Lectures 18-23
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| What is the function of the cervical spine? | show 🗑
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| Is neck pain more common in women or men? | show 🗑
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| show | 20-40
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| What is the peak age of neck pain in the general population? | show 🗑
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| True or false: Neck pain is the most common musculoskeletal presentation. | show 🗑
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| show | 2/3
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| What are some factors associated with neck pain and radiculopathy? | show 🗑
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| show | autonomic failure, CV disease, digestive system disease, dizziness, headaches, low back pain, shoulder pain, TMJ syndrome, etc.
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| How many cervical vertebrae are there? | show 🗑
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| show | lordosis
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| What is significant about the spinous processes from C2-C6? | show 🗑
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| show | increased support for the cervical spine and prevention of herniation
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| show | the vertebral artery runs through the foramen
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| show | the occipital-atlantal segment, the atlantal-axial segment, and the typical cervical vertebrae
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| show | the articulation of the occiput and the atlas
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| show | the articulation of the atlas and the axis
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| What is the function of the cervical muscles? | show 🗑
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| show | flexors and extensors
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| What motions are enabled when the cervical muscles act bilaterally? | show 🗑
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| show | sidebending and rotation
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| How many cervical nerves are there? | show 🗑
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| show | ABOVE the corresponding cervical vertebrae (for example: C1 nerve root exits above the C1 vertebrae)
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| Where does the nerve root of C8 exit? | show 🗑
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| show | below the corresponding vertebrae (for example: the nerve root of T4 will exit below T4)
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| Where is the most common herniation in the cervical spine? | show 🗑
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| What is the primary motion of the occipital-atlantal joint? | show 🗑
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| What percent of cervical flexion occurs at the OA? | show 🗑
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| show | NO
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| When sidebending is induced at the OA joint, what direction will rotation occur? | show 🗑
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| show | rotation (almost entirely)
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| show | 50%
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| What happens to the facets during flexion of the cervical spine? | show 🗑
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| show | they close
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| show | to the same side (sidebend left = rotate left)
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| show | in patients with depression, advanced age, etc.
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| show | fibromyalgia, osteoarthritis, and/or cervical strain
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| What is torticollis caused by? | show 🗑
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| Should you assess active or passive ranges of motion in the cervical spine first? | show 🗑
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| show | Passive range of motion should be equal to or greater than active range of motion.
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| show | loss of rotation (rotation to either side should be near 90 degrees with a smooth end feel)
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| show | perform a neuro exam of the upper extremities and consider doing an x-ray to evaluate for osteoarthritis, cervical radiculopathy, and severe cervical strain.
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| show | diminished ability to sidebend (should be greater than or equal to 45 degrees)
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| What is the most commonly irritated neck muscle? | show 🗑
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| Muscle tenderness in the cervical spine may be indicative of... | show 🗑
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| The Spurling maneuver is specific for... | show 🗑
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| show | Press on the top of the head while extended and sidebent
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| show | C5
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| show | C6
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| wrist flexors nerve | show 🗑
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| show | C8
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| show | T1
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| show | C5
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| brachioradialis reflex nerve | show 🗑
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| show | C7
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| show | for vertebral artery insufficiency
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| How do you perform the Wallenberg test? | show 🗑
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| What is a positive Wallenberg test? | show 🗑
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| What is contraindicated by a positive Wallenberg test? | show 🗑
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| What would indicate cervical radiculopathy? | show 🗑
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| How might you treat cervical joint somatic dysfunctions? | show 🗑
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| What tests should you perform before treating cervical somatic dysfunction? | show 🗑
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| show | when there is persistent muscle spasm and restricted range of motion, when the patient is apprehensive with active motion, when there is persistent inflammation, or when there is hypermobility
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| show | whiplash
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| show | muscular injury
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| What is sprain? | show 🗑
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| What are common cervical flexion injuries? | show 🗑
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| show | anterior muscle strain, anterior ligament sprain, brachial plexopathy, and fracture of the dens (atlanto-axial subluxation)
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| What is at risk when there is a contusion caused by a shearing injury? | show 🗑
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| What is at risk for sprain caused by shearing injury? | show 🗑
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| show | the articular pillar, the subchondral plate, evulsion of the endplate, and the articular surface
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| If someone is sidebent and rotated (aka looking to the side) at the onset of whiplash... | show 🗑
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| True or false: Whiplash may result in facial/sinus pain, headache, ear pain, sensory disturbances, back pain, and/or pain in the extremities. | show 🗑
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| show | they are older in age, are female, had initial neck pain, allowed time to pass b/w the accident and treatment, had high initial pain intensity, had lawyer involvement, and/or were injured while working.
