What is Maitland Grade 3?
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Large amplitude into resistance.
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What is Maitland Grade 3?
Large amplitude into resistance.
What is the characteristic slope of the cervical spine (C2-C7)?
It slopes down backwards.
Why does performing a cervical high velocity thrust (HVT) pose a risk?
It risks damage to the carotid and vertebral arteries.
What are the common symptoms of wry neck (torticollis) in adults?
Acute neck pain, stiffness, and muscle spasm
What is a facet joint headache?
Headaches resulting from irritation or dysfunction of the facet joints in the cervical spine.
Where is the vertebral artery located in the neck?
Inside the left and right side of the spinal column in the neck. It passes through the transverse foramen of C1 through C6 and through the foramen magnum to become the basilar artery.
What is another name for wry neck?
Torticollis
What movement does the cervical spine (C2-C7) favor?
Rotation (approximately 45 degrees).
What are yellow flags in assessment?
Unhelpful beliefs, emotions, and pain behaviors.
What anatomical variation is associated with the thoracic spine?
Cardiac pathology.
What other movements occur at the OC1 (AO joint) besides flexion/extension?
A small amount of other movements.
What are red flags in assessment?
Serious pathology such as history of cancer, constant unrelenting night pain, unexplained weight loss.
What are the symptoms of facet joint headaches?
Localized pain in the neck with referral to the back of the head and temples, stiffness in the neck with limited movement, and headache triggered or worsened by specific neck movements.
What is Maitland Grade 5?
High velocity thrust (HVT).
What activities can lead to headaches due to overuse of neck and shoulder muscles?
Strenuous exercise or weightlifting.
What is the typical prognosis for wry neck (torticollis) in adults?
It is benign and usually resolves within a few days
What is the predicted outcome for patients classified as low risk according to the Whiplash Risk Stratification Tool?
Predicted full recovery.
What are the management strategies for cervical spine issues?
Rest, heat, medications, and manual therapy (DO NO HARM).
Where does the sensory neuron synapse in a reflex arc?
The sensory neuron directly synapses with a motor neuron in the spinal cord.
Why is suspected vascular pathology a contraindication to manual therapy?
Because manual therapy could exacerbate the condition and lead to serious complications.
What is high velocity, small amplitude movement at the limit of a joint's accessory or restricted range of motion often accompanied by?
A small click (cavitation).
What does a receptor in a monosynaptic reflex arc detect?
A receptor detects a stimulus, such as muscle stretch, in muscle spindles.
What is the purpose of the Whiplash Risk Stratification Tool?
To predict the risk of ongoing moderate/severe disability and guide treatment strategies for whiplash patients.
What is Maitland Grade 1?
Small amplitude short of resistance.
What is Maitland Grade 4?
Small amplitude into resistance.
What physical examination is included in the form?
Blood pressure measurement and Cervical Artery Sustained Rotation Test.
What is the supportive hand used for in manual therapy?
The supportive hand supports the head and adds counter pressure to the motive hand.
What is an example of a monosynaptic reflex arc?
The knee-jerk (patellar tendon) reflex.
What anatomical variation is associated with the cervical spine?
Vascular pathology.
What is spinal stenosis?
Narrowing of the space within the spine, such as the spinal canal or intervertebral foramina.
What are some cranio-vertebral anomalies that contraindicate manual therapy?
Congenital absence of odontoid.
What are the common causes of tension-type headaches?
Prolonged poor posture, stress, anxiety, mental fatigue, and overuse of neck and shoulder muscles.
What does the motive hand do in manual therapy?
The motive hand creates the motion.
What are the causes of cervical instability?
Trauma, congenital abnormalities, inflammatory disease, generalized hypermobility syndromes.
What are short lever movements used for?
Short lever movements generate accessory movement in the joint and can be useful for testing, acute, or elderly spines.
What is diplopia?
Double vision.
Where is the cell body of the dorsal root located?
In the posterior horn.
What is nystagmus?
Involuntary eye movement.
What type of presentations are associated with nerve root, cranial, and peripheral nerves?
Lower Motor Neuron (LMN) presentations.
Why do LMN presentations have localized symptoms?
