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slightly extended, slight lordosis
what could cause a flattening of the c-spine (reduction in lordosis)
muscle spasm, like in whiplash
close-packed c-spine -- what position?
capsular pattern of c-spine if there's a R facet problem
on L lat bending, L rotation, and FB, head will deviate to the R
most unstable pos for c-spine
Grieves' 3 mandatory questions for c-spine pain
- 1) dizziness, vertigo, drop attacks?
- 2) H/O RA, other inflam arthritis, treatment by steroids, Down's
- 3) neuro involvement of LEs (indicates SCI)
3 things to observe in c-spine pt
- head/neck posture
- rel of head to midline
- willingness to move head/neck
specific history to ask about for C-spine troubles
- bifocals or progressive glasses (they make people hold their heads at funny angles)
- swallowing (is it difficult? discs can press on the esophagus, which is just ant to c-spine)
- mouth breathing
- sleeping positin
in structural exam, look for what conditions?
hyoid is at level of what c-spine?
thyroid -- at what level of vert?
- try for lat-lat mobility (pt must be very relaxed)
what is it? what vert level?
- ring of cartilage around trachea
where to find C1 TPs?
btwn mastoid and inf angle of mandible, ant to SCM
trick for finding C@ SP in supine
have pt tuck chin to make C2 drop into your hand
posterior triangle's borders
- ant: SCM
- post: trap
- inf: clavicle
inside, find scalenes, first rib, carotid artery
scalenes - general attachments
TPs of cervical vert to 1st and 2nd ribs
swallowing tests what?
- lips, jaw, pharynx, larynx, suprahyoid, infrahyoid
- (palpate while they swallow)
borders of ant triangle
midline, mandible, SCM
functional tests for neck
- look at ceiling
- look at shoes
- look over shoulder (rot)
- tuck chin (nod)
- poke chin out (jut)
cerv motion happening in a chin-tuck
- upper c-spine flex
- lower c-spine ext
c-spine motion in chin-jut
- upper c-spine -- ext
- lower c-spine -- flex
active movement testing of AO joint w jut and nod
- look for lat deviation of nose and head
- the restriction is on the side to which the head deviates
active movement testing of AA joint
- fully flex neck to lock the c-spine (don't just tuck the chin, rather roll down so you use the lower c-spine too)
- see if there's restricted rot to R or L
active movement testing of flexion - how to do it, what you want to see
- first nod (retract head)
- then fold forward
- chin should reach chest w mouth closed, or be no more than 2 finger widths away
extension in active movement testing
- start motion with a jut, then tilt back
- never do over pressure in this position! but do over pressure in all others if there's no pain
motions for active movement testing
- flex and rotate
- lat flex
tips on overpressure
- don't do it for extension
- for others, use supporting hand on pecs or contralat shoulder
- for rot, bury her nose in your elbow / really wrap her head with your arm
passive movement testing tips
- do force coupling -- put hands on opp sides of head so they work together, pressing and supporting
- palpate ROM, location of end feel, type of end feel
- test in sitting
resisted testing hand positions
- ext -- inion
- lat flex -- beside of sagital sutures - so, high on head, but lateral
- flex -- forehead
compression and distraction of head
- compress from the top
- distract by grasping sides of head and pulling up
patellar reflex tests what nerves?
triceps reflex tests what nerves
VBI stands for what
what is it?
- vertebral basilar insufficiency
- reduction of blood flow thru vertebrobasilar arterial system
the vertebrobasilar arterial system supplies what?
- attaches to foramen magnum
- upper continuation of PLL
ant AO and AA membrane
runs up anteriorly, as the upward continuation of the ALL
posterior AO and AA membrane
cont of ligamentum flavum
(the tectoral membrane is the cont of the PLL)
before doing any manip, or even just taking a pt of end of range, if the pt is > 30 yo or if you're at all concerned, you must ...
- check the pt for VBI to check the vertebral artery
- and put results in your chart!
vertebral artery test
- (tests for VBI)
- pt supine, head off table in your hands
- extend, SB, and rot head to each side, holding 15-30 seconds, looking for nystagmus, blurry vision vyrtigo, dizzy, HA, pain, tinnitus, ear feels clogged, nausea, difficulty standing
what to look for in a VBI test
- blurry vision
- ear feels clogged,
- difficulty standing
what's happening to the vertebral artery in a VBI test?
you're compressing the artery on the side you turn to, and you're stretching it on the opp side
a way to differentiate cervical vs vestibular problems
- rotate body on head (keep head steady and move body beneath it)
- if this leads to symptom it's cervical, not vestib
mobilization of upper c-spine if pt has any pos signs for VBI?
NO! sooo contraind!
spurling test the basics of the motions
- ext, SB, rot to same side
- with compression (Magee)
- with distraction (Saunders)
Spurling test - what's a positive sign? what does it indicate?
assesses nerve root pain / impingement
- paraesthesia, spasm, neuro complaints
- compression of neural foramen and vertebral artery
l'Hermitte's sign - how to do this test
pt in long sit, now PT flex the head and the hip (raising the leg straight) (pt is passive)
L'hermitte's sign - what's the positive sign, what does it indicate?
- sharp pain like an electric shock
- meningeal or dural irritation
if pt does L'Hermitte test but pt does the motion actively it's called...
shoulder abduction test (relief test)
- pt sitting
- passively or actively, raise arm thru abd til hand rests atop head
shoulder abd test, positive sign, what does it indicate
- decrease or relief of symptoms
- cervical extradural compression (ie. disc, nerves C4-5_
valsalva test -- how, indicates what?
- bear down, see if it increases symptoms
- space occupying lesion (herniation or tumor)
(but you already asked about this in hx when you asked if there's pain on coughing, sneezing, pooping)