Classify
Pt is a 30 year old female who presents to PT 3 months following trauma. MOI included several falls during "combat training" for work in a corrections facility. Cranio-cervical Flexion Test: successfully achieves 22 mmHG. Deep Neck Flexor Endurance Test: Pt score 15 seconds. Pain with mid-range and end-range motions, especially flexion and extension.
Neck pain with movement coordination impairments (WAD)
Norms for Deep neck flexor endurance test
Male and female
Males: 39 seconds
Females: 29 seconds
How do you stretch the upper trapezius muscle
sidebend away, rotate Towards
PAIVMs vs PPIVMs (Passive Accessory Intervertebral Movements) (Passive Physiological Intervertebral Movements)
Passive Accessory: joint play
Passive Physiological: what the joint does with passive motion; is it moving appropriately at the joint level
Normal ROM Values (opening, lateral excursion, protrusion, retrusion)
Lateral excursion: 25% of opening
Protrusion: 6-9 mm
Retrusion: 3 mm
Pt is a 23 year old female who presents to PT with a 2 week history of R sided neck pain. Pt reports waking up with the pain. Pain is reproduced with L rotation and forward flexion and she presents with 50% of full ROM in these planes. She also complains of pain in the upper trapezius region, reproduced with joint play. PPIVMs: decreased upglide on the R. PAIVMs: decreased R sided PA glide. Deep neck flexor endurance: 20 seconds.
Neck pain with mobility deficits
+ Cervical Flexion Rotation Test Degrees
<32 deg
Normal: 45 deg
Name 2 treatments for cervical pain with radiating symptoms
1) repeated motions in directional preference
2) neurodynamics (nerve glides)
3) traction
4) strength/endurance
5) postural control
6) stretching
Pt is presenting with decreased right cervical rotation and pain on the right side of neck. Name 2 joint mobilizations that would facilitate right cervical rotation and why you might choose one way over the other.
1) Left upglide
2) Right downglide
Name the 3 classifications of TMD
I: Masticatory muscle disorders
II: Disc displacement
III: Joint Dysfunction (OA, arthalgia)
Pt is a 55 year old male who presents to PT with complaints of high pain levels in his neck and into the R arm. Pain travels down the posterior arm and into digits 2 and 3. Pt describes pain as sharp and shooting and notes intermittent numbness/tingling in this same distribution. He presents with strong biceps, deltoid and wrist extension, though 4- in the triceps and wrist flexors.
Neck pain with radiating pain
Which nerve root is compressed?
Cluster for neck pain with radiating pain
+ULTT
+Spurling's
+Distraction
also look for < cervical rotation and valsalva
What classification might you use vestibular/eye-head-neck coordination exercises for if indicated?
Neck pain with movement coordination impairments (WAD)
What movement would a bilateral upglide on C4 facilitate
Cervical flexion
What happens at the joint level as the mouth opens.
Posterior rotation and then anterior translation.
Pt is a 42 y/o female who presents to PT with complaints of a 3 month history of L sided neck pain. She also notes intermittent headaches that are brought on with holding the phone in between her neck and ear while at work. Cervical flexion rotation test: 28 degrees. Decreased joint mobility at the OA and AA joints. Cranio-cervical flexion test: achieves 26 mmHg successfully
Neck pain with headaches (cervicogenic headaches)
Cranio-cervical flexion test procedure
20-22-20
20-24-20
20-26-20
20-28-20
20-30-20
Record performance: aberrant motion, mouth movements, inability to return to baseline, look for SCM contraction
What are the Rocobado 6x6 exercises?
1) resting tongue position + nasal and diaphragm breathing
2) controlled opening
3) rhythmic stabilization (open, close, lateral dev.)
4) self-traction (15 degrees of flexion)
5) chin tuck (cervical retraction)
6) scapular retraction (scap squeeze)
You are assessing a patients PPIVM's. You note she rests with C5s R transverse process in a downglided position and has hypomobility with upglide on the R. What motion will be difficulty for her?
Left rotation
Forward flexion
Left sidebend
Name the 3 muscles that elevate (close the mouth), and 1 muscle that opens the mouth (depresses)
a) masseter, temporalis, mEdial pterygoid
b) LATeral pterygoid
Migraine HA distribution
Cluster HA distribution
Tension HA distribution
often unilateral, frontal
retro-oribital
band at level of temple; occipital
Thoracic Manipulation Clinical Prediction Rule
1) Pain <30 days
2) FABQ <12
3) No pain distal to shoulder
4) decreased kyphosis T3-5
5) No increase in pain with cervical extension
6) Cervical extension < 30 deg
+3/6 = 86%
Your patient complains of several of the "5 D's & 3 N's." What is your treatment approach?
BONUS! Can anyone name them?
Referring out for further consult
1) dizziness, 2) drop attacks, 3) dysphagia, 4) diplopia, 5) dysarthria
AND: ataxia
1) nausea, nystagmus, numbness
Pt has trouble with R rotation and you find to be secondary to impaired joint mobility. How will they perform a self-mobilization to facilitate this motion?
towel at 45 degrees pulling upward. rotate head to right. assist with left upglide using towel.
a)masseter and temporalis= ipsilaterally
b)medial and lateral pterygoids= contralaterally