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  1. Cervical-spine manipulation: RELATIVE contraindications:
    • Recent trauma without workup
    • Fracture or suspected fracture
    • open wounds
    • Skin infections
    • Rheumatoid arthiritis
    • Down Syndrome
  2. When does cervical lordotic curve become most noticeable?
    As a child begins to lift head (3-4 months)
  3. Most mobile region of the spine and has the most mms
    Cervical spines
  4. Typical ribs: vertebral
  5. SB and R to SAME side
    N, F, or E
    ~50% of Rotation of C-spine from these levels
  6. Atypical cervical spine
    OA and AA
  7. Atypical C-spine that makes up ~50% of F and E of c-spine by primarily gliding on condyles
  8. At this level, SD always have a F or E component with SB and R to OPPOSITE sides
  9. C-Spine level that is purely rotational (~50% of Cervical rotation)
  10. C-spine with the LONGEST transverse processes
  11. Where can you feel the TP of C1
    Between Angle of mandible and mastoid process (behind ear lobe)
  12. Where the occiput glides on the ATLAS
    • Superior Articular Facets
    • Image Upload
  13. Where the atlas rotates on axis
    • Inferior Articular processes
    • Image Upload
  14. Dens articulate with which part of the atlas
    part behind the anterior tubercle at the articular facent for odontoid process
  15. What goes thru the transverse foramen?
    • Vertebral A
    • Vertebral V
    • Vertebral Sympathetic plexus
    • Image Upload
  16. This structure wraps around and hides the dens
    • Tectorial membrane
    • TeImage Upload
  17. Origin of the dens
    • Body of C1, it dissociated from atlas and fused with body of C2
    • C1- has NO body
  18. Ligament that gives integrity to the AA joint and if torn can lead to sudden death
    • Cruciform ligament holds the dens against the atlas and keeps it from compressing the spinal cord
    • CrImage Upload
  19. What passes thru the intervertebral foramen?
    • Spinal nerve
    • Image Upload
  20. This can lead to Osteophytes (bony outgrowths) which can compress the nerve and artery leading to Chronic neck pain
    • Unconvertebral arthrosis
    • Image Upload
  21. This a load-bearing structure of the IV disc
    Anterior aspect is stronger
    Pain sensitive
    Annulus fibrosus
  22. Most common area for Annulus fibrosus herniation
  23. Thickest in lumbar
    2nd thickest in cervical
    Thinnest in thoracic
    Centrally placed in cervical
    Gelatinous substance (absorbs majority of fluid)
    Nucleus Pulposus
  24. Attached to IVD and 2 vertebral bodies
    Cartilaginous end plate
  25. Prevent vertebral bodies from undergoing pressure atrophy
    Cartilaginous end plate
  26. Keep annulus fibrosus and nucleus pulposus within anatomic borders
    Cartilaginous end plate
  27. Most common causes of nerve root compression in C-spine
    • Degeneration of joints of Lushka (uncovertebral joints) ANTERIORLY
    • Hypertrophic osteo-arthritis of synovial joints POSTERIORLY at IV foramen
  28. Position that pt prefer with cervical nerve root compression
    Front bending (Flexion)
  29. Position that pt dislike with cervical nerve root compression
    BB, SB, or R Ipsilateral to side of compression b/c these motions decrease size of IV foramen
  30. Position pt prefers if have cervical disc herniation
    BB and slight SB TOWARD side of herniation to keep nucleus pulposus away from neural structures
  31. What are the 3 components of suboccipital triangle?
    • Occipital bone
    • Tip of the TP of the Atlas
    • Ligamentum nuchae and SP of the axis
    • Image Upload
  32. Nerves on the posterior part of the head that if they get squeezed, you'll have sx of tension at the posterior part of head
    Greater and lesser occipital nerves
  33. mm Origin: external occipital protuberance, ligamentum nuchae, SP of C7-T12
  34. mm insertion: Lateral 1/3 of clavical, spine of scapula, base of scapular spine
  35. mm function: elevate shoulder, depress and retract scapula, and steady scapula and thorax
    EXTEND, laterally FLEX, and contralaterally rotate head
  36. mm O: SP of C1-C4
    Levator Scapulae
  37. mm I:Superior angle of scapula
    Levator scapulae
  38. mm Fxn: Elevates Scapula
    Levator scapulae
  39. O: SP of C7-T3
    I: lateral aspect of nuchal line on rough area of occipital bone and mastoid
    Fxn: Extend, laterally flex, and rotate head to same side
    Splenius capitus
  40. mm Fxn: Laterally flex and rotate neck to same side
    O: SP of T3-T6
    Splenius cervicis
  41. O: TP of C7-T6
    I: Occiput
    Fxn: Extend head
    Semispinalis capitis
  42. O: vertebral bodies of lower cervicals and upper thoracics; TP of lower cervicals
    Fxn: Flexion of spine, some lateral flexion
    • Longus coli
    • Image Upload
  43. Order for Dx C-Spine
    • Observe, Palpate, ROM
    • ALWAYS palpate PRIOR to ROM
  44. ROM: Flexion of C-spine
    • 45-90 degrees
    • 50% from OA
  45. ROM: Extension
    • 45-90 deg.
