Card Set Information
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
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
What are the 5 ds for special questions?
- 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
- 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?
- 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?
- 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
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)
- +/- 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
- 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
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?
- 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
- manipulation- to get afew degrees of movement, where oscillating tech might aggravate
What are some additional treatments you can conduct on a pt?
- local heat, ice
- 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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