{"id":9491,"date":"2024-04-18T11:09:28","date_gmt":"2024-04-18T11:09:28","guid":{"rendered":"https:\/\/langs.physio-pedia.com\/the-upper-cervical-spine-and-cervicogenic-headaches-fr\/"},"modified":"2024-04-18T22:48:17","modified_gmt":"2024-04-18T22:48:17","slug":"the-upper-cervical-spine-and-cervicogenic-headaches-fr","status":"publish","type":"page","link":"https:\/\/langs.physio-pedia.com\/fr\/the-upper-cervical-spine-and-cervicogenic-headaches-fr\/","title":{"rendered":"Rachis cervical sup\u00e9rieur et c\u00e9phal\u00e9es cervicog\u00e8nes"},"content":{"rendered":"<div class=\"mw-parser-output\">\n<div class=\"editorbox\"><b>R\u00e9dactrice originale <\/b>&#8211;  <a title=\"User:Jess Bell\" href=\"\/User:Jess_Bell\">Jess Bell<\/a> <b>Principales collaboratrices<\/b>  &#8211;  <a class=\"mw-userlink\" title=\"User:Jess Bell\" href=\"\/User:Jess_Bell\"><bdi>Jess Bell<\/bdi><\/a>,  <a class=\"mw-userlink\" title=\"User:Kim Jackson\" href=\"\/User:Kim_Jackson\"><bdi>Kim Jackson<\/bdi><\/a>,  <a class=\"mw-userlink\" title=\"User:Tarina van der Stockt\" href=\"\/User:Tarina_van_der_Stockt\"><bdi>Tarina van der Stockt<\/bdi><\/a> et <a class=\"mw-userlink\" title=\"User:Lucinda hampton\" href=\"\/User:Lucinda_hampton\"><bdi>Lucinda Hampton<\/bdi><\/a><\/div>\n<div id=\"toc\" class=\"toc\" role=\"navigation\" aria-labelledby=\"mw-toc-heading\"><input id=\"toctogglecheckbox\" class=\"toctogglecheckbox\" style=\"display: none;\" role=\"button\" type=\"checkbox\"><\/p>\n<div class=\"toctitle\" dir=\"ltr\" lang=\"en\">\n<h2 id=\"mw-toc-heading\">Contenu<\/h2>\n<\/div>\n<ul>\n<li class=\"toclevel-1 tocsection-1\"><a href=\"#Introduction\"><span class=\"tocnumber\">1<\/span> <span class=\"toctext\">Introduction<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-2\"><a href=\"#Headache_Assessment\"><span class=\"tocnumber\">2<\/span> <span class=\"toctext\">\u00c9valuation des c\u00e9phal\u00e9es<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-3\"><a href=\"#Subjective_Assessment\"><span class=\"tocnumber\">2.1<\/span> <span class=\"toctext\">\u00c9valuation subjective<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-4\"><a href=\"#Objective_Assessment\"><span class=\"tocnumber\">2.2<\/span> <span class=\"toctext\">\u00c9valuation objective<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-5\"><a href=\"#Red_Flags\"><span class=\"tocnumber\">2.3<\/span> <span class=\"toctext\">Signaux d&rsquo;alerte (\u00ab\u00a0red flags\u00a0\u00bb)<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-6\"><a href=\"#Upper_Cervical_Ligament_Instability\"><span class=\"tocnumber\">2.3.1<\/span> <span class=\"toctext\">Instabilit\u00e9 ligamentaire cervicale sup\u00e9rieure<\/span><\/a>\n<ul>\n<li class=\"toclevel-4 tocsection-7\"><a href=\"#Transverse_Ligament\"><span class=\"tocnumber\">2.3.1.1<\/span> <span class=\"toctext\">Ligament transverse <\/span><\/a><\/li>\n<li class=\"toclevel-4 tocsection-8\"><a href=\"#Alar_Ligament\"><span class=\"tocnumber\">2.3.1.2<\/span> <span class=\"toctext\">Ligament alaire<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-2 tocsection-9\"><a href=\"#Range_of_Motion\"><span class=\"tocnumber\">2.4<\/span> <span class=\"toctext\">Mobilit\u00e9 articulaire<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-10\"><a href=\"#OA_Joint_(C0-1)\"><span class=\"tocnumber\">2.4.1<\/span> <span class=\"toctext\">Articulation atlanto-occipitale (AO, C0-1)<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-11\"><a href=\"#AA_Joint_(C1-2)\"><span class=\"tocnumber\">2.4.2<\/span> <span class=\"toctext\">Articulation atlanto-axo\u00efdienne (AA, C1-2)<\/span><\/a>\n<ul>\n<li class=\"toclevel-4 tocsection-12\"><a href=\"#Cervical_flexion_rotation_test\"><span class=\"tocnumber\">2.4.2.1<\/span> <span class=\"toctext\">Test de flexion-rotation cervicale<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-3 tocsection-13\"><a