    • 50% from OA
  46. ROM: SB of C-spine
    30-45 deg
  47. ROM: Rotation of C-spine
    • 70-90 deg
    • 50% from AA and 50% from C2-C7
  48. SD of AA joint: Motion testing
    • Passively FLEX C-spine to lock-out lower vertebrae - if paintful, consider meningitis
    • Rotate to barriers
    • Compare, assess, and Dx
    • Assess OA dx as well
  49. Name this method: Px finger pads of caudad hand touch cervical paravertebral mm on side of neck opposite of Px
    gently draw PV mm VENTRALLY to produce min EXTENSION of c-spine in Rhythmic, kneading fashion
    Image Upload
    Contralateral Traction (supine)
  50. Type of traction created by Cradling with Traction, supine
    Image Upload
    Longitudinal traction
  51. Type of pressure created with Suboccipital release
    Image Upload
    Constant Inhibitoriy pressure
  52. C2-C7 ME and HVLA emphasis:
    Directed at closed Zygapophyseal joint to de-rotate segment back to neutral
  53. C2-C7 ME and HVLA emphasis:
    Treating hand is ON side of the CLOSED joint
  54. C2-C7 ME and HVLA emphasis:
    Rotate into Barrier before SB
  55. C2-C7 ME and HVLA emphasis:
    SB into ease to get into the plane of Zygapophyeal joint
  56. C2-C7 ME and HVLA emphasis:
    Tx is directed at closed zygapophyseal joint by SB segment back to neutral
    SB emphasis
  57. C2-C7 ME and HVLA emphasis:
    Treating hand on side of OPEN joint
  58. C2-C7 ME and HVLA emphasis:
    Flex down to level being treated
  59. C2-C7 ME and HVLA emphasis:
    Rotate into ease to localize SD and get into plane of zygapophyseal joint
  60. Image Upload
    SB emphasis
  61. Glide head on condyle into F or E barrier
    SB to barrier
    R to barrier
    Exert continuous traction
    Short Rotational thrust thru barrier in direction of IPSILATERAL eye
    • HVLA for OA
    • Image Upload
  62. HVLA: Short rotational thrust thru barrier in direction IPSILATERAL eye
  63. ME: Flatten AP curve, rotate to barrier while pt rotate to ease
  64. Cervical Dx: Change in gait or balance, paresthesia, loss of agility in hands
    Cervical myelopathy
  65. Cervical Dx: Profound UMN sx; combination of arm and leg sx and gait disorder
    Cervical Myelopathy
  66. Cervical Dx: causes due to compression of spinal cord and or nerve roots in cervical canal
    Cervical myelopathy
  67. Cervical Dx: OMT by INdirect tx and avoid cervical extension and rotation
    Cervical myelopathy
  68. Cervical Dx: Nerve-related sx such as pain, numbness, or mm weakness in specific nerve distribution
    Cervical radiculopathy
  69. Cervical Dx: distal parenthesias, sensory loss, motor weakness, decreased DTRs
    Cervical radiculopathy
  70. Cervical Dx: Caused by compression (oteophyte or disc protrusion) of cervical nerve root
    Cervical radiculopathy
  71. Cervical Dx: OMT by avoid HVLA at site of herniation; ME and SCS are good
    Cervical Radiculopathy
  72. Red flags include:
    • Fever (infection)
    • Wt. loss (tumor)
    • Acute localized bone pain (fracture/expansion of bone)
    • Morning stiffness of neck (Spondylo-arthropathies/RA)
    • Visceral causes (angina, esophageal dz, TOS)
    • Neck pain and fever (meningitis)
  73. DTR: Biceps
  74. DTR:Brachioradialis
  75. DTR:Triceps
  76. Neurological Motor testing: C5
    Deltoid abduction at shoulder
  77. Neurological Motor testing:C6
    Elbow/bicepts flexion at forearm or Wrist extension (ECR)
  78. Neurological Motor testing:C7
    Wrist Flexion or Elbow extension
  79. Neurological Motor testing:C8
    Finger flexion, middle finger (FDP)
  80. Neurological Motor testing: T1
    Small finger abductors (ADM) or sperad fingers (interossei)
  81. Contraindications to provocative tests:
