7q - cervical spine t & m midterm

7/25/2019 7Q - Cervical Spine T & M Midterm

1/27

J.C. Lau 2002

Cervical Spine Technique and Management - MidtermOutline1. Anatomy2. Biomechanics3. Chiropractic Analysis MAN Analysis

a. Subluxation/ Manipulable lesion/ Adjustable lesion(Locate u!lu"ation #ia$1. MotionAnalsis

Motion %alpation Motion &'ray

Cinema a)io*raphy

!. AlignmentAnalsis

". #eurologic Mani$estationAnalsis

Mani+estations o+ the u!lu"ation itsel+ (pain, ten)erness, tissue te"ture, re+le" analysis,

le* len*th analysis, muscle stren*th$

When all 3 agree, we have a high confidence that we are on the correct location!!

-. Chiropractic A)ustment. ther herapies

M%&T'(M

. Con)itions o+ the Cer#ical pine. Mana*ement +or these Con)itions4. 5ea)aches

Anatomo$ the Spinal Cord

Lar*est in the nec6 than any other area o+ the !o)y

Cer#ical 7ntumescentia C81 Contains Brachial %le"us

9ery sensiti#e structure

LAYERS from inside out:1. :loatin* in C:

Menin*es is +at

C: is +lui)

hus the spinal cor) +loats in +lui) helps +or shock absorption!

!. urroun)e) !y ;pi)ural :at

". urroun)e) !y the Spinal Column

Spinal Column1. )O&*' less compressi#e stren*th

Can lea) to compression +racture

a. Compression+racture

ually ;? :LA@

7+ A/B 2/3s, than pt. is consi)ere) sta!le

b. Schmorl,s#ode

c. )urst+racture

1


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J.C. Lau 2002

%ieces !rea6 +ree allo=in* potential o+ Neurolo*ical )ama*e

!. OST'(%O(A(Ca. edicle

hortene) pe)icles =ill cause !o)y an) Articular %illar to o#erlap on Lateral &'ray.

%re)isposes to pinal Stenosis

b. /ncinate rocesses N yno#ial !ut has 5yaline Cartila*e

Can !e a source o+ ca#itation, !ut not pro#en

%rotects the 79: (ner#e root$ +rom the ?isc C spine disc lesions are LESS COMMON!

pertroph o$the /ncinaterocesses

1. @reater inci)ence o+ ?isc Bul*e %ro!lems2. &'ray e#i)enceD

a)io'opacity seen at Lo=er Bor)er o+ 9erte!ral Bo)y

c. Articularillar

Barrier !et=een Li*amentum :la#um an) the 79:

Li*amentum :la#um =ill lose elasticity =ith a*e an) can also hypertrophy lea)in* to "

Stenosis

Superior Sur$ace Superior an) osterior

%n$erior Sur$ace %n$erior an) Anterior

d. +acets


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J.C. Lau 2002

!2 Annulus +ibrosis(inner#ation E $ecurrent %eningeal &erve$

Bul*e E causes more motor +in)in*s (anterior$

%# &NCNA'E (ROCESS

%rotects ner#e root +rom )isc !ul*e

?e*eneration o+ Lusch6a Joints E correlates =/?J?/arthritis I )isc protrusion

Anterior to 79: causes more motor +in)in*s (than sensory$

C# )Y*A(O(+YSEAL ,ON'

yno#ial Capsule/ Capsular Li*ament is #ery hi*hly inner#ate)

urroun)e) !y capsular li*ament

?e*enerati#e hypertrophic chan*e (spurs$ causes more sensory +in)in*s ()orsal$

yno#ial 5y*iene E maintain 7MB7B77N

3. 4%5AM'#TS re#ie=a. Anterior Lon-itudinal Li-ament anterior to 9erte!ral Bo)y (9B$

7nner#ate)

!. (osterior Lon-itudinal Li-ament' posterior to 9B

c. Supra.spinousLi-ament (Li*amentum Nuchae$ E o#er %

). nterspinousLi-ament E !et=een %

e. Li-amentum"la/um hi-h 0elastin1 .!/t LAM7NA o+ a)acent #erte!rae

AN;


