Anatomy of Head and Neck

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Questions and Answers

What is a characteristic of a visceral problem?

It gives a firm end feel

It gives a rubbery end feel (correct)

It is always accompanied by fatigue

It is an acute issue

According to Fryette Law 1, what happens when side-bending is attempted from a neutral position?

Rotation occurs towards the concavity of the curve

Rotation precedes side-bending to the opposite side

Side-bending precedes rotation to the opposite side (correct)

Side-bending and rotation occur to the same side

What is a necessary condition for Fryette Law 1 to apply?

The spine must be in an extreme position

The spine must be in a neutral position (correct)

The spine must be in a hyperextended position

The spine must be in a hyperflexed position

Which of the following is an example of a chronic issue?

A patient complaining of fatigue due to a slow GI blood loss over many months Signup and view all the answers

What happens when side-bending is attempted from a non-neutral position, according to Fryette Law 2?

Rotation precedes side-bending to the same side Signup and view all the answers

What type of dysfunction is diagnosed when Fryette Law 1 applies?

Type I dysfunction Signup and view all the answers

What percentage of the cervical spine's rotational motion is accounted for by the AA joint?

50% Signup and view all the answers

What is the primary function of the sternocleidomastoid muscle in the neck?

Rotation and sidebending in opposite directions Signup and view all the answers

What is the primary purpose of the Spurling test?

Assessing for neural foraminal narrowing Signup and view all the answers

What is the significance of the occiptomastoid suture dysfunction?

It can cause nausea and vomiting Signup and view all the answers

What is the contraindication for upper cervical direct manipulation in patients with rheumatoid arthritis, Down Syndrome, and ligamentous instability?

HVLA, articulatory, and other forms of direct manipulation Signup and view all the answers

What is the primary characteristic of somatic dysfunction?

Impaired or altered function of related components of the somatic system Signup and view all the answers

What is the visceral stimuli result in?

segmentally related visceral reflex response patterns Signup and view all the answers

Which of the following is associated with T1-T4 sympathetic levels?

Head and Neck Signup and view all the answers

Which of the following is associated with T10-T11 sympathetic levels?

Appendix Signup and view all the answers

Which of the following is not a sympathetic level?

OA, C1, C2 Signup and view all the answers

Which of the following is associated with OA, C1, C2 parasympathetic levels?

All of the above Signup and view all the answers

What happens to vertebrae in case of dysfunction?

Rotate towards the side of the dysfunction Signup and view all the answers

What is the sympathetic level associated with the prostate?

T12-L2 Signup and view all the answers

Which of the following is associated with S2-S4 parasympathetic levels?

Distal to the splenic flexure of the transverse colon Signup and view all the answers

What does a patient with a Triggerband (TB) often exhibit?

A sweeping motion with the fingers Signup and view all the answers

What is a key word often associated with a Herniated Trigger Point (HTP)?

Feels tight Signup and view all the answers

What is a crucial step in treating a Triggerband (TB)?

A and B Signup and view all the answers

What is a characteristic of a Continuum Distortion (CD)?

Aching in one spot Signup and view all the answers

How is a Herniated Trigger Point (HTP) typically treated?

By reducing protruding tissue below the fascial plane Signup and view all the answers

What is unique about treating a Folding Distortion (FD)?

It should be painless Signup and view all the answers

What is important to pay attention to when treating a Continuum Distortion (CD)?

The angle of the patient's finger when pointing to the CD Signup and view all the answers

Why might a Triggerband (TB) need to be treated more than once?

Because partial treatment may allow the TB to reform Signup and view all the answers

What is the primary goal of the Still Technique?

To move the tissue/joint through a restrictive barrier Signup and view all the answers

A deep sulcus on the right side of the OA indicates?

OA is rotated right Signup and view all the answers

What is the primary difference between Postisometric Relaxation and Reciprocal Inhibition?

Direction of patient's effort Signup and view all the answers

What is the indication for using the Still Technique?

Somatic dysfunction Signup and view all the answers

What is the purpose of locking out C3-C7 in a cervical HVLA setup?

To isolate the dysfunctional segment Signup and view all the answers

What is a contraindication for using HVLA in the upper cervical spine?

All of the above Signup and view all the answers

What is the position of the metacarpal phalangeal joint in a C2 E RL SL rotational correction?

Posterior aspect of C2 left articular pillar Signup and view all the answers

What is the purpose of repositioning the patient to the feather edge of the new barrier?

To move the tissue through the restrictive barrier Signup and view all the answers

What is the primary goal of the Muscle Energy Technique?

To re-establish the normal motion barrier Signup and view all the answers

What is the indication for using the Still Technique in a patient with C2 E RL SR?