href=\"#Suboccipital_Muscles\"><span class=\"tocnumber\">2.4.3<\/span> <span class=\"toctext\">Muscles sous-occipitaux<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-14\"><a href=\"#Treatment\"><span class=\"tocnumber\">3<\/span> <span class=\"toctext\">Traitement<\/span><\/a>\n<ul>\n<li class=\"toclevel-2 tocsection-15\"><a href=\"#Specific_Mobilisation_Techniques\"><span class=\"tocnumber\">3.1<\/span> <span class=\"toctext\">Techniques de mobilisations sp\u00e9cifiques<\/span><\/a><\/li>\n<li class=\"toclevel-2 tocsection-16\"><a href=\"#Exercise_Therapy\"><span class=\"tocnumber\">3.2<\/span> <span class=\"toctext\">Exercices th\u00e9rapeutiques<\/span><\/a>\n<ul>\n<li class=\"toclevel-3 tocsection-17\"><a href=\"#AA_Self-SNAG\"><span class=\"tocnumber\">3.2.1<\/span> <span class=\"toctext\">Auto-SNAG \u00e0 l&rsquo;AA<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-18\"><a href=\"#Evidence\"><span class=\"tocnumber\">3.2.2<\/span> <span class=\"toctext\">\u00c9vidences scientifiques<\/span><\/a><\/li>\n<li class=\"toclevel-3 tocsection-19\"><a href=\"#Deep_Neck_Flexor_Training\"><span class=\"tocnumber\">3.2.3<\/span> <span class=\"toctext\">Entra\u00eenement des fl\u00e9chisseurs profonds du cou<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-2 tocsection-20\"><a href=\"#Soft_Tissue_Techniques\"><span class=\"tocnumber\">3.3<\/span> <span class=\"toctext\">Techniques de traitement des tissus mous<\/span><\/a><\/li>\n<\/ul>\n<\/li>\n<li class=\"toclevel-1 tocsection-21\"><a href=\"#Summary\"><span class=\"tocnumber\">4<\/span> <span class=\"toctext\">R\u00e9sum\u00e9<\/span><\/a><\/li>\n<li class=\"toclevel-1 tocsection-22\"><a href=\"#References\"><span class=\"tocnumber\">5<\/span> <span class=\"toctext\">R\u00e9f\u00e9rences<\/span><\/a><\/li>\n<\/ul>\n<\/div>\n<h2><span id=\"Introduction\" class=\"mw-headline\">Introduction<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Introduction\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=1\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Introduction\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=1\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Muscles_of_the_cervical_region_multifidus_intermediate_layer_Primal.png\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/3\/3f\/Muscles_of_the_cervical_region_multifidus_intermediate_layer_Primal.png\/300px-Muscles_of_the_cervical_region_multifidus_intermediate_layer_Primal.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/3\/3f\/Muscles_of_the_cervical_region_multifidus_intermediate_layer_Primal.png\/450px-Muscles_of_the_cervical_region_multifidus_intermediate_layer_Primal.png 1.5x, https:\/\/www.physio-pedia.com\/images\/thumb\/3\/3f\/Muscles_of_the_cervical_region_multifidus_intermediate_layer_Primal.png\/600px-Muscles_of_the_cervical_region_multifidus_intermediate_layer_Primal.png 2x\" alt=\"\" width=\"300\" height=\"300\" data-file-width=\"660\" data-file-height=\"660\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Figure 1. Muscles de la r\u00e9gion cervicale.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>La <a title=\"Introduction \u00e0 la c\u00e9phal\u00e9e cervicog\u00e8ne\" href=\"\/Introduction_to_Cervicogenic_Headaches\">c\u00e9phal\u00e9e cervicog\u00e8ne<\/a> (CGH) est une c\u00e9phal\u00e9e secondaire chronique dont l&rsquo;origine provient du rachis cervical. <sup id=\"cite_ref-1\" class=\"reference\"><a href=\"#cite_note-1\">(1)<\/a><\/sup> La c\u00e9phal\u00e9e commence dans la r\u00e9gion cervicale ou occipitale et peut s&rsquo;\u00e9tendre au visage et \u00e0 la t\u00eate. Les sources sp\u00e9cifiques de la c\u00e9phal\u00e9e cervicog\u00e8ne sont toutes les structures innerv\u00e9es par les racines nerveuses C1 \u00e0 C3.