics) |
Mainly closing muscle
From the pterygoid fossa and extend downward/backward to insert in the medial surface of the mandibular surface of the mandibular angle Active bilaterally in protruding the mandible Unilateral contraction: contralateral movement |
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If you unliaterally contract the medial or inferior lateral pterygoid muscles you will see
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contralateral movement...if you contract right the mandible will move left
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If you bilaterally contract the medial or lateral ptyergoid muscles you will see...
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Protrusion of the mandible
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Inferior Lateral Pterygoids
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From lateral pterygoid plate and extends back and upward to insert on the neck of the condyle
Function: bilateral contraction = protrusion...unilateral contraction = contralateral movement Active with opening muscles |
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Superior Lateral Pterygoids
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From the sphenoid and extend almost horizontally, backward to insert in the neck of condyle, disc, and capsule
Function: Stabilize condyle-disc complex (maintain the disc in forward position during posterior rotation of condyle ON CLOSING) Unilateral contraction: ipsilateral movement |
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Unilateral contraction of superior lateral pterygoid will cause?
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Ipsilateral movement
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Unilateral contraction of inferior lateral pterygoid will cause?
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Contralateral movement
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Suprahyoid muscle are antagonists to the _____ muscles
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closing
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Suprahyoid muscles (Function)
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Open the mouth
Raise hyoid bone |
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Digastric muscle
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Posterior: Mastoid process-tendon to the hyoid bone
Anterior: Lingual surface of mandible-tendon to the hyoid bone |
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Movements of the mandible include:
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Depression (Opening)
Elevation (Closing) Lateral movements Protrusion Retrusion |
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Movements of the condyle include:
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Pure rotation (1/3)
Rotation and gliding (1/3) Pure gliding (1/3) |
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TMJ Arthrokinematics
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Rotational movement (20-25mm, inferior joint/lower cavity)
Translational movement (25mm, superior joint/upper cavity) |
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Main muscle for opening the mouth
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Digastric muscles
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How many fingers in your mouth is "normal" mouth opening?
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three fingers
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Biomechanic: Opening mouth
(Describe) |
When mouth opens, the disc rotates posteriorly/medially on the condyle, then the condyle glides forward (with the disc) on the articular fossa...
Movement of the condyle: downwards and forward Condyle always articulates with intermediate zone of disc (move together) Fluids (lubrication) moves from anterior compartment to posterior) |
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Superior retrodiscal lamina is stretched at _____ of mouth
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Full opening
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What muscle contracts to maintain the disc in anterior position when mouth closes?
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superior head of lateral pterygoid
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Condyle articulates with intermediate zone during ____ of mouth
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Opening
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Mouth closed position is maintained by?
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Interarticular pressure (elevator muscles)...Prevents separation of structures
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Normal function (Mouth Opening)
you will open mouth ___ mm and will have absence of ___? |
Opening: 35 - 50mm
Absence of : joint sounds mandible deviation pain |
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Closing muscles include?
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Masseter
Temporalis Medial Lateral Pt Superior head of Lateral Pt |
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The disc is rotated posteriorly on the condyle as the condyle translated our of the fossa describes?
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Mouth opening movement
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The disc is rotated anteriorly on the condyle as the condyle translated into the fossa describes?
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Mouth closing movement
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Possible causes for deviation to the right
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R SH lateral Pterygoid
L medial ptyergoid L IH lateral pterygoid R Masseter |
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In deviation to the right, which condyle translates forward and which rotates?
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Right condyle: rotation
Left condyle: translation |
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Cranial verve V
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Trigeminal nerve
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Trigeminal nerve is composed of?
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Opthalmic (V1)
Maxillary (V2) Mandibular (V3) |
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Mandibular nerve branches into
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Inferior alveolar (tooth)
Auriculotemporal (TMJ) Masseteric Deep Temporal Medial and Lateral Pterygoids |
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The main disorders of the craniocervical-mandibular system
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TMD (TM Disorders) Part of orofacial pain
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TMD (Definition)
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Musculoskeletal disorder including a number of problems involving the masticatory muscles, TMJ and associated structures
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Signs and Symptoms of TMD
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Manifest with one or more of the following:
Pain in the TMJ Limitation of the madibular movements Headaches Sounds in the TMJ during mandibular function Otalgia (ear pain) Fatigue of the masticatory, cervical or scapular muscles |
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TMD (Etiology)
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Multifactorial...
Nueromuscular factors (bad posture and bruxism)...Anatomical factors (dental occlusion)...and Psychological factors (stress) |
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TMD (Epidemiology)
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20 million adults affected in US
3.6 - 7% need treatment 50% have at least 1 S/S of TMD More in females (2 or 3:1) |
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TMD (Diagnosis)
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CLINICAL interdisciplinary evaluation and additional exam such as EMG, radiographs, MRI, etc
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TMD Classifications
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TMD arthrogenous (TMJ)
TMD myogenous (Masticatory muscles) TMD mixed (Arthrogenous and myogenous) |
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TMD Arthrogenous include:
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Disc Displacement with reduction
Disc Displacement w/o reduction Inflammation Hypermobility Fibrous adhesions (capsular-lig) Osteoarthritis |
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Disc displacement with reduction (Etiology)
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Trauma:
Macrotrauma (blow in the jaw) Microtrauma (repetitive forces such as bruxism, hyperactivity) |
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Disc displacement with reduction
(Signs and Symptoms) |
Pain may be present (If pain present its associated with the dysfunction)...
Normal ROM if not limited by pain |
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Disc displacement with reduction
Opening (ROM): Presence of: |
Opening: Normal range
Presence of: Joint sounds Mandible deviation Pain (may be present) |
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Disc displacement with reduction...Describe it (whats elongated? Location of structures? etc)
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Elongation of the inferior retrodiscal lamina and discal collateral ligament (disc in an anterior position - dislocated)...Superior head of lateral pterygoid pull the disc forward...condyle resting on a more posterior portion of the disc or retrodiscal tissues...Click (single or reciprocal) which indictaed disc is reduced (back to normal)
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When you hear a click the movement is
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Corrected
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Treatment of disc displacement with reduction
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Re-establish the normal condyle-disc relationship
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Should we treat an asymptomatic joint with clicking?
