Upper Quadrant Examination

Combined movements are also performed in a sitting position. Maitland proposed that the upper cervical spine lock is useful in detecting difficult upper cervical lesions.7® This method may be beneficial in ruling out upper cervical spine disorders. Since coupling of the upper cervical spine changes during motion initiation, it is prudent to adjust the procedure to the initiated motion. For example, Figure 6.35 outlines the upper c-spine quadrant during side-flexion initiation while Figure 6.36 displays the same procedure during rotation initiation. The coupling movements are in opposition because the initiation of the motion alters the locking position of the upper cervical spine. Because the movement is very provocative, it should only be used when the concordant sign is not found during normal assessment maneuvers. If pain occurs with any of the preceding examinations, the upper cervical quadrant is unnecessary. The following procedure outlines the upper quadrant during side flexion initiation.

Figure 6.35 Upper Quadrant-Side Flexion Initiation-Upper C-spine Lock


Step One: The head is positioned in designated neutral position. Step Two: The clinician stands to the side that he or she desires to assess.

Step Three: The chin is protracted and a downward force is applied to the head.

Step Four: The clinician then passively side glides the head away until a feeling of a tightening of the “slack” is interpreted. Step Five: The clinician then passively side-flexes the upper cervical spine (the spine should only move 5-10 degrees).

Step Six: Passive rotation of the upper cervical spine by the clinician then follows (or to the same side as side flexion), with a concurrent gentle overpressure.

Step Seven: Repeat on the opposite side.

Because the upper cervical spine changes its coupling pattern with a different initiation of movement, it is essential to discuss the upper cervical quadrant during rotation initiation. Like the other upper cervical spine quadrant test, it should only be used when the concordant sign is not found during normal assessment maneuvers.


Figure 6.36 Upper Quadrant-Rotation lnitia-tion-Upper C-Spine Lock


Step One: The head is positioned in designated neutral position. Step Two: The clinician stands to the side that they desire to assess.

Step Three: The clinician protracts the chin and applies a downward force on the head.

Step Four: The clinician passively side glides the head away until he or she feels a tightening of the “slack. ”

Step Rve: The clinician then passively rotates the upper cervical spine away (limit the movement to 5-10 degrees to ensure no recruitment from the lower cervical spine).

Step Six: Passive side flexion of the neck toward the clinician then follows (the movement should be limited to 5-10 degrees) with a light application of an overpressure.

Step Seven: Repeat on the opposite side.

Summary


Passive physiological movement firther localized cervical movements that contribute to concordant patient complaints.

Passive physiological movements have demonstrated acceptable interclinician reliability.

Passive physiological movcments may be single plane or combined to engage the articular or surrounding strictures.

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