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Spinal, Visceral referral - Lung & diaphragm: left neck &…

- - - - Nerves: Trigeminal
        
        Disc displacement with reduction (click)
        
        Disc displacement without reduction (lock)
        Closed: anterior
        Open: posterior
        
        Rx
        "J- stroke"
        caudal & anterior glide
        
        Hypomobility
        
        Decreased ROM
        
        Pain EOR
        
        Hx of trauma
        
        Secondary myofacial pain
        
        Deviation towards affected/ipsilateral side
        
        Myofacial pain
        
        Pain on full opening
        
        No jt noise
        
        Trigger points refer to other areas
        
        Postural cause
        
        Excessive use, grinding, holding mouth open
        
        Rx
        
        Postural education, stress mx
        
        Relaxation
        
        Tongue/TMJ proprioception
        
        Strengthening
        
        Mobilisations
        
        Stretching
        
        Soft tissue mobilization
        
        Modalities
        
        Hypermobility
        
        Excessive anterior translation
        
        Opening ROM of 50+mm
        
        Generalised laxity
        
        Deviation away from affected/contralateral side
        
        Noise EOR
        
        OA S&S
        
        Diffuse pain
        
        pain when biting firm foods
        
        :arrow_down: ROM improves throughout day
        
        Atrophy
        
        Crepitus
- - - - Rx:
        Stenosis: flexion & traction
        Disc herniation: E
        
        Special tests
        
        Spurling's (foramen compression)
        
        Cervical distraction
        
        ULTT
        
        Median nerve innovation
        (2LOAF)
        
        Lumbricals 1 & 2
        
        Opponens pollicus
        
        Abductor pollicus brevis
        
        Flexor pollicus brevis
        (Thenar eminence)
        
        Radial nerve innovation
        (BEST)
        
        Triceps / Anconeus
        
        Supinator
        
        ECRL
        
        Brachioradialis
        
        Ulnar nerve innovation
        
        FCU
        
        FDP
        
        Lumbricals 3 & 4
        
        Hypothenar muscles
        
        Interossei (DAP/PAD)
        
        Adductor pollicis
        
        ULTT 1: median 110 degrees ab
        ULTT 2: median 10 degrees ad
        ULTT 3: radial
        ULTT 4: ulnar
      - Brachial plexus injury's
        
        Erbs palsy (upper; C5,6): waiters tip. Shouler dystocia
        
        Klumpke's (lower; C8,T1): Bicep flex & claw hand. Hyperabduction
      - VBI testing
        5D's
        
        Dizziness
        
        Drop attacks
        
        Diplopia
        
        Dysphagia
        
        Dysarthria
        
        3N's
        
        Nausea
        
        Nystagmus
        
        Neurological signs
        
        Vertebral artery/ quadrant test: Supine E & LF + Rt for 10-30sec. Dizziness or nystagmus indicate contralateral stretch/ compression of vertebral artery.
    - - UMN reflexes
        Babinski: toe splay, big toe E
        Clonus: 5+ beats
    - - Upper crossed syndrome
        
        Chin poke
        
        Tightness in SCM & Scalenes, suboccipitals, capitis muscles
        
        DNF weakness
        
        Increased stress on posterior structures
        
        PBU (craniocervical flexion test)
        
        unable to increase to at least 26mmHg
        
        Unable to hold pressure for 10sec
        
        Inability to raise in small 2mmHg increments
        
        Compensation (SCM or extends head)
        
        DNF training: Analgesic effect, coordination & timing
    - - S&S
        
        Lump in throat
        
        Dizziness
        
        Lip/ face paraesthesia
        
        Hesitant to flex neck
        
        Pupil changes
        
        Severe headache
        
        Severe muscle spasm
        
        Special tests
        
        Anterior shear / sagittal stress (Supine PA glide)
        
        Lateral flexion/ alar ligament stress test
        Stabilise C2 & LF neck
        +ve if excessive LF or soft end feel
        
        Lateral/ transverse shear test
        Tests lateral ligaments
        +ve if excessive ROM, instability, spinal or vascular signs
        
        Sharp-purser (iso neck F)
        +ve neck slides backwards. Indicates relocation of subluxed atlas
        
        Cervical flexion - rotation (headaches)
        Chin to chest with 45 degrees rt
- - - - Deformities
        - Flat back
        
        Round back (decreased ant pelvic tilt, forward head, rounded shoulders)
        
        Dowagers hump (stress #, decreased height)
        
        Hump back (Gibbus; localised sharp posterior angulation) #, tumor, bone disease
        
        Scheuermann's (Weakening of vertebral endplate)
        
