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neutral c-spine
slightly extended, slight lordosis
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what could cause a flattening of the c-spine (reduction in lordosis)
muscle spasm, like in whiplash
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close-packed c-spine -- what position?
complete extension
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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
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most unstable pos for c-spine
flexion
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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)
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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
- pillows
- headaches
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in structural exam, look for what conditions?
- temp
- moisture
- edema
- nodules
- spasm
- alignment
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hyoid is at level of what c-spine?
C3
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thyroid -- at what level of vert?
- C4-5
- try for lat-lat mobility (pt must be very relaxed)
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cricoid
what is it? what vert level?
- ring of cartilage around trachea
- C6
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where to find C1 TPs?
btwn mastoid and inf angle of mandible, ant to SCM
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trick for finding C@ SP in supine
have pt tuck chin to make C2 drop into your hand
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posterior triangle's borders
- ant: SCM
- post: trap
- inf: clavicle
inside, find scalenes, first rib, carotid artery
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scalenes - general attachments
TPs of cervical vert to 1st and 2nd ribs
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swallowing tests what?
- lips, jaw, pharynx, larynx, suprahyoid, infrahyoid
- (palpate while they swallow)
-
borders of ant triangle
midline, mandible, SCM
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functional tests for neck
- swallow
- 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
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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
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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)
- rotate
- see if there's restricted rot to R or L
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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
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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
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motions for active movement testing
- nod
- jut
- flex and rotate
- flex
- ext
- lat flex
- rot
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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
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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
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patellar reflex tests what nerves?
L2,3,4
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triceps reflex tests what nerves
C6,7, 8
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VBI stands for what
what is it?
- vertebral basilar insufficiency
- reduction of blood flow thru vertebrobasilar arterial system
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the vertebrobasilar arterial system supplies what?
posterior brain
-
tectorial membrane
- 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)
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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!
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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
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what to look for in a VBI test
- nystagmus,
- blurry vision
- vyrtigo,
- dizzy,
- HA,
- pain,
- tinnitus,
- ear feels clogged,
- nausea,
- 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
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mobilization of upper c-spine if pt has any pos signs for VBI?
NO! sooo contraind!
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spurling test the basics of the motions
- ext, SB, rot to same side
- with compression (Magee)
- with distraction (Saunders)
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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)
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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...
Sotohall test
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shoulder abduction test (relief test)
how?
- 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_
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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)
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