Examination of the Spine 2024 PDF

Examination of the Spine https://www.healthline.com/hlcmsresource/images/topic_centers/ osteoarthritis/642x361-Treating_Spinal_Stenosis-  Objectives Review relevant anatomy of the cervical, thoracic and lumbar spine along with the TMJ Discuss typical...

Examination of the Spine https://www.healthline.com/hlcmsresource/images/topic_centers/ osteoarthritis/642x361-Treating_Spinal_Stenosis-  Objectives Review relevant anatomy of the cervical, thoracic and lumbar spine along with the TMJ Discuss typical motion in the spine Discuss principle of a typical examination techniques for the spine Perform pscyhomotor skills for spine and TMJ Lots of Spine Jokes  Start with a good subjective Symptom Location Pain diagram Aggravating / alleviating factors / 24hr pain pattern Time frame / chronicity / prior history Work / family responsibilities Yellow/Red flag screening and special questions https://media.poetryfoundation.org/m/image/2497/emert talking.jpg?w=1200&h=1200&fit=max  Look before you touch. Quality & Quantity!! http://healthsurgical.com/lumbar-lordosis.htm  Measurement Options 1. Goniometer 2. Inclinometer 3. Tape Measure - 3 measurements offer different methods to objectify ROM - Based on: - Clinician preference - Known norm values - Possibly patient modification needs - Available tools in clinic - Intra-rater reliability benefits https://images-na.ssl-images-amazon.com/images/I/ Cervical Spine Considerations  Atlanto-occipital Joint (AO) Synovial joint C0-1 Flexion/extension –Nodding “yes” –AKA: capital flex/ext Combined 20 – 30 degrees flex/ext aroundm-L axis Almost no rotation  Atlanto-axial joint (AA) C1-2 –Primarily rotation –Contributes greater than ½ of entire C-spine rotation  Mid/lower Cervical Spine 3 planes of motion – Flex/ext – Rotation – Sidebending/lateral flexion Unilateral motion requires bilateral spine mobility – Example: Left cervical rotation needs spinal movement on left and right side Think facets on left/right side; need to work in tandem https://embed.widencdn.net/img/veritas/ldzfe5zipj/576px/cervical- spine-vertebrae.jpg?quality=80&u=at8tiu&use=lnueb  Cervical Motion Lots of variability in measuring including different methods, tools, patient positions, etc. Normal ROM (use these for class) Flexion: 45 degrees or 2 cm Extension: 45 degrees or 20.0 cm Lateral flexion: 45 degrees, 11.0 cm Rotation: 60 degrees, 12.0 cm ** Values in degrees for goniometer and inclinometer ** Values in cm for tape measure technique Capital Flexors Rectus Capitis Anterior Rectus Capitis Lateralis Longus Capitus Deep palpation NOT RECOMMENDED (carotid artery) Muscles That Rotate and Extend http://philschatz.com/anatomy-book/contents/m46484.html  Special Consideration: Neurovascular Structures  Weakness of capital extensors… Image: https://www.michaelcurtispt.com/chronic-neck- pain/supine-chin-tuck-and-hold-f/ Non-patent airway Inability to swallow Thoracic Spine Considerations  Thoracic Spine T1-T6 – Frontal plane facet orientation – Limits flexion-extension, encourages sidebending – Ribs and costal joints restrict lateral flexion T7-12 – Sagittal plane facet orientation – Allows more flexion extension  Thoracic Spine T1-T10: inferior slant of spinous processes T5-T8 overlap T11-T12: horizontal spinous processes Articulation of ribs between T2-T9 https://embed.widencdn.net/img/veritas/r3rabeyma1/576x324px/ spinal-canal-spinal-cord.jpeg?u=at8tiu&use=idsla&k=c  Thoracic Spine Motion Generally less mobility: Tighter joint capsule Orientation of facets Presence of ribs https://en.wikipedia.org/wiki/Rib_cage Thoracic/Rib - or - Internal Organ? https://brooklynreflexology.com/2014/01/01/visceral-refe  Measuring Thoracic, Lumbar, and Thoracolumbar Often will combine thoracic ROM with lumbar ROM for a functional measure – Isolated lumbar and thoracic