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Only joint sounds associated with pain should be considered for treatment
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Disc displacement with reduction...the disc is in the _____ position during resting when it should be in a ____ position
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disc is in the anterior position when it should be posterior
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Disc displacement with reduction the disc ___
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the disc goes back (when disc is reduced there will be clicking)
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True or False...Painless joint that may still clicks is a treatment failure
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False
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Neck pain was shown to be present in about ____ of TMD patients
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70%
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Neck and shoulder pain is more frequent w/ TMD patients with a ____ involvement
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Muscular
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Cervical spine is a predisposing and precipitating variable to...
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masticatory muscle pain or bruxism
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Pain distribution (referred pain patterns) includes....
(Cervical spine) |
Not only the trigeminal (V1-V3) but C2-C4 dermatomes
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Typical Vertebrae contains
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Body (Weight bearing)
Vertebral Arch Pedicles Laminae Vertebral foramen Transverse Processes (2) Spinous Process (1) Articular Process (4) Vertebral notches |
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Unique characteristics of cervical vertebrae
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Smallest, Lightest
Most flexible Triangular vertebral foramen Transverse processes have foramen (transverse foramen) Spinour processes bifid (forked) except C7 |
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Cervical spinous processes are all bifid (forked) except?
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C7
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How many cervical vertebrae
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7
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How many thoracic vertebrae?
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12 (T1-T12)
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Unique features of thoracic vertebrae
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Heart shaped body
Costal facets Round/oval vertebral foramen Form the posterior part of rib cage Larger/Stronger bodies Longer processes Demifacets for ribs (T1-T10) |
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How many lumbar vertebrae
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5 (L1-L5)
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Unique features of lumbar vertebrae
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Massive block-like bodies
Short, thick spinous processes (attachment site for back musculature) Limited mobility |
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Axial skeleton includes?
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Skull
Vertebral column Thoracic cage |
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Difference in vertebral column in fetus/infants compared to adults
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Infants/Fetus have 33 separate vertebrae...Adults have 24 with the inferior 9 fusing and forming the sacrum (5) and coccyx (4)
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Which vertebrae have a lordotic curvature?
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cervical and lumbar
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Which vertebrae have a kyphosis curvature
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thoracic and sacral
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What are some non-bony parts to the vertebral column
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Intervertebral discs
Ligaments such as ALL, PLL, Ligamentum flavum, Interspinous and supraspinous ligaments |
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Which ligament prevents hyperextension?
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Anterior Longitudinal Ligament
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Anterior Longitudinal Ligament
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Wide, Strong
Attaches to vertebrae as well as discs Prevents hyperlordosis |
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Posterior Longitudinal Ligament
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Narrow and relatively weak
Attaches only to discs Prevents excessive flexion |
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Vertebral foramen
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The opening formed by a neural arch through which the spinal cord passes
Vertebral foramen is the foramen (opening) formed by the anterior segment (the body), and the posterior part, the vertebral arch. |
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Intervertebral foramen
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The intervertebral foramen is an opening made by two adjacent, stacked vertebrae...Spinal nerves go through this space
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True Ribs
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Ribs 1-7
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Ribs 8-12
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False Ribs
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Floating Ribs
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Ribs 11-12
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Sternum consists of?
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Manubrium
Body Xiphoid process |
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Which vertebrae have costal facets?
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Thoracic
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Typical Rib's Anatomy
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Facets for vertebral articulation
Head Neck Shaft Tubercle facets Costal angle Costal groove |
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When viewed from the side the cervical vertebrae are _____ posteriorly
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Concave (Lordosis)
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When viewed from the side the Lumbar vertebrae are _____ posteriorly
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Concave (Lordosis)
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When viewed from the side the thoracic vertebrae are _____ posteriorly
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convex (Kyphosis)
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When viewed from the side the sacral vertebrae are _____ posteriorly
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Convex (Kyphosis)
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More than 10 degrees of lateral curvature = ______
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Scolisis
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2 vertebral notches together = ______
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Intervertebral foramen
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All vertebral foramen together = _______
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Spinal Canal
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Vertebral column (Functions)
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Is the axis of the human body
Functions: Protect the spinal cord and the nerve roots that emerge from it...Sustain the viscera that are fastened to it...Provide support and movement to the head and the shoulder girdle |
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a bundle of nerves occupying the spinal column below the spinal cord
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Cauda Equina
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Spinal cord typically ends at what level?
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L1-L2
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Each ____ is responsbile for either the movement of a specific muscle(s) (myotome) or the sensation from the skin for a specific region (dermatome)
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Nerve
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Which ligament forms a long fibrous network from the anterior tubercle of the atlas to the sacrum
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Anterior Longitudinal Ligament
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Which ligament is firmly adherent to the vert disc?
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Posterior Longitudinal Ligament
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PLL is strong in the _____ and weakest at the ____ levels
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Strongest = thoracic spine
Weakest = lumbar |
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What connects the contiguous spinous processes?
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Interspinous Ligament
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Composed of two halves that meet in the midline, adjoining the vertebral laminae and thus closing the vertebral canal
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Ligamentum Flavum
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Connects the transverse process to the fifth lumbar vertebra to the ilium
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Iliolumbar ligament
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False ligaments consist of?
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Intertransverse ligaments, transforaminal ligaments
Mamilo-accessory ligaments |
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The 12 vertebral bosies in the upper back make up the ____
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Thoracic spine
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Motility of thoracic is ____ than that of the cervical and lumbar spines
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Less than
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What is the one of the most unique featurs of the thoracic spine?
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Its vertebrae attaches to a pair or ribs
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Functions of the intervertebal discs
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Spacers to provide clearance for exiting spinal nerves...
Connectors to link adjacent vertebrae together and allow movement... Shock absorbers |
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Which discs are less likely to become injured? Why?
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Thoracic spine discs less likely because od the rib articulations made by the vertebrae which significantly increases the stability of the thoracic spine
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Thoracic facet joints allow considerable amount of what movement? They become injured with excessive amounts of what movement?
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Allow: Flexion/Extension
Injured: Rotation and extention |
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Thoracic spinal nerve roots exit openings formed between adjacent thoracic vertebrae termed?
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Intervertebral foramina (IVF)
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Spinal nerves of the thoracic spine innervate?
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Many muscles of the back as well as the many visceral organs and tissues of the chest and abdominal regions
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Each radicular artery gives rise to ?
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An intercostal or a lumbar artery
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Prior to entering the intervertebral foramen, each artery subdivides into three tributaries...What does each tributary do?
