Review: HVLA Thoracic and Cervical Spine, Innominates Flashcards

1
Q

doc/pt positioning for HVLA supine T-spine

A

Doc stands opposite side of PTP

Type 1: side bend away from doc
Type 2: sidebend toward doc

Upon exhalation, doc exerts posterior to anterior HVLA thrust through their abdomen toward PTP

[this is Kirksville Crunch]

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2
Q

Doc/pt positioning for HVLA prone (note type 1 vs. type 2 hand placement)

A

Stand opposite side of PTP

Type 1: hand facing caudad, place hypothenar eminence on PTP. Hand facing cephalad, place thenar eminence on opposite TP

Type 2 (flexed): hand facing cephalad, place thenar eminence on PTP; hand facing caudad, place hypothenar eminence on opposite TP

At end of exhalation, a downward anterior HVLA thrust with a counterbalance (twist) in direction the fingers are pointing with greater force on PTP side

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3
Q

OA E RR SL: HVLA

A

Contact right posterior occiput posterior to mastoid process

Cradle head w/ left hand, sideband OA joint right, rotate left and extend to engage RB and add localizing cephalad directed traction

instruct pt to inhale deeply; at the end of exhalation, perform HVLA thrust medially, anteriorly, and superiorly

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4
Q

AA RL: HVLA

A

Cradle head in hands, contacting left lateral mass of atlas w/ lateral margin of left index finger

Flex the C spine towards a straighter alignment and allow minimal extension to localize to the monitoring index finger

Rotate head right to the RB

Instruct pt to inhale; at the end of exhalation apply HVLA rotational thrust through a combined motion of both hand contacts and movement of the head and atlas

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5
Q

C4 E RR SR: HVLA rotational emphasis

A

Index finger pad (straight bridge) or 2nd MCP is placed behind the articular pillar on the side of the PTP to restrict motion at that segment

Flex pts head until motion is identified at C4, then allow the head to move into slight extension (isolates motion from above and below segment)

Sidebend towards the freedom of motion (right), to C4-C5 interspace (locks out vertebrae above dysfunction)

Rotate towards the RB (left) through the C4-5 interspace. With the pt relaxed, the doc uses rapid acceleration supinating the left hand and wrist, which directs a left rotational arc-like thrust in the plane of the oblique facet

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6
Q

C4 E RR SR: HVLA sidebending emphasis

A

Physician’s 2nd MCP joint contacts tip of transverse process of C3 on the left

Flex the cervical spine through the C3-C4 interspace

Rotate C spine towards freedom (right) to C3-C4 interspace (locks out vertebrae above dysfunctional segment)

Sideband towards the RB (left) through, and including the C3-4 interspace

Thrust in the side bending plane toward the T1 spinous process (or sternal notch)

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7
Q

“Rays of the sun” approach to direction of HVLA thrust in cervical region

A

Upper cervicals: thrust toward the eye

Middle cervicals: thrust straight across the neck

Lower cervicals: thrust down toward the chest

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8
Q

Innominate HVLA: Superior shear

A

Pt supine with feet off end of table

Doc grasps pt’s tibia and fibula superior to the ankle.

Internally rotate and abduct the pt’s leg; lean back and induce axial traction. Instruct pt to inhale and exhale slowly over 2-3 cycles and gently increase traction on exhalation

Exert axial HVLA thrust

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9
Q

Innominate HVLA: inferior shear

A

Pt lateral recumbent, affected side up, with doc behind pt

Cephalad hand on PSIS, caudad hand on ASIS

Provide lateral distraction to gap SI joint, then cephalad force. Instruct pt to inhale and exhale slowly over 2-3 cycles and gently increase force on exhalation

Exert cephalad HVLA force through ASIS and PSIS contacts

[Alternative technique: same position but monitor lumbosacral junction, pt straightens bottom leg and places top leg just distal to popliteal fossa of bottom leg. cephalad hand monitors SI joint while caudad hand placed inferior aspect of ipsilateral ischial tuberosity; simultaneously push shoulder posterior and roll pelvis anterior to induce axial rotation until movement of SI joint is palpated. HVLA force delivered with caudad forearm, parallel to table]

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10
Q

Innominate HVLA: Anterior rotation

A

Pt lateral recumbent, dysfunctional side up w/ doc facing pt

Cephalad hand between L5 and S1 SP, caudad hand flexes pts hips and knees until L5 and S1 SP’s separate

Drop pts top leg off table (foot should not touch floor), cephalad hand moves to antecubital fossa, with forearm on shoulder; caudad forearm is placed along femur between PSIS and trochanter. Simultaneously push shoulder posterior and roll pelvis anterior to induce axial rotation until movement of SI joint is palpated. HVLA force delivered with caudad forearm, directed down the shaft of the femur

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11
Q

Innominate HVLA: Posterior rotation

A

Pt lateral recumbent with doc facing pt

Cephalad hand between L5 and S1 spinous process; caudad hand flexes pts hips and knees until L5 and S1 SP’s separate

Pt straightens bottom leg and places foot of top leg just distal to popliteal fossa of bottom leg. Cephalad hand moves to antecubital fossa with forearm on shoulder; caudad forearm is placed on PSIS and iliac crest. Simultaneously push shoulder posterior and roll pelvis anterior to induce axial rotation until movement of SI joint is palpated. HVLA force delivered with caudad forearm, directed towards umbilicus

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