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0102 Dr Youssef Masharawi

Dr Youssef Masharawi 2010

Dr Youssef Masharawi 2010

Dr Youssef Masharawi 2010

Dr Youssef Masharawi 2010

Dr Youssef Masharawi 2010

Dr Youssef Masharawi 2010

Dr Youssef Masharawi 2010

Dr Youssef Masharawi 2010

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THESINUVERTEBRALNERVE THE SINUVERTEBRAL NERVE


T Transverseview.Nerve i N supplytothelumbarfacet j joint. MbMedialbranchofthe dorsalprimaryramus LbLateralbranchofthe dorsalprimaryramus Dr Dorsal root DrDorsalroot SvN SinuvertebralNerve Vr Ventral root VrVentralroot GrGrayramus communicante
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Sinuvertebral nerves innervate


The ligaments of the atlantoaxial region (C1 and C3 sinuvertebral nerves) Dura mater of upper spinal cord and posterior cranial fossa (C1 and C3 sinuvertebral nerves) Dura mater of the remaining cervical spine cord, posterior longitudinal ligament and posterior aspects of the cervical intervertebral discs (C3 to C8 sinuvertebral nerves) Laterally the cervical intervertebral disc are ll h i li b l di 20 Dr Youssef Masharawi 2010 innervated by branches of the vertebral nerve

The ventral rami of the cervical spinal nerves innervate: Prevertebral muscles of the neck P t b l l f th k ( (including scalenus, trapezius and g p sternocleidomastoid) Atalanto-occipital and lateral atlantoaxial joints l i lj i
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The dorsal rami of the cervical spine nerves inervate:


Superficial posterior neck muscles (lateral branches of dorsal rami) b h fd l i) Deeper more medial muscles of the neck di l l f h k (medial branches of dorsal rami) Cervical zygapophyseal joints

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UpperExtension Upper Extension

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UpperFlexion Upper Flexion

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Flexion
The upper vertebral body tilts and j slides forward on the subjacent vertebra with ventral compression and dorsal distraction of the disc. disc Inferior facets of the upper vertebra move superiorly and anteriorly on the superior facets of the lower vertebra.
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Coupled lateralflexionandrotation
During lateral flexion the inferior facet on the concave side of movement slides down and p back while the superior facet on the convex side of movement slides up and forward with a combined effect of producing lateral flexion and rotation on the same side. Slight medial translation also occurs on the concave side of this movement .
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Dynamicmechanical factorsincervical spondyloticmyelopathy. spondylotic myelopathy (left)duringflexion,the spinalcordisstretched overventralosteophytic over ventral osteophytic ridges.(Right)During extension,the ligamentumflavummay ligamentum flavum may buckleintothespinal cordreducingspacefor thecord. the cord.

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sagittalMRIshowing narrowingofthespinal canalasaresultof anteriorherniated disc/osteophytes(left) andposteriorbuckling ofhypertrophied ligamentumflavum.

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Screeningquestions Screening questions


Sustained flexion (reading, computer work, driving posture, handicrafts, etc.) gp , , ) Return from flexion Speed of movement Weight of head Extension activities (hanging clothes, shaving, hairdresser)

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Screeningquestions Screening questions ((cont.))


Rotation activities (reversing car, conversation ) in fixed rotation) Upper extremity use (reaching, pushing/pulling, etc.) pushing/pulling etc ) Effect of thoracic/lumbar and lower extremity posture (long sitting, etc.) t (l itti t ) Carrying loads in arms or bag over shoulder

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:Torticollis
%79 07 %79-07
)5991 (Cheng et al 1994 Parter et al ,4991

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Scalenus
tubercles transverseprocess 1 -2 scalenes Brachialplexus p -SubclavianArtery
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)ThoracicOutletSyndrome(TOS )Thoracic Outlet Syndrome (TOS


/ : , ,P&N, : , ,
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AdsonTest Adson Test


Patientbreathesdeeply Neckextended Chinturnedtoward affectedside Repeattestwithchinto R i h hi oppositeside .1 .2 .3 .4 4

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LongusColliandCapitis Longus Colli and Capitis


Longus capitis

- 3 LongusColli multiplefascicles multipleattachments "! " ! -TP LongusCapitis occipitalbone occipital bone
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Longus colli

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WhiplashInjury Whiplash Injury


" / Whiplash h l h - . . , )"WhiplashAssociatedDisorders(WAD
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)5991(QuebectaskForce

WhiplashInjury Whiplash Injury


/ Hyperextension = 57% strain L.Colli Excessive lateral flex= 56% strain L Capitis L.Capitis

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(Porterfield J, DeRosa C 1995) Dr Youssef Masharawi 2010

Quebecclassificationofwhiplash injuries
Grade0 Nopain&Nophysicalsigns Grade1 Necksymptoms,nophysicalsigns Grade 1 Neck symptoms, no physical signs Grade2 Necksymptomsandsigns: ROMandtenderness Grade3 Grade2+neurologicalsigns Grade 3 Grade 2 + neurological signs Grade4 Necksymptoms+fracture

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WAD :
: jointpositionsense joint position sense : / NTPT
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consideringthedeepcervicalmuscles,longus considering the deep cervical muscles longus colliandlonguscapitis,arefundamentally importantfortheprovisionofsupportforthe important for the provision of support for the cervicallordosisandthecervicaljoint changesinthefeedforwardresponsemight p leavethecervicalspinevulnerabletostrain
(Fallaetal,.2004)

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Rectuscapitis Rectus capitis


2 occipitalbone atlas occipital bone atlas - atlantooccipitaljoint anterior = lateralis =

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PosteriorRegion P t i R i
Superficialgroup: Superficial group: Spleniuscervicis Spleniuscapitis Splenius capitis Deep(suboccipital)group: Rectuscapitis posteriormajor+minor Obliquecapitis Oblique capitis superior+inferior
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Splenius Cervicis & Capitis SpleniusCervicis&Capitis


(splenion=bandage) : Unilateral= sideflexion+ipsilateral rotation Bilateral= extofupperCx ext of upper Cx

capitis cervicis

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AdsonorScaleneManeuver Adson or Scalene Maneuver

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AdsonTest Adson Test


Patientbreathesdeeply Neckextended Chinturnedtoward affectedside Repeattestwithchinto R i h hi oppositeside .1 .2 .3 .4 4

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ProvocativeElevationTest

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Whitehandsign White hand sign

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Cervicogenicheadache Cervicogenic headache


)(unilateral l l occiput p mildmoderate = ache )(post
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Cervicogenicheadache Cervicogenic headache


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:**** vertebralartery vertebral artery ,, ,


(Sjaastad et al, 1990,1998 Cervicogenic international headache study group) (Sjaastadetal,1990,1998Cervicogenicinternationalheadachestudygroup)
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Cervicogenicheadache Cervicogenic headache


:
: H/A
SF36 : Headachespecificdisabilityquestionnaire Headache specific disability questionnaire

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Trapezius Levatorscapula Erectorspinemuscles: S spleneus spinaliscervicis C M Lev.scap spinaliscapitis longissimuscervicis Scalenus Med longissimuscapitis Ant iliocostaliscervicis trapzius Semispinalis omohyoid Multifidus+rotators
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Brachial plexus


: - feedforwardcontrolcontraction !!!!!!
)4002 (D Falla 4002D.Falla
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Forward h d posture F d head t

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Triggerpoints Trigger points


Suboccipital muscle

Levator scapula L t l
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