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One supplies the spinal nerve
One penetrates the vertebral bosy and the one below One supplies the posterior arch and the most medial paravertebral muscles |
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Two ascending plexiform cords, converging in the interpedicular space and united by a transverse anastomotic vein
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Intraspinal Venous Plexus
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Located along the anterior and lateral aspect of the vertebral body and on the posterior aspect of the posterior neural arch
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Perispinal Venous Plexus
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Dorsal rami innervate?
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Back muscles and zygapophyseal joints
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Ventral rami innervate
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Psoas Major and Quadratus lumborum
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Sympathetic Trunks
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Extensive plexuses accompanying the longitudinal ligaments
Nerves enter the outer third of the annulus fibrosus |
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Sinuvertebral Nerves
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Short branches innervate the vertebral periosteum
Long branches enter the vertebral body from all aspects of the circumference Nerves enter the outer third of the annulus fibrosus The posterior plexus innervates the dura mater and nerve root sleeves along anterior and lateral aspects |
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Scheuermann’s kyphosis
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The wedging of vertebrae in Scheuermann’s kyphosis is most common in the thoracic spine (upper back), with the apex of the curve typically between the T7 and T9 levels of the spine. Although less common, Scheuermann’s kyphosis may also occur in the junction between the thoracic and lumbar spine (thoracolumbar spine) or in the lumbar spine (lower back).
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Cause of Scheuermann's
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The cause of Scheuermann's disease is unknown, but is thought to be due to a growth abnormality of the vertebral body. The growth plate anteriorly (in the front) stops growing but the posterior part of the growth plate continues to grow. This is due to a condition known as osteochondrosis.
Scheuermann’s disease does not spread and is not really a “disease” but a condition that can arise during growth. It is more common in males and appears in adolescents usually towards the end of their growth spurt. |
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Treatment of Scheuermann's disease
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The treatment of Scheuermann's disease depends upon the degree of kyphosis, the age of the patient and the levels of the spine which are affected.
Early diagnosis is key in optimally treating this type of kyphosis. In a skeletally immature patients (still growing) treatment for significant deformity is directed at bracing. A custom brace is made and worn by the patient 23 hours a day during remaining growth (until skeletal maturity) in order to assist remodeling and corrected growth of the spine. Once an adolescent has stopped growing, or in older adults, bracing is no longer an effective option in correcting abnormal curvature. Treatment at that point is directed toward symptoms such as pain, fatigue, weakness and possible neurologic problems due to spinal stenosis or disc herniations. In mild cases physical therapy, strengthening exercises, pain modalities and medication/bracing may help. Congenital kyphosis requires corrective surgery at an early age. Scheuermann's disease is initially treated with a |
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The aims of history taking are?
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Determine the stage of the disorder
Establish functional limitations and the patient’s response to them Identify red flags or contraindications Severity of the problem which will guide the physical examination Determine baseline measurements Propose a provisional classification |
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History Tips
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As a general rule, patients whose symptoms are of recent onset will provide information more accurately.
The more chronic the condition, the more difficult it is to obtain accurate information. The repetition and re-phrasing of the of questions can be very important. Draw-out the information without biasing patient’s response. Gather only essential information, know the reason behind every question you ask. Always remain neutral Do NOT ask leading questions You must understand the reason for each question you ask. How will the next answer contribute to the clinical picture? Be ready with follow up questions. Ask the patient to justify his/her answer (why do you think you are improving?) Don’t hesitate to come back to a question that has not been fully answered. Remember to establish baselines (symptomatic, mechanical, e.g: pain and stiffness on sit to stand, in am, after bending) |
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Complete history (Magee)
|
Age and sex?
Occupation? Why has the patient come for help (c/c), functional complaint? Mechanism of injury? (Macro vs. Micro trauma)? Was the onset slow or sudden? Where are you hurting? Anywhere else? Where were the symptoms initially? (Centr / periph) What activities produce the pain (Can you turn it on? – don’t move them yet!) How long? (A/ SA / C) Has the condition occurred before? What did you do for it? Are the intensity, duration, frequency of symptoms increasing? Constant / intermittent ? Is the pain associated with rest / activity / certain postures? / time of day? What type or quality of pain (Nerve, Bone, Vascular, Muscular, Joint, visceral? What type of sensation does the patient feels and where are these abnormal sensations? Does the joint exhibit locking, unlocking, twinges, instability, or giving way? Spinal cord symptoms? Drop attacks? Fainting? Saddle anesthesia? Bladder function? Any changes in color of limb? Psychological stress? Does the patient have any chronic or serious systemic i |
|
|
Principles of Examination
(pg. 16 Magee) |
Tell the patient what you are doing
Test normal (uninvolved) side first Do active movements first then passive movements then resisted isometric movements. Do painful movements last (depends) Apply overpressure with care to test end feel. Repeat movements or sustain certain postures or positions if history indicates. Do resisted isometric movements |
|
|
Red Flag include
|
Severe, unremitting pain
Pain unaffected by medication or position Severe night pain Severe pain with no history of injury Severe spasm Inability to urinate or hold urine Elevated temprature (especially prolonged) Psychological overlay |
|
|
History for the thoracic spine
|
Age and occupation? (Schermann’s disease occurs between 13-16 years, Idiopathic scoliosis commonly seen in adolescent females)
What was the mechanism of injury? (Most commonly rib injuries are caused by trauma, pain from thoracic spine injury tends to be localized to the area of injury) What are the sites and boundaries of the pain? Have the patient point to location/s, is there any radiating pain? (Stomach, liver, pancreas, Thoracic root involvement often causes chest pain that follows the path of the ribs or a deep “through-the-chest” pain. Does the pain occur on inspiration? Expiration or both? (If breathing problem exist – it may be caused by structural deformity (scoliosis), thoracic trauma such as disc lesion, fractures, contusion, pneumothorax, pleurisy, tumors, pericarditis) Is the pain deep, superficial, shooting, burning or aching? (Symptoms above line joining the inferior angle of the scapula are considered cervical until proven otherwise). Is the pain affected by coughing sneezing or str |
|
|
Observation
|
When do you start your observation?