<sup id=\"cite_ref-2\" class=\"reference\"><a href=\"#cite_note-2\">(2)<\/a><\/sup><\/p>\n<p>Lors de l&rsquo;\u00e9valuation et du traitement des patients atteints de c\u00e9phal\u00e9e cervicog\u00e8ne, il est important de pouvoir identifier clairement la zone symptomatique du rachis cervical sup\u00e9rieur. Les zones \u00e0 \u00e9valuer sont les suivantes : <sup id=\"cite_ref-:0_3-0\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<ul>\n<li><a title=\"Atlanto-occipital joint\" href=\"\/Atlanto-occipital_joint\">l&rsquo;articulation atlanto-occipitale<\/a> (C0-1);<\/li>\n<li><a title=\"Atlanto-axial joint\" href=\"\/Atlanto-axial_joint\">l&rsquo;articulation atlanto-axo\u00efdienne <\/a> (AA, C1-2);<\/li>\n<li>l&rsquo;articulation C2-3;<\/li>\n<li><a title=\"Rectus Capitis Posterior Major\" href=\"\/Rectus_Capitis_Posterior_Major\">les muscles sous-occipitaux.<\/a><\/li>\n<\/ul>\n<h2><span id=\"Headache_Assessment\" class=\"mw-headline\">\u00c9valuation des c\u00e9phal\u00e9es <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Headache Assessment\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=2\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Headache Assessment\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=2\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<h3><span id=\"Subjective_Assessment\" class=\"mw-headline\">\u00c9valuation subjective <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Subjective Assessment\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=3\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Subjective Assessment\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=3\">\u00e9diter la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>L&rsquo;\u00e9valuation subjective du rachis cervical est abord\u00e9e <a title=\"Cervical Examination\" href=\"\/Cervical_Examination\">ici<\/a>, mais lorsqu&rsquo;un patient rapporte des c\u00e9phal\u00e9es, il est important de l&rsquo;interroger sp\u00e9cifiquement sur les aspects suivants : <sup id=\"cite_ref-:0_3-1\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<ul>\n<li>l&rsquo;intensit\u00e9 des c\u00e9phal\u00e9es;<\/li>\n<li>la fr\u00e9quence des c\u00e9phal\u00e9es;<\/li>\n<li>la dur\u00e9e des c\u00e9phal\u00e9es.<\/li>\n<\/ul>\n<h3><span id=\"Objective_Assessment\" class=\"mw-headline\">\u00c9valuation objective <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Objective Assessment\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=4\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Objective Assessment\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=4\">\u00e9diter la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Une description compl\u00e8te de l&rsquo;\u00e9valuation cervicale est disponible <a title=\"Cervical Examination\" href=\"\/Cervical_Examination\">ici<\/a>. Mais lors de l&rsquo;\u00e9valuation de la c\u00e9phal\u00e9e cervicog\u00e8ne, les mesures suivantes devraient \u00eatre incluses : <sup id=\"cite_ref-:0_3-2\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3) <\/a><\/sup><\/p>\n<ul>\n<li>\u00e9valuation de l&rsquo;amplitude des mouvements;<\/li>\n<li>\u00e9valuation de l&rsquo;endurance des fl\u00e9chisseurs profonds du cou;<\/li>\n<li>palpation et \u00e9valuation de la mobilit\u00e9 articulaire.<\/li>\n<\/ul>\n<p>Les m\u00e9thodes cliniques courantes d&rsquo;\u00e9valuation de la mobilit\u00e9 du rachis cervical sont les suivantes : <sup id=\"cite_ref-:7_4-0\" class=\"reference\"><a href=\"#cite_note-:7-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li><a title=\"Cervical Flexion-Rotation Test\" href=\"\/Cervical_Flexion-Rotation_Test\">test de flexion-rotation cervicale;<\/a><\/li>\n<li>amplitude des mouvements actifs cervicaux;<\/li>\n<li><a title=\"Cervical Examination\" href=\"\/Cervical_Examination\">mouvements intervert\u00e9braux accessoires passifs et mouvements intervert\u00e9braux physiologiques;<\/a><\/li>\n<li>test de flexion cervicale actives;<\/li>\n<li>\u00e9valuation des points g\u00e2chettes myofasciaux;<\/li>\n<li><a title=\"Sensorimotor Impairment in Neck Pain\" href=\"\/Sensorimotor_Impairment_in_Neck_Pain\">\u00e9valuation de la proprioception<\/a> cervicale.