Anatomy
What travels through the transverse foramen of the cervical vertebrae C1-C6? C7?
The vertebral artery AND vein C1-C6. Only the vertebral vein in C7.
What motion to the uncinate processes guide?
Flexion/extension
How do you perform the Sharp Purser test? What ligament is it testing?
Seated with neck in semi-flexed position. Place index finger on C2 spinous process and other hand on patient's forehead. Testing for upper cervical instability (transverse ligament). (+) = excessive motion, sliding, or clunking felt or heard. May relieve symptoms.
How many degrees and from which plane are the zygapophyseal joints oriented? What motions does this introduce?
45 degrees. Lateral flexion and rotation
What is the purpose of the 1 major column? 2 minor columns?
Major: WB (vertebral bodies) Minor: guide motion (zygaphophyseal joints)
When laterally flexing to the RIGHT, the (left/right) zygapophyseal joints are opening and the (left/right) zygapophyseal joints are closing.
left are opening. right are closing.
What are the 5 D's and 3 N's?
Drop attacks, dizziness or lightheadedness related to neck movement, dysphasia, dysarthria, and diplopia. Nystagmus, nausea, and numbness.
What are indications for low level laser? Does the PT need to wear goggles or just the patient?
Acute neck pain with radiating pain (905 nm laser) and chronic neck pain with mobility deficits (830 nm laser).
What is a Jefferson fracture? What is the MOI?
The 2 lateral masses separate. Axial load.
What are the 3 main identifying characteristics of the typical cervical vertebrae? (C3-C6)
Triangular vertebral foramen, bifid process, transverse foramen
Which Fryette's Law does the lower cervical spine follow? What does this mean for the motion of the spine?
2nd law (non-neutral mechanics). side bending and rotation occur to the same side.
In the cervical rotation lateral flexion test, if the patient is rotated and laterally flexed to the R, which rib (L/R) are we testing?
Which nerve am I mobilizing if I depress the scapula, IR the shoulder, hand is in a fist with finger flexion, wrist flexion, and shoulder abduction?
Radial nerve.
Do nerves regenerate from the outside in or the inside out?
From the inside out. They degenerate (Wallerian degeneration) from the outside in (burning bush example.)
What are the 3 most common areas of compression for thoracic outlet syndrome?
Scalene triangle: brachial plexus between the anterior and middle scalenes
Costoclavicular interval: between 1st rib and clavicle (downwardly rotated scapula so clavicle is now compressing 1st rib and soft tissue between)
Pectoralis minor: entrapment beneath it. downward rotation or depression of the scapula leads to restriction of the channel where the brachial plexus runs
When laterally flexing to the RIGHT, the RIGHT zygapophyseal joint is sliding _______ and ________ on the vertebrae below.
inferiorly and posteriorly (downglide)
What are S/S of cervical myelopathy?
Sensory changes, muscle wasting of hand intrinsics, unsteady gait, hyperreflexia, bowel/bladder disturbances, multi-segmental weakness and/or sensory changes
How would you treat a cervical extension movement fault?
Unloading upper extremities, capital flexion, deep neck flexor strengthening, quad rock with cervical spine control, shoulder flexion with cervical spine control, improve upper thoracic spine extension flexibility
Rank the nerve injuries from least to worst. Neurotmesis, Neuropraxia, Axonotmesis
Neuropraxia (prognosis: hours to days), Axonotmesis (prognosis: axon regeneration 1 mm per day, 1 inch per month), Neurotmesis (months and ONLY with SURGERY. no guarantee of return of function)
Describe the release phenomenon. What part of the nerve is affected?
No symptoms while the cord or trunk is compressed (all day with TOS compression). When it is released (sleeping), the symptoms come on. Pins and needles when it is released.
Describe what is occurring with side bending to the right?
Right facets slide inferior and posterior (downglide) and close on the right while the left facets slide superior and anterior (upglide)
What is the CPR for cervical radiculopathy?
ULTT A (median nerve). ROM < 60 rotation toward painful side. Distraction eases pain. Spurling’s A. Compression test increases pain
What are contraindications for TENS?
Take us through the UE dermatomes and myotomes :)
DO IT