Cervical Radiculopathy: An Eclectic Approach. Kaarthick Mani, PT, MS, DPT, FAAOMPT. Clinical Specialist- OMPT, DuPage Fitness & Rehab. Naperville, Illinois ...
Cervical Radiculopathy: An Eclectic Approach Kaarthick Mani, PT, MS, DPT, FAAOMPT Clinical Specialist- OMPT, DuPage Fitness & Rehab Naperville, Illinois, US & J Mohanakrishnan, PT, JIPMER, Puducherry , India
Education Kaarthick Mani
J Mohanakrishnan
• BPT- College of Physiotherapy, SRIPMS, Coimbatore, India. • MS (Ortho PT)- Quinnipiac University, Hamden, Connecticut, USA. • Clinical Residency in Ortho Manual PT, Institute of Therapeutic Sciences, Livonia, Michigan, USA. • Doctorate (DPT)- A. T. Still University of Health Sciences, Mesa, Arizona, USA. • Post-Doctoral Fellowship (FAAOMPT)Regis University, Denver, Colorado, USA.
• PhD Scholar. • SRIPMS Aluminus
Cervical Anatomy
1)Upper Cervical/Sub occipital/Sub cranial 2)Mid Cervical Spine
Ligamentous Anatomy • Anterior and Posterior Ligaments • Ligamentum Flavum • Ligamentum Nuchae
• SubCranial • Fibrous Capsule • Atlanto Occipital Membrane • Tectorial Membrane • Atlanto axial Ligament • Alar • Apical • Cruciform • Transverse
• Anterior Musculatures
• Posterior Musculatures
Bio-Mechanics
Rotation
Combined Bio-Mechanics Flexion
Extension
Side Bending
Rotation
Occipit
forward on Atlas
Backward on Atlas
Down To the side
Back on the side of rotation and front on the opposite side
Atlas
Atlas Follows the Occipit
Atlas Follows the Occipit
Slides to the side
Slides to left & opposite side flexion at C0-C1
Uncinate
Forward Translation
Backward Translation
Backward Translation On the side & forward translation on the opposite side
Backward Translation On the side & forward translation on the opposite side
Mid Cervical
Forward and Upward
Backward and Downward
Back and down on the side while Up & forward on the opposite side
Back and down on the side while Up & forward on the opposite side
Dynamic Model
Patho Mechanics • Cervicogenic Headaches • Sub Occipital Structures Shortening(Semispinalis capitis) -Greater occipital Nerve
Forward Head Posture
Neck Pain associated with Levator scapulae
Cervical Disc Degeneration
Neuro-Dynamics • Definition • Clinical application of mechanics and physiology of nervous system integrated with musculoskeletal function
Three Part System • Mechanical Interface • Neural Structures • Innervated Tissues
Neuro Dynamic Tests
Neuro BioMechanics • Scapular Depression • Gleno Humeral Abduction/ External Rotation/ Horizontal Extension/ Internal Rotation • Elbow Flexion/Extension • Wrist Flexion/Extension,Adduction/Abduction • Fingers Flexion/Extension
Neuro Patho Dynamics • Mechanical Interface Dysfunctions • Closing • Reduced • Excessive
• Opening • Reduced • Excessive
• Neural Dysfunctions • Sliding • Tension
• Neural hypermobility-Instability • Patho anatomical Dysfunction • Pathophysiological Dysfunction
Neck And Upper Limb • • • • • • •
Slump Test MNT1 UNT MNT2 RNT ANT RSNT
Mtn1
UNT
RNT
ANT
RNST
Evidence Based Practice (EBP) Model Copyright: www.dfitrehab.com
Diagnostic Test Cluster Clinical Prediction Rules (CPR) for Cerv. Radic (Wainner et al): 1. Positive upper limb tension test A (ULTT-A) 2. Involved-side cervical rotation range of motion less than 60 degrees, 3. Positive distraction test (Distraction test: symptom reduction) 4. Positive Spurling's test A (Spurling's A: symptom reproduction)
Test Cluster (Cont’d.) Number of Positive Tests
Sensitivity
Specificity
LR +
LR -
Two
39%
56%
0.88
1.09
Three
39%
94%
6.1
0.65
Four
24%
99%
30.3
0.77
Differential Diagnosis Rule out: • Lesions of RC and Adh. Capsulitis • Cervical myelopathy • Mono neuropathies of median, ulnar and radial nerves • Idiopathic Brachial neuritis • Rarely found & mistaken for Cerv. Radic.: intracarnial tumor, axillary Schwannoma, epidural varicose veins, glenoid cyst, vertebral artery dissection, and Osteochondroma of upper Cspine
Orthopaedic Manual Physical Therapy (OMPT)
Eclectic Approach • • • • • • •
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