        Compression # Rx
        
        Posture edu
        
        Stabilisation
        
        Scapular
        
        Extension
        
        Weight bearing
        
        CI- aggressive mobs & trunk flexion Ex's
        
        Scoliosis
        
        Labelled by side of convexity
        
        More than 1 curve = major & minor
        
        Functional
        Poor posture, muscle guarding, nerve root irritation, inflammation, leg length discrepancy
        
        Structural
        
        Vertebra rotate towards side of convexity
        
        Up to 10degrees normal
        
        Cobb angle more than 60 degrees = compromised cardioresp
        
        Rib hump/ razor back spine
        
        Rx
        
        Posture
        
        Stretch concave side
        
        Strengthen convex side
        
        Stabilization
        
        Scapular ex's
        
        Bracing (Milwake)
        
        Surgery more than 40degrees
        
        Annual x-ray to track progression
- - - - Reflexes
        L3-4: Patella
        L4-5: tib post
        L5-S1: medial HS
        S1-2: lateral HS & Achilles
    - - Spinal stenosis: Central or lateral may or may not be symptomatic. Neurogenic claudication
        Better with flexion, worse with E
        
        Neurogenic vs intermittent claudication
        
        Nerve root compression vs peripheral artery disease
        
        Immediate onset vs gradual
        
        P-D vs D-P
        
        Burning/tingling vs cramping
        
        Eased with F vs rest
        
        Rx
        
        Flexion exercises
        
        Avoid E
        
        Laminectomy
      - Disc herniation
        
        Stages
        
        Protrusion (bulge)
        
        Prolapse (still within tissue)
        
        Extrusion (outside annulus)
        
        Sequestration (leaking)
        
        Posteriolateral herniation:
        
        Flexion MOI
        
        Worse in morning
        
        Worse with cough, sneeze, valsalva
        
        Lateral shift away from injury
        
        Rx
        "Push bulge back in"
        
        Repeated extensions
        
        Lateral glides towards injury
        
        May be painful initially, however complete entire set
        
        Green, yellow, red system
        
        Y- no change in neural, but increase in pain
        
        Schmorl node: Herniation of nucleus up/downwards into vertebral body from axial loading
      - Lower crossed syndrome
        
        Increase Lx lordosis
        
        Overactive hip F = weak abdominals
        
        Overactive HS & erector spinae = weak glutes & trying to correct anterior pelvic tilt
      - Spondylosis (OA)
        
        Loss of disc height (DDD)
        
        Approximation of vertebral bodies
        
        Degeneration of plates
        
        Fibrosis in disc
        
        Osteophyte formation
        
        Loss of lordosis
        Stiff, muscle spasm, back ache. Worse with prolonged positioning better with laying down
      - Facet syndrome:
        May refer to low back, glutes, hips, groin, thighs
        Special test: Kemps/Quadrant
        Rx: Flexion ex's
      - Spondylolysis: pars interarticularis defect
        Spondylolisthesis: slippage
        
        Traumatic (#)
        
        Isthmic (repetitive microtrauma; L5/S1)
        
        Degenerative (lig laxity)
        
        Dysplastic (congenital)
        
        Pathological (secondary to other condition)
        
        Grades of slippage
        1: 0-25%
        2: 25-50%
        3: 50-75%
        4: 75%+
        5: 100%
        
        Special tests for lx instability
        H & I stability (Hypomobile if 2 mvts in same quadrant painful, instability if only painful in one quadrant without LF)
        Prone segmental instability (prone PA pressure applied, when legs are lifted less pain than when on floor)
        
        Wrong TA activation
        
        No mvt of lower abdomen
        
        Rapid contraction/tremor
        
        Visible contraction (obliques)
        
        Bulging under palpated area
        
        Upper abdominal/ rib cage mvt
        
        Breath holding
        
        Core stabilisation
        
        isolate inner unit
        
        train inner unit (heel slides)
        
        Dynamic mvt (glute bridge)
        
        Integrate into function
        
        S&S
        Hyperlordotic
        Tight HS
        Scotty dog
        Step deformity
      - Post OP mx
        
        Max protect phase
        
        No lifting more than 10lbs for 3mnths
        
        Avoid getting incision wet for 1-2wks
        
        Bed mobility (heel slides, quad set, ankle pumps)
        
        Mobility
        Contraindicated: Extension based exercises
        
        Min protection phase (4-6wks):
        
        Scar mobilization
        
        Grd 1/2 mobs on adjacent jts
        
        Segmental strengthening
        CI: Jt manipulations at level of fusion & extension ex's if laminectomy
      - Sinister pathology
        
        Cauda equina
        
        Damage to long nerve roots below L1
        
        Flaccid paralysis
        
        Areflexive B&B
        
        Sacral anaesthesia
        
        Malignancy/cancer red flags
        
        50+yrs
        
        Hx of ca
        
        Unrelenting pain
        
        Night pain
        
        Weight loss
        
        Unrelieved by rest
        
        Doesn't improve within 1mnth