Amanda Week 8 Notes PDF

**Upper Cervical Spine Anatomy** Upper Cervical Spine consists of Occiput, Atlas (C1) & Axis (C2) Joints include OA & AA Alar & Transverse Ligaments support upper cervical spine - holds the dens in place should there be an injury to the Upper cervical spine Biomechanically, OA allows flexion, ex...

**Upper Cervical Spine Anatomy** Upper Cervical Spine consists of Occiput, Atlas (C1) & Axis (C2) Joints include OA & AA Alar & Transverse Ligaments support upper cervical spine - holds the dens in place should there be an injury to the Upper cervical spine Biomechanically, OA allows flexion, extension, lateral flexion - NO ROTATION Biomechanically, AA allows rotation only (70% of total cervical rotation) In Lower Cervical Spine, coupling of lateral flexion & rotation is ipsilateral - - - - In Upper Cervical Spine, coupling of lateral flexion & rotation is contralateral - - **Upper Cervical Spine Musculature** Sub-Occipital Muscles ◦ Rectus Capitus Posterior Major ◦ Rectus Capitus Posterior Minor ◦ Oblique Capitus Inferior ◦ Oblique Capitus Superior - - - Origin: Axis & Atlas Insertion: Occipital Bone Action: Extension, Side-bending, and Rotation of Upper Cervical Spine - Greater Occipital Nerve Entrapment - - In patients with forward head posture the head increases its weight because of the lever that\'s placed on the cervical spine - - **Signs and Symptoms of Upper Cervical Spine Dysfunction** - - - - - **TABLE** - - - - - - - **Cervicogenic Headache (Tension Headache / Mechanical Headache Syndrome)** Cervicogenic Headache occurs in the presence of: ◦ Upper or Lower cervical spine disc dysfunction - no disc at OA or AA but both will respond to both types of treatment ◦ Upper or Lower cervical spine facet dysfunction - most common cause ◦ Upper or Lower cervical spine postural dysfunction - poor posture for an extended period of time but no tissue change ◦ Upper cervical spine instability (0.1-0.6%) ◦ Down Syndrome (10-20% occurrence, 1-2% symptomatic) ◦ Rheumatoid Arthritis ◦ Cervical spine trauma / Whiplash  - - **Upper Cervical Spine Interventions** Manual Therapy has been found effective in treating pain, headache, & limited mobility Greater short-term pain relief with manual therapy than exercise alone Before implementing manual therapy\*, patients should be screened for upper cervical spine instability and vertebral artery dysfunction ◦ \*Including mobilization, manipulation, traction, or extension off the end of the table - these techniques increase risk of significant injury to the OA and AA region (UCS instability) or loss of consciousness or death (vertebral artery)  - **Evaluation of the Upper Cervical Spine** Prone Vertebral Artery Test Supine Vertebral Artery Test Sharp-Purser Test Alar Ligament Test Transverse Ligament Test - - - - - - - **Prone Vertebral Artery Test** Patient Position: Prone with patient's hands under chin Force Application: Patient uses hands to move upper cervical spine to end-range extension for 10+ seconds while clinician performs cranial nerve screening (screen CN II, III, IV, V, VI, VII, VIII, IX, X, and XII) Positive Test: Dizziness, nausea, or abnormal cranial nerve function Diagnostic Accuracy: 10 Sens Spec + LR - LR N/A N/A N/A N/A  **Supine Vertebral Artery Test** Step One Hold each position for a minimum of 10 seconds while assessing CN function Positive test is dizziness, nausea or abnormal CN function Step Two Also known as the Progressive Minimized DeKleyn's Test Progress from steps 1-4 only if test is negative Step Three:Hold each position for a minimum of 10+ seconds while assessing CN function Positive test is dizziness, nausea or abnormal CN function Step Four: Also known as the Full DeKleyn's Test Diagnostic Accuracy: Sens Spec + LR - LR N/A N/A N/A N/A **Sharp-Purser Test** Patient Position: Seated with slight upper cervical spine flexion Hand Placement: One hand on forehead, one hand on C2 (to find the C2 find the external occipital protuberance, move inferior to it, then 1 finger below that space) Force Application: Force is applied posteriorly through the patient's forehead and anteriorly at C2 Positive Test: Feeling of instability ("clunk") or neurologic symptoms - - Diagnostic Accuracy: Author Sens Spec + LR - LR Matthews 0.19 0.71 0.67 1.13 Stevens 0.44 0.98 28.44 0.56 Uitvlugt 0.69 0.96 15.64 0.33 **Alar Ligament Stress Test** Patient Position: Supine Hand Placement: One hand on SP of C2, other hand on the occiput, apply gentle compression with clinician's shoulder on crown of head Force Application: Clinician passively side bends occiput while stabilizing C2 Positive Test: Failure to feel ligamentous end-feel, indicating alar ligament injury Diagnostic Accuracy: Author Sens Spec + LR - LR Kaale (Right) 0.69 1.00 94.09 0.33 Kaale (Left) 0.72 0.96 16.37 0.29 **Transverse Ligament Stress Test** Patient Position: Supine with eyes open Hand Placement: Fingers of both hands placed over "posterior arch" of C1 Force Application: Clinician attempts to move occiput and C1 anteriorly on C2 (hold position for 10+ seconds) Positive Test: Cranial Nerve Symptoms indicating instability of the transverse ligament Diagnostic Accuracy: Author Sens Spec + LR - LR Kaale 0.65 0.99 51.44 0.35