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J.C. Lau 2002

3. 7nterspinalis-. 7ntertrans#ersalis

b. Sub'Occipitals

ta!iliFe C'pine

Sensor similar to ype 3 li*amentous receptor in cat

#erve9 muscle ratioE )etermines control ()e"terity$1$ 5i*hest ratio E e"trinsic muscle o+ eye2$ imilar ratio E u!'ccipital muscles

Suboccipitals91. SuperiorOblique!. %n$eriorOblique". (ectus Capitusosterior Major3. (ectus Capitusosterior Minor - Most hi*hly inner#ate) muscle in the !o)y

:i!rous colla*en !ri)*e attachment !et=een this muscle an) the Menin*es o+ the pinal

Cor)

heory that this muscle is a source o+ muscle contraction headaches!!

Suboccipital Triangle

Ner#es e"it out o+ the u!'ccipital rian*le (7n+erior !li>ue, C% Maor an) uperior

!li>ue$

4


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J.C. Lau 2002

c. OT'( M/SC4'S9 :4arger2

'rector Spinae muscles

ri*inate in the acrum

hus can palpate +or ten)erness here a lot o+ the time

1. Spinalis' % to %a. pinalis Cer#icis!. pinalis Capitus (to cciput instea) o+ another %$

2. 4ongissimus' 9% to 9%a. Lon*issimus Cer#icis!. Lon*issimus Capitus (to Mastoi) %rocess instea) o+ another

9%$

'cciput is the (P analog %astoid is the )*P analog

". %liocostalisa. 7liocostalis Cer#icis

Ner#eD %osterior !ranch o+ pinal Ner#e

Semispinalis9% !elo= to the % a!o#e

1. SemispinalisCervicis

!. SemispinalisCapitus

9% !elo= to cciput a!o#e (li6e the % o+ the s6ull$

Ner#eD

Splenius% !elo= to the 9% a!o#e

1. SpleniusCervicis

!. SpleniusCapitus

% !elo= to the Mastoi) a!o#e (9% o+ the s6ull$

@reater ccipital Ner#e

5


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J.C. Lau 2002

4evator ScapulaeOrigin9 %s o+ C1' C-%nsertion9 uperior an*le o+ capula#erveD Cer#ical Ner#e C3'C- ?orsal capular C

Trape;ius

Origin9

;%

uperior Nuchal line

Li*amentum Nuchae

%s o+ C 12

%nsertion9

Cla#icle

Acromion

pine o+ capula

1. /pperTraps ele#ates capula2. MiddleTraps retracts capula3. 4o6erTraps )epresses capula

When upper and lower traps contract together, (capular

A+duction will occur!! Pec %ayor - %inor (err Ant

'7'(C%S'S +O( 4O


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J.C. Lau 2002

8. Strapmusclesa. mohyoi) ' *oes !ac6 to the scapula!. ?i*astricc. Myohyoi) ' helps to open the a=). tylohyoi)e. hyroihyoi)

+. ternohyoi)*. ternothyroi)

Can all !e inure) an) cause &sphagia

=. latsma

5as N si*ni+icant +unction in humans

Terms o$ Conditions1. Concussion (!ump$

Hill cause temporary loss

2. Contusion (!ruise$

Hill cause permanent )ama*e

". Cervical %ntumessentia

Bul*e occurs at the area o+ Brachial Cor)s +rom C'1 re*ion

7t houses the !rachial ple"us

3. Stinger>)urner

Loo6 up in ol) material

8. )urning ands Sndrome

B/L tin*er +ollo=in* C'spine inury

=. Transient ?uadraplegia

%aralyFe) +ollo=in* a concussion (since it is a concussion temporary$

. SC%


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J.C. Lau 2002

harnx > 4arnx > Trachea > 'sophagus1. harnx

Carries !oth +oo) an) air

!. 4arnx he =itchin* station

". Trachea' anterior attachment to the Laryn"