Somatic dysfunction Signup and view all the answers

Study Notes

Sympathetic Innervation to the Head and Neck

Sympathetic innervation to the Head and Neck: T1-T4
Upper cervical area and sacrum are connected by dural connections

Cervical Spine Anatomy

AA (C1 on C2) accounts for 50% of the cervical spine's rotational motion
OA (C0 on C1) accounts for 50% of the cervical spine's flexion/extension motion

Spurling Test

Assesses for neural foraminal narrowing

Sternocleidomastoid Muscle

Rotates and side-bends the neck in opposite directions

Occiptomastoid Suture Dysfunction

Can cause nausea and vomiting

Contraindications for Upper Cervical Direct Manipulation

Rheumatoid arthritis
Down syndrome
Ligamentous instability

Somatic Dysfunction

Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements
Diagnosed by T.A.R.T.T: Tissue Texture Changes, Asymmetry, Restriction of motion, Tenderness
Named for the way it likes to go
In axial spine, the reference point is the superior/anterior aspect of the vertebra

Fryette Laws

Fryette Law 1: When side-bending is attempted from neutral (anatomical) position, rotation of vertebral bodies follows to the opposite direction
Fryette Law 2: When side-bending is attempted from non-neutral (hyperflexed or hyperextended) position, rotation must precede side-bending to the same side

Viscerovisceral Reflex

Localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures

Sympathetic Levels

Head and Neck: T1-T4
Heart: T1/T2-T5/T6
Respiratory: T1/T2-T6/T7
Esophagus: T2-T8
Upper GI Tract: T5-T9
Middle GI Tract: T10-T11
Lower GI Tract: T12-L2

Parasympathetic Levels

Vagus Nerve (OA, AA, C2): Trachea, esophagus, heart, lungs, liver, gallbladder, stomach, pancreas, spleen, kidneys, proximal ureter, small intestine, ascending colon, and transverse colon up to the splenic flexure
S2-S4: Distal to the splenic flexure of the transverse colon, descending colon, sigmoid colon, rectum, distal ureter, bladder, reproductive organs, and external genitalia

Still Technique

Tissue/joint placed in EASE of motion position (augments the somatic dysfunction)
Compression (or traction) vector force added
Tissue/joint moved through restriction (into and through the restrictive barrier) while maintaining compression (or traction) and force vector

Muscle Energy Technique

Postisometric Relaxation
Reciprocal Inhibition
Procedure:
- Dysfunctional Structure Positioned at Feather Edge of Direct Barrier
- Physician Continuously Monitors Dysfunction
- Patient is Instructed to GENTLY Push AWAY From/ TOWARD the Barrier
- Physician Resists Patient's Effort for 3-5 Seconds
- Patient is Instructed to Relax
- Physician Repositions Patient to Feather Edge of New Barrier
- Repeat 3-5 Times or until Maximum Improvement

Cervical HVLA Set Up Examples

C2 E RL SL: Rotational correction emphasis
- Rotate C2 to the right (this automatically side-bends C2 to the right)
- Metacarpal phalangeal joint is positioned over POSTERIOR aspect of C2 left articular pillar
- Lock out C3-C7 by side-bending those segments to the left
C2 E RL SL: Side-bending correction emphasis
- Side-bend C2 to the right (this automatically rotates C2 to the right)
- Metacarpal phalangeal joint is positioned over LATERAL aspect of C2 right articular pillar
- Lock out C3-C7 by rotating those segments to the left

Indications and Contraindications

Remember indications and contraindications for techniques
Example: if a patient is too young or is not able to follow commands, you can not do techniques such as muscle energy
Example: if a patient has lax ligaments such as Rheumatoid Arthritis or Trisomy 21, you do not want to do HVLA, or ANY type of articulatory techniques in the upper cervical spine

Triggerbands (TB)

Body language: sweeping motion with the fingers
Verbal Description: burning, pulling, tethering, restricted motion, tightness
Key words: "pulls", "heard it snap"
Treatment:
- Recognize body language to support triggerband
- Find discrete starting point and ending point that is painful
- Use thumb tip to "iron out" twisted fascial band
- Treat the entire pathway, partial treatment may allow TB to reform
- May need to treat more than once

Herniated Trigger Points (HTP)

Body Language: pushes with fingers or fist into non-jointed area
Verbal Description: aching or tightness in soft tissue
Key Words: "feels tight", "stiff", or "pinches"
Treatment:
- Observe patient gesture indicating HTP
- Palpation of HTP
- Verification of most tender area
- Reduction of protruding tissue below the fascial plane
- Palpation for firm residual edges of protrusion through the fascial plane
- Tuck any remaining edges under fascial plane

Continuum Distortions (CD)

Body language: points to one or more spots of pain
Verbal description: hurts in one spot
Key word: just that one spot
Treatment:
- Reduction of shifted continuum material by application of pressure from tip of thumb
- Pay attention to angle of patient finger when pointing to CD

Folding Distortions (FD)

Body language: places hand over a joint; cupping area
Verbal description: aches deep in the joint, feels unstable
Key words: unstable, changes with the weather
Treatment:
- Should be PAINLESS!
- Reduction of shifted continuum material by application of pressure from tip of thumb

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Description

This quiz covers the anatomy of the head and neck, including sympathetic innervation, cervical spine movements, and muscle functions.