![Page 1: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/1.jpg)
Upper Quarter Cervical Dysfunction Combined
PathologyJasmine Chan
Andy ChiuBrandon HigaBryce KeyesMinsu Kim
Derek MatsuiAdrian Ruiz
Traci Yamashita
![Page 2: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/2.jpg)
www.powerhealths.com/2009/05/shoulder-pain/
![Page 3: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/3.jpg)
![Page 4: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/4.jpg)
![Page 5: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/5.jpg)
![Page 6: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/6.jpg)
![Page 7: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/7.jpg)
![Page 8: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/8.jpg)
askdrkit.com/neck-pain
![Page 9: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/9.jpg)
askdrkit.com/neck-pain
![Page 10: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/10.jpg)
Shoulder Impingement1 • Primary
o Subacromial crowding o Shape of the Acromion o Superior migration of humeral heado Tight posterior capsule
• Secondaryo Relative decrease in subacromial
space due to instability of the glenohumeral or scapulothoracic joint
![Page 11: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/11.jpg)
2 types of shoulder stabilizers• Static
o Glenohumeral ligaments o Capsule o Angle of the Glenoid cavity
• Dynamic o Rotator cuff musculature o Scapular stabilizers o May be affected by cervical pathology
Stabilizers of the Shoulder2-4
![Page 12: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/12.jpg)
Patient presentation• 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.
o painful arc may be present during elevation of the arm from 60° to 120°6
![Page 13: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/13.jpg)
Standard Protocol for Shoulder Impingement7
• Muscle strengtheningo Rotator cuff trainingo Scapular stabilizers training
• Stretchingo Rotator cuff o PROM
• Pain reductiono Ice/heato Anti-inflammatory medication
![Page 14: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/14.jpg)
Shoulder Assessment• Signs that point to cervical spine
o Posture Forward head posture Head orientation Humeral head location
o AROM/PROM for glenohumeral joint, and scapulothoracic joint
o Strength Myotomal
o Sensory Dermatomal Peripheral
o Reflex Asymmetrical UE reflex
C4 – C8 diminished or absent in involved side
![Page 15: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/15.jpg)
Cervical Spine Contribution• Abnormal movement
o Facet Hypermobility o Facet Hypomobility o Muscle Imbalance
• Whiplash• Cervical Disc Herniation• Cervical Spinal Stenosis• Posture/Resting Alignment
o May alter mechanics of the C-spineo May increase stress on surrounding
![Page 16: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/16.jpg)
Cervical Spine Contribution
• Whiplash8,9o Secondary shoulder
impingement associated with whiplash injury
![Page 17: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/17.jpg)
Cervical Spine Contribution
• Cervical Disc Herniation4o Disc degenerationo Trauma
![Page 18: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/18.jpg)
Cervical Spine Contribution
• Cervical Spine Stenosis4o Bone spurs around
intervertebral and facet joints
![Page 19: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/19.jpg)
Cervical Spine & Shoulder Assessment
• C-spine clearing testso VBI, Sharp-Pursar, Sidebend, Traction
• Postural Assessment • PROM/AROM• Accessory motion of the C-spine
o upglide, downglide, gapping • Upper limb tension test
o Ulnar, Median, Radial• Sensory• Provocation/Alleviation
o Technique that allows us to identify a specific problematic segment
o Increases the efficiency of treatment o Provides the patient with a better prognosis
• Soft tissue accessory assessment
![Page 20: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/20.jpg)
Postural Assessment: Slumped Sitting4,8 • May effect overall mechanics of the
shoulder and neck• Upper Crossed Syndrome
o tightness of the anterior musculature of thorax
o Elongation of the posterior musculature of thorax
o Weakness of the posterior musculature of thorax and deep neck stabilizers
o Shortening of suboccipitals• Ischemia and nerve damage • Decreased innervation to the rotator cuff• Indirectly related to posterior capsular
tightness
![Page 21: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/21.jpg)
Postural Assessment: Slumped Sitting8
• Proprioceptive changes• Strength deficits• Length Deficits• Nerve Compression• Muscle Fatigue• All can contribute to possible signs of impingement
![Page 22: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/22.jpg)
Scapulohumeral Rhythm
• 4 Joints7o glenohumeralo scapulothoracico sternoclavicularo acromioclavicular
• 2 purposes7o distribute motion between glenohumeral and
scapulothroacic jointso maintain optimal length/tension relationship of
muscles
![Page 23: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/23.jpg)
Glenohumeral/Scapulothoracic Contribution
• Shoulder flexion 180°7o Glenohumeral contribution 120°o Scapulothoracic contribution 60°o 2:1 ratio
![Page 24: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/24.jpg)
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
![Page 25: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/25.jpg)
Cervical Spine Intervention• The cervical spine must be treated first.
o A muscle that is neurologically compromised cannot reach full strength.
• Should focus on joint mobilization o Upglide, downglide
Depending on dysfunction o Gappingo Traction
• Soft tissueo Contract/Relax of trapezius, scaleneso Soft tissue mobilization
• Mobilizations of asymptomatic cervical spines have even been shown to improve shoulder range of motion and pain.11
![Page 26: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/26.jpg)
Interventions
• Strengthening/ control c-spine muscles• Shoulder can then be addressed.
o Strengthening of rotator cuff muscles and scapular stabilizers.
o Scapulo-humeral dissociation o Inferior glide?
![Page 27: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/27.jpg)
Tracking Down the Problem
• Shoulder impingement • Weak shoulder stabilizers• Cervical radiculopathy• Posture, disc herniation, stenosis,
traumatic, etc.
![Page 28: Upper Quarter Cervical Dysfunction Combined Pathology Jasmine Chan Andy Chiu Brandon Higa Bryce Keyes Minsu Kim Derek Matsui Adrian Ruiz Traci Yamashita](https://reader036.vdocuments.us/reader036/viewer/2022062421/56649e405503460f94b31f6b/html5/thumbnails/28.jpg)
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):212-2248. 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.