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What kind of history do pts with cervical spine problems present with?
- - area of pain- occipital- C1-C2
- - arm pain, paraesthesia, numbness
- - headache- type
- - facial pain, paraesthesia (where and what fingers), numbness
- - diziness
- - trauma
What are the aggravating factors for cervical spine issues?
- -turning head to reverse car
- - reading- flexion problems
- - computer use- using mouse- forward movement
- - holding phone (with ear and shoulder) (LF), hanging washing (ext)
- - sports- swimming
- - sleeping position- pillows sleep on- edge of pillow
What are some easing factors for the cervical spine?
- - lie down
- - get up, move around, walk
- - night position
- - pillows
What are the 5 ds for special questions?
- - dizziness
- - dysphagia (swallow)
- - dysarthria (speech)
- - diplopia (double vision)
- - drop attacks (like fainting)
What are the special questions that need to be asked for a pt with cervical spine problems?
- - 5 ds
- - nausea/vomiting
- - spinal cord (tingling hands/ feet), bilateral limb paraesthesia, unsteadiness on feet (ataxia- wide BOS)
- - medication (long term, steriods)
- - medical history- RA- ligs unstable
- - weight loss
What observations do you make when assess a cervical spine pt?
- - lordosis (FHP- forward head posture)
- - lateral tilt
- - arm supported (nerve root compromise)
- - dowager's hump (senile osteoporosis- kyphosis)
- - mm spasm
- - is the posture correct?
What functional movements would you conduct with your patient?
- - flex
- - ext
- - rot
- - lat flex
What active movements would you conduct for a pt with cervical spine problems?
- All done in sitting:
- - flex- OP for just cervical flexion cross hands over
- - flex + rotation test_ FRT-can differentiate
- - ext- hold jaw to OP
- - Rot- look left, then right OP- one hand behind head with elbow on shoulder
- - lateral- low/mid/upper- using hand to block level and OP
What are we looking for with active movements?
- pain reproduction
- local restrictions
- - effect of correcting deviations
- - OP, repeated, quick, sustained
What are the active movements of the upper cervical spine?
- -flexion- chin tuck
- - ext- stick chin out
What are the quadrants for the upper cervical spine and what are they used for?
- - used to clear the neck
- - upper Csp
- - lower Csp
How to do a quadrant of the Lower Csp?
- look up to the roof- ext
- lateral flex to the same side
- rot to the same side turn head towards to side u laterally flexed
- then compress
How do perform a quadrant for the upper Csp?
- Ext- bring chin forward
- - rot same side
- - lateral flex- chin goes away
- O1, C2, C3
What is the spurling's sign?
- - it is to reproduce nerve root problems
- - compression to reproduce pain in the arm (sustained sl E/ sl LF)
- - distraction- (to relieve arm symptoms)
- Stages 1- compression in neutral
- 2- compression in ext
- 3- compression in both ext ad lateral felx to side effected
What jts would you ensure to clear?
- - TMJ- open mouth, side to side, clearing scalenes, traps, SCM
- - shoulder- flex, ext, abd- OP
- - elbow- flex, ext- OP
What is the neurodynamic test ULTT 1 for and conduct it?
- - median nerve test
- - can tell if the P is from shoulder or neck
- - no pillow- person needs to be flat
- - lateral flex of neck and taking arm in ext pulls the nerve more
- - any tightness or pain reproduced
- - sh dep, sh abd, wrist ext, ER, elb ext, Csp LF
- Once pain is brought on pt laterlly flexes away and towards, if P isbrought on and relieve it is a +ve test.
- Way to know is to compare to the other side.
What physical examinations do you conduct on a Csp pt?
- - clear jts
- - neurodynamic test
- - neurological examination
- - vertebral artery testing
Conduct a neurological examination on you Csp pt
- - sensation- reproduced- pin prick
- - motor power (C5-T1)
- - reflexes
- - +/- clonus/ babinski- shows an UMNL
Conduct the apropriate vertebral artery testing on ur Csp pt
- Need to see pts eyes at all times
- Hold 10 sec one side, rest for 10 sec, hold 10 sec other side
- Do in sitting because the heart has to work against gravity
- - sustained bilateral rotation- both sides
- - additional tests as indicated- eg going to put pt in ext u conduct the test in ext
- - differentiate between VA and vestibular. Done by pt in standing and getting them to rotate there body holding there head still
Conduct a general palpation of a Csp pts neck
- arms by side- want pts head and mm relaxed
- - temp, sweating- use back of hands
- - spinal body alignment
- - spasm
- - tenderness
- - soft tissue thickening
- - A/C jt (C7- T1)
what other areas will you palapate on a Csp pt?
- - spinous process (C2, C7 prominent)- ensure u angle at the curve of the lordosis
- - Zjts- will feel the ridge- use dom thum and reinforce with the other
- - Transverse process of C1- much further out near jaw
- - cervical rib- sit at 45 degrees
- - arch of C1- angle fingers towards pts eyes
Spinous process of Csp
- C2- big
- C3- small
- C6- should be big but disappear when pt ext
- C7- sticks out
What are the PAIVMS- passive accessory intervertebral movments for Csp?
- - Central PA- in line with lordosis- on spinous processes
- - Unilateral PA- Z jts
- - transverse- only on C1 C6, C7
- Looking at range, P reproduction, vary angle pressure
What are PPIVMS and PAIVMS?
- PPIVMS- passive physiological movements
- PAIVMS- passive accessory movements
Conduct the PPIVMS for Csp
- - flexion- for C6/7 hold the pt in more flex, pt head off end of bed, you support with belly, trying to feel the gap of the spinous processes
- - Ext same as above- using legs, can hold head as a Basket ball
- - Rot- hands on side of head- rot away from side palpating
- - lateral flexion- hands either side of head, using side of fingers to feel the movement
Support head with belly- have bed at the right height, bend knees more to make the movements- alows you to concentrate on what you are feeling.
- C0-C1- can feel transverse process move away from the skull
- ALWAYS COMPARE TO THE OTHER SIDE
If pt has decrease ext how would you treat them?
- - accessory
- - central PA grade as you go
- - central due to central pain
Pt has pain on the posterior of neck, left side
Rot and lateral flex to left decrease ROM, palpate find level- use unilateral on level of pain and side of pain
- - 30 sec - look at problems eg rot then do 3 x 30
- - in reassessment can look at PIVMS
- - if pt is irritable- open jt via lateral flex away from side. if close MUST be low grades
- NOTE/ if PNS down arm as well as neck pain- always do an open tech
What are some openning techniques for nerve root compression?
- - lateral glide
- - lateral flex away
- - distraction- pull up
- - rot away
- - transverse- push towards side
- - take pressure off nerve with pillows under arm
Traction for C6 neck in flexion- hold chin and occiput, one leg in front of the other and lean back for 30 sec/ min support head on tummy
- - traction
- - manipulation- to get afew degrees of movement, where oscillating tech might aggravate
- - pillows
What are some additional treatments you can conduct on a pt?
- - local heat, ice
- - EPA
- - Isometric exercise
- - Postural advice/ correction
- - deep cervical flexor strengthening
- - Scap control
When do you use a central PA?
- bilateral symptoms
When do you use a unilateral or transverse PA?
When do you use rotation?
- unilateral pain/ movt abilities
When do you use lateral flexion
- unilateral pain/ movt abnormalities
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