Cervical and thoracic Lab Flashcards Preview

Ortho 1 > Cervical and thoracic Lab > Flashcards

Flashcards in Cervical and thoracic Lab Deck (66)
Loading flashcards...
1

Quick clear for UE conditions

-SPurling's test
- central and unilateral PA's
- upper limb neurodynamics tension test (median nerve)

2

upper cervical flexion

Purpose: to assess active mobility of upper cervical vertebrae, specifically flexion

-Patient is seated at the edge of the plinth. have patient pull chin straight back while keeping their eyes level, and teeth together. therapist adds a posterior force at the chin with one hand and an anterior/superior force near posterior occiput. then with OP.

3

upper cervical extension

Purpose: to assess active mobility of upper cervical vertebrae, specifically extension
- Patient is seated at the edge of the olinth. have patient jut their chin straight out anteriorly while keeping their eyes level, keeping teeth together. therapist will then add a superior force from just underneath the chin with one hand while adding an inferior force near posterior occiput. then OP

4

Upper cervical Quadrant

Purpose: to assess active mobility of upper cervical vertebrae
- Patient is seated at edge of plinth. instruct patient to jut chin forward. Rotate head toward right side. side bend head toward right side. with their hand around each ear, the PT will then add OP into upper cervical extension, rotation, and side bending directions simultaneously. OP

5

Flexion-Rotation test

Purpose: to assess passive mobility of upper cervical rotation ROM
-patient is supine on plinth with pillow under knees. Cradle patient's head in your hands, with patient's ears in the webspace of each thumb. with the patient relaxed, flex patient's head up, then rotate patient's nose toward their R shoulder. assess end feel and change in symptoms. slowly return head to neutral

normal: 45 deg. (+) <33deg in cervicogenic headache patients

6

Palpation of suboccipital extensors

Purpose: to assess the suboccipital extensor muscles. assessing whether they are hypertonic, leathery, or atrophied. comparing sides is also important
-Patient is supine with head resting at the edge of table. cradle patient's head in your hands, with tips of fingers palpating in the suboccipital region. assess for tissue tonicity, restrictions and symptoms reproduction. this can be used as a STM

7

extension- Retraction

Purpose: to assess passive mobility of cervical retraction ROM
-patient is supine on plinth with head off end of plinth, supported by therapist. cradle patient's head in one heand at occiput, with other hand on patient's forehead. with the patient relaxed, retract patient's head by dropping hand on occiput posteriorly and pushing forehead posteriorly

8

OA nodding

Purpose: to assess passive mobility of OA nodding ROM
-patient is supine on plinth. cradled patient's head in your hands, with patient's ears in the wbspace of each thumb. with the patient relaxed, move patient's head in a slight nodding motion from the OA articulation

9

OA side glide

Purpose: to assess passive mobility of OA side glide ROM
-patient is supine on plinth. cradle patient's head in your hands, with patient's ears in the webspace of each thumb. with the patient relaxed, move patient' head in a slight side bending motion from the OA articulation

10

C1 side glides

Purpose: assess ROM in the frontal plane or improving segmental ROM
-patient is supine on plinth, head off plinth. support top of head with abdomen. cradle patients head in hands. palpate the mastoid process behind patient's ears, then slide fingers just distally, onto transverse process of C1. Index and middle finger pads apply a sideglide force.

11

palpation of arch of C1

Purpose: palpate for stiffness or reproduction of pain
- patient is positioned in the prone position. therapist palpates the occiput and moves just inferior onto the arch of C1. therapist palpates along the arch looking for reproduction of patient's pain

12

palpation of transverse process of C1

Purpose: assessing symptoms
- therapist palpates the angle of the mandible. therapist then palpates the mastoid process. examiner moves down along the angle of the mandible and along the anterior surface of the SCM. The first hard bony structure found s the transverse process of C1

13

Side Glide

Purpose: assess facet joint accessory motion
-Patient is positioned in supine. therapist palpates the spinous process at the level of involvement. therapist then moves lateral to the spinous process to find the involved facet joint. Using the lateral aspect of the 2nd middle phalanx applies a lateral glide to the facet. (+) test is reproduction of symptoms, hypomobility, or hypermobility.