    • Inability to tolerate position
    • Paralysis
    • Increase or significant alteration of sx
    • Localized path. tissue conditions (infections, tumors, congenital defects of bone/tissue)
    • Fracture
    • Vertebral artery compromise
  82. Provocative tests:
    Test for vertebral artery insufficiency
    Supine, Extend, R, and WAIT for 30 S
    • Underburg Test
    • Image Upload
  83. Provocative tests:
    Positive test
    Dizziness, nausea, lightheadedness
  84. Provocative tests:
    Flex pt's neck and hips until sx reproduced or end of ROM
    • Lhermitte's sign
    • Image Upload
  85. Provocative tests:
    LHermitte's Sing Positive
    • Electrical shock sensation down spine or both arms or legs
    • suggests a lesion or dorsal columns of cervical cord or of caudal medulla
  86. Provocative tests:
    Lhermitte's sign causes
    Most often by multiple sclerosis or a large disc herniation impinging on anterior spinal cord (cervical myelopathy)
  87. Provocative tests:
    Extend Pt's neck and SB it to ONE side with coresponding axial compression of pt's head
    Image Upload
    Spurling's Test
  88. Provocative tests:
    Positive sign of Spurling's Test
    Pain elicited down ipsilateral arm from neck
  89. Provocative tests:
    Postive sx of this test indicates cervical disc dz; STINGER
    Spurling's Test
  90. Provocative tests:
    Palpates radial pulse on affected arm with arm at pt's side
    As pulse is monitored, Px moves pt's arm into abduction and exteral rotation
    Pt. takes deep breath and turns head toward raised arm
    Image Upload
    Adson's Test
  91. Provocative tests:
    Positive test marked diminution or loss of pulse
    Adson's test
  92. Provocative tests:
    Positive test indicates Subclavian artery compression by cervical rib and/or scalene mm
    Vascular thoracic outlet syndrome
    Adson's test
  93. Conditions that should not be missed due to morbidity/mortality
    • Fracture/dislocation
    • AO ligament disruption
    • Herniated Cervical disc
    • Stingers/burners/neurapraxia
    • Transient quadrilegia
    • Tumors
    • Arnold-chiari malforation
    • Neurolofic injury causing neurapraxia/paralysis
  94. Q: Neck pain
    C4 prefers to SB to R
    Feels better in F
    C4 F SBrRr
  95. Q: Neck/back/shoulder pain
    head is bent backwards (E) and SB to one side
    • Cervical disc herniation
    • E and SB toward side of herniation to keep nucleus pulposus from impinging on nerve
  96. Q:
    Neck stiffness
    AA joint testing shows pt has to raise shoulders off table
  97. Q:
    Neck/shoulder/back pain
    (+) Adson's test
    Subclavian A. compression secondary to cervical rib
  98. Q:
    As brachial Plexus if forming, which mm does it pass directly posterior to?
    • Anterior Scalene
    • Brachial plexus passes between A and M scalenes
  99. Q:
    MM with dural attachment
    • Rectus capitus posterior minor
    • has fibers that penetrate between occiput and atlas that penetrate into the dura
  100. Q:
    Unilateral contraction of SCM
  101. Q:
    Attachments of SCM are posterior to line of gravity, so when they contract, occiput glides forwards into extension, causing___
  102. Q:
    Bilateral contraction of SCM will cause _________
  103. Q:
    Minor MVA where car was tapped from behind while he was stopped at a toll booth
    No pain immediately to accident
    Woke up with neck stiffness and pain
    Dx: Jolt syndrome in which the force of impact was low, but driver's seat back acted as a spring catapult
    PE: SD at OA level
    HVLA at OA causes diplopia and visions of flashing lights, vertigo follows along with dysarthria
    This indicates what?