<\/li>\n<\/ul>\n<h3><span id=\"Red_Flags\" class=\"mw-headline\">Signaux d&rsquo;alerte (\u00ab\u00a0red flags\u00a0\u00bb) <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Red Flags\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=5\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Red Flags\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=5\">\u00e9diter la source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Il est essentiel de d\u00e9pister les <a title=\"The Flag System\" href=\"\/The_Flag_System\">signaux d&rsquo;alerte<\/a> et les affections graves lors de toute \u00e9valuation du rachis cervical. Pour plus d&rsquo;informations sur les signaux d&rsquo;alerte des affections rachidiennes, veuillez consulter cette page : <a title=\"Une introduction aux drapeaux rouges pour les pathologies graves\" href=\"\/An_Introduction_to_Red_Flags_in_Serious_Pathology\">Introduction aux signaux d&rsquo;alerte des pathologies graves<\/a> et <a title=\"Tumeurs malignes au niveau de la colonne vert\u00e9brale\" href=\"\/Spinal_Malignancy\">Tumeurs malignes du rachis<\/a>.<\/p>\n<p>Les signaux d&rsquo;alerte sp\u00e9cifiques aux c\u00e9phal\u00e9es sont les suivants : <sup id=\"cite_ref-5\" class=\"reference\"><a href=\"#cite_note-5\">(5)<\/a><\/sup><\/p>\n<ul>\n<li>apparition soudaine d&rsquo;une nouvelle c\u00e9phal\u00e9e s\u00e9v\u00e8re;<\/li>\n<li>aggravation d&rsquo;une c\u00e9phal\u00e9e pr\u00e9existante en l&rsquo;absence de tout facteur pr\u00e9disposant \u00e9vident;<\/li>\n<li>c\u00e9phal\u00e9e associ\u00e9e \u00e0 de la fi\u00e8vre, \u00e0 une raideur de la nuque, \u00e0 une \u00e9ruption cutan\u00e9e et \u00e0 des ant\u00e9c\u00e9dents de cancer, de VIH ou d&rsquo;autres maladies syst\u00e9miques;<\/li>\n<li>c\u00e9phal\u00e9e associ\u00e9e \u00e0 des signes neurologiques focaux autres qu&rsquo;une <a title=\"Headaches and Dizziness\" href=\"\/Headaches_and_Dizziness\">aura<\/a> typique;<\/li>\n<li>c\u00e9phal\u00e9e mod\u00e9r\u00e9e ou s\u00e9v\u00e8re d\u00e9clench\u00e9e par la toux, l&rsquo;effort ou le fait de se pencher;<\/li>\n<li>apparition d&rsquo;une nouvelle c\u00e9phal\u00e9e pendant ou suivant la grossesse.<\/li>\n<\/ul>\n<p>Les affections graves comprennent :<\/p>\n<ul>\n<li><a title=\"Vascular Pathologies of the Neck\" href=\"\/Vascular_Pathologies_of_the_Neck\">dysfonctionnement de l&rsquo;art\u00e8re cervicale :<\/a>\n<ul>\n<li>art\u00e8re cervicale;<\/li>\n<li>art\u00e8re carotide.<\/li>\n<li>Pour plus d&rsquo;informations sur les risques li\u00e9s \u00e0 l&rsquo;\u00e9valuation cervicale, veuillez consulter le <a title=\"International Framework for Examination of the Cervical Region\" href=\"\/International_Framework_for_Examination_of_the_Cervical_Region\">Guide international pour l\u2019examen de la r\u00e9gion cervicale.<\/a><\/li>\n<\/ul>\n<\/li>\n<li>probl\u00e8me intracr\u00e2nien<\/li>\n<li><a title=\"Cervical Instability\" href=\"\/Cervical_Instability\">instabilit\u00e9 ligamentaire cervicale sup\u00e9rieure<\/a> (voir ci-dessous) :\n<ul>\n<li><a title=\"Transverse Ligament of the Atlas\" href=\"\/Transverse_Ligament_of_the_Atlas\">ligament transverse;<\/a><\/li>\n<li><a title=\"Alar ligaments\" href=\"\/Alar_ligaments\">ligament alaire.