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| show | 56%
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| show | 82%
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| show | chronic pain
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| show | pain and disability at 2 years
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| Patient guarding with active ROM is a red flag for... | show 🗑
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| Why is ROM at 3 months important? | show 🗑
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| How long after a whiplash injury should you wait to use direct techniques? | show 🗑
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| During the first two weeks (acute stage) after injury caused by whiplash, how should you treat the patient? | show 🗑
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| show | direct techniques and home flexibility
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| show | add injections and move on to multidisciplinary treatment
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| What is somatic dysfunction? | show 🗑
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| What hypothesis is used to explain counterstrain and muscle energy? | show 🗑
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| show | TRUE
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| show | making anatomic correlation with history, observation, and palpation. (Ask yourself: How and Where is the pain generated?)
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| show | the neuromuscular component
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| afferent nerves | show 🗑
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| efferent nerves | show 🗑
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| What is proprioception? | show 🗑
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| What is used for proprioception? | show 🗑
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| Nociception is carried out via... | show 🗑
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| show | activate muscle (outside of the muscle spindle)
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| show | changes the base length of the muscle spindle (within the muscle spindle)
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| show | stretch, rate of stretch, and relative/absolute position in space
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| counterstrain hypothesis | show 🗑
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| show | alpha/gamma resetting
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| show | the nociceptive model
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| counterstrain/gamma gain hypothesis order of events: | show 🗑
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| show | postural imbalance - strain - PAIN - neural imbalance - muscle spasm - tenderness
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| What are we trying to fix in the counterstrain/gamma gain hypothesis? | show 🗑
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| show | pain b/c this is the cause
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| Who developed the concept of osteopathy in the cranial field and the theory of the primary respiratory mechanism? | show 🗑
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| show | 1. motility of the brain and spinal cord 2. fluctuation of CSF 3. mobility of the intracranial and intraspinal membranes 4. mobility of cranial bones 5. involuntary mobility of the sacrum between the ilium
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| show | pulse pressure fluctuation
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| show | cranial rhythmic impulse (CRI)
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| show | the sphenobasilar synchondrosis
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| show | the SBS moves inferiorly; the examiner would feel the head getting longer and thinner
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| How does the SBS move in flexion? | show 🗑
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| What is the typical CRI rate? | show 🗑
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| amplitude of CRI measurement is the distance from... | show 🗑
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| show | CRI rate, amplitude, and symmetry
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| show | 4-5
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| True or false: Sacral motion is linked to cranial motion. | show 🗑
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| The CRI can be palpated over the entire body as... | show 🗑
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| show | articulation b/w the frontal and parietal bones
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| show | articulation b/w the parietal bones
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| lambdoidal suture | show 🗑
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| show | articulation b/w the parietal and temporal bones
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| pterion | show 🗑
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| show | articulatory spot where the temporal, parietal, and occipital bones all meet
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| show | articulation b/w the occiput and temporal bones
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| bregma | show 🗑
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| show | where the lambdoidal and sagittal sutures touch
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| Indications for cranial manipulative therapy | show 🗑
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| show | intracranial bleed, subdural/epidural hematomas, skull/facial fracture, infection of the brain/dura/meninges (during the acute phase of infection), seizure disorders, and CNS malignancies
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| What is the cranial base? | show 🗑
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| show | a union of two bones formed by hyaline cartilage or fibrocartilage (allows for slight movement)
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| True or false: Most cranial base strain patterns are named in relation to what the SBS is doing. | show 🗑
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| show | there are 2 parallel TRANSVERSE axes; during flexion the sphenoid and occiput rotate in opposite directions around the axes so that the SBS moves superiorly
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| show | 2 parallel TRANSVERSE axes; the sphenoid and occiput rotate in opposite directions so that the SBS moves inferiorly
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| What are the physiologic cranial base strain patterns? | show 🗑
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| What are the non-physiologic cranial base strain patterns? | show 🗑
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| show | non-physiologic; physiologic strain patterns can be normal cranial motion and are not usually related to trauma
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| SBS torsion | show 🗑
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| show | it is named for the greater wing of the sphenoid that is superior
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| SBS sidebending rotation | show 🗑
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| show | for the side of convexity
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| show | shearing forces at the SBS (such as a helmet to helmet hit at the top of the head)
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| Describe the movement associated with a vertical strain: | show 🗑
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| How is vertical strain named? | show 🗑
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| What might cause an SBS lateral strain pattern? | show 🗑
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| show | the sphenoid and the occiput rotate in the same direction (either clockwise or counterclockwise) around 2 parallel VERTICAL AXES
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| How would lateral strain feel to the practitioner? | show 🗑
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| show | for the position of the basi-sphenoid in relation to the basi-occiput. (if your index fingers move left, it is a right lateral strain. if your index fingers move right, it is a left lateral strain.)
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| What might cause SBS compression? | show 🗑
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| How is SBS compression classically described? | show 🗑
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| show | Embryologically, the cranial base is derived from cartilagenous bone while the cranial vault develops from membranous bone.