3. 'sophagus' posterior attachment to the Laryn"

7s +lat =hen nothin* is in it

Hill !ul*e out =ith a !olus o+ +oo) in it

8. Throid5land

?ama*e) )urin* acne treatment in many people

=. Stellate5anglion

7rritation or e"cess +unction E )arre 4ieou Sndrome

+unction E orner@s Sndrome9 ptosis mosis anhdrosis

(eticular +ormation1. Origin

Brainstem

@rey I =hite matter

!. +unctionso$ the (eticular +ormationa. Control o+ A7C %


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J.C. Lau 2002

his possi!ly e"plains ho= an a)ustment helps stomach pro!lems, or other #isceral

pro!lems

Coul) also a++ect posture ne*ati#ely i+ su!lu"ation is not a))resse).

/pper Cervical Subluxation MAG a++ect (i.e. possi!ility o+ a++ectin*$1$ Autonomic +unctions2$ eticular Acti#ation ystem

7nsomnia A??

)iomechanics o$ the Spine1. +lexion/'xtension

Lo=er horacic 9erte!rae act li6e Lum!ars

A)ustments shoul) !e similar to Lum!ar a)ustmenti)e posture push

!. (otation

Most occurs in the horacic re*ion

to a)ust patients =ith ?isc Lesions in Lum!ar spine !ecause not that much rotation occurs

there

)iomechanics o$ the Cervical Spine

SEGMENT Flexion

Extension

Lateral

Flexion Rotation

C0/C1 Moderate Moderate

C1/C2 Moderate High

1. /pper Cervical Spinea. Motor units

cciput / Atlas motor unit

Atlas / A"is motor unit

b. +unction' ee notes Mo)erate amount o+ :le"ion/;"tension

Coupled MotionO$ /pper C-Spine

=o motions that are ;C"motor unit to CB>T1motor unit

9


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J.C. Lau 2002

Coupled MotionO$ 4o6er C-Spine

CC8motor unit

1. @reatest motion2. @reatest le#era*e3. Ape" o+ C'spine

-. MC location o+

Arthritis

/isc lesion(!ut usually +oun) lo=er$

&C,s91. He use Couple) Motion to loc outse*ments so =e can a)ust only N; M


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J.C. Lau 2002

!. permobilit

u**esti#e o+ li*ament inury

4ateral +lexion T(A/MA9

#O(MA4 T(A/MA

Side o$ 4ateral +lexion


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J.C. Lau 2002

Ieeping head 4'0'4in (otation (i*ht otation =ithout Lateral :le"ion$

(ight (otationH75


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J.C. Lau 2002

Normal E 3' -P

A#era*e E 20 ' 2(asymptomatic$

=. 4ong-term +lexion osture

Creates la" anterior li*aments shortens +i!ers (#ia #isco'elastic creep$

Creates ti*ht posterior li*aments

Management Considerations91. Antalgia


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J.C. Lau 2002

'xtension 'xercise

1. o stren*then the muscles that are nee)e) +or N;C ;&;N7N

hese muscles ha#e a har)er time e"ten)in* !ecause %atient

has a military nec6

;"ercise also +lushes !loo) 5


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J.C. Lau 2002

Chiropractic Analsis' 5;; 7 N @L? AN?A?MA# Analsis973 MotionAnalsis

Motion %alpation

Motion &'ray

23 AlignmentAnalsis When A 3 agree, we have ()$'&6 confidence &'ray Analysis that our assessment is correct!!!

%osture Analysis

tatic %alpation

83 #eurologic Mani$estationanalsis

Collagen > 0ascular&iseases

heumatoi) Arthritis nee)s lots o+ tests to positi#ely 7? (only a positi#e o+ 5 is not *oo) enou*h$