<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h4><span id=\"Upper_Cervical_Ligament_Instability\" class=\"mw-headline\">Instabilit\u00e9 ligamentaire cervicale sup\u00e9rieure <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Upper Cervical Ligament Instability\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=6\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Upper Cervical Ligament Instability\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=6\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<div class=\"thumb tright\">\n<div class=\"thumbinner\" style=\"width: 302px;\"><a class=\"image\" href=\"\/File:Upper_cervical_ligaments.png\"><img loading=\"lazy\" decoding=\"async\" class=\"thumbimage\" src=\"https:\/\/www.physio-pedia.com\/images\/thumb\/3\/3e\/Upper_cervical_ligaments.png\/300px-Upper_cervical_ligaments.png\" srcset=\"https:\/\/www.physio-pedia.com\/images\/thumb\/3\/3e\/Upper_cervical_ligaments.png\/450px-Upper_cervical_ligaments.png 1.5x, https:\/\/www.physio-pedia.com\/images\/3\/3e\/Upper_cervical_ligaments.png 2x\" alt=\"\" width=\"300\" height=\"291\" data-file-width=\"500\" data-file-height=\"485\"><\/a><\/p>\n<div class=\"thumbcaption\">\n<div class=\"magnify\"><\/div>\n<p>Figure 2. Ligaments du rachis cervical.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<p>L&rsquo;instabilit\u00e9 ligamentaire cervicale sup\u00e9rieure a un taux de pr\u00e9valence de 0,6 %<sup id=\"cite_ref-:1_6-0\" class=\"reference\"><a href=\"#cite_note-:1-6\">(6)<\/a><\/sup>, mais elle est plus fr\u00e9quente chez les patients souffrant d&rsquo;arthrite inflammatoire (par exemple la <a title=\"Rheumatoid Arthritis\" href=\"\/Rheumatoid_Arthritis\">polyarthrite rhumato\u00efde<\/a>). <sup id=\"cite_ref-7\" class=\"reference\"><a href=\"#cite_note-7\">(7)<\/a><\/sup> <sup id=\"cite_ref-8\" class=\"reference\"><a href=\"#cite_note-8\">(8)<\/a><\/sup> Malgr\u00e9 les faibles taux de pr\u00e9valence dans la population g\u00e9n\u00e9rale, il est important de d\u00e9pister ces affections.<\/p>\n<h5><span id=\"Transverse_Ligament\" class=\"mw-headline\">Ligament transverse <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Transverse Ligament\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=7\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Transverse Ligament\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=7\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<p>Le ligament transverse permet \u00e0 l&rsquo;atlas de pivoter sur son axe. Il maintient l&rsquo;atlas dans sa position correcte afin d&rsquo;\u00e9viter la compression de la moelle \u00e9pini\u00e8re lors de la flexion cervicale et de la t\u00eate.<sup id=\"cite_ref-9\" class=\"reference\"><a href=\"#cite_note-9\">(9)<\/a><\/sup><\/p>\n<p>Le test de Sharp Purser est couramment utilis\u00e9 en pratique clinique pour \u00e9valuer l&rsquo;instabilit\u00e9 atlanto-axiale, en particulier chez les patients atteints de polyarthrite rhumato\u00efde.<sup id=\"cite_ref-:2_10-0\" class=\"reference\"><a href=\"#cite_note-:2-10\">(10)<\/a><\/sup> Ce test est abord\u00e9 plus en d\u00e9tail <a title=\"Sharp Purser Test\" href=\"\/Sharp_Purser_Test\">ici<\/a>.<\/p>\n<p>Veuillez regarder cette vid\u00e9o pour une d\u00e9monstration du test Sharp Purser (en anglais original).<\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 648px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 640px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/eqS2tIGauXU?\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-11\" class=\"reference\"><a href=\"#cite_note-11\">(11)<\/a><\/sup><\/p>\n<p>L&rsquo;utilisation de ce test est toutefois consid\u00e9r\u00e9e comme controvers\u00e9e en raison de son potentiel de dangerosit\u00e9 (c&rsquo;est-\u00e0-dire qu&rsquo;un test positif implique la compression de la moelle \u00e9pini\u00e8re par l&rsquo;odonto\u00efde de C2 et l&rsquo;ex\u00e9cution d&rsquo;une man\u0153uvre pour diminuer la pression sur la moelle \u00e9pini\u00e8re. Cette man\u0153uvre pourrait \u00eatre risqu\u00e9e dans les populations \u00e0 haut risque).<sup id=\"cite_ref-:2_10-1\" class=\"reference\"><a href=\"#cite_note-:2-10\">(10)<\/a><\/sup> Bien qu&rsquo;il n&rsquo;y ait actuellement aucune preuve de la dangerosit\u00e9 de ce test, il y a un manque de preuves quant \u00e0 son utilisation dans les populations \u00e0 haut risque. Il pr\u00e9sente \u00e9galement une validit\u00e9 variable et une faible fiabilit\u00e9 entre \u00e9valuateurs.