Practical Application Q2 FC

Cervical, Thoracic, Ribs

What percentage of cervical rotation occurs at C1-C2 (Atlantoaxial)?

50% of cervical rotation occurs at the atlantoaxial joint

What type of coupled motion occurs at C3-C7?

Sidebending and rotation occur to the same side (coupled motion)

What type of mechanics does C0-C1 (Occipitoatlantal) follow?

Type I mechanics - sidebending and rotation occur to opposite sides

How many articulations exist at the Atlas-Axis (C1-C2)?

Four articulations: right/left facets, anterior odontoid-atlas, posterior odontoid-transverse ligament

What is the primary motion at C1-C2?

Rotation

What is the primary motion at C0-C1?

Flexion/Extension around an axis through the ears

What happens to facets during cervical flexion?

Flexion opens the facets

What happens to facets during cervical extension?

Extension closes the facets

What does a positive VBI test indicate?

Ischemia on the opposite side of the rotation; suggests vertebral basilar artery impingement

How do you perform the VBI test?

Client seated, extend and rotate head toward ceiling for ~30 seconds; monitor for dizziness, nausea, syncope

What is the purpose of the Valsalva test?

Increase intrathecal pressure to detect disc pathology or tumor

What indicates a positive Valsalva test?

Increased or recreated pain following a dermatomal pattern into the extremity

How do you perform Adson's test?

Monitor radial pulse, abduct/extend/laterally rotate arm, client inhales deeply and holds breath while turning head toward tested arm

What does a positive Adson's test reveal?

Diminished/absent radial pulse and/or numbness, tingling, pain (subclavian artery or brachial plexus impingement)

What is the purpose of the Compression test?

Detect neural foramen narrowing, facet dysfunction, or muscle spasm

How do you perform the cervical Compression test?

Client seated, therapist applies downward pressure on top of head and observes for pain reproduction

What does pain relief during Decompression/Distraction test indicate?

Nerve root compression

What does pain creation during Decompression/Distraction test indicate?

Ligament damage

How do you perform Spurling's (Quadrant) test?

Rotate head 30-45°, add extension + sidebending toward test side, interlock fingers and apply downward pressure on head

What does Spurling's test help identify?

Vertebral foramen narrowing and facet dysfunction (F.R.S or E.R.S)

Your client has restricted active cervical rotation. What upper cervical assessment should you perform?

C1 (Atlas) assessment for rotated C1

How do you assess for rotated C1?

Client supine, introduce full flexion to lock lower vertebrae, maintain flexion and rotate head each direction

If rotation is restricted to the LEFT during C1 assessment, what is the dysfunction?

C1RRT (C1 rotated right) - vertebra stuck rotated RIGHT

If rotation is restricted to the RIGHT during C1 assessment, what is the dysfunction?

C1RLT (C1 rotated left) - vertebra stuck rotated LEFT

What are common indicators for Occiput (C0) assessment?

Headaches, tension, restricted motion (flexion or extension)

How do you test the occiput in flexion?

Grasp head with palms over ears, introduce flexion (chin to chest), perform scissoring motion to sidebend while maintaining flexion

How do you test the occiput in extension?

Fingers at base of occiput as fulcrum, heel of hands extend the occiput, perform scissoring motion to sidebend while maintaining extension

If sidebending is restricted during flexion testing of the occiput, what is the dysfunction?

FSR (Flexed, Sidebent, Rotated) - occiput stuck in flexed position

If sidebending is restricted during extension testing of the occiput, what is the dysfunction?

ESR (Extended, Sidebent, Rotated) - occiput stuck in extended position

What muscles are hypertonic in C1RRT?

Right obliquus capitis inferior and rectus capitis posterior major

What muscles are hypertonic in C1RLT?

Left obliquus capitis inferior and rectus capitis posterior major

What muscles are hypertonic in ESrtRlt?

