Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
71 Cards in this Set
- Front
- Back
|
Why are we so concerned with alar lig and cruciate lig?
|
Hold dens in place, if they rupture, you dead
|
|
|
What is the uncinate process?
|
Accessory joint - adds lateral support going superior in c3-c6 vertebral bodies = few disc herniations. Immediatley adjacent to IV foramen and fit into a groove in the vertebrae above, making the "Joint of Luschka"
|
|
|
Reasons for few (relative to lumbar) disc herniations?
|
uncinate process, strong ALL and PLL
|
|
|
Coupled motion of OAA vs rest of cercical spine?
|
OAA: SB and rotation to opposite side so we can see straight ahead (due to alar lig)
C2-C7: Same side |
|
|
What do we add to the subjective hx during cervical eval?
|
HAs, Jaw pain
Dizziness, blurred vision/speech b/c of vertebral a. in transverse foramen |
|
|
Why do we retract jaw before performing FIS and EIS
|
To look at the WHOLE C-sp. If we don't, we won't be able to see OA movt
|
|
|
What do we look for in FIS and EIS?
|
AP curves, amount, deviation, segments that don't move
|
|
|
What do we make sure pt doesn't do with rotation in sitting?
|
Ext head to get more motion
Stick chin out = bypass AA (50% rotation from AA) |
|
|
After doing ROM, what would tell you a person has an AA problem?
|
rotation limited
Rotate to same side with side bending |
|
|
After doing ROM, what would tell you a person has an OA problem?
|
difficulty with retrusion
Limited flexion and extension |
|
|
Sharpe's Percer test
|
To check for stability of dens/c1. Put finger into C2 at back of neck to block it, and push posterior on chin. CLUNK = pos = ER
|
|
|
Vertebral a. test (BS)
|
Ext and rotate head with head off table. Talk to pt and keep his eyes open to look for slurred spech, pupil dilation, blurred vission, dizziness
|
|
|
What things should you check in supine?
|
mm length - traps, levator, scalenes, paravertebrals, suboccipitals
Mobility - PAs Articular pillar - facet joints in line and convex/concave going down |
|
|
Closed pack position of cervical spine?
|
Full extension - maximal joint contact and load bearing. This is different from most synovial joints because EXT slackens the joint capsule of the apophyseal joints
|
|
|
Essentially, what movement is protrusion and retraction?
|
Protrusion = EXT of OAA
Retraction = FLEX of OAA |
|
|
What should you note when you check the rotation of the OAA?
|
Check ligs on neck before AROM
Palpate C2 spinous proces and SB If C2 rotates to same side then NO MOBS b/c alar lig is lax (should have rotation to opposite side) |
|
|
DISC HERNIATION:
Demographics Most common areas MOI s/s |
Middle aged, M or F
C5-C6 > C6-C7 > C4-C5 Traumatic or overuse w/ minor inj that pushed them over edge Neck pain w/ radicular s/s in UE. Dermatomal pattern. Bilateral if central (rare). |
|
|
What do you expect to find in objective eval for DISC HERNIATION?
|
1. Flexion = radicular s/s (bad)
Retraction alone or retraction plus extension = centralization 2. If don't get centralization in sitting, go supine (NWB) w/ shoulders off table and do it again. 3. Retraction/extension with lil bit of rotation 4. Traction |
|
|
How to perform traction of cervical spine?
|
Higher in neck = more of pts head on table
Lower in neck = head off table Use hands or towel with head in slight flexion Can do static or cyclic Can also pinch the spinous process below to isolate the segment If manual works well, do mechanical |
|
|
Where do radicular s/s SOMETIMES go with a disc herniation in the cervical spine.. say C6-T1 area
|
Scapula - especially medial border
|
|
|
How do you tell if a disc lesion is acute vs chronic?
|
Type of radicular s/s
Sharp - pins/needles - numbness - reflex/mm weakness - atrophy |
|
|
How often does directional preference work in the cervical spine for disc lesion? What's the answer?
|
50% of time. Try traction after doing WB and NWB retraction, retraction/ext, and retraction/ext/rotation
|
|
|
How can we provide "additional" traction with a towel?
|
Side bend to opposite side (?)
|
|
|
HEP traction
|
NWB supine w/ something under to head to flex neck.
FLEX/SB/ROT to opposite side to open up IV foramen ("chin tuck"). 10 reps qh |
|
|
Why is posterior scapular strength important for any cervical problems?
|
Need gos pos scapular stability b/c it gives good neck posture.
|
|
|
How do we tx postural abnormalities?
|
First need to strengthen/stretch weak and/or tight structures. Strengtehn pos scauplar stabilizers and stretch Pecs.
Then education - eyes level and straight, ears over shoulders, head set phone |
|
|
Sleep advice for someone w/ a disc lesion?
|
No prone sleeping b/c rotation is a killa. Need support under neck: round pillows, towel rolls
|
|
|
Tx for DJD
|
AROM, strengthen, aqua aerobics, joint mobs, activity modification and pt. education, core strengthening,
|
|
|
How will a facet lock present if VERY acute?
|
Pt. won't be able to move at all b/c of all the mm guarding. After a lil bit of time it will go into normal facet pattern
|
|
|
What will tell you a facet lock is OAA vs. lower cervical
|
OAA = SB and rot to opposite sides
Lower cervical = SB and rot to same side |
|
|
What objective measures should you do if you suspect facet lock?
|
AROM
Articular pillar palpation PAs |
|
|
3 best tx options for facet lock
|
1. Grade 5 PAs
2. mm energy techniques 3. Specific traction w/ grade 4 PAs |
|
|
Explain how we will tx facet locks in the cervical spine
|
1. Soft tissue and modalities to dec. mm guarding
2. Traction (holding spinous process below) 3. Grade 4 PAs |
|
|
What will often happen initially after a pt. first tries mechanical tracking?
|
s/s get worse when you take traction off... which is normal so don't fret
|
|
|
How far should you pump the mechanical traction machine?
|
Until you get centralization
|
|
|
How many grade 4 mobs do you do in the cervical spine?
|
10-20... less than the rest of the spine. Stop when you get mm guarding
|
|
|
HEP for facet lock
|
NWB b/c they're sore from WB!