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| What bones make up the cranial vault? | show 🗑
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| Which of the bones composing the cranial vault are 'paired'? | show 🗑
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| show | the occiput and sphenoid (greater wings)
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| show | the sphenoid and occiput; they move through flexion and extension
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| show | They move through internal and external rotation
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| show | When the midline bones are in FLEXION, the paired bones are in EXTERNAL ROTATION. When the midline bones are in extension, the paired bones are in internal rotation.
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| Articulations of the occiput include... | show 🗑
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| show | the occiput, the temporal bones, the ethmoid, the palatine bones, the frontal bone, and the vomer
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| show | trauma with forceps delivery, endocrine problems can result from sphenoid dysfuncion, and there may be problems with CN I-VI if there is sphenoid dysfunction
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| articulations of the frontal bone: | show 🗑
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| The frontal bone has an inferior attachment site for what important cranial structure? | show 🗑
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| What brain region is housed in the frontal bone? | show 🗑
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| show | the frontal bone forms the roof of the orbit and the floor of the anterior cranial fossa
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| Indications for frontal lift (a cranial vault technique): | show 🗑
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| The parietal bone encloses the anterior and posterior division of... | show 🗑
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| What brain structure is protected by the parietal bones? | show 🗑
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| Dural reflections from the parietal bone form what sinus? | show 🗑
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| show | sphenoid, temporal, occipital, and frontal
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| show | hypertensive headaches, impulsivity, headache, idiopathic epilepsy, and local pain along the cranial suture. This technique enhances drainage along the superior sagittal sinus and can help relieve dural tension
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| articulations of the temporal bones: | show 🗑
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| important osteological features of the temporal bones: | show 🗑
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| show | it is parallel to the external auditory canal within the petrous portion of the bone
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| show | the organs of hearing and balance as well as the openings of several foramen for cranial nerves and the fossa for the trigeminal ganglion
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| The most common clinical problems involving temporal bone dysfunction relate to... | show 🗑
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| Why might strabismus improve with temporal balancing? | show 🗑
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| Temporal balancing is good for children with... | show 🗑
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| show | CN VII and VIII, the trigeminal ganglion, the jugular vein, the carotid artery, TMJ, and the Eustachian tube
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| show | vertigo, nausea, chronic headaches, hearing problems, recurrent ear infections, tinnitus, optical difficulties, Bell's palsy, and trigeminal neuralgia
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| show | it overlies the anterior branch of the middle meningeal artery and is the thinnest region of the cranial vault; restrictions at the PRM can shut down the entire PRM
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| show | it is commonly tender and restricted by tightness of the SCM and can cause focal sutural pain or retro-orbital headache
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| show | the squamosal or temporoparietal suture and cause sutural pain or temporal headache
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| show | sutural tenderness or cranial bone restriction associated with headache, cranial nerve entrapment, or other problems
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| show | through the general visceral afferent neurons of the autonomic nervous system
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| show | ambiguity at the barrier
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| True or false: The intensity of the palpatory findings is often not a good indicator of the severity of the causative visceral pathology: | show 🗑
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| show | small (2-3 mm) firm nodular masses, palpable in soft tissue, that demonstrate sharp pinpoint nonradiating tenderness; Chapman's reflexes provide another method of recognizing viscerosomatic effects.
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| To diagnose viscerosomatic reflexes, it is recommended that special palpatroy attention be directed toward to costotransverse area in the thoracic spine. Viscerosomatic reflexes may be differentiated from primary somatic dyfxn by... | show 🗑
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| What are some signs of acute viscerosomatic reflex? | show 🗑
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| What are some signs of chronic viscerosomatic reflex? | show 🗑
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| Viscerosomatic reflexes classified as sympathetic are found... | show 🗑
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| Viscerosomatic reflexes classified as parasympathetic are found... | show 🗑
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| Somatic dysfunction that is the reflex result of primary visceral pathology is treated by employing... | show 🗑
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| True or false: Manipulative treatment may be directed at the somatic dysfunction to decrease the facilitated state, even if it is of viscerosomatic reflex origin. This results in a beneficial effect upon the site of pathology. | show 🗑
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| show | inhibitory pressure procedures
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| show | congested states (such as pneumonia) or hypoactive conditions (such as constipation)
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| show | the presence of a possible viscerosomatic reflex
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| show | it interrupts the reflex arc
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| show | massage of the point for 10-30 seconds
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| head and neck | show 🗑
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| cardiovascular | show 🗑
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| Respiratory | show 🗑
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| Stomach, liver, gallbladder | show 🗑
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| Small intestines | show 🗑
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| show | T9-T10
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| Kidney, ureters, and bladder | show 🗑
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| show | T8-L2
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| uterus | show 🗑
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| Prostate | show 🗑
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Created by:
smuncy