    Positional vertebral basilar insufficiency, abort the technique
  104. Q:
    Rheumatoid arthiritis
    Stiff neck
    Incredible headache
    OMT for headach should be ______
    • Indirect method - using inherent force
    • B/c Rheumatoid arthiritis is a relative CI to OMT, so you dont want to do anythin direct
  105. Upper part of Typical C-spine favors what motion?
    More R and Less SB
  106. Lower part of Typical C-Spine favors what motion?
    More SB and less R
  107. C-vertebral with longest TP
  108. C-vertebral:
    Greater AP diameter for vertebral foramen
    Long TP
  109. Ligament that was a portion of NOTOCHORD that normally becomes nucleus pulposus
    Connects the dens with occiput
    Apical Dental ligament (suspensory lig)
  110. C-vertebral that develops from 3 primary centers of ossification: 2 lateral masses and 1 anterior arch
  111. C-vertebral:
    Thick pedicles
    Small TP
  112. Vertibrobasilar insufficiency test
    E, SB, R ipsilaterally to assess fxn vascular adequacy
    Underberg or Wallenburg test
  113. Cervical Dx:
    Secondary to compression of spinal cord and/or nerve roots
    Numbness, tingling, burning
    Cervical Myelopathy
  114. Acute Radicular (in younger pts) is due to:
    Sprain, Strain, and HNP
  115. Chronic Radicular Pain (older pt) is due to:
    Compression of nerve due to facet or uncovertebral joint hypertrophy
  116. Provocative test:
    Test Supraspinatus
    90 deg ABduction and 30 deg ADduction
    Test to detect unilateral weakness
    • Full can test
    • Image Upload
  117. Provocative test:
    Positive test indicates Spacy occupying lesion
  118. Provocative test:
    Positive Adson's test indicates:
    Thoracic Outlet Syndrome
  119. Provocative test:
    3 major causes of Adson's Sign
    • Anatomic
    • Trauma/repetitive activities
    • Neurovascular entrapment at costoclavicular space
  120. Provocative test:
    Positive Adson's: Anatomic problem due to____
    • Cervical ribs
    • Congenital fibromuscular bands
    • TP of C7 elongated
  121. Provocative test:
    TOS tx for Adson's
    • OMT: tx ribs, scalenes, cervical and thoracic vertebrae
    • Surgery: Decompress depending on cause
    • Often 1st rib removed
    • Cervical rib removed
    • Release A and M scalenes
  122. Q:
    Types of head pain that will likely have SD
    Migrane headache
  123. Q:
    What is NOT a CI using OMT in head pain
    Hx of cervical vertebral fusion
  124. Q:
    SD of the following region is involved in headache
    Cranium, cervical spine, ribs, and sacral
  125. Common patient complaint for MCA
    Neck pain
  126. Q:
    Neck pain 8 hours after MVA
    Struck from behind while stopped at a light
    No airbag restrained
    All Anterior structures are stretched
    • Whiplash leading to headaches, neck pain, thoracic pain, back pain
    • Hyperextension leading to stretch of all anterior mm
  127. Q:
    If pushed on Scalene and pain doesn't go anywhere
  128. Q:
    If pushed in scalene and pain radiates down the arm
    Trigger point
  129. Q:
    MVA by hitting a patch of ice on road and struck a tree head on at 25 mph
    Neck pain
    No trauma
    restrained by seatbelt only
  130. Q:
    L. arm pain with parasthesias after dog pulled her off balance
    Brachial plexus impigement
  131. Q:
    Moderate headache
    hx: Acute GI bleed from gastric ulcer, transfusion of 4 units of PRBC
    Steady dull pain and pressure extending across back of head
    Vitals: Afebrile
    OSE: OA ESBrRl, C2 ESRr, pain on palpation of C2-C3 radiates to area of right orbit, SBS strain pattern
    • Muscle tension type headache
    • Migrain heachache
    • SD of head, cervical, thoracics, Ribs, ...
    • Aneurysm, subarachnoid hemorrhage
    • Tumor
  132. Vascular Headache from cranial Dysfunction can be due to dysfunction in:
    Venous sinuses, Internal Jugular Foramen, Occiput, Temporalis, Frontal
  133. Headaches from visceral origin referral from:
    Eyes, ears, Nose, Sinuses, Cardiac, Upper GI
  134. Headaches from visceral origin: common innervations
    Autonomics Parasympathetics
  135. OMT for Tension-type headaches:
    • Remove facilitation/ SD
    • Reduce stressors
    • Increase relaxation
    • Tx T1-T4 via HVLA, ME, MFR, CS, ST
  136. OMT Contraindications for Tension-type headache:
    Acute Neurological event: Ruptured berry aneurysm or Arteriovenous malformation
Card Set:
2012-03-05 00:00:26
OMM Cervicals

test 1
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