Normal standing posture Is there a correlation between the posture and the pathology presented? Note movement, manner, attitude, willingness to cooperate, signs of overt pain behavior (guarding, abnormally stiff, bracing, rubbing, facial expressions, sighing.) Observe gait (Trendelenburg sign, drop foot, shift). Alignment in general, Structural deformities (stay at rest), Functional deformities (scoliosis, flat foot may change when off loaded). Muscle wasting? Color, temperature of the skin. Does appearance of skin differ in area of pain? (Ecchymosis or bruising, trophic changes on skin – loss of skin elasticity, shiny skin, hair loss on skin – all are signs of peripheral nerve lesion.), Cyanosis vs redness. Crepitus, snapping, abnormal sounds? What attitude does the patient have towards their condition or toward you? |
|
|
When to use scanning examination?
|
When there is no history of trauma
There are radicular signs Trauma WITH radicular signs Altered sensation in the limb Spinal cord signs Patient presents with abnormal patterns Suspected psychogenic pain |
|
|
Page 19 Magee
|
History
Observation Movements Scanning Exam (Movements, Peripheral Joint Scan, Myotomes, Sensory scan, Reflexes) Functional Assessment Special Tests Joint Play Palpations Imaging |
|
|
Shape of vertebral bodies and discs determine _____
|
Thoracic kyphosis
|
|
|
For TRUE thoracic ROM you must
|
Stabilize the pelvis (short sit)
|
|
|
With age, thoracic kyphosis increases or decreases?
|
Increases
|
|
|
High disc pressures leads to
|
Disc hernication into vertebral bodies (Schmorl's nodes)
|
|
|
True/False. You must rule out cervical spine first?
|
True
|
|
|
Movements in checking the cervical spine
|
Protrusion/Retraction
Flexion/Extension Rotation (Left/Right) Lateral Flexion (Left/Right) |
|
|
Most pains above inferior angle of scapule (T9/T10) is of what origin?
|
Cervicogenic (of cervical origin)
|
|
|
Most pains inferior angle to L1 is of what origin?
|
Thoracic spine
|
|
|
Slouch Overcorrect
|
20 Reps X 5 sets a day
Move from slouched posture to a perfect erect posture...After 20 reps, relax from 100% to 90% to take the strain off...Always correct posture to see if any effect on symptoms Performing without back support best (easier to reproduce the patient's complaints) |
|
|
True/False. You can lose lumbar lordosis
|
False. It is something you can never lose
|
|
|
Most back pain are of ____ origin
|
Mechanical or non-organic (meaning that they are not caused by serious conditions such as inflammatory arthritis, infection, cancer, fx
|
|
|
Back pain is the ____ most common reason for Dr. visits, outnumbered only by ____
|
Second most:
Outnumbered by upper-respiratory infections |
|
|
How can you eliminate cervical lordosis?
|
By pertrusion
|
|
|
Name the different types of pains
|
Somatic (involves musculoskeletal structures)
Radicular (Nerve root pain) Central (Abnormalities in CNS) Visceral (From Organs) |
|
|
This type of pain is deep and aching in quality, vague/hard to localize. The stronger the noxious stimulus the further pain spreads down the leg
|
Somatic
|
|
|
If you walk and sprain your ankle you will feel ____ pain
|
Chemical Pain
|
|
|
Cardinal signs of chemical pain
|
Swelling
Redness Heat Tenderness |
|
|
Chemical Pain (Characteristics)
|
Constant pain
Recent onset Cardinal signs - swelling, redness, heat, tenderness Lasting aggravation of pain by movement No movement abolishes or centralizes pain |
|
|
Nociceptors are activated by what three mechanisms?
|
Thermal
Chemical Mechanical |
|
|
How can you activate pain?
|
You can heat it up (Thermal)
Move it and it will hurt, stop moving stops hurting (mechanical) and chemical |
|
|
Mechanical Pain (Characteristics)
|
May be constant or intermittent
Movement in one direction may cause centralization or a lasting improvement in pain Movement in other directions may cause worsening of symptons Mechanics will improve with the symptoms (ex: getting out of car you are stiff, you straighten and walk and the stiffness goes away) |
|
|
The progressive retreat of the most distal extent of referred or radicular pain toward the lumbar midline
|
Centralization
|
|
|
The progressive advance of the most proximal extent of referred or radicular pain toward the periphery
|
Peripheralization
|
|
|
Centralization vs Peripheralization
|
Centralization implies the pain is moving toward or is centered in the lumbar spine
Peripheralization implies the pain is being referred or moving into the limb |
|
|
This type of pain may be influenced by non-mechanical factors...still should receive mechanical assessment...many will respond normally...response may be more gradual
|
Chronic pain
|
|
|
Key factors in chemical pain
|
Constant
Recent onset (Trauma or possibly insidious) Lasting aggravation of pain with all movements No movement found which abolishes or centralizes the pain |
|
|
Key factors in mechanical pain
|
Constant or intermittent pain...
BUT... Certain repeated movements cause a lasting reduction, abolition or centralization of pain Movements in one direction may worsen symptoms, whereas movements in the other direction will improve them (directional preference) The mechanical presentation will improve along with symptoms (getting out of car stiff example) |
|
|
Stages of Healing
|
Inflammation stage: 0-4/7 days (about one week)
Repair stage: From first few days to 3 weeks Remodeling Stage: 3-4 weeks onward |
|
|
During onset and first week (Injury and Inflammation) you/patient must
|
Protect from further damage
Prevent excessive inflammation Reduce Swelling |
|
|
During Week 2 - 4 (Repair and Healing) you/patient must
|
Gentle tension and loading
Progressive return to normal loads and tension |
|
|
During week 5 and onwards (Remodeling) you/patient must
|
Prevent contractures
Full range movement Increase strength and flexibility |
|
|
Based on studies, the predominant source of back pain is due to?
|
Disc
|
|
|
Based on studies, the predominant source of sciatica is due to?
|
Nerve compression
|
|
|
Where can pain in your back come from?
|
From 14 different areas such as:
Vertebrae Ligaments Muscles Discs Nerves |
|
|
Sideways curvature of the thoracic spine indicates?.
|
Scoliosis
|
|
|
Contralateral shift exists when...
|
The patient's symptoms are on one side and the shift is in the opposite direction. For ex: right back pain with or without thigh/leg pain, the upper trunk and shoulders displaced to the left (shift left)
|
|
|
Ipsilateral shift exists when...
|
The patient's symptoms are on one side and the shift is to the same side. For ex: right back pain, with or without thigh/leg pain, upper trunk and shoulders displaced to the right (shift right)
|
|
|
Which shift (contra or ipsi) is easier to fix?