<sup id=\"cite_ref-:2_10-2\" class=\"reference\"><a href=\"#cite_note-:2-10\">(10)<\/a><\/sup><\/p>\n<p>D&rsquo;autres tests incluent le <a title=\"Transverse Ligament Stress Test\" href=\"\/Transverse_Ligament_Stress_Test\">test du ligament transverse<\/a>. Ce test a une sp\u00e9cificit\u00e9 suffisamment \u00e9lev\u00e9e pour exclure les patients pr\u00e9sentant une instabilit\u00e9 du rachis cervical sup\u00e9rieur. Cependant, lorsque Hutting et ses coll\u00e8gues ont examin\u00e9 une s\u00e9rie de tests d&rsquo;instabilit\u00e9, ils ont conclu qu&rsquo;il n&rsquo;\u00e9tait pas possible \u00e0 l&rsquo;heure actuelle de d\u00e9pister avec pr\u00e9cision l&rsquo;instabilit\u00e9 cervicale sup\u00e9rieure.<sup id=\"cite_ref-:1_6-1\" class=\"reference\"><a href=\"#cite_note-:1-6\">(6)<\/a><\/sup><\/p>\n<h5><span id=\"Alar_Ligament\" class=\"mw-headline\">Ligament alaire <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Alar Ligament\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=8\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Alar Ligament\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=8\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<p>Les ligaments alaires servent \u00e0 stabiliser le rachis cervical mais peuvent \u00eatre endommag\u00e9s \u00e0 la suite d&rsquo;un traumatisme. Il est important de les \u00e9valuer, en particulier chez les patients qui pr\u00e9sentent un dysfonctionnement cervical \u00e0 la suite d&rsquo;une blessure. <sup id=\"cite_ref-:3_12-0\" class=\"reference\"><a href=\"#cite_note-:3-12\">(12)<\/a><\/sup> L&rsquo;examen de r\u00e9f\u00e9rence (\u00ab\u00a0gold standard\u00a0\u00bb) est l&rsquo;IRM, mais lorsque celle-ci n&rsquo;est pas disponible, il existe un certain nombre de tests cliniques qui peuvent \u00eatre utilis\u00e9s, notamment :<sup id=\"cite_ref-:3_12-1\" class=\"reference\"><a href=\"#cite_note-:3-12\">(12)<\/a><\/sup><\/p>\n<ul>\n<li><a title=\"Alar Ligament Test\" href=\"\/Alar_Ligament_Test\">test de la mise en tension en flexion lat\u00e9rale;<\/a><\/li>\n<li>test de la mise en tension en rotation;<\/li>\n<li>test de cisaillement lat\u00e9ral.<\/li>\n<\/ul>\n<p>Une \u00e9tude r\u00e9cente a montr\u00e9 que la sensibilit\u00e9 et la sp\u00e9cificit\u00e9 de ces tests variaient de 80 \u00e0 85,7 % et de 69,2 \u00e0 90,9 %, respectivement. Les rapports de vraisemblance positifs et n\u00e9gatifs varient respectivement de 2,6 \u00e0 9,41 et de 0,15 \u00e0 0,26. Ces chiffres indiquent que ces tests n&rsquo;ont qu&rsquo;une valeur diagnostique clinique faible \u00e0 mod\u00e9r\u00e9e. Toutefois, lorsqu&rsquo;ils sont utilis\u00e9s en tant qu&rsquo;un ensemble de tests, la sensibilit\u00e9 et la sp\u00e9cificit\u00e9 atteignent respectivement 85,7 % et 100 % si plus de deux tests sont positifs. Les rapports de vraisemblance sont pass\u00e9s \u00e0 l&rsquo;infini (rapport de vraisemblance positif) et \u00e0 0,15 (rapport de vraisemblance n\u00e9gatif). Ces ratios indiquent que cet ensemblesde tests a une valeur diagnostique clinique mod\u00e9r\u00e9e \u00e0 excellente.<sup id=\"cite_ref-:3_12-2\" class=\"reference\"><a href=\"#cite_note-:3-12\">(12)<\/a><\/sup><\/p>\n<h3><span id=\"Range_of_Motion\" class=\"mw-headline\">Mobilit\u00e9 articulaire <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Range of Motion\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=9\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Range of Motion\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=9\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>L&rsquo;amplitude des mouvements cervicaux fait g\u00e9n\u00e9ralement partie de l&rsquo;\u00e9valuation du rachis cervical. Bien qu&rsquo;il ait \u00e9t\u00e9 constat\u00e9 que son inclusion est d&rsquo;une certaine valeur, les conclusions cliniques ne doivent pas \u00eatre tir\u00e9es sur la base de l&rsquo;amplitude des mouvements uniquement.