Upper Cervical Instability (UCI)

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Management resources for clinicians

The downloadable resources and web links on this page have been provided to support clinicians in assessing and managing UCI in patients with symptomatic generalised hypermobility. The content is designed to supplement the following presentations at the Ignite 2023 Australian Physiotherapy Association Conference (Brisbane, October 5-7 2023) and is available for personal use. If you wish to reproduce or utilise any of the content for any other purpose, please contact us to discuss:

1. Upper cervical spine joint instability management (Symposium)

Convenor: Nicole Frost

Presenters: A/Prof Cliffton Chan & Sharon Hennessey

2. Upper cervical spine instability assessment and musculoskeletal care pathways

Presenter: Mark Comerford

Supported by Dr Lucy Thomas, Dr Julia Treleaven, and A/Prof Leslie Nicholson

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Journal Articles

Full text (open access) of Russek LN, Block NP, Byrne E, Chalela S, Chan C, Comerford M, Frost N, Hennessey S, McCarthy A, Nicholson LL, Parry J. Presentation and physical therapy management of upper cervical instability in patients with symptomatic generalized joint hypermobility: International expert consensus recommendations. Frontiers in Medicine. 2023 Jan 18;9:4020.

Full text of Nicholson LL, McKay MJ, Baldwin JN, Burns J, Cheung W, Yip S, Chan C. Is there a relationship between sagittal cervical spine mobility and generalised joint hypermobility? A cross-sectional study of 1000 healthy Australians. Physiotherapy. 2021 Sep 1;112:150-7.

Full text (open access) of Nicholson LL, Rao PJ, Lee M, Wong TM, Cheng RH, Chan C. Reference values of four measures of craniocervical stability using upright dynamic magnetic resonance imaging. La radiologia medica. 2023 Mar;128(3):330-9.

Assessment Tools

Download assessment & management resource pack here or individual components via links below

Diagnostic flowchart for UCI in generalised hypermobility (Russek et al (2023))

Assessing joint hypermobility

Symptoms suggestive of UCI in generalised hypermobility (Russek et al (2023))

Assessing and classifying irritability in UCI (Russek et al (2023))

Yellow & Red flags and Differential Diagnoses in UCI (Russek et al (2023))

Physical Examination of UCI (Russek et al (2023))

UCI Management

Physical Therapy Management of UCI according to irritability/severity (Russek et al (2023))

Technique Videos

Videos of assessment and management techniques for UCI by Mark Comerford

Movement control & Muscle Function

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Case Studies

Case studies illustrating management of mild to severe UCI are available in the supplemental data published with Russek et al 2023. Presentation and physical therapy management of upper cervical instability in patients with symptomatic generalized joint hypermobility: International expert consensus recommendations. Frontiers in Medicine. 2023 Jan 18;9:4020.

Conference Slides & Handouts

1. Symposium: Upper cervical spine joint instability management

Slides

2. How To Session: Upper cervical spine instability assessment and musculoskeletal care pathways

Further Learning

The Ehlers Danlos Society Project ECHO : A multidisciplary, online learning program provided by the Ehlers Danlos Society offering lecture and case-based learning in the multi-systemic manifestations of EDS and HSD. Subsidised by the EDS Society, this program is an excellent, low cost opportunity to expand your clinical knowledge and network with other professionals working with symptomatic hypermobility clients.

APA recent resources:

Hypermobility lecture series available as APA lectures on demand
InMotion article: Switching on the lightbulb to see hypermobility
InMotion article : Not a cervicogenic headache

Podcasts discussing the UCI management guidelines:

Bendy Bodies Podcast: Codifying upper cervical instability with Leslie Russek, DPT, PhD
Bendy Bodies Podcast: Cervical Instability: Thinking Beyond the Neck with Patty Stott, DPT

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