Because the impacted signals are from a single defined nerve or spinal segment.
Where is the carotid artery located in relation to the sternoclavicular joints?
Posterior to the sternoclavicular joints, in the carotid sheath posterior to the sternocleidomastoid muscle.
What is a monosynaptic reflex arc?
A monosynaptic reflex arc is an involuntary, fast reflex involving a single synapse between a sensory neuron and a motor neuron.
What are the causes of facet joint headaches?
Degeneration or injury to the cervical facet joints, joint stiffness or misalignment often linked to poor posture, and muscle guarding around the cervical joints.
What anatomical variation is associated with the lumbar spine?
Cauda equina.
What are some MSK-specific causes of neck pain?
Disc, facet, instability/ligament, muscle, postural.
Why is recent trauma a contraindication to manual therapy?
Recent trauma can lead to instability or incomplete healing, making manual therapy potentially harmful.
What ligaments are involved in cervical instability?
Transverse, alar, tectorial membrane.
What is dysarthria?
Speech difficulty.
Why is paresis more common than paralysis in upper motor neuron (UMN) lesions?
Because signals between the muscle and the spine (alpha motor neurons) remain intact, so muscle activity is present but not normal.
What type of movement is described as a 'horizontal cradle'?
Movement at the OC1 (AO joint).
When do individuals often experience the onset of wry neck (torticollis)?
Often upon waking from sleep
What is mechanical neck pain presumed to arise from?
Nociceptive sources in the cervical spine.
What connective tissue disease is mentioned as a contraindication to manual therapy?
Ehlers-Danlos syndrome.
What is the most common type of primary headache linked to muscle tension in the head, neck, and shoulders?
Tension-type headache.
What are some of the symptoms listed under 'Light headedness'?
Light headedness, blurred vision, postural hypotension, tinnitus.
What is the description of myofascial headaches?
Headaches that arise from trigger points or muscle knots in the head, neck, or shoulders.
Describe the chin hold technique.
The chin hold is an alternative grip of the head where the therapist's non-contact arm is placed along the side of the face with either a small amount of contact with the chin or none.
What is tinnitus?
Ringing in the ears.
What does a Grade 0 in the Quebec Task Force Classification indicate?
No complaints about the neck and no physical signs.
What does a Grade 3 in the Quebec Task Force Classification indicate?
Neck complaint and neurological signs such as decreased ROM and point tenderness.
What is the primary movement favored by the OC1 (AO joint)?
Flexion/Extension (F/E) approximately 20 degrees.
What are the symptoms of headaches caused by overuse of neck and shoulder muscles?
Sudden onset of throbbing pain during or after exercise, pain may affect both sides of the head (bilateral) or be localized, and may last from minutes to hours.
What factors are considered in the Whiplash Risk Stratification Tool to determine risk levels?
NDI (Neck Disability Index) score, age, and hyper-arousal status.
What is Maitland Grade 2?
Large amplitude short of resistance.
What is the purpose of the Musculoskeletal Cervical Spine Screening and Consent Form?
To screen for cervical spine issues and obtain consent for assessment and potential treatment.
What symptoms are listed under the '5 D's and 3 N's' section?
Diplopia, Dysarthria, Dysphagia, Dizziness, Drop attacks, Nausea, Nystagmus, Numbness.
What does the 'Record of Informed Consent' section ensure?
It ensures that the patient understands the assessment, potential benefits and risks, and has the opportunity to ask questions and select alternate management.
What are the common examination findings for cervicogenic headache?
Upper cervical spine dysfunction (O/C1-C1/2) and positive cervical flexion rotation test (C1/2 rotation).
What is Temporomandibular Joint (TMJ) dysfunction headache related to?
Dysfunction in the jaw joint (TMJ) and surrounding muscles.
What are the causes of Temporomandibular Joint (TMJ) dysfunction headaches?
Bruxism (teeth grinding or clenching), jaw misalignment or injury, and arthritis affecting the TMJ.
What term did Dr. Ottar Sjaastad coin in 1983?
Cervicogenic headache (CGH).
What are the characteristics of upper motor neuron (UMN) damage?
