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Evaluations and Treatment of the Cervical Spine, 2nd Edition: Summary
Japanese Orthopedic Association Cervical Myelopathy Questionnaire (JOACMEQ): • Self-report questionnaire the client fills out to evaluate the neurological function of cervical myelopathy
• Incorporates five domains: cervical spine function, upper extremity function, lower extremity function, bladder function, and quality of life
SPECIAL TESTS Special Test Odontoid Fracture Test
Purpose
Technique
Result Interpretation
To assess integrity of the odontoid process of C2, the dens
Position: supine Clinician palpates lateral mass of the atlas (C1) and applies a medial force in each direction Position: Supine With clinician hands under occiput, passively extend, side bend, and rotate the cervical spine; hold up to 30 seconds Best to engage in conversation to monitor pupils and affect; consider having the client count backward from 10 Position: Sitting or supine Clinician palpates C2 spinus process with thumb and index fingers while stabilizing the top of the head Lateral flexion and rotation will cause the spinus process to move immediately; end feel should be capsular Position: Supine with head cradled in clinician’s hands Palpate each side of C2 with the thumbs Lift the head with cupped hands to translate the skull and C1 anteriorly on C2; hold for up to 30 seconds Position: Seated, with slight cervical flexion Stabilize spinus process of C2 with thumb and index finger; opposite hand applies a posteriorly directed force on the forehead
Positive test = increased translation Clinical significance: A positive test is indicative of a dens fracture; this is a serious medical emergency Positive test = 3 N and 5 D = nystagmus, nausea, numbness of face; dizziness, dysarthria, dysphasia, diplopia, drop attacks, tinnitus, confusion Clinical significance: VBI (vertebrobasilar insufficiency), decreased blood to the brain; cervical manipulation is contraindicated Positive test = delay in movement of C2 spinus process and/or excessive ROM unilaterally; soft end feel Clinical significance: A torn alar ligament compromises upper cervical spine stability; therefore, manual therapy is contraindicated Positive test = sensation of lump in the throat, nystagmus, vertigo, or paresthesia of the face and/or upper extremity Clinical significance: A torn transverse ligament compromises stability of the upper cervical spine; thus, manipulation is contraindicated Positive test = excessive movement of the head posteriorly, or a soft end- feel Clinical significance: A torn transverse ligament compromises stability of the upper cervical spine; thus, manipulation is contraindicated
Vertebral Artery Test (VBI)
To assess the integrity of the internal carotid arteries
Alar Ligament Test
To assess the integrity of the alar ligament, which connects the dens (C2) to the occiput
Transverse Ligament Test/ Anterior Shear Test
To assess the transverse portion of the cruciform ligament that keeps the dens in contact with the atlas
Sharp-Purser Test To test the integrity of the transverse
ligament that keeps the dens in contact with the atlas
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