Opp 2 Miller- Cervical Injury

Front 1

Atypical cervical vertebrae

Back 1

C1 (and OA joint) SB and Rotation to OPPOSITE sides (Type 1)*

C2 ( and AA joint) R only
C7

Front 2

Typical cervical vertebrae

Back 2

C2-C7
TYpe 2, SB, R same side, F/E

Front 3

OA Joint vs AA Joint

Back 3

OA joint
Primarily Flexion / Extension
50% of Cervical Flexion / Extension
“YES” joint

AA joint
Primarily Rotation
50% of Cervical Rotation
“NO” joint
Alcoholics learn to say “NO” in AA

Front 4

Uncovertebral Joints

Back 4

“Joints of Luschka” C3-C7

Add stability to C-spine while allowing sidebending

Ipsilateral facets glide up and forward
Contralateral facets glide down and back (Type 2)

Prevent disc herniation

Must be engaged to test AA

Front 5

HOw do you to engage the Joints of Luschka?

Back 5

F the neck

Front 6

Rotation component?

will feel “firmer” when you press on the right pillar

Back 6

Right

Front 7

Sb component?

Sidebent ___ will feel “firmer” when you press on the LEFT articular pillar

Back 7

RIGHT

Front 8

Fryette’s Third Principle

Back 8

Initiating motion of a segment in any plane will modify movement of that segment in all other directions

Front 9

Press on the lateral surfaces of the articular pillars of C4.
It’s easier to press on the left side
Sidebending __

Back 9

left

Front 10

Press on the posterior surfaces of the articular pillars of C4.
It’s easier to press on the right side
Rotation =

Back 10

left

Front 11

Passive ROM Testing for OA

Back 11

Sideslipping of the OA is a result of the orientation of the occipital condyles articulating with the superior facets of C1

Front 12

Rotation of the AA is a result of the Atlas_________

Back 12

pivoting around the dens of the Axis

Front 13

Simply, AA dysfunction is a ____ lesion

Back 13

Rotation

Front 14

Lifting with the upper extremity transmits force to the cervical spine via…

Back 14

Trapezius Posterior
Scalenes Lateral
Strap mm Anterior

Front 15

3 sites of Neurovascular Compromise due to compression:

Back 15

Ant / Mid Scalenes
Clavicle / 1st Rib
Pec Minor / Upper Ribs
Compromise is detected by pain / paresthesias / weakness in the upper extremity

Front 16

List the Cervical Techniques

Back 16

Indirect Fascial
GENTLE Muscle Energy
Soft Tissue
HVLA
FPR
Cranial
Tx Upper Thoracics
Tx Scalenes, SCM, Longus Group

Front 17

Sympts suggesting serious neck and upper extremity pain

Back 17

HPI of trauma,
weight loss, fever, chills, HA, HPI of cancer, IV drug use, Chronic steroid use, Immunosupression, Neurologic signs and sympts (clumisiness, gait problem, bowel-bladder dysf, Babinski)

Front 18

Symptoms worse with eating or running? Think

Back 18

visceral

Front 19

Routine cervical spine evaluation includes the following:

Back 19

Observe movement and resting posture of the head and neck; estimate cervical ROM
Look for specific TART findings
Palpate the paraspinal and upper trapezial muscles
Evaluate for radicular neurological symptoms: reflexes, motor and sensory testing
Evaluate for upper motor neuron signs
Perform provocative maneuvers for radicular pain
Examine the shoulder for painful range of motion

Front 20

Suboccipital Triangle

Back 20

Inferior nuchal line+C1+C2

Front 21

Horner’s Syndrome

Back 21

Horner syndrome is a rare condition that affects the nerves to the eye and face.
Sympathetic Cervical Chain Ganglion compromise (one of many causes)

Sympathetic response cannot get to the pupillary constrictors to respond to changing in light conditions

Anisocoria = unequal pupil size
Notice pt’s ptosis from A-C

Front 22

Traumatic damage can be either _____________ or _____________

Back 22

Physical
Ischemic

Front 23

Why do we perform HVLA with the cervical spine in FLEXION???