Just li6e u!lu"ation theory

Chiropractic 0ital Signs1. AlignmentAnalsis

LA;AL 97;H

osturalAnalsis

%atient shoul) !e in their Neutral position

ry to i)enti+y +or Anterior Hei*ht Bearin* (#ia ;AM an) shoul)er

ali*nment$

7-raanalsis

1. Cervicalcurve measurement

C2' Cshoul) !e 3 '-S current a#era*e is 2S

!. 5eorge@s 4ine

7nsta!ility i+ !rea6 is 3. mm

". resence o$ Anterior


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J.C. Lau 2002

Be sure to outline all pe)icles o+ &'ray to !e sure that there are no 9inkin- O6l si-ns

(metastasis o+ some sort$

(otation osture

At the pinolaminar Junction, % =ill !e either or L

Can also see i+ !oth %e)icles are e>ui')istant +rom !or)ers

1. maller %e)icle E Contralateral % rotation

2. Lar*er %e)icle E 7psilateral % rotation

4ateral +lexion osture Open


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J.C. Lau 2002

Motion alpation +indings and their Corresponding 4istings9

+ixation 4isting rocedure

(ight osterior(otation+ixation

%L / % listin*

estricte) =hen pushin* on i*ht

Articular %illar !ecause it is stuc6on the Le+t

Contactin* i*ht Articular %illar,

+ully rotatin* to the Le+t

4e$t osterior(otation+ixation

%/L% listin* Contactin* Le+t Articular %illar,

+ully rotatin* to the i*ht

(ight 4ateral+lexion +ixation pen He)*e on i*ht

Contactin* Lateral aspect o+ i*ht

Articular %illar an) +ully Laterally+le" to=ar)s the i*ht (usin* the+in*er as the :ulcrum o+ motion$

Just li6e a Cer#ical emps mo#e

:i"ation note) =hen tryin* to

close )o=n the open =e)*e(=ont !e sprin*y =hen =e+ulcrum at that le#el$

4e$t 4ateral+lexion +ixation pen =e)*e on Le+t Contactin* Lateral aspect o+ Le+t

Articular %illar, +ully lateral +le" toLe+t =ith +in*er as :ulcrum

Complex 4istings1. (S / 4%

Static postural $indings Le+t otation posture

Le+t Lateral :le"ion posture

5ross (OM $indings i*ht rotation restriction

i*ht lateral +le"ion restriction

Star &iagram i*ht Lateral :le"ion estriction

Le+t %osterior otation :i"ation

!. 4% > (S

Static postural $indings i*ht otation posture

Le+t Lateral :le"ion posture

5ross (OM $indings Le+t rotation restriction


Star &iagram i*ht Lateral :le"ion estriction

i*ht %osterior otation :i"ation

". (% > 4S

Static postural $indings Le+t otation posture

i*ht Lateral :le"ion posture


Le+t lateral +le"ion restriction

Star &iagram Le+t Lateral :le"ion estriction

Le+t %osterior otation :i"ation

17


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J.C. Lau 2002

3. 4S > (%

Static postural $indings i*ht otation posture

i*ht Lateral :le"ion posture



Star &iagram Le+t Lateral :le"ion estriction

i*ht %osterior otation :i"ation

A(& 4%ST%#5SHH

7n the Cer#ical pine, there are 2 Lo=er !li>ue an*lesD

a. (ight Anterior(otation +ixationb. 4e$t Anterior (otation +ixation

A#T'(%O( (OTAT%O# +%7AT%O#S(%ullin* A to % on Articular %illar$

p. 12 %A


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J.C. Lau 2002

4ateral $lexion % 6ic6s to CNALA;AL

(otation % 6ic6s to CNALA;AL

". 7-ra Motion Analsisa. +lexion/ 'xtension 7-ras

Loo6in* +or the presence o+ !loc6in* (in)icates the le#el o+ u!lu"ation$

)locingE a!sence o+ mo#ement !et=een 2 a)acent su!ects

b. 4ateral+lexion 7-ras

A!sence o+ couple) motion (couple) motion o+ e"tension an) rotation$

7n)icati#e o+ u!lu"ation

c. Cineradiograph

a6es a lot o+ &'ray e"posure

3. Motion M(%

o i)enti+y occult ?isc Bul*es

#eurologic Mani$estions

A)ustments ha#e !een sho=n to help =ith ALL o+ these

ALL are possi!le mani+estations o+ a su!lu"ation

1. ain

9A / 9?