|
Contralateral
|
|
|
When talking shifts (stating which way the shift is going) always go with
|
Upper body...Left lateral shift, the upper body is to the left
|
|
|
The phenomenon that "Mr. Smith" experienced of pain moving to the center of the spine as a result of lying in a certain position is called?
|
Centralization
|
|
|
Characteristics of Centralization
|
Refers to the abolition of peripheral or radiating pain in response to therapeutic loading strategies
Is usually a rapid change in pain Is always a lasting change in pain Occurs in acute and chronic patients Often occurs in patients with obstruction to movement Occurs most commonly with extension Occurs with end-range repeated movements or postural correction Occurs less commonly with lateral movements or flexion Is accompanied by improvements in mechanical presentation Indicates directional preference Indicates good prognosis Can be reliably assessed Failure to achieve indicates poor prognosis Only occurs in derangement syndrome Occurs with the reduction of the derangement |
|
|
Characteristics of Peripheralization
|
Only occurs in derangement syndrome
Lasting production and/or worsening of distal symptoms Occurs in response to loading strategies |
|
|
What comes before pain?
|
Stiffness
|
|
|
Where does the nucleus pulposa leak through?
|
A fissure
|
|
|
Which way will disc move if patient is lying prone in a hammock shape?
|
Anterior
|
|
|
What type of pain is a disc herniation?
|
Chemical Pain
|
|
|
Displaced nuclear disc material mechanically stimulating the pain sensitive annulus or nerve root causes?
|
Referred/radiating pain
|
|
|
As long as the annulus and the hydrostatic mechanism of the disc are intact, repeated end range loading of the spine (repeated movements) can...
|
Return the displaced nuclear material, thus centralizing and reducing pain
|
|
|
How can the displaced nuclear material return and centralize/reduce pain?
|
With repeated end range loading of the spine...As long as the annulus and hydrostatic mechanism of the disc are intact
|
|
|
If no directed movements centralize the pain and if multiple movements result in peripheralization of the pain, it is theorized that...
|
the annulus us torn and the hydrostatic mechanism of the disc is no longer functioning
|
|
|
Bending forward (Flexing) squeezes the nucles pulposa?
|
Backwards
|
|
|
Bending backwards (Extension) squeezes the nucleus?
|
Forward
|
|
|
What activities cause high percentage of load on L3 disc? Which cause least?
|
High: lifting wrong (1), forward bending with 20gk in hands (2) Lifting right (3) Situps (4)
Least: Lying (1) Standing (2) Walking (3) |
|
|
If patient cannot walk on their toes which nerve root is affected? Disk?
|
S1 nerve root...L5-S1 disk
|
|
|
If patient cannot extend big toe which nerve root is affected?
|
L5 nerve root...L4-L5 disk
|
|
|
If patient can't dorsiflex which nerve root is affected? disc?
|
L4 nerve root...L3-L4 disk
|
|
|
What is Discectomy?
|
Surgical procedure in which a disk bulge or herniation is excised causing relief of the compressed nerve root
|
|
|
Disc herniation may be due to?
|
Aging
Some type of trauma |
|
|
What is the purpose of a discectomy?
|
To relieve pressure placed on a nerve root by a herniated disk
|
|
|
What are some reasons one should consider a discectomy
|
Severe sciatica
Failed conservative treatment Severe leg and back pain that increases over time Bladder problems |
|
|
Discectomies can occur in what part of your body/spine?
|
In the cervical, thoracic, lumbar
|
|
|
Name the types of discectomies
|
Open (Traditional)
Microscopic Laser |
|
|
Discectomy (Contraindications)
|
Lack of conservative Tx preoperatively (need to always exhaust other options before surgery)
Diseases or co-morbidities Lack of clear clinical diagnosis, anatomical level of lesion, and radiograph evidence Disc herniation at a level of instability |
|
|
Complications associated with discectomy
|
Recurrent disc prolapse
Nerve scarring (scar tissue always forms in area of discetomy) Back pain Nerve damage Paralysis Bleeding/Hematoma Infection Dural tear Blood clots Wrong level of spinal cord |
|
|
Bone forming the roof of the spinal canal
|
Lamina
|
|
|
A laminectomy can be performed in the? (areas)
|
Cervical spine
Thoracic spine Lumbar spine |
|
|
What is the purpose of a laminectomy?
|
Removes pressure on the spinal cord or nerve roots by either partial or complete removal of the lamina
|
|
|
Reasons for getting a laminectomy
|
Herniated disc
Spinal stenosis Removal of a metastatic tumor Anklyosing spondylitis Sciatica Spondylosis |
|
|
Indications for Laminectomy
|
Neurogenic claudication, radicular leg pain, or both
Failure of 6 to 12 weeks of conservative treatment Neurologic deterioration Bladder or bowel changes, or both Worsening leg symptoms |
|
|
Contraindications for Laminectomy
|
Patients not medically stable to undergo general anesthesia
Back pain without leg symptoms No evidence of stenosis on imaging studies Active systemic infection or local skin disease |
|
|
Complications for Laminectomy
|
Bleeding
Infection Blood clots Nerve root damage or bowel/bladder incontinence Spinal fluid leak Dural tear DVT |
|
|
This surgery is designed to join two or more vertebrates in the spine permanently
|
Spinal Fusion Surgery
|
|
|
Indication for Spinal Fusion
|
Spinal stenosis (can be bony or tissue; true bony stenosis cant be fixed)
Injury or fractures Weak/unstable spine caused by tumors or infections Spondylolisthesis Abnormal curvatures |
|
|
Side effects of spinal fusion surgery
|
Pain at the bone graft site.