measures is complicated by joint structures, challenge with identifying CORRECT landmarks, hip rotation, etc. Thoracolumbar ROM includes: – Flexion – tape measure, fingertip to floor, double inclinometer – Extension – tape measure (standing, prone press up), double inclinometer – Lateral Flexion/sidebending – goniometer, fingertip to floor, double inclinometer – Rotation (t/l and thoracic) – goniometer (dowel option), double inclinometer Lumbar ROM includes: – Flexion – tape measure, single/double inclinometer – Extension – tape measure, single/double inclinometer – Lateral flexion/sidebending – single/double inclinometer, ThoracoLumbar Rotation  Thoracolumbar ROM Measures Thoracolumbar Rotation – Seated – Feet/knees together – Bar behind shoulders with both hands on bar/stick For visualization – Normal: 45 degrees – What compensations Hoogenboom & Voight, 2015 might you expect?  Goniometer placement Bar under or over shoulders – doesn’t matter Hoogenboom & Voight, 201 Johnson and Gindstaff, 201 Lumbar Spine Considerations Lumbar Spine  Lumbar 5 lumbar vertebrae Spinous processes are horizontal Facets in sagittal plane –Allows flexion/extension –Limits lateral flexion and rotation http://readanddigest.com/wp-content/uploads/2015/04/human-  Lumbopelvic Rhythm Interrelation between spine, pelvis and hip during lumbar flexion Neumann Text, 2009  Thoracolumbar ROM Measured a number of ways Various resources for typical ROM Landmarks should be T1 and S2 http://www.scranton.edu/faculty/kosmahl/courses/gonio/spine/pages/thor- side.shtml http://www.kosim.ca/products/rom_measurement.html Spine Review Anatomy C0-1: 20-30 degrees of flexion/extension C1-2: supplies 50% of total cervical spine rotation Thoracic Spine T1-T6 sidebending greater than flexion/extensi on T7-12 more flexion extension that sidebending Overall less motion than C and L-spine Lumbar spine Greater Flexion/Extension than sidebending Looser capsule does allow sidebending and rotation, however. TMJ  Temporomandibular Joint http://www.mhase-omfs.com.au/procedures/temporomandibular-joint-problems-  TMJ One of the most commonly used joint R and L directly influenced by each other Often under-assessed in clinical situations 3 degrees of freedom – Opening / closing (depression / elevation) – Lateral protrusion – Protraction / retraction https://www.regenexx.com/wp-content/uploads/2016/04/tmj-  TMJ Motion Opening (depression) – Initially gravity – Digastrics, lateral pterygoids, suprahyoid, infrahyoid for forceful opening – Functional Motion: 40-50mm Closing (elevation) – Masseter, temporalis, medial pterygoid; lateral pterygoid - eccentric only for controlling disk motion http://www.dentalhealth.org/uploads/images/jaw.jpg  TMJ Motion Protraction / protrusion – Bilateral contraction lateral pterygoids, medial pterygoids, masseter – Functional Motion: 6-9 mm (stretches retrodiscal tissue, bottom in front of top) Retraction / retrusion – Temporalis, deep masseter; digastric and suprahyoids – Functional Motion: 3 mm (limited by TM ligament)  TMJ Motion Laterotrusion: – Contralateral lateral pterygoids and medial pterygoids (glide condyle forward) – Ipsilateral temporalis and masseter (roll condyle posterior) – Normal Value: 8-12mm https://fadavispt.mhmedical.com/data/books/1964/ norkinjoint4_ch13_f017.png  Let’s limit the TMJ information you have to know Know what is in bold below: ROM: – Opening (depression) – Laterotrusion (lateral deviation) – Protrusion/Retrusion MMT – Jaw Closure (Mandiubular elevation) – Jaw Opening (Mandibular depression) – Lateral Jaw Deviation – Protrusion – F: Functional;appears normal or only slight impairment – WF: Weak Function; moderate impairment that affects the degree of active motion – NF: Nonfunctional; severe impairment – 0: Absent Healthy TMJ during opening http://www.coalcreekpt.com/textingneck/