Widespread symptoms, hypertonia or spasticity, hyperreflexia and clonus, pathological reflexes (Babinski), paresis rather than paralysis, and rare atrophy.
What causes hypertonia or spasticity in upper motor neuron (UMN) lesions?
Because descending regulatory/inhibitory pathways are interrupted, allowing local peripheral pathways to fire 'unchecked', causing heightened tone and reflexes.
What is the Babinski reflex and when is it considered pathological?
The Babinski reflex is a pathological reflex seen in upper motor neuron (UMN) lesions, where the big toe extends upward when the sole of the foot is stimulated.
What type of coupled movement occurs in the cervical spine?
Rotation and side bend to the same side.
What are the components of treatment for whiplash according to the Whiplash Risk Stratification Tool?
Accurate advice and education, relative rest, simple medications, exercise appropriate to patient condition, manual therapy, specific dizziness assessment and management, referral (imaging, medical, psychological).
What vascular structures should be considered in regional considerations for spinal areas, particularly the cervical region?
Vertebral artery and carotid artery (internal and external).
What are the possible results for the Cervical Artery Sustained Rotation Test?
Negative or Positive.
What is the believed pathophysiology of cervicogenic headache?
Convergence of sensory input from the upper cervical spine into the trigeminal spinal nucleus, including upper cervical facets and muscles, C2-3 IVD, vertebral and internal carotid arteries, dura mater of the upper spinal cord, and posterior cranial fossa.
What percentage of the global population suffers from headaches and what percentage of those are cervicogenic?
Approximately 47% of the global population suffers from headaches, and 15-20% of those headaches are cervicogenic.
What are downslope movements in the cervical spine?
Downslope movements are movements of the facet joints in the mid to lower cervical spine that occur during ipsilateral side-bending, rotation, and extension.
What is radicular pain and where is it felt?
Pain in the distribution of a nerve root, felt in the dermatomal distribution of a nerve root.
Where do individuals sometimes present with wry neck (torticollis)?
Emergency Department (ED)
What type of headache is mentioned in the provided text?
Tension type headache.
What are some cervical spine issues in children?
5 cm tumor or fibrosis, abnormal development of the cervical vertebrae, cervical spine articular disruption, intracranial pathology, inflammation or infection in the neck.
What are the symptoms of cervical instability?
Neurovascular compromise including 5Ds 3Ns, headaches/dizziness/facial symptoms, widespread neurological changes, lump in throat, fatigue with prolonged postures.
Why is the knee-jerk reflex considered involuntary and very fast?
It involves only one synapse, providing a quick protective response.
What does PPIVM stand for and what does it involve?
PPIVM stands for Passive Physiological Intervertebral Movement, where the therapist passively moves a joint through its physiological range.
What is the Quebec Task Force Classification used for?
Classifying whiplash-associated disorders (WAD).
What does a Grade 1 in the Quebec Task Force Classification indicate?
Neck complaint of pain, stiffness, or tenderness only with no physical signs.
Which age groups are mostly affected by wry neck (torticollis)?
Adolescents and young adults
What are blue flags in assessment?
Work-related perceptions.
Why is malignancy a contraindication to manual therapy?
Manual therapy could potentially spread malignant cells or worsen the condition.
What are some unclear causes of cervical spine issues?
Muscle spasm, facet sprain or synovial fold, disc material.
What are the 5 D's and 3 N's in the context of cervical spine assessment?
Diplopia, Dysarthria, Dysphagia, Drop attacks, Nausea, Nystagmus, Numbness.
What are drop attacks?
Sudden falls without loss of consciousness.
What does Law 3 state about spinal motion?
Motion in one plane will reduce motion in the other two planes.
What is the resolution rate of mechanical neck pain within one year?
Only 1/3 fully resolved within one year.
What is the predicted outcome for patients classified as high risk according to the Whiplash Risk Stratification Tool?
Predicted ongoing moderate/severe disability.
What are the typical symptoms of tension-type headaches?
Bilateral head pain described as a tight band around the head, dull pressing or tightening sensation, and mild to moderate intensity without nausea or vomiting.
What is the function of an afferent neuron?