Breathing problems. Blood clots: Can lead to pulmonary embolism. Heart attack. Stroke. Infection: Lungs, bladder or kidney. Graft rejection. Nerve injury. |
|
|
Difference between a laminotomy and laminectomy?
|
Laminotomy - a part of the lamina is removed
Laminectomy - the entire lamina is removed |
|
|
Foraminotomy vs Foraminectomy
|
Foraminotomy - Removal of small amount of bone and tissue to expand the nerve root openings
Foraminectomy - Removal of large amount of bone and tissue |
|
|
Risks associated with spinal decompression surgery
|
Infection
Bleeding Blood clots Nerve/Tissue damage Allergic reaction to anesthia |
|
|
Can fissures heal?
|
Yes. they require time, scar tissue, and specific positions and exercises (done every 1-2 hours)
|
|
|
Cauda Equina Syndrome
|
Back pain, lower limb weakness, saddle anaesthesia, sphincter disturbance, impotence
Causes – usually disc, rarely tumour, abscess, advanced AS Diminished sensation L4 to S2 (sacral numbness), weakness ankle and plantar dorsiflexion, loss ankle jerks, urinary retention, loss anal tone Urgent MRI and surgical decompression |
|
|
Night sweating and no change in position will alleviate pain are symptoms of?
|
Cancer
|
|
|
What are some unsafe movements/positions for ppl with osteoporosis?
|
Slumped posture
Forward Head Posture Twisting at the spine to a pt of strain Twisting and Bending at the waist Reaching far |
|
|
Exercises that should be avoided for pt with osteoporosis
|
Sit-ups
Crunches Toe-Touches Sports: Yoga, Pilates, Golf (need to be modified) |
|
|
Proper sitting posture (Osteoporosis)
|
Hips & Knees aligned
Feet flat on the floor Use legs to help you out of the chair When driving use head rest |
|
|
Proper form: Pushing & Pulling
(Osteoporosis) |
Keep feet apart and one foot in front of the other
Shift weight from foot to foot Keep knees bent & shoulder blades pinched |
|
|
Proper way to cough and sneeze
(Osteoporosis) |
Support your back with at least one hand (Place hand behind or on your thigh)
DO NOT FLEX Stand up to sneeze If seated extend back before sneezing |
|
|
Proper way of Getting in & out of bed (Osteoporosis)
|
First sit on the side of the bed
Lean towards the head of the bed while supporting your body with both hands Lie on your side to bring your feet to the bed at the same time Then roll on to your back with the knees and arms in front of you DO NOT: lift your head and upper back to move in bed |
|
|
Name the four problems that can result for an injury to the disc
|
Protrusion
Prolapse Extrusion Sequestration |
|
|
Disc bulges posteriorly without rupture of the annulus fibrosus
|
Protrusion
|
|
|
Only the outermost fibers of the annulus fibrosus contain the nucleus
|
Prolapse (Disc)
|
|
|
The annulus fibrosus is perforated, and discal material (part of the nucleus pulposus) moves into the epidural space
|
Extrusion
|
|
|
Formation of discal fragments from the annulus fibrosus and nucleus pulposus outside the disc proper
|
Sequestration (Disc)
|
|
|
The exiting nerve root takes the name of the vertebral body ____ which it travels into the neural foramen
|
Under...Ex: L4-L5, nerve root L5
|
|
|
What anatomical structure is key to proper back posture?
|
Pelvis
|
|
|
Herniation of the disc between L4 and L5 compresses which nerve root?
|
L5
|
|
|
Muscles that flex lumbar spine
|
Psoas Major
Rectus abd external abd oblique Internal abd oblique Transverse abd |
|
|
Muscles that extend lumbar spine
|
Lats Dorsi
erector spinae Iliocostalis lumborum Longissimus thoacis transversospinalis interspinales quadratus lumborum multifidus rotatores glut max |
|
|
Muscles that side flex lumbar spine
|
Lat Dorsi
Erector spinae Transversalis Intertransversarii Quadratus lumborum Psoas Major |
|
|
Muscles that rotate lumbar spine
|
Transversalis
Rotatores Multifudus |
|
|
Isometric Abdominal Test
|
Normal (5) = Hands behind neck, until scapulae clear table (hold 20-30 seconds)
Good (4) = Arms crossed over sheet, until scapulae clear table (15-20 sec hold) Fair (3) = Arms straight, until scapulae clear table (10-15 sec) Poor (2) = Arms extended, towards knees, until top of scapulae lift from table (1-10 sec) Trace (1) = unable to rise more than head off table |
|
|
Isometric Extensor Test
|
Normal (5) = With hands clasped behind the head, extends the lumbar spine, lifting the head/chest/ribs from the floor (20-30 sec hold)
Good (4) = With hands at the side, extends the lumbar spine, leifting head/chest/ribs from the floor (15-20 sec hold) Fair (3) = With hands at the side, extends lumbar spine, lifting the sternum off the floor (10-15 sec) Poor (2) = With hands at the side, extends lumbar spine, lifting head off the floor (1-10sec) Trace (1) = Only slight contraction of the muscle with movement |
|
|
Horizontal Side Support Test (Side Bridge)
|
Normal (5) = Able to lift pelvis off examining table and hold spine straight (10-20 sec hold)
Good (4) = Able to lift pelvis off examining table but has difficulty holding spine straight (5-10 sec) Fair (3) = Able to lift pelvis off examining table and can't hold spine straight (<5 sec hold) Poor (2) = Unable to lift pelvis off examining table |
|
|
Myotomes of the Lumbar and Sacral Spines
|
L2 - Hip flexion
L3 - Knee Ext L4 - Dorsiflexion L5 - Great toe ext S1 - Plantar flexion, eversion, hip extension S2 - Knee Flexion |
|
|
Tests for malingering
|
Hoover Test
Burns Test |
|
|
Reflexes of the Lumbar Spine
|
Patellar (L3-L4)
Posterior Tibial (L4-L5) Medial Hammy (L5-S1) Lateral Hammy (S1-S2) Achillies (S1-S2) |
|
|
What bony landmark is used to locate L4-L5 joint interspace
|
Palpate Top of iliac crest and go medially
|
|
|
Scottie dog decapitated =
|
Spondylolisthesis
|
|
|
Scottie dog with collar =
|
Spondylolysis
|
|
|
Root: L1
Dermatome: Muscle Weakness: Reflexes/Special Tests Affected: |
Root: L1
Dermatome: Back, over trochanter, groin Muscle Weakness: None Reflexes/Special Tests Affected:None |
|
|
Root: L2
Dermatome: Muscle Weakness: Reflexes/Special Tests Affected: |
Root: L2
Dermatome:Back, front of thigh to knee Muscle Weakness: Psoas, hip adductors Reflexes/Special Tests Affected: None |
|
|
Root: L3
Dermatome: Muscle Weakness: Reflexes/Special Tests Affected: |
Root: L3
Dermatome: Back, upper butt, front of thigh and knee, medial lower leg Muscle Weakness: Psoas, Quad Reflexes/Special Tests Affected: Knee jerk sluggish, PKB, positive pain on full SLR |
|
|
Root: L4
Dermatome: Muscle Weakness: Reflexes/Special Tests Affected: |
Root: L4
Dermatome: Inner butt, outer thigh, inside of leg, dorsum of foot, big toe Muscle Weakness: Tibialis anterior, ext. hallucis Reflexes/Special Tests Affected: SLR limited, neck-flexion pain, weak knee jerk, side flexion limited |
|
|
Root: L5
Dermatome: Muscle Weakness: Reflexes/Special Tests Affected: |
Root: L5
Dermatome: Buttock, back and side of thigh, lateral aspect of leg, dorsum of foot, inner half of sole and 1-3 toes Muscle Weakness: Ext. hallucis, peroneals, glut medius, ankle dorsiflex, hammy Reflexes/Special Tests Affected: |
|
|
Root: S1
Dermatome: Muscle Weakness: Reflexes/Special Tests Affected: |
Root: S1
Dermatome: Buttock, back of thigh, and lower leg Muscle Weakness: Calf and hammy, wasting of gluts, peroneal, plantar flexors Reflexes/Special Tests Affected: SLR limited |
|
|
Root: S2
Dermatome: Muscle Weakness: Reflexes/Special Tests Affected: |
Root: S2
Dermatome: Same as S1 Muscle Weakness: Same as S1 except peroneals Reflexes/Special Tests Affected: Same as S1 |
|
|
Root: S3
Dermatome: Muscle Weakness: Reflexes/Special Tests Affected: |
Root: S3
Dermatome:Groin, inner thigh to knee Muscle Weakness:None Reflexes/Special Tests Affected:None |
|
|
Root: S4
Dermatome: Muscle Weakness: Reflexes/Special Tests Affected: |
Root:S4
Dermatome: Perineum, genitals, lower sacrum Muscle Weakness: bladder, rectum Reflexes/Special Tests Affected: None |
|
|
PKB test presence of what lesion?
