Cervical Biomechanics
Disc Related disorders
Thoracic
TMJ
Pathology
100
Define opening and closing patterns
Opening: flexion and contralateral rotation Closing: extension and ipsilateral rotation
100
What is a primary cause of chronic neck problems?
Posture
100
Define a scoliosis
a lateral deviation in the frontal plane associated w/ rotation
100
What is the physiological resting position for TMJ?
Tongue resting on roof of mouth breathe through nose, diaphragmatic breathing teeth not touching, except to eat avoid habitual chewing mouth guard at night if dysfunctional swallowing, refer for swallowing (SLP)
100
In the cervical spine, where is the first area you see degenerative changes?
Uncovertebral joints.
200
With lateral bending to the L. What coupled movements are expected at the cervical levels C2 and below? OA?
C2 and below: ipsilateral rotation OA: Contralateral rotation
200
Pt presents with neck pain and spots of pain between his shoulder blades that does not refer to the upper extremities. What might be the source of the pain?
Cervical disc
200
How do you measure and name a scoliosis?
Measure the Cobb angle (angle b/t the first curved vertebra and the bottom) defined by the side of convexity
200
Besides the TMJ itself, what else needs to be addressed with TMD (tempromandibular dysfunction)?
Posture, neck position, cervical ROM, suboccipital release
200
What are the most common symptoms of vertebral artery syndrome?
Neck pain, headache
300
C1 translates in which direction in relation to the occiput?
C1 translates in the direction the occiput rolls.
300
What is myelopathy and what are some potential positive findings? When do you refer immediately?
Pressure on the spinal cord. Hoffman's, Babinski, increase LE DTR, ataxic gait Immediate referral: if bowel/bladder involvement, LE involvement, loss of neural function
300
What are the causes of scoliosis and give an example of each.
Idiopathic: leg length discrepancy Acquired: fracture, paraplegia, tumors, rickets congenital: spina bifida, muscular dystrophy, arthrogyposis
300
What is the treatment for hypomobility of the TMJ?
Mobilization: distraction, anterior and lateral glides
300
Define whiplash associated disorders (how do they occur) and what are some things that can happen (name 3).
Acceleration/deceleration injuries / flexion/extension injuries. Fractures, ligamentous involvement, nerve root involvement, brachial plexus injury, spinal cord involvement, psychological issues (fear of movement which leads to avoidance behaviors), concussion or TBI
400
Pt presents with full cervical rotation to the L and limited rotation to the R. When laterally bent to the R, the rotation to the R is further limited and R rotation reproduces the pt's symptoms. At what level(s) are the symptoms produced from? How do you know?
From C2 and below.
400
What is the cervical radiculopathy test cluster and what are the expected positive findings? How is it treated?
Ipsilateral rotation limited to < 60' w/ UE symptoms + Spruling's A (compression not bending) for UE symptoms + distraction: relieves UE symptoms + ULNTT A Treatment: traction
400
What are the patterns of idiopathic scoliosis and for what pattern must you refer immediately?
right thoracic (T5-T11) Thoracolumbar (T8-T3, apex at T12-L1) Lumbar (T11-L4) Double major (right thoracic, left lumbar) double thoracic (left T2-T7, R T7-L1) Refer: primary Left thoracic (likelihood of congenital or acquired etiology)
400
What is the treatment for hypermobility at the TMJ?
Rhythmic stabilization tongue position education physiological rest
400
What are the Canadian C-spine rules?
High risk factors: >/= 65 y/o, dangerous mechanism, or paresthesias in extremities = radiography required Inability to rotate head 45' L and R = radiography
500
L lateral bending: limited R lateral bending: full L rotation: full R rotation: limited Where is the problem stemming from and how do you know?
OA
500
Describe posture syndrome, when a patient would have pain and most common posture. What muscles are shortened? What muscles are weak? What are some potential complications?
Head forward, rounded shoulder. Usually intermittent pain associated w/ positions and activities. Shortened: upper trap, levator, SCM, scalenes, suboccipital muscles, pec minor Weak: middle and lower trap, deep cervical muscles Complications: trigger points, radiculopathy, thoracic outlet, shoulder impingement, tension headaches, adaptive shortening
500
What are the treatments for scoliosis and what has the best supportive literature?
Exercise, modalities, surgery, bracing Best evidence is for combination bracing and exercise. depends on the age of the pt, the cause, and if it is structural or non-structural.
500
Define Myofacial pain dysfunction syndrome (MPD) and what are some treatment?
Refers to pain in the facial region that is believed to be caused by: muscle hyper-activity (trigger points), psychological involvement. Typically includes headache symptoms. Treatment: stress management, soft tissue and muscle management techniques, pt education, strengthening of deep cervical flexors, positional release, trigger point release, splinting
500
Name some (at least 5) red flags/ contraindications / precautions when evaluating cervical pain.
Cancer, uncontrolled DM, spinal cord compression, Child, pregnancy, B symptoms, fever, systemic steroid intake, recent protracted fatigue, constant pain, acute capsular pattern, empty end feel, Undiagnosed dizziness, facial paresthesia Horner's syndrome, dysphagia, CN signs
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