7 - Spine Advanced Ortho Issues Issues and Special Tests (copy)

What motions primarily occur at the occipitoatlantal joints?

Flexion and extension

What is the primary motion at the atlantoaxial joint?

Rotation

Fibroadipose meniscoids are commonly found in the cervical zygapophysial joints and can become impinged.

True

What are the goals during the acute phase of cervical spine injury?

• Head nod then return to neutral using segmental recruitment of cervical flexors and extensors

• Coupling motions (ex. combining nod, rotation, and side bending)

• AAROM/AROM

• Global Strengthening -submaximal isometrics

What are the goals for subacute through chronic cervical spine injury?

• Postural stabilization throughout the spine

• Cervical and cervicothoracic stabilization exercise will help the patient:

*Move to maintaining stability with UE activity

Cervicogenic Headaches

• Pain in the cervical spine that often radiates to the head, forehead and occipital area 

• Thought to be connected to inflammation or dysfunction of the upper cervical joint, ligaments and muscles.

• Associated with weak deep cervical flexor muscles, poor posture and trauma to the neck.

• Patients often have limitations in cervical joint motion

What special test(s( are used to diagnose cervicogenic headaches?

Deep Neck Flexor Endurance Test

What interventions are used to treat cervicogenic headaches?

• Emphasis on strengthening exercise for the deep cervical flexors

• Strengthening and stabilization exercise for the cervical spine and scapula

• Cervical and thoracic joint mobilizations

• Postural education

• Patient education about avoiding prolonged positions

• Pain relieving modalities

• Proprioception training for cervical spine

Degenerative Joint Disease in the Neural Foramen

• Osteoarthritis, DJD (and shrinking of disc) and osteophytes narrow the foraminal space

• Common signs are cervical and UE pain, altered sensation, weakness and hyporeflexia

• Symptoms are typically unilateral

What motion of the spine do people with DJD in the neural foramen show a bias towards?

Flexion

What special test(s) are used for DJD in the neural foramen?

• A relief of symptoms with the UE over the head is called the shoulder abduction relief sign

• Other associated tests: Cervical distraction test, Spurling's Compression test and ULT

What interventions are used to treat DJD in the neural foramen?

• Strengthening of the deep cervical flexors

• Nerve gliding

• Strengthening of scapular stabilizers

• Cervical and thoracic mobilizations

• Cervical traction (manual or mechanical)

• Postural education

Compression fractures

• Stable fracture that results in collapse of the vertebral body. Most commonly occurring in the lower thoracic spine due to osteoporosis or trauma (car accident, fall)

• Sudden onset pain that increases with sitting, standing, bending, lifting and walking. Lying down relieves symptoms

• Progressive compression and additional fractures will result in increased thoracic kyphosis, decreased height and decreased space between the ribs and pelvis

What interventions are used to treat compression fractures?

• Strengthening of the spinal extensors

• Core stabilization (avoiding trunk flexion) 

• Begin with prone scapular retraction

• Prone trunk and UE lifts o Progress to standing UE raises while maintaining correct posture

• Gradually add resistance as appropriate

• Proprioceptive and balance exercise to reduce risk of falls leading to fractures

What motion should be avoided when working with a compression fracture or lumbar radiculopathy?

Excess flexion

Spondylolysis/Spondylolisthesis

• Erosion or defect of the pars interarticularis that most commonly occurs at L5

• Defect may come from congenital thinning, stress fracture, or traumatic fracture

• More likely to occur in gymnasts, weightlifters, football players, wrestlers and divers

• Occurs more in men than women

Spondylolysis will lead to spondylolisthesis in about 25% of cases.

True

Spondylo-

Spine

lysis-

erosion

listthesis-

tilting or slipping

What are the clinical signs of spondylolysis/spondylolisthesis?

• Increased lumbar lordosis

• Hamstring tightness

• Step-off deformity in the lumbar spine

• Increased pain with extension

• Decreased pain with sitting o Neurological signs in higher grades of slippage

What interventions are used to treat spondylolysis/spondylolisthesis?

• Flexion exercises, lumbar stabilization exercises, stretching of hamstrings and hip flexors, general conditioning

• Myofascial techniques and modalities to decrease muscle spasm

What motion should be avoided when working with a patient with spondylolysis/spondylolisthesis or spinal stenosis?

Excess extension

Ankylosing Spondylitis

• Chronic, progressive, inflammatory arthritis that results in ossification of the soft tissues of the spine. This eventually leads to anatomical fusion

• Often begins in the SI joints and progresses superiorly •

• Called "bamboo spine"

• Largely hereditary. Males are twice as likely to develop it.

• Patients will complain of pain, stiffness, limited range of motion, and fatigue.

What interventions are used to treat ankylosing spondylitis?

Spine (flexion and extension) ROM, hip ROM, aerobic exercise, strengthening of the trunk extensor muscles, aquatic exercise

Scoliosis

Curvature of the spine in the frontal plane

• Structural irreversible and fixed

• Nonstructural can be decreased by a change in position

  • Ex: Curvature caused by leg length difference can be corrected by a shoe lift

• Named for the direction of the convexity

What special tests are used to diagnose scoliosis?

Adams Forward Bend Test. Positive test is a rib hump when bending forward.

What interventions are used to treat scoliosis?

Stretching of the paraspinals on the concave side of the curve. Strengthening of the paraspinals on the convex side of the curve.