Right obliquus capitis superior, rectus capitis posterior major, rectus capitis posterior minor

What muscles are hypertonic in FSrtRlt?

Right longus capitis, rectus capitis anterior

What does ESR stand for?

Extended, Sidebent, Rotated - a flexion restriction with occiput stuck extended

What does FSR stand for?

Flexed, Sidebent, Rotated - an extension restriction with occiput stuck flexed

In ESR conditions, what motion is restricted?

Flexion - the occipital condyle cannot glide posterior normally on atlas

In FSR conditions, what motion is restricted?

Extension - the occipital condyle cannot glide anterior normally on atlas

How do you assess lower cervical spine (C3-C7) using translating technique?

Rest head between palms, ears between index fingers and thumb, place middle/index finger posterolaterally on articular pillar, translate head side to side

What does right to left movement indicate during lower cervical translation?

Right sidebending

What does left to right movement indicate during lower cervical translation?

Left sidebending

Which nerve root is tested with neck flexion?

C1-C2

Which nerve root is tested with shoulder abduction?

C5

Which nerve root is tested with elbow flexion or wrist extension?

C6

Which nerve root is tested with elbow extension or wrist flexion?

C7

Which nerve root is tested with thumb extension or ulnar deviation?

C8

Which nerve root is tested with hand abduction or adduction?

T1

Where do you brush to test C5 dermatome?

Lateral deltoids and down

Where do you brush to test C6 dermatome?

Base of thumb down lateral side to tip of thumb

Where do you brush to test C7 dermatome?

Middle finger dorsal and ventral sides from MCP to fingertips

Where do you brush to test C8 dermatome?

Ulnar border of little finger from wrist to tip

Where do you brush to test T1 dermatome?

Ulnar border of forearm up to medial elbow

What does hypoesthesia mean?

Decreased sensation

What does hyperesthesia mean?

Excessive sensation

What does anesthesia mean?

Loss of sensation

What does paresthesia mean?

Numbness, tingling, burning sensation

How do you perform MET for rotated C1?

Client supine, cradle head, introduce full flexion, rotate away from dysfunction to barrier, client attempts to rotate toward dysfunction against resistance for 3-5 seconds

How do you perform MET for ESR?

Client supine, grasp head with palms over ears, introduce flexion, sidebend away from dysfunction, client attempts to sidebend toward dysfunction against resistance for 3-5 seconds

How do you perform MET for FSR?

Client supine, grasp head with palms over ears, introduce extension, sidebend away from dysfunction, client attempts to sidebend toward dysfunction against resistance for 3-5 seconds

What is the Rule of 3 for thoracic spine?

T1-T3 & T12: SP = TP level; T4-T6 & T11: TP is ½ level above SP; T7-T9 & T10: TP is one full level above SP

What does a posterior TP indicate?

The side of rotation in the dysfunction

In ERS dysfunction, when does the posterior TP appear?

In neutral AND flexion (symmetry returns in extension)

In FRS dysfunction, when does the posterior TP appear?

In neutral AND extension (symmetry returns in flexion)

In Neutral Group dysfunction, when does the posterior TP appear?

In ALL three positions (neutral, flexion, extension)

What does ERS stand for in thoracic spine?

Extended, Rotated, Sidebent - a flexion restriction with segment stuck closed

What does FRS stand for in thoracic spine?

Flexed, Rotated, Sidebent - an extension restriction with segment stuck open

What muscles are involved in ERS dysfunction?

Multifidi (below) and erector spinae on the same side as posterior TP

What muscles are involved in FRS dysfunction?

Multifidi (above) and rotatores on the same side as posterior TP

How many vertebrae are typically involved in Neutral Group dysfunction?

3 or more vertebrae acting as a group

What muscles are primarily involved in Neutral Group dysfunction?

Erector spinae (long-restrictors) on the concave side

Your client has restricted sidebending and rotation to the SAME direction. What type of dysfunction do you suspect?

