Mišično-skeletna fizioterapija 3 / Musculoskeletal physiotherapy 3
 
 
Fizioterapija 2013, letnik 21, suppl 1   
Diagnostika in fizioterapija pri pacientki z nestabilnostjo zgornje 
vratne hrbtenice – poročilo o primeru 
 
Barbara Pantar, viš. fiziot.1, strok. sod. Matthias Klauser, dipl. fiziot.2 
 
1
Fizioterapija Barbara Pantar, Ljubljana, Slovenija; 
2
Zdravstvena fakulteta, Univerza v Ljubljani, Slovenija 
 
Korespondenca/Correspondence: Matthias Klauser; e-pošta: matthias.klauser@zf.uni-lj.si 
 
 
Uvod: Nestabilnost zgornje cervikalne hrbtenice se največkrat odkrije kot dodatna diagnoza v okviru 
skrbne preiskave vratne hrbtenice (1). Dejstvo odkritja nestabilnosti vsekakor pomembno vpliva na vrstni 
red in izbor metod terapije, ki zahteva obravnavo radikulopatije. Namen: Predstaviti fizioterapevtsko 
diagnostiko s testi stabilnosti vratne hrbentinice, testiranje prevodnosti vertebralne arterije (2), preiskavo 
mobilnosti živčevja (3) in obravnavo nestabilnosti vratne hrbtenice (4) ter mobilizacijo živčevja (5). 
Metode: Poročilo prikazuje primer preiskovanke, ki je prišla na obravnavo s simptomatiko radikulopatije 
C 7 (3) in z okcipitalnimi glavoboli. V preiskavi, v katero so bili vključeni testi hipermobilnosti zgornjih 
vratnih segmentov (1) in provokacijski test za vertebralno arterijo po De Kleijnu ter preizkus po Hautantu 
(2), je bilo ugotovljeno, da dodatno trpi še za nestabilnostjo zgornje vratne hrbtenice. Na podlagi 
fizioterapevtske ocene in imobilizacije nevrologa so bile uporabljene te fizioterapevtske tehnike: 
mobilizacija medianega in ulnarnega živca (5) in terapevtske vaje za stabilizacijo vratne in prsne 
hrbtenice (4). Rezultati: Po sedmih obravnavah je preiskovanka dobila dober občutek za pravilno 
stabilizacijo vratne hrbtenice pri aktivnostih vsakdanjega življenja. Mravljinčenje in bolečine, zaradi 
katerih je preiskovanka prišla v ambulanto, so se v poteku obravnave zmanjšali. Refleks mišice triceps 
brachii se ni opazno spremenil. Tudi zmanjšana mišična moč se je le nekoliko poboljšala. Zaključek: Ker 
stabilizacija vratne hrbtenice in obravnava radilukopatije zahtevata dolgoročno terapijo, štejemo zaradi 
razmeroma naglega poboljšanja splošnega občutka (nočni spanec, glavoboli) in s tem kakovosti življenja 
fizioterapevtsko obravnavo kot uspešno.  
 
Ključne besede: manualna terapija, mobilizacija živčevja, stabilizacija, vratna hrbtenica. 
 
  
Mišično-skeletna fizioterapija 3 / Musculoskeletal physiotherapy 3
 
 
 Fizioterapija 2013, letnik 21, suppl 1 
Diagnosis and physiotherapy of a patient with instability in upper 
cervical spine – a case report 
 
 
Background: Instability of upper cervical spine is often detected as an additional diagnosis within a 
diligent examination of the cervical spine (1). The fact of having discovered instability certainly has a 
significant impact on the order and selection of methods and therapies required in the treatment of 
radiculopathy. Purpose: To present a physiotherapeutic diagnosis of cervical spine stability tests, a 
conductivity test of artery vertebralis (2), an investigation of mobility of the nervous system (3), including 
a treatment of cervical spine instability (4) and mobilization of the nervous system (5). Methods: The 
report shows an example of a woman patient who came to be treated for the symptoms of radiculopathy 
of C 7 (3) and occipital headaches. Investigation which included the tests of hyper mobility of the upper 
cervical segments (1) and provocation tests of the artery vertebralis according to De Kleijn and Hautant 
(2) revealed the existence of further suffering - the instability in the upper cervical spine. Based on 
physical therapy evaluation and immobilization by the neurologist the following physical therapy 
techniques were applied: mobilization of median and ulnar nerve (5) and medical training to stabilize the 
cervical and thoracic spine (4). Results: After seven treatments the patient got a good feeling for the 
proper stabilization of the cervical spine in her activities of daily living. The tingling and pain, which 
guided her to the health care, reduced in the course of treatment. M. triceps reflex did not significantly 
change and the decreased muscle strength also only slightly improved. Conclusion: Since the cervical 
spine stabilization and the treatment of radiculopathy requires a long-term therapy and the present 
physiotherapeutic treatment resulted in a relatively rapid improvement of general good health (sleep, 
headaches) and consequently in the quality of life, the therapy is considered to be successful.  
 
Keywords: manual therapy, nerve mobilization, stabilization, cervical spine. 
 
Literatura/ References: 
1. Winkel D, Aufdemkampe G, Meijer OG, Opitz G (1993). Diagnostik und Therapie der Wirbelsäule, Gustav 
Fischer Verlag, 179–224. 
2. Brokmeier AA (2009). Kursbuch Manuelle Therapie: OMT - Orthopaedic Manipulative Therapy, Books on 
Demand; Auflage: 4, 230–3. 
3. Butler DS (1997). Mobilisation des Nervensystems, Springer, Berlin – Heidelberg, 235–56. 
4. Seidenspinner D (2005). Training in der Physiotherapie, Springer; Auflage: 2005.  
5. Shacklock M (2008). Angewandte Neurodynamik: Neuromuskuloskeletale Strukturen verstehen und behandeln, 
Urban & Fischer Verlag/Elsevier GmbH, 199–220.