<sup id=\"cite_ref-13\" class=\"reference\"><a href=\"#cite_note-13\">(13)<\/a><\/sup><\/p>\n<h4><span id=\"OA_Joint_.28C0-1.29\"><\/span><span id=\"OA_Joint_(C0-1)\" class=\"mw-headline\">Articulation atlanto-occipitale (AO, C0-1) <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: OA Joint (C0-1)\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=10\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: OA Joint (C0-1)\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=10\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Cette articulation peut \u00eatre \u00e9valu\u00e9e \u00e0 l&rsquo;aide d&rsquo;un simple test de hochement, qui l&rsquo;isole efficacement.<sup id=\"cite_ref-:0_3-3\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<h4><span id=\"AA_Joint_.28C1-2.29\"><\/span><span id=\"AA_Joint_(C1-2)\" class=\"mw-headline\">Articulation atlanto-axo\u00efdienne (AA, C1-2) <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: AA Joint (C1-2)\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=11\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: AA Joint (C1-2)\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=11\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Les patients souffrant de c\u00e9phal\u00e9es cervicog\u00e8nes sont plus susceptibles de pr\u00e9senter un dysfonctionnement au niveau de l&rsquo;articulation AA. On a constat\u00e9 que ce segment \u00e9tait symptomatique chez 63 \u00e0 70 % des patients souffrant de cette affection. <sup id=\"cite_ref-:4_14-0\" class=\"reference\"><a href=\"#cite_note-:4-14\">(14)<\/a><\/sup> Il est donc essentiel que le clinicien soit en mesure d&rsquo;identifier les dysfonctionnements au niveau de cette articulation. <sup id=\"cite_ref-:0_3-4\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<h5><span id=\"Cervical_flexion_rotation_test\" class=\"mw-headline\">Test de flexion-rotation cervicale <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Cervical flexion rotation test\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=12\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Cervical flexion rotation test\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=12\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h5>\n<p>Le test de flexion-rotation cervicale s&rsquo;est av\u00e9r\u00e9 le plus fiable et le plus pr\u00e9cis pour le diagnostic des c\u00e9phal\u00e9es cervicog\u00e8nes. <sup id=\"cite_ref-:4_14-1\" class=\"reference\"><a href=\"#cite_note-:4-14\">(14)<\/a><\/sup> Sa sensibilit\u00e9 est de 91 % et sa sp\u00e9cificit\u00e9 de 90 %. Sa validit\u00e9 diagnostique globale est de 91 %.<sup id=\"cite_ref-15\" class=\"reference\"><a href=\"#cite_note-15\">(15)<\/a><\/sup><\/p>\n<p>Un r\u00e9sultat normal est une rotation de 40 degr\u00e9s ou plus. Moins de 32 degr\u00e9s constitue une mesure anormale. Ce r\u00e9sultat indiquerait un dysfonctionnement de l&rsquo;articulation AA (C1-2).<sup id=\"cite_ref-:0_3-5\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<p>NB : ce test est influenc\u00e9 par le degr\u00e9 de flexion dans lequel le clinicien place la t\u00eate et le cou du patient. Si la t\u00eate et le cou ne sont pas compl\u00e8tement fl\u00e9chis, l&rsquo;articulation AA ne sera pas isol\u00e9e. Cela peut entra\u00eener des r\u00e9sultats faussement n\u00e9gatifs. Ce test peut donc \u00eatre influenc\u00e9 par le niveau de douleur du patient et sa capacit\u00e9 \u00e0 tol\u00e9rer une flexion cervicale compl\u00e8te.<sup id=\"cite_ref-:0_3-6\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<p>Veuillez regarder la vid\u00e9o suivante pour un r\u00e9sum\u00e9 et une d\u00e9monstration du test de flexion-rotation cervicale (en anglais original).<\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 648px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 640px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/4NIshu8tGA4?