5o= )oes it a++ect A?Ls

!. Tenderness

Al*ometry / ?olorimetry

en)erness in)icates possi!leD

u!lu"ation 5ypermo!ility

". Musclespasm

?ecrease) issue Compliance

3. Muscle Si;eand Strength

Myotomal )istri!ution o+ =ea6ness / atrophy

Can also use ?s

8. resence o$ aresthesiaor per>poesthesia

?ermatomal pattern

=. Cervical&ere$ield Test

Le* Len*th est

5a#e patient rotate hea) to !oth )irections

u!lu"ation causes irritation o+ %ropioceptors in nec6, causin* stimulus to casca)e )o=n to

%el#is

B. Sintemperature changesa. @o'scope

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J.C. Lau 2002

b. hermo*raphyc. 7n+rare) computin*d. #euro dermo Thermograph

Measures temperature chan*es in the s6in

Mechanism)ased on the Smpathetic #.S.

N causes an in ympathetic acti#ity at the le#el o+ the u!lu"ation

roblem

7+ there =as a Subluxation9

7t =oul) sprea) the A%s up an) )o=n the ympathetic chain

his =oul) cause a more 6idespreadheat )i++erential

ossible (eason9 An inflamed 87oint capsule is what is causing the heat reading

J. 'lectricalSin (esistance

Measures electrical resistance !ecause the s6in s=eats

K. Muscle Testing(Applie) inesiolo*y$

Theor

MeasuresQpee) o+ ma"imum contractionR 4ocing

A LStrong muscleR E no su!lu"ation

ouchin* the su!lu"ation =ill !loc6 the propioceptor mechanism

his causes a slo=in* o+ the spee) o+ Ma"imum Contraction ma6in*

it =ea6

Therap 4ocali;ation Challen*in* #erte!rae to=ar)s su!lu"ation =ill ma6e it =ea6er

Challenge Testing %ushin* #erte!rae to=ar)s correction ma6es it stron*er

Surrogate Testing Challen*e urro*ate =hile he/she is touchin* the patient

1. 4eg4ength Analsis

?irectional Non':orce echni>ue herapy localiFation

Challen*e estin*

hompson ?rop echni>ue

11. endulumTechnique

Mo#in* crystal o#er su!lu"ation =ill rotate cloc6=ise +or a % an) countercloc6=ise +or a %L

1!. Aura

Ha#in* han) o#er !ac6

CORREC'N* S&%L&:A'ONS ;A$,&S'MEN'S#

7# S/)4/7AT%O# A(T%C/4A(SE speci+ic thrust *i#es speci+ic correction

2# ST'0'#SO# T'O(*E innate

8# Osseus ad


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J.C. Lau 2002

Contact

(houl) !ecom+orta!le yet

+irm$

1. )onprominence

%

Articular %illar

Lamina

9% / Mammilary process

!. TissuepullE usually in )irection o+ thrust

B7M;C5AN7CD Allo=s us to !rin* one speci$icoint into QensionR


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J.C. Lau 2002

"2 in Muscle tension ' s 79: siFe

his impro#es ANG :oraminal ;ncroachment con)ition

hus can !e & +or +oraminal encroachment

32

inain F Tenderness

?ue to lesion !ein* remo#e)

Q@ate heory ;++ectR

82 #erve Compression > %rritation

79: siFe

Ner#e root encroachment

Motion increases #ascular +lo=

?;C;A; in+lammation

9ltimately decreasing nerve root

compression!!

=2 Alignment s

ALL CAN CC


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J.C. Lau 2002

3. CO(& COM('SS%O#

;LA79; CNA7N?7CA7ND1. e#ere %A7N / A7N o+ Cer#ical )isc2. Anytime there is Severe pain)urin* the Qset'upR3. 5ypermo!lity

-. ?isc lesions. ?J?

