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Upper Quarter Cervical Dysfunction Combined Pathology

Upper Quarter Cervical Dysfunction Combined Pathology. Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita. www.powerhealths.com/2009/05/shoulder-pain/. askdrkit.com/neck-pain. askdrkit.com/neck-pain. Primary Subacromial crowding 

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Upper Quarter Cervical Dysfunction Combined Pathology

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  1. Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita

  2. www.powerhealths.com/2009/05/shoulder-pain/

  3. askdrkit.com/neck-pain

  4. askdrkit.com/neck-pain

  5. Primary • Subacromial crowding  • Shape of the Acromion • Superior migration of humeral head • Tight posterior capsule • Secondary • Relative decrease in subacromial space due to instability of the glenohumeral or scapulothoracic joint Shoulder Impingement1

  6. Stabilizers of the Shoulder2-4 • 2 types of shoulder stabilizers • Static • Glenohumeral ligaments  • Capsule  • Angle of the Glenoid cavity • Dynamic  • Rotator cuff musculature  • Scapular stabilizers  • May be affected by cervical pathology

  7. pain, weakness and a loss of movement5 • may occur at night if the patient lies on the affected shoulder.  • other symptoms include grinding or popping during movement6 • range of motion may be limited by pain.  • painful arc may be present during elevation of the arm from 60° to 120°6 Patient presentation

  8. Muscle strengthening • Rotator cuff training • Scapular stabilizers training • Stretching • Rotator cuff • PROM • Pain reduction • Ice/heat • Anti-inflammatory medication Standard Protocol for Shoulder Impingement7

  9. Signs that point to cervical spine • Posture • Forward head posture • Head orientation • Humeral head location • AROM/PROM for glenohumeral joint, and scapulothoracic joint • Strength • Myotomal • Sensory • Dermatomal • Peripheral • Reflex • Asymmetrical UE reflex • C4 – C8 diminished or absent in involved side Shoulder Assessment

  10. Abnormal movement • Facet Hypermobility  • Facet Hypomobility  • Muscle Imbalance • Whiplash • Cervical Disc Herniation • Cervical Spinal Stenosis • Posture/Resting Alignment • May alter mechanics of the C-spine • May increase stress on surrounding  Cervical Spine Contribution

  11. Whiplash8,9 Secondary shoulder impingement associated with whiplash injury Cervical Spine Contribution

  12. Cervical Disc Herniation4 Disc degeneration Trauma Cervical Spine Contribution

  13. Cervical Spine Stenosis4 Bone spurs around intervertebral and facet joints Cervical Spine Contribution

  14. C-spine clearing tests • VBI, Sharp-Pursar, Sidebend, Traction • Postural Assessment  • PROM/AROM • Accessory motion of the C-spine • upglide, downglide, gapping  • Upper limb tension test • Ulnar, Median, Radial • Sensory • Provocation/Alleviation • Technique that allows us to identify a specific problematic segment • Increases the efficiency of treatment  • Provides the patient with a better prognosis • Soft tissue accessory assessment Cervical Spine & Shoulder  Assessment

  15. Postural Assessment: Slumped Sitting4,8  • May effect overall mechanics of the shoulder and neck • Upper Crossed Syndrome  • tightness of the anterior musculature of thorax • Elongation of the posterior musculature of thorax •  Weakness of the posterior musculature of thorax and deep neck stabilizers  • Shortening of suboccipitals • Ischemia and nerve damage  • Decreased innervation to the rotator cuff • Indirectly related to posterior capsular tightness 

  16. Postural Assessment: Slumped Sitting8 • Proprioceptive changes • Strength deficits • Length Deficits • Nerve Compression • Muscle Fatigue • All can contribute to possible signs of impingement

  17. Scapulohumeral Rhythm • 4 Joints7 • glenohumeral • scapulothoracic • sternoclavicular • acromioclavicular • 2 purposes7 • distribute motion between glenohumeral and scapulothroacic joints • maintain optimal length/tension relationship of muscles

  18. Glenohumeral/Scapulothoracic Contribution • Shoulder flexion 180°7 • Glenohumeral contribution 120° • Scapulothoracic contribution 60° • 2:1 ratio

  19. Postural Intervention We look to restore integrity, length, and strength Postural Taping Postural Re-education Lengthening of the anterior muscles Strengthening of the posterior muscles Strengthening/re-educating the deep cervical stabilizers Strengthen core

  20. The cervical spine must be treated first. • A muscle that is neurologically compromised cannot reach full strength. • Should focus on joint mobilization • Upglide, downglide • Depending on dysfunction • Gapping • Traction • Soft tissue • Contract/Relax of trapezius, scalenes • Soft tissue mobilization  • Mobilizations of asymptomatic cervical spines have even been shown to improve shoulder range of motion and pain.11 Cervical Spine Intervention

  21. Interventions • Strengthening/ control c-spine muscles • Shoulder can then be addressed. • Strengthening of rotator cuff muscles and scapular stabilizers. • Scapulo-humeral dissociation • Inferior glide?

  22. Shoulder impingement • Weak shoulder stabilizers • Cervical radiculopathy • Posture, disc herniation, stenosis, traumatic, etc. Tracking Down the Problem

  23.                       References  1. Ferdig S. Shoulder Pathology Lecture.  Spring 2009. Chapman University, Department of Physical Therapy. 2. Wilson C. Rotator cuff versus cervical spine: making the diagnosis. Nurse Pract. 2005;30(5):44-50. 3. Hess SA.  Functional stability of the glenohumeral joint.  Man Ther. 2000;5(2):63-71. 4. Magee DJ. Orthopedic Physical Assessment. W.B. Saunders Company; 2002. 5. Fongemie AE, Buss DD & Rolnick SJ.  Management of shoulder impingement syndrome and rotator cuff tears. Am     Fam Physician. 1998;57:667–674. 6. Chen AL, Rokito AS & Zuckerman JD. The role of the acromioclavicular joint in impingement syndrome. Clin             Sports Med . 2003;22:343–357. 7. Kamkar A, Irrgang J, Whitney S. Nonoperative management of secondary shoulder impingement syndrome.                 JOSPT. 1993;17(5):212-224 8. Chauhan SK, Peckham T, Turner R. Impingement syndrome associated with whiplash injury. J Bone Joint Surg Br.     2003;85-B:408-410. 9. Abbassian A, Giddins, GE. Subacromial impingement in patients with whiplash injury to the cervical spine. J             Orthop Surg Res. 2008;3:25.  10. Langford ML.  Poor posture subjects a worker's body to muscle imbalance and nerve compression.  Occup Health         Sci. 1994: 63(1); 38-41.  11. McClatchie L, Laprade J, Martin S, Jaglal SB, Richardson D, Agur A. Mobilizations of the asymptomatic cervical         spine can reduce signs of shoulder dysfunction in adults. Man Ther. 2008;14(4): 369-374.

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