62
Evaluations and Treatment of the Cervical Spine, 2nd Edition: Summary
NEURAL TISSUE PROVOCATION Nerve Purpose
Technique
Result Interpretation
Median
To assess neurodynamics of the median nerve
Supine or sitting with contralateral cervical side bending and ipsilateral shoulder depression Shoulder extension, elbow extension, forearm supination, wrist extension, finger extension Supine or sitting with contralateral cervical side bending and ipsilateral shoulder depression Shoulder abduction to 90° with shoulder external rotation; elbow flexion, forearm pronation, extension of wrist and fingers; attempt to place the palm of the hand on the ipsilateral ear or encircle the eye with the thumb and index finger Supine or sitting with contralateral cervical side bending and ipsilateral shoulder depression Shoulder extension, elbow extension, forearm pronation, wrist flexion, finger extension
Positive test = pain or paresthesia to the median nerve distribution Clinical significance: Mechanical tension of the neural structures is useful clinically to help differentiate neural versus musculoskeletal (non- neural) anatomic structures Positive test = pain or paresthesia to the ulnar nerve distribution Clinical significance: Mechanical tension of the neural structures is useful clinically to help differentiate neural versus musculoskeletal (non- neural) anatomic structures
Ulnar
To assess neurodynamics of the ulnar nerve
Radial
To assess neurodynamics of the radial nerve
Positive test = pain or paresthesia to the radial nerve distribution Clinical significance: Mechanical tension of the neural structures is useful clinically to help differentiate neural versus musculoskeletal (non- neural) anatomic structures
Joint Mobility • Passive accessory intervertebral movement (PAIVM) : Determining if there is normal joint movement versus hypermobility versus hypomobility: ○ Commonly performed in prone but can also perform seated: ■ Posterior to anterior (PA) glide is most common in the cervical spine, C2–C7 – Central: Thumbs on the spinous process: • Causes anterior vertebral glide – Unilateral: Thumbs on the transverse process: • Causes contralateral rotation – Transverse: Thumbs on lateral aspect of spinous process: • Causes ipsilateral rotation • Side glide : ○ Client is supine ○ Support head with one hand and mobilize with the other ○ Lateral border of index finger and/or webspace contacts the articular pillar of the segment to be mobilized
○ Forearm of the mobilizing hand should be near- perpendicular to the client’s neck for optimal direction of force ○ Force is directed in a lateral direction, making sure not to allow lateral flexion, keeping the head and neck in neutral alignment ○ Clinician assesses cervical mobility of C2–C7 bilaterally • Distraction: ○ Client is supine ○ Clinician uses lateral border of index fingers for distraction force while the remaining fingers help cradle the head and neck ○ For entire head and neck distraction, cranial directed force is applied on the occiput ○ To mobilize an individual segment C2–C7, cranial directed force is applied at the spinous process • Flexion : Opening of the spinous processes • Extension : Closing of the spinous processes • Lateral flexion : Closing of the superior spinous process • Rotation : Lateral movement of the superior spinous process
Powered by FlippingBook