=# NON osseus ad /oesn;t make a


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J.C. Lau 2002

xercise F(ehabilitation

1. assive (OMa3 Results

tren*thens scars

a)hesions

b3 '5pes of (assi/e ROM . E4ercise B Rehabilitation73 *ross ROM

nly ;N? AN@; =ithout pain

23 Stair.steppin-

QAnterior translationR =ith pt. upine

"i-ure.(+rom $ ' QAnterior translationR =ith pt. upine

=hile mo#in* hea) in a :i*ure 4 motion

83 Mobiliation(speci+ic$ Qset'upR H75


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J.C. Lau 2002

OT'( T'(A%'S1. So$t-Tissue Therapies

uantity o+ +orce is an art (touch chan*es +rom patient to patient

ela" to pressure (=ant patient to rela" so you can push )eeper$

a (oint (ressure 'ri--er (oint(can use in conunction =/other therapies$

(ROCE$&RE: )o allow patient to rela.1. A)ust 1st

2. 5eat/col)

%rior to therapy (to )esensitiFe tissues$

3. opical a*ents

-. %oint pressure =ith #i!ration

. Muscle contraction

%ressure =ith %A79; or AC79; mo#ement

Contract Antagonistcauses inhi!ition an) rela"ation o+ the treate) muscle

. :ollo= =/stretch

b3 Cross."iber "riction Massa-e1. ?irection o+ mo#ement E perpen)icular to =ea6 +i!ers

s car stren*th

ear scar tissue perpendicular to *rain o+ muscle to stren*then

Can use all o+ the pre#iously mentione) mo)alities to %;% the patient !ecause this

therapy hurtsH

c Strippin- Massa-e> go parallel to the fibers

%ushin* meta!olites

1. AR' Acti/e Release 'echniDue stretches the a)hesions

?urin* therapy patient contracts anta*onistic muscles

:ollo= =/ice U stretch i+ #i*orous

2. Traction V o+ BH to a maximumo+ 30 0 l!sa3 +alter '5pe> over the door traction

1. Chin strap an) ccipital strap

is6 o+ MJ inury

2.


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J.C. Lau 2002

d3 %ntermittentTraction

s A)hesions

7s B;; than Constant raction

$emoves edema by increasing *A("9A$ P9%P2&6!!

e3 ositions1. 'xtension Traction

7ncreases C'spine cur#e

!. #eutral Traction

7ncreases 79: siFe

". Slight +lexion Traction

:oraminal ;ncroachment )ecreases

3. T

5eat herapy

Cryotherapy Col) Motor Ner#e timulation

-. Orthopedic SupportsE Cer#ical Collars ' N tractiona. o+t +oam collar

?ecreases M

?ecreases =ei*ht !earin*

Allows muscles to $A!!

!. emporary use only

3 months MA& (usually only 1 2 months$

c. (isso$ overuse - emporary

Hea6ness Atrophy

A)hesions

:i"ations

8. #utritional Supplementsa3 Antiinflammatory protocolb3 Proteolytic en#ymes: %romelain 'r5ptin Ch5motr5ptinc3 *alerianroot muscle rela"antd3 B 5)P controls pain an) )epressione3 Cartilage (epair

6lucosamine sulfate

"hondroitin sulfate 0 %(%

. &rugs ?Cs are allo=e) to Qrecommen)R Cs (7lle*al to Qprescri!eR$

He can only tell them to ta6e =hat the !ottle recommen)s, no more

a Anti.inflammator5C&(A2/(@

i)e e++ect o+ stomach complications

a6e =/+oo) to )ecrease the ris6 o+ @7 !lee)in*

Aspirin 7!upro+en

26


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J.C. Lau 2002

Napro"en (Alee#e$

b AcetaminophenC)ylenol@E pain relie#er only, N Anti'in+lammatory

Hill mas6 the pain allo=in* them to hurt themsel#es e#en more

7q - cervical spine t & m midterm

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