Self-mob in NWB: towel roll or use hand for traction AROM |
|
|
Subjective info of chronic facet lock
|
Woke up one day a year ago and was stiff as shit. Felt better after a few days but it has always been stiff. Hx of neck aches that last a few days. May have HA that goes with it.
|
|
|
Tx for chronic facet lock
|
More aggressive - can do grade 4's right away by they don't have the acute irritability
|
|
|
Demographics of hypermobility - 2 "mechanisms"
|
Young female
1. born with it 2. Whiplash |
|
|
What objective measures will clue you into a diagnosis of hypermobility?
|
Excessive AROM
Catch/painful arc when coming up from flexion PAs are hypermobile and possibly painful |
|
|
Tx for hypermobility?
|
Strengthen the deep flexors
BP cuff under neck and have them flex down into it so they can see pressure read out Strengthen pos scapular stabilizers and stretch the pecs |
|
|
What objective measures will clue you into a diagnosis of stenosis?
|
Radicular s/s with extension - AROM and quadrant
|
|
|
What is whiplash and what is it caused by?
|
Hyperflexion AND hyperextension injury. Tearing of soft tissue - capsule, mm, ligs
High impact injury - MVA |
|
|
Common exam findings for whiplash pt?
|
Intense pain
mm guarding and HAs Non-dermatomal radicular s/s possible They won't move |
|
|
How long is the soft collar worn after whiplash injury? Why is this a problem/
|
1 week, 24/7. They stiffen up a lot... we need some movt. Should take off collar when head is supported.
|
|
|
Tx for a person with acute whiplash?
|
Modalities - soft tissue (light), little manual traction, ice
AROM |
|
|
Why do we need to continue to reassess a pt with a whiplash injury?
|
Can develop something secondary to whiplash - facet lock, hypermobility, weakness
|
|
|
How can the TMJ be injured with a whip lash injury?
|
Jaw drops down with hyperextension of neck
|
|
|
When does a pt with whiplash hurt the most?
|
24-48 hrs later b/c INFLAM sets in
|
|
|
Cervical screen components
|
AROM with over pressure
Spurling's |
|
|
Normal ROM of TMJ
|
Open 45-55 mm
Protrusion edge to edge Lateral movt 10 mm (one incisor) |
|
|
How do you palpate masseter
|
ANT fibers Horizontally
POS fibers Vertically INTERM fibers in between |
|
|
What do we know how to do for the TMJ?
|
Palpate condyles, masseter, temporalis
Measure ROM |
|
|
Common findings for TMJ DJD
|
decreased ROM bilateral, F>M
Chewing and talking are bothersome |
|
|
HEP for mm imbalance at TMJ
|
stand in front of mirror and open mouth until you start to deviate. 5-10x every time you are in front of a mirror.
|
|
|
How does the TMJ present in a pt who has just had jaw trauma?
|
Lateral deviation to side of injury
Mouth slightly opened Very tender/swollen Pt may have dec hearing or "water in the ear" |
|
|
Posterior capsulitis of TMJ
|
TMJ trauma - condyle gets shoved backward into posterior capsule.
|
|
|
Tx for someone who just got their ass kicked (TMJ trauma)
|
Pain free ROM
Liquid diet Limit speaking/chewing Modalities, ice |
|
|
What type of HAs do we NOT treat?
|
Recent, severe HAs that does not let up (Red flag = aneurysm)
Migraines Cluster HA Sinus HA |
|
|
Characteristics of a migraine
|
F>M and start in teens
1 sided, never change sides Aura 30 min prior, usually visual (can be taste, smell, hearing) Aura ends once HA comes on Nausea, vomin, intesne, can't stand light |
|
|
Diagnostic for migraine
|
Take the meds when aura comes on. If you don't get the HA, it's a migraine. If you do, you don't get migraine's
|
|
|
Characteristics of a Cluster HA
|
M>>F
Vasculature in origin, one sided, can have aura Several severe HAs in a row, then no HAs for a year Nausea, vomiting Take meds |
|
|
Characteristics of a Sinus HA
|
Pressure and pain behind eyes, around cheek bones
Bending forward makes it worse We dont' treat |
|
|
Subjective Q's to ask about HAs
|
When does it start and where?
How long does it last? How often do you get them? Aggravating and relieving factors? |
|
|
What are you thinking if pt says they have HA that starts in occipital region and then spreads?
|
Suboccipital tightness
|
|
|
What you thinking if pt says they have a HA that starts in temporal region?
|
UT and levator refer up to temporal region
Mid to lower facets refer up Temporalis mm NOT TMJ |
|
|
What are you thinking if pt says they have a HA that starts on top of the head and spreads?
|
OA jt - upper cervical
T4-T6 refer here so check out mid-thoracic |
|
|
What you thinking if pt says they have a HA that "wraps around head"
|
AA jt - upper cervical
|
|
|
How can we tx HAs?
|
By treating the problem areas in the spine that refer pain to the head. Soft tissue, stretching, trigger points
|
|
|
Food logs and HAs?
|
If HAs aren't getting better, have pt keep a diet log to see if they have food allergies. Dairy>wheat>red wine and choc
1st week HA will get worse, then better |