Carries the signal to the spinal cord.
What anatomical structures are affected in Whiplash Associated Disorders (WAD)?
Oedema, haemorrhage, and inflammation.
What are the primary types of headaches according to the International Headache Society?
Cluster and migraine headaches (vascular origin), tension-type headaches (muscular origin).
What are upslope movements in the cervical spine?
Upslope movements are movements of facet joints in the mid to lower cervical spine that occur during contralateral rotation or side bending.
What does a Grade 2 in the Quebec Task Force Classification indicate?
Neck complaint and musculoskeletal signs such as decreased ROM and point tenderness.
Why is advanced diabetes a contraindication to manual therapy?
Advanced diabetes can lead to complications such as poor wound healing and increased risk of infection, making manual therapy risky.
Why is the use of anticoagulant medication a contraindication to manual therapy?
Anticoagulant medication increases the risk of bleeding, which can be exacerbated by manual therapy.
What are common treatments for MSK neck pain?
Manual therapy and exercise.
Why is osteoporosis a contraindication to manual therapy?
Osteoporosis weakens bones, increasing the risk of fractures during manual therapy.
What types of headaches can present with neck pain, complicating differential diagnosis?
Migraine and tension-type headaches.
What are the symptoms of myofascial headaches?
Pain localized to specific muscles with referred pain patterns, muscle tenderness with palpable trigger points, and restricted range of motion in the neck.
What symptoms are commonly reported in Whiplash Associated Disorders (WAD)?
Neck pain, stiffness, dizziness, paraesthesia/anaesthesia in the upper quadrant, headache, arm pain, concentration and sleep deficits, psychological changes, disability, decreased quality of life, and psychological distress.
What is the cradle hold technique?
The cradle hold involves both hands cradling the head using the hypothenar eminence, allowing fingertips to palpate or create other movements.
Where is the C8 nerve root located?
The C8 nerve root is located between the C7 and T1 vertebrae.
Where is the cell body of the ventral root located?
In the anterior horn.
What is the purpose of mobilization in manual therapy?
Mobilization involves movements generated by the therapist that put the joint through a range of motion up to and including the end of the available range, which are controlled, rhythmical, and do not exceed the physiological joint range.
What is hyporeflexia?
Hyporeflexia is a condition where there is a reduced reflex response.
What is the expected recovery for Neurotmesis?
Poor recovery.
What changes in sensation or output can result from peripheral nerve injury?
Weakness, reduced coordination, and sensory change.
What are black flags in assessment?
Regulatory, medico-legal, and insurance-related factors.
What are some medical/specific causes of MSK neck pain?
Fractures, infections, inflammatory disorders, malignancy, vascular pathology, neurological pathology.
What subjective information is collected in the form?
Information about headaches or migraines, neck pain, medical history, and general medical problems.
What causes myofascial headaches?
Overuse of muscles, poor posture or repetitive activities causing muscle imbalance, and muscle trauma or injury.
What are the symptoms of Temporomandibular Joint (TMJ) dysfunction headaches?
Pain in the temples, jaw, or ear region.
What is dysphagia?
Difficulty swallowing.
Why is muscle atrophy rare in upper motor neuron (UMN) lesions?
Because signals between the muscle and the spine (alpha motor neurons) remain intact, maintaining some muscle activity.
What is the role of the sensing hand in manual therapy?
The sensing hand is in direct contact with the joint to be tested.
What are Whiplash Associated Disorders (WAD) commonly associated with?
Sudden acceleration-deceleration associated with motor vehicle accidents (MVA).
How are long lever movements achieved in manual therapy?
Long lever movements lock 2+ cervical segments to create a lever, assessing physiological and/or accessory movements, making the movement more specific to a particular level.
What type of information does the ventral root carry?
Motor information.
Why do upper motor neuron (UMN) lesions cause widespread symptoms?
Because tracts in the spinal cord transmit signals from multiple spinal levels and areas of the cerebral cortex represent body regions.
What is the reason for hyperreflexia and clonus in upper motor neuron (UMN) lesions?
Because descending regulatory/inhibitory pathways are interrupted, allowing local peripheral pathways to fire 'unchecked', causing heightened reflexes.