14

contract relax for side glides

Purpose: To improve accessory mobility of cervical facet joints
1. Patient is positioned in supine. Resting symptoms are assessed. 2. Therapist palpates the spinous process at the level of involvement. 3. Therapist then moves lateral to the spinous process to find the involved facet joint. 4. Using the lateral aspect of the 2nd middle phalanx applies a lateral glide to the facet to the barrier. 5. Keeping glide on with R hand, place L hand on side of patient’s head. 6. Ask patient to meet your resistance with your L hand. Hold 7 seconds. 7. Have patient relax and side glide further into new range.

15

upglides

Purpose: To assess how the facet joints are opening
1. Patient is positioned in the supine position. Resting symptoms are assessed. 2. Therapist palpate the spinous process at the level of involvement 3. Therapist then moves lateral to the spinous process to find the involved facet joint 4. Examiner applies a force at the involved facet towards the opposite eye 5. Positive if there is a reproduction of pain, hypomobility, or hypermobility

16

down glides

Purpose: To assess how the facet joints are closing down
1. Patient is positioned in the supine position. Resting symptoms are assessed. 2. Therapist palpate the spinous process at the level of involvement 3. Therapist then moves lateral to the spinous process to find the involved transverse process 4. Examiner applies a force at the involved transverse towards the opposite shoulder 5. Positive if there is a decrease in pain, hypomobility, or hypermobility

17

Sharp Purser's Test

Purpose: To assess upper cervical instability
1. Patient is seated with neck in semiflexed position. Resting symptoms are assessed. 2. Place palm of one hand on patient’s forehead or hug the patient’s head, and index finger and thumb of other hand on spinous process of axis. 3. Apply a posterior translation through the forehead. 4. Assess stability of atlantoaxial joint. 5. (+) test is reproduction of myelopathic symptoms during forward flexion or decrease in symptoms during anterior to posterior movement or excess displacement during the AP movement. 6. Refer out for radiograph and stabilization.

18

Alar ligament test

Purpose: To assess upper cervical instability
1. Patient is supine on plinth, head in neutral. 2. Stabilize C2 by grabbing spinous process and lamina with fingers. 3. Side bend patient’s head to R side and feel for L transverse process to come into fingers. 4. Assess end feel. 5. Return head too neutral. 6. Repeat to L side. 7. (+) test is significant side bending with empty end feel, and transverse process does not come into fingers with side bending.

19

VBI (vetebrobasilar artery insufficiency test)

Purpose: To assess vertebral basilar artery insufficiency
1. Patient is sitting, neutral spine 2. Ask patient to lean forward, with their elbows on their knees, and place their head in their hands (cervical extension) 3. Remain in that position for 15 seconds. 4. Assess reproduction of symptoms. 5. Return too neutral for 15 seconds to assess for latent symptoms 6. From that position, ask patient to return to elbows on knees and turn their head to the R, keeping cervical extension. 7. Remain in that position for 15 seconds. 8. Assess reproduction of symptoms. 9. Return too neutral, and assess for 15 seconds 10. Repeat to on L side. 11. Remain in that position for 15 seconds. 12. Assess reproduction of symptoms. 13. (+) test is reproduction of nystagmus, nausea, numbness/tingling faintness, 5 D’s (dizziness, dysarthria, dysphagia, diplopia, drop attack)

20

Cervicogenic Vertigo Differentiation

Purpose: To differentiate cervicogenic vertigo symptoms from positional vertigo
1. Patient is standing with neutral spine. Resting symptoms are assessed. 2. Hold patient’s head in your hands, with patient’s ears in the webspace of each thumb. 3. Ask patient to step and rotate their body to the right while you hold their head facing forward. 4. Hold position for up to 1 minute and assess symptoms. 5. Ask patient to return too neutral. 6. Assess to left side. 7. (+) test is reproduction of cervicogenic symptoms.

21

SPecial tests for cervical rediculopathy

1. Bakody’s Sign/Shoulder Abduction Test
2. Spurling’s Compression Test
3. Neck Distraction Test
4. Upper Limb Neurodynamic Testing

22

Bakody’s Sign or Shoulder Abduction Test

Purpose: To assess upper limb neurodynamic symptoms
1. Patient is seated, arms at sides. 2. Therapist assesses resting symptoms. 3. Ask patient to actively place arm on top of his head. 4. Assess change in symptoms. 5. (+) test is reduction of arm pain.