Unilateral segmental dysfunction (ERS or FRS)

Your client has restricted sidebending and rotation to OPPOSITE directions. What type of dysfunction do you suspect?

Neutral group dysfunction

Paravertebral fullness spans more than 3 vertebrae. What does this suggest?

Neutral group dysfunction

Paravertebral fullness spans 1-2 vertebrae. What does this suggest?

Segmental dysfunction (ERS or FRS)

How do you verify ERS dysfunction with oscillation?

Place thumbs over facet articulation (~2-3cm lateral of midline), apply anterior pressure on lamina - further compresses facet causing discomfort on dysfunctional side

How do you verify FRS dysfunction with oscillation?

Place thumbs over facet articulation (~2-3cm lateral of midline), apply anterior pressure on lamina - further opens facet causing discomfort on dysfunctional side

What is a Bilaterally Extended vertebra?

Flexion restriction - both facets stuck closed

Where do you find the exaggerated gap in Bilaterally Extended vertebra?

Exaggerated gapping with two approximated SPs BELOW the gap during flexion

What is a Bilaterally Flexed vertebra?

Extension restriction - both facets stuck open

Where do you find the exaggerated gap in Bilaterally Flexed vertebra?

Exaggerated gapping with two approximated SPs ABOVE the gap during extension

How do you verify Bilaterally Extended dysfunction with oscillation?

Use pisiform contact on spinous process, apply anterior pressure - further compresses both facets causing irritation on superior of two approximated SPs

How do you verify Bilaterally Flexed dysfunction with oscillation?

Use pisiform contact on spinous process, apply anterior pressure - further opens both facets causing irritation on inferior of two approximated SPs

What muscles are involved in Bilaterally Extended vertebra?

Multifidi and rotators bilaterally BELOW dysfunctional segment

What muscles are involved in Bilaterally Flexed vertebra?

Multifidi and rotators bilaterally ABOVE dysfunctional segment

How do you perform MET for ERS?

Client seated, stand opposite tight musculature, cradle head, rotate toward tight musculature, sidebend away with flexion component, client sidebends toward dysfunction against resistance 7-10 seconds

How do you perform MET for FRS?

Client seated, stand opposite tight musculature, cradle head, rotate toward tight musculature, sidebend away with flexion component, client rotates away from dysfunction against resistance 7-10 seconds

How do you perform MET for Neutral Group dysfunction?

Part 1: Client sidebends toward dysfunction against resistance 7-10 seconds (repeat 3x). Part 2: Maintain position, client rotates away from dysfunction against resistance 7-10 seconds (repeat 3x)

What type of motion do ribs 1-5 perform?

Pump Handle motion - moves forward and upward

What type of motion do ribs 6-10 perform?

Bucket Handle motion - moves laterally (sides lifting out)

What type of motion do ribs 11-12 perform?

Caliper motion - flares posterior-laterally

What diameter increases with Pump Handle motion?

Anterior-Posterior (A-P) diameter

What diameter increases with Bucket Handle motion?

Lateral diameter

What diameter increases with Caliper motion?

Posterior-lateral diameter

What happens to ribs during inhalation?

Ribs elevate

What happens to ribs during exhalation?

Ribs depress

Where is the key rib located in an inhalation restriction group?

TOP of the dysfunctional group (rib stuck DOWN)

Where is the key rib located in an exhalation restriction group?

BOTTOM of the dysfunctional group (rib stuck UP)

Which nerves may be impinged by cervical dysfunction affecting the diaphragm?

Phrenic nerve (C3-C5)

Where does the diaphragm attach in relation to the lumbar spine?

Diaphragm attaches onto all lumbar vertebrae

What fascia is continuous with the diaphragm fascia?

Fascia of psoas and quadratus lumborum

What are positive signs during the Spring Test for rib fracture?

Sharp or local rib pain, hard/rigid end feel, client suddenly catches breath