Back 23

When you extend the occiput and rotate simultaneously, there’s a functional occlusion of the vertebral artery on the contralateral side
i.e. Extend, then rotate RIGHT….this occludes the LEFT vertebral artery

Front 24

Cervical Fractures' list***

Back 24

Jefferson Fracture
Odontoid Fractures
Hangman’s Fracture
Clay Shoveler’s Fracture
Burst Fracture

Front 25

Jefferson Fracture

Back 25

C1 fractures in multiple places with disruption of the Transverse Ligament. Similar to a “Burst” Fracture.

Likely cause: Axial Compression

Note how the lateral masses of C1 (arrows) are lateral to the lateral masses of C2 . 

Front 26

Odontoid Fractures

Back 26

Look for tilt of odontoid on Open-Mouth PA view

Likely Cause: Axial Compression

Type I : Superior Tip. This type of fracture is potentially unstable and relatively rare.

Type II : Base. It is the most common type of odontoid fracture. It is an unstable fracture.

Type III : Thru Base into Body of C2. It has the best prognosis.

Front 27

Hangman’s Fracture

Back 27

Spondylolisthesis of C2 due to a fracture through its pedicleLikely Cause: Hyperextension (i.e. hanging, chin hits dashboard in MVA)

FYI: Despite marked anterior displacement of C2 on C3, minimal or no spinal cord injury may result if the victim survives the initial injury.
Patients with hangman's fractures present with neck pain and often have no neurologic symptoms or signs.

Front 28

Clay Shoveler’s Fracture

Back 28

a.k.a. Cervical spinous process fracture
An avulsion fracture of the tip of the spinous process, most commonly involving C7.

Likely Cause: More commonly result of assault or motor vehicle accident, but classically due to vigorous labor and forceful contraction of the shoulder muscles

Note: Typically painful, yet stable (unless base of process is involved)

Front 29

Burst Fracture

Back 29

Occurs C3-C7. Injury to spinal cord, secondary to displacement of posterior fragments, is common. Likely Cause: Axial Compression

Note: CT is required for all patients to evaluate extent of injury

Front 30

Wedge Fracture

Back 30

Lateral X-Ray will show compressed vertebral body appearing as a wedge. Likely Cause: hyperflexion and compression; acceleration/deceleration

Front 31

What is Whiplash?

Back 31

Extension lesion : often seen in MVA
Tx modalities : SCS, Cranial, Indirect Fascial
Order* :
Upper Thoracics
Suboccipital Triangle
Rest of Cervical Spine

Front 32

Toriticollis

Back 32

Muscle Energy, if gently done, can be very helpful
Find midpoint of PAINFREE ROM
Have patient turn toward the restriction (though not completely to the barrier) against your isotonic force
Not direct or indirect, because you’re not fully engaging the barrier, instead you are positioning them to a balance point

Front 33

Treatment Guidelinesfor Symptomatic, Cervical Spine Problems

Back 33

1. Avoid HVLA manipulation of the cervical spine.
2. Decrease muscle tension. Treatment of the upper thoracic spine and ribs is essential to accomplish this goal.
3. Counterstrain, Cranial, and Indirect Techniques are the least traumatic to the neck. Muscle Energy Technique, if done without pain, is appropriate.
4. Traction, with proper direction of force, is also appropriate.

Front 34

HVLA Relative Contraindications

Back 34

Acute herniated nucleus pulposis
Don’t perform HVLA at the affected disc segment!
Acute radiculopathy
Acute whiplash / severe muscle spasm/ strain/sprain
Treat the spasms first.
Treat the approximating structures
Thoracic inlet, anterior vertebral structures, TMJ, SPG SBS, CRI
Appositional musculature
You know you will be successful if you resolve the spasms and can feel the sweet spot
Osteopenia / Osteoporosis
Spondylolisthesis (ask!)
Pregnancy (think Gumby)
Pt on anticoagulation
Metabolic bone disease