\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-16\" class=\"reference\"><a href=\"#cite_note-16\">(16)<\/a><\/sup><\/p>\n<h4><span id=\"Suboccipital_Muscles\" class=\"mw-headline\">Muscles sous-occipitaux <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Suboccipital Muscles\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=13\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Suboccipital Muscles\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=13\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Le dysfonctionnement de ces muscles peut \u00eatre identifi\u00e9 par palpation.<sup id=\"cite_ref-:0_3-7\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<h2><span id=\"Treatment\" class=\"mw-headline\">Traitement<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Treatment\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=14\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Treatment\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=14\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<p>La c\u00e9phal\u00e9e cervicog\u00e8ne \u00e9tant associ\u00e9e \u00e0 un dysfonctionnement musculosquelettique et \u00e0 un d\u00e9s\u00e9quilibre musculaire, il est n\u00e9cessaire d&rsquo;adopter une approche de prise en charge multimodale ax\u00e9e sur les d\u00e9ficiences sp\u00e9cifiques du patient.<sup id=\"cite_ref-:6_17-0\" class=\"reference\"><a href=\"#cite_note-:6-17\">(17)<\/a><\/sup><\/p>\n<p>Les traitements pour les segments cervicaux sup\u00e9rieurs comprennent :<\/p>\n<ul>\n<li>mobilisations ou manipulations du rachis cervical; <sup id=\"cite_ref-:6_17-1\" class=\"reference\"><a href=\"#cite_note-:6-17\">(17) <\/a><\/sup><sup id=\"cite_ref-:5_18-0\" class=\"reference\"><a href=\"#cite_note-:5-18\">(18)<\/a><\/sup><\/li>\n<li>exercices de renforcement; <sup id=\"cite_ref-:6_17-2\" class=\"reference\"><a href=\"#cite_note-:6-17\">(17) <\/a><\/sup><sup id=\"cite_ref-:8_19-0\" class=\"reference\"><a href=\"#cite_note-:8-19\">(19)<\/a><\/sup><\/li>\n<li>techniques de traitement des tissus mous. <sup id=\"cite_ref-:0_3-8\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3) <\/a><\/sup><sup id=\"cite_ref-:6_17-3\" class=\"reference\"><a href=\"#cite_note-:6-17\">(17) <\/a><\/sup><sup id=\"cite_ref-:9_20-0\" class=\"reference\"><a href=\"#cite_note-:9-20\">(20)<\/a><\/sup><\/li>\n<\/ul>\n<h3><span id=\"Specific_Mobilisation_Techniques\" class=\"mw-headline\">Techniques de mobilisations sp\u00e9cifiques <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Specific Mobilisation Techniques\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=15\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Specific Mobilisation Techniques\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=15\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<ul>\n<li>Mobilisations post\u00e9ro-ant\u00e9rieures de l&rsquo;articulation AA et de C2-3 : <sup id=\"cite_ref-:0_3-9\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup>\n<ul>\n<li>palper l&rsquo;apophyse \u00e9pineuse C2 (c&rsquo;est-\u00e0-dire la premi\u00e8re apophyse \u00e9pineuse que l&rsquo;on peut sentir apr\u00e8s l&rsquo;occiput);<\/li>\n<li>se d\u00e9placer l\u00e9g\u00e8rement lat\u00e9ralement;<\/li>\n<li>appliquer une petite force oscillatoire sur le pilier articulaire.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>Afin de mobiliser pr\u00e9f\u00e9rentiellement l&rsquo;articulation AA par rapport \u00e0 C2-3, il faut tourner l\u00e9g\u00e8rement la t\u00eate du patient (environ 20 \u00e0 30 degr\u00e9s). Cela permettra de mettre de la tension dans l&rsquo;articulation AA.<sup id=\"cite_ref-:0_3-10\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<p>Si la t\u00eate reste droite, l&rsquo;articulation C2-3 sera pr\u00e9f\u00e9rentiellement mobilis\u00e9e.<\/p>\n<p>Pour cibler l&rsquo;articulation AO : <sup id=\"cite_ref-:0