|
Upper lumbar lesion
|
|
|
Stage 1 TMD dysfunction
|
Disc slightly anterior and medial on mandibular condyle
Inconstitent click (may or may not be present) Mild or no pain |
|
|
Stage 2 TMD dysfunction
|
Disc anterior and medial
Reciprocal click present (early opening; late on closing) Severe consistent pain |
|
|
Stage 3 TMD dysfunction
|
Reciprocal consistent click present (later in opening; earlier in closing)
Most painful stage |
|
|
Stage 4 TMD dysfunction
|
Click rare (disc no longer relocates)
No pain |
|
|
The later the click in opening, the _____ the disc dislocation is
|
the more severe
|
|
|
What is the clinical importance of the referral pain?
|
Guide the clinician to locate the trigger points for a treatment plan
|
|
|
Cervical spine considerations:
Name the three theories |
Covergence between the trigeminal and the upper three cervical nerves
Synergic relationship between cervical spine masticatory Patients present bruxism in response of neck pain |
|
|
Pain distribution (referred pain patterns) invludes not only trigeminal but
|
C2-C4 dermatomes
|
|
|
How can you decrease intensity and duration of bruxism?
|
By reducing the activity of the cervical spine muslces
|
|
|
Masticatory muscles contract in response to the cervical muscle contraction, working together describes?
|
synergic relationship b/w cervical spine and masticatory muscles
|
|
|
Balance of the head and neck muscles is important in order to?
|
maintain proper head position and function
Craniocervical-mandibular system |
|
|
Cranio-cervical region's function
|
hold head against gravity
Position the head in space |
|
|
Clinically, you measure posture by ___
|
using landmarks
|
|
|
Bony landmarks include
|
Behind the coronal suture
Thru external auditory meatusThru the dens of the axis Thru cervical vert bodies Thru lumbar vert bodies Thru sacral promontory Behind the hip joint Anterior to the knee joint anterior to ankle joint thru calcanocuboid joint |
|
|
Major weight of the head and center of gravity is ____ to the occiptal condyles creating a _____ moment
|
Anterior
Flexion moment |
|
|
What supports the head against gravity
|
Anti-gravity muscles
Posterior cervical muscles (Contraction of subboccipital muscles) |
|
|
Craniocervical stability
Active stability created by? Passive stability? |
Active: posterior muscles
Passive: ligaments |
|
|
T/F
Posture is important for the craniocervical mandibular system |
True
|
|
|
What happens to the entire system if one muscle breaks?
|
THE BALANCE OF THE ENTIRE SYSTEM IS DISRUPTED AND THE HEAD POSTURE IS ALTERED
|
|
|
Name the 4 neuromuscular mechanisms
|
Vestibular
Ocular Proprioceptive Control of ventilation |
|
|
IF you are a mouth breather, describe where the hyoid bone is located and what alteration can be done to not have such difficulty breathing
|
Hyoid bone falls down and backwards in mouth breather thus decreasing the airway...With FHP hyoid bone moves up and forward thus restoring the air passage
|
|
|
Consequences of head/neck postural alterations
|
Increase effort to balance the head against the forces of gravity
Increase tension and stress in cervical structures (fighting against gravity) |
|
|
The most common postural impairment in the cervical spine
|
FHP
|
|
|
Consequences of FHP
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Facet joint compression...trigeminal nerve compressed...head/neck pain...(if occipital nerves also involved then cerviogenic headache)
2. Cervical muscle tension...elevation of first and second ribs...neurovascular compression causing hyper or hypoesthesia of the neck/shoulder 3. Masticatory system alteration...changes in the mandibular position (mandible displaced upward and backward)...stretch of lateral pterygoid which pulls TMJ disc forward...altering TMJ |
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FHP may ____ physiological freeway space during rest
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Decrease
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FHP can modify ____ and alter ___
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mandibular rest position and alter the closure contact
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T/F
Use of oral appliance with FHP patient is the best treatment option |
False. FHP can affect the mandibular position therefore interfere with the effect of the appliance...Head/neck posture ahouls be treated before or in combination with the use of the appliance
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Pain in the cervical spine and TM region can come from different disorders of the cervical spine such as
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disc disorders (hernia, degeneration)
nerve root compression/irritation Spinal cord myelopathy Facet joint dysfunction muscle spasm, pain |
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Where does cerviogenic headache originate from?