What is hypotonia?
Hypotonia is a condition characterized by reduced muscle tone.
What are the key characteristics of cervicogenic headache?
Associated with neck pain and stiffness, unilateral, starts from one side of the posterior head and neck, can migrate to the front, associated with ipsilateral arm discomfort, aggravated by neck positions and specific occupations.
What is the function of the contact hand during a technique?
The contact hand is in direct contact with the joint being mobilized.
What is the effector in a reflex arc?
The muscle that responds by contracting.
What type of information does the dorsal root carry?
Sensory information.
What are fasciculations and what causes them?
Fasciculations are muscle twitching caused by damaged alpha motor units producing spontaneous action potentials.
How are the nerve roots positioned below the C8 nerve root?
The nerve roots below the C8 nerve root come from under their respective vertebrae.
What is a characteristic of LMN presentations related to localized symptoms?
Localized symptoms such as affecting a single myotome, dermatome, or nerve.
What causes hyporeflexia in LMN presentations?
Hyporeflexia is caused by damage to the motor nerve directly supplying the muscle, preventing the signal from reaching the muscle.
What is the role of an efferent neuron?
Sends a signal from the spinal cord to the muscle.
What happens when the motor nerve directly supplying the muscle is damaged?
The signal does not get to the muscle, causing weakness and muscle atrophy.
How are the nerve roots for C1-7 positioned relative to their respective vertebrae?
The nerve roots for C1-7 are positioned above their respective vertebrae.
What causes hypotonia in LMN presentations?
Hypotonia is caused by damage to the motor nerve directly supplying the muscle, preventing the signal from reaching the muscle.
What is the physiotherapy management for cervical instability?
Education, manual therapy, motor control and strength training, referral if required.
What are secondary headaches?
Headaches that result from another source such as inflammation or head and neck injuries.
What does PAIVM stand for and what does it involve?
PAIVM stands for Passive Accessory Intervertebral Movement, where the therapist creates an accessory glide at the joint.
What is the mixed spinal nerve root a part of?
The peripheral nervous system.
What does HVT stand for in manual therapy?
HVT stands for High Velocity Thrust Manipulation.
What does a Grade 4 in the Quebec Task Force Classification indicate?
Neck complaint and fracture or dislocation.
What are the main causes of peripheral nerve injury?
Chemical, physical (compression/stretch/cut), hypoxia, and disease.
What are the neurological symptoms of peripheral nerve injury?
Sensory loss, weakness, and reduced coordination.
What are the classifications of peripheral nerve injury?
Neuropraxis (myelin disruption), Axonotmesis (varying axon disruption), and Neurotmesis (complete transection).
What is the expected recovery for Neuropraxis?
Quite good recovery.
What is the expected recovery for Axonotmesis?
Some recovery.
What are the symptoms of radiculopathy?
Numbness/sensory change, weakness, reflex changes, and pain.
What causes radiculopathy?
Compression or disruption of the function of a nerve root.
What are the effects of disrupted transmission of signals from higher areas such as the cerebellum?
Coordination problems (ataxia) and gait and balance disturbance.
How is a dermatome different from a named peripheral nerve?
A dermatome is supplied by a single nerve root, whereas a named peripheral nerve may supply multiple areas.
What are the causes of Postural Headache?
Forward head posture, slouching or sitting for long periods without movement, and muscle fatigue and tightness in the neck and shoulder region.
Which nerves are mixed motor and sensory?
Cranial nerves.
What is Occipital Neuralgia?
A type of headache caused by irritation or compression of the occipital nerves at the back of the head.
What movement is produced by the L3 myotome?
Knee extension.
Where does the spinal cord end and what is the cauda equina?
The spinal cord ends at L1-2, and the cauda equina consists of the L2-5 and sacral nerve roots.
What is an Exertional Headache?
Headaches triggered by physical exertion, particularly involving neck or back muscles.
What movement is produced by the C6 myotome?
Elbow flexion.
What is a dermatome?
An area of skin supplied by a single nerve root.
What is somatic referred pain and what causes it?