23

SPurling's compression test

Purpose: To assess reproduction of cervical radiculopathy symptoms
1. Patient is seated, with head slightly side bent to the test side. 2. Interlock fingers over the top of patient’s head. 3. Apply 7kg of pressure in a downward through the top of the patient’s head. 4. (+) is reproduction of symptoms.

24

neck distraction test

Purpose: To assess relief of cervical radiculopathy symptoms
1. Patient is seated, neutral spine. Assess resting symptoms. 2. Grasp patient’s head with thenar eminences under occipital protuberance. 3. Apply distraction force through occipital protuberance. 4. Assess for change in symptoms 5. (+) test is reduction of symptoms

25

Median nerve General screen

Purpose: Assess neurodynamic mobility and sensitivity
1. Cervical spine neutral 2. Shoulder girdle depression 3. GH Abd to 110 deg 4. Wrist finger extension with supination of forearm 5. GH external rotation 6. Elbow extension 7. Cervical side bending 8. *need to assess start symptoms, ask for changes as each component is added, ask for THE symptoms, should be done to the uninvolved side first!

26

Radial nerve

1. Therapist stands at side of table facing the patient’s feet 2. Patient supine and laying diagonally across table 3. Arm is 10 degrees abducted 4. Elbow starts flexed 5. Gentle depression of shoulder with therapist’s hip 6. Depression is maintained and elbow is extended 7. Shoulder if internally rotated 8. Forearm is pronated 9. Keep all the components locked 10. Wrist is flexed with thumb in fist 11. Wrist is ulnarly deviated 12. Release of shoulder girdle depression to implicate dural tightness

27

Ulnar nerve

1. Scapular depression 2. Shoulder ER 3. Shoulder Abduction to 90° 4. Elbow flexion to 90° 5. Forearm pronation 6. Wrist extension/Finger Extension (especially digits 4 and 5) 7. Elbow flexion until symptoms are reproduced

28

Deep neck Flexor muscle endurance test

Purpose: assess DNF muscle endurance
1. Patient is supine on plinth. 2. Position patient’s head in full retraction. 3. Flex patient’s head about 2.5 cm off the plinth and ask patient to hold position. 4. Therapist places hand under head to detect change in position, and observe skin folds on patient’s neck. 5. (+) test is patient is unable to hold position for Men: 38.9 seconds, Women: 29.4 seconds as evidenced by head dropping or skin folds lessening.

29

Craniocervical flexion test

Purpose: DNF coordination
1. Patient nods their chin down and then lifts their head off table 2. Therapist assesses quality of motion and muscle activation 3. Biofeedback cuff is then used under the neck pumped up to 20 mm Hg 4. Patient nods their head "yes" trying to move to 22 mm Hg 5. Patient holds for 10 seconds 6. Patient then relaxes for 10 seconds 7. Patient performs again then moves to again to 24 mm Hg 8. Patient repeats the cycle increasing in increments of two until reaching 30 mm Hg 9. Patient can place their tongue on the roof of their mouth in an N position to help limit superficial muscles while they hold this position

Normal - If patient can hold for 10 seconds at each level up to 30 mm Hg

Abnormal - Patient is unable to get to 30 mm Hg with a hold of 10 seconds - Patient is unable to hold for 10 seconds - Patient demonstrates poor quality of motion and chin juts forward or uses excessive superficial cervical flexors such as sternocleidomastoid or scalenes

30

deep neck extensor coordination assesment

Purpose to assess deep neck extensor strength, endurance and coordination
: 1. Ask patient to “Lift up your head”
2. Observe the preferred movement pattern, does the patient demonstrate the following faulty patterns? - initiates this motion with craniocervical extension? - excessively extend at 1 area of the spine with significant creasing of the skin - experience reproduction of their symptoms
3. Correct the movement with the following cue: “Lift your head while keeping your eyes on a spot/object (like a book or a phone) here right between your hands. Do not let your eyes leave this spot.” 4. This should maintain the upper cervical spine in neutral as they lift their head 5. Reassess patient’s movement with this cue and ask if the symptoms have changed. 6. Have the patient repeat this movement 5-10 times 7. The patient fails the test if: - They lift the head with excessive upper cervical extension - They cannot get to the full head lift in the upper cervical neutral position - They cannot complete 5 to 10 repetitions with smooth, controlled movement 8. This movement can be used to improve deep neck extensor coordination, strength and endurance by repeating multiple repetitions