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Neck (cervical area)
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Characteristics of cervicogenic headache
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Originates from the neck
Predominatly unilateral Common after neck trauma Spread of pain to the occipital area, radiating to frontal, retro-orbital or temporal areas Accounts for 15-35% of headaches More prevalent in women |
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Cervicogenic headache pain is triggered by
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Neck movement or poor posture
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Occipital Neuralgia
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Tension on occipital muscles involving GON (Branch of C2)
Pain pattern: occipital region, top of skull, TMJ, and ear |
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Which are the atypical vertebrae of the cervical spine?
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C1 C2 C7
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Upper cervical spine includes what vertebrae
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C0-C2
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Occipital condyle are convex or concave?
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Convex
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Atlas is C_
Axis is C_ |
Atlas C1
Axis C2 |
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Is there a disc present in the upper cervical spine (C0-C2)
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No
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Which vertebrae has no vertebral body/spinous process
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C1 (Atlas)
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Function of Alar ligaments
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Limit rotation-flexion
Prevent C1-C2 distraction |
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Function of cruciform ligament of the atlas
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Transverse ligament (holds dens against anterior arch of atlas)
C1-C2 stability |
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Tectorial membrane function
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Limit rotation-flexion
Covers dens and ligaments |
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Tectorial membrane is a continuation of the _____ ligament
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Posterior longitudinal
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What are continuations of the ligamentum flavum
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posterior atlanto-occipital membrane
posterior atlantoaxial membrane |
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Ligamentum Nuchae resists
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Flexion
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In C0-C1 you will find ___ joints
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Atlanto-occipital
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During flexion: occipital condyles rotates ____ and slides ____
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Rotates forward and slides backward
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During extension: occipital condyles rotates ___ and slides ___
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Rotates backwards and slides forward
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C1 -C2 will find ___ joint
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Atlanto-axial joint
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In the atlanto-axial joint you will have how many degrees of rotation? flexion? extension? side flexion?
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Rotation - 50
Flexion/Ext/Side flexion: 10 |
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55-58% of total cervical spine rotation occurs at
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C1-C2
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Lower cervical spine include which vertebrae
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C3-C7
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uncinate process limits
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side flexion
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Superior Facet joint (cervical) face?
Inferior faces? |
Sup: face up, back, medially
Inf: down, anterior, laterally Prevent rotation or side flexion |
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Cervical spine allows ___ degrees of flexion? extension? lateral flexion and rotation? Rotation
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Flexion: 45-50
Ext: 85 Side flex & rotation: 40 Rotation: 70-90 |
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What ligament limits extension in vertebral area
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Anterior longitudinal ligament
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Which cervical spine segment has more flexion thus subjecting its disc to greater amounts of stress
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C5-C6
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Posterior muscles - cervical spine include
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trapezius
levator scapulae splenius semispinalis suboccipital |
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Upper trapezius
Origin/Insertion: Contraction Bilateral/Ipsi/Contra for the following movements: Ext/Latreal flex/Rotation |
Occiput-cervical spinous process-spine of scapula-acromium, lateral clavicle)
Ext: Bilaterally Side Flex: Ipisi Rotation: Contra |
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Levator scapulae
Origin/Insertion: Contraction Bilateral/Ipsi/Contra for the following movements: Lateral flex/Rotation |
Lateral Flex: Ipsi
Rotation: Ipsi |
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Splenius
Origin/Insertion: Contraction Bilateral/Ipsi/Contra for the following movements: Ext/Rotation |
Lower half of ligamentum nuchae and spinous processes of c7-t5. transverse processes of c3-c7 and base of skull
Ext: bilaterally Rotation: ipsi |
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semispinalis
Origin/Insertion: Contraction Bilateral/Ipsi/Contra for the following movements: Ext/Rotation |
Extension: bilaterally
Rotation: ipsi |
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Suboccipital
Origin/Insertion: Contraction Bilateral/Ipsi/Contra for the following movements: Ext/Lateral flex/Rotation |
Occipital ext: bilaterally
Rotation: ipsi Lateral flex: ipsi |
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Lateral neck muscle
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Scalene
Sternocleidomastoid |
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Scalene
Origin/Insertion: Contraction Bilateral/Ipsi/Contra for the following movements: Ext/Lateral flex/Rotation |
Anterior: 1st rib-transverse process of c3-c6
Flexion: bilaterally lateral flexion: ipsi Rotation: contra Middle: 1st rib- transverse c2-c7 Posterior: 2nd rib - transverse process c5-c7 Lateral flexion |
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FHP can be caused by weakness of
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deep neck flexors together with lower trap and rhomboids
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Sternocleidomastoid
Origin/Insertion: Contraction Bilateral/Ipsi/Contra for the following movements: Flex/Ext/Lateral flex/Rotation |
Manubrium and clavicle -mastoid process
Flexion: bilaterally Extension: bilaterally LF: ipsi Rotation: contra |
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Cervical spine common pathologies include
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Cervical disc herniation
Cervical Spondylosis Cervical myelopathy Cervical facet joint syndrome Whiplash |
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For which nerve root do radicular symptoms not go down the arm or above the nerve root injury (cervical spine)
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C4
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Postural muscle = tonic or phasic muscles? Reps should be?
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Postural muscles = tonic muscles (they work all day)...Reps should be higher than 10-15
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Phasic muscles =
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Prime movers (large muscles) Reps should be 10-15
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If it hurts when bring stretched its probably ____
If it hurts when being compressed its probably ____ |
stretch - muscle
compressed - joint |
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which segment is the most prevalent for elbow tendinosis/pain
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C6
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What is the most effective treatment of pain?
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Manual therapy with specific exercise and cortico-steroids
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What are the two reasons for muscle guarding>?
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nuerophysiological (nuerogenic) and vascular
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How do you fix vascular problem?
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High reps (exercise)
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How do you fix nuerophysiological (nuerogenic) problems?
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Manual therapy
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What are the three types of mobilizations?
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Non-thrust Grade 2 osscillations
Non-thrust Grade 4 Thrust manipulation |
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Non-thrust grade 2 oscillations is used for
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swelling and pain
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non-thrust grade 4 stimulate
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mechanoreceptors 1 and 2
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Thrust manipulation stimulate
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mechanoreceptor 3
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Which mobs do you always strat with? why?
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Grade 2 osscillations...b/c its the safest...you DO NOT hit an end point
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When do you use grade 4?
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When hypomobile
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What are some causes of stiffness?
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muscle guarding
pain tight capsule |
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If you have pain in your neck anwhere what muscle goes into guarding
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Scalenes
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