Somatic referred pain comes from noxious stimulation of somatic (musculoskeletal) tissue, such as a disc or ligament.
What is a Postural Headache?
Headaches caused by prolonged poor posture, especially of the neck and upper back.
How does the Gendrasic manoeuvre affect the body?
It increases tension in the body and changes flow in pathways.
What are the signs and symptoms of Cauda Equina Syndrome?
Bilateral lower limb neurological changes, reduced perineal sensation, altered bladder function, reduced anal tone, loss of sexual function, and pain.
What types of fibers can peripheral nerves contain?
Motor, sensory, or mixed fibers.
What movement is produced by the C8 myotome?
Thumb extension and long finger flexors.
What is assessed in the context of paralysis?
Dermatomes, myotomes, and reflexes.
What are the three main changes that occur due to sufficient compression of a nerve?
Power loss, sensory alteration/loss, and reflex changes.
What are the symptoms of Occipital Neuralgia?
Sharp, shooting pain starting at the base of the skull and radiating to the scalp, forehead, or behind the eyes; tenderness over the occipital area; and sensitivity to light (photophobia).
Which peripheral nerve contains only motor fibers?
The suprascapular nerve.
What movement is produced by the S1 myotome?
Ankle plantarflexion.
What is an example of visceral pain and how does it occur?
An example is pain in the arm during a heart attack, caused by the convergence of nerves from the heart and shoulder to the same point in the spinal cord, leading to confusion in the brain.
What movement is produced by the C5 myotome?
Shoulder abduction.
What is the Gendrasic manoeuvre for the upper limbs?
Clench teeth.
What are the causes of Occipital Neuralgia?
Tightness or spasms in the neck muscles compressing the occipital nerves, trauma to the neck or head, and chronic tension or overuse of neck muscles.
What is the function of the myelin sheath in peripheral nerves?
The myelin sheath, made up of Schwann cells, increases the speed at which action potentials travel down nerves.
What movement is produced by the L4 myotome?
Ankle dorsiflexion.
What are common symptoms of jaw issues?
Jaw clicking or popping, and difficulty opening or closing the mouth.
What type of fibers are C fibers and what is their function?
C fibers are unmyelinated and are associated with pain.
What movement is produced by the L1-L2 myotome?
Hip flexion.
What is the Gendrasic manoeuvre for the lower limbs?
Pull arms apart.
What usually causes compression of the cauda equina?
Lumbar disc pathology.
What causes Exertional Headache?
Increased muscle tension during physical activities.
What movement is produced by the C7 myotome?
Elbow extension.
What is the result of less descending inhibition during the Gendrasic manoeuvre?
The reaction is stronger and produces a larger reflex.
What are the risks of permanent life-changing dysfunction associated with Cauda Equina Syndrome?
Incontinence and sexual dysfunction.
What are the types of fibers found in peripheral nerves?
Alpha, beta, delta fibers, and C fibers (pain).
What movement is produced by the T1 myotome?
Finger abduction/adduction.
Why is somatic referred pain difficult to localize?
Because it involves wide areas and the brain cannot distinguish between the neurons from the irritated tissue and neurons from elsewhere.
What are the symptoms of Postural Headache?
Dull, aching pain that develops gradually, pain typically starts in the neck and radiates to the back of the head or temples, and symptoms worsen as the day progresses or with prolonged static positions.
What is the role of Schwann cells in peripheral nerves?
Schwann cells catapult action potentials across the cells at a fast pace, increasing the speed of nerve conduction.
What movement is produced by the L5 myotome?
Big toe extension.
Which peripheral nerves contain only sensory fibers?
The saphenous nerve and the lateral cutaneous nerve of the thigh.
What movement is produced by the S2 myotome?
Knee flexion.
What are some contraindications to manual therapy?
Suspected vascular pathology, malignancy, inflammatory or infective arthritis, advanced diabetes, haemophilia, connective tissue disease such as Ehlers-Danlos, anticoagulant medication or long-term use of corticosteroids, cranio-vertebral anomalies (e.g., congenital absence of odontoid), deteriorating neurological status, recent trauma, joint or fracture instability, marked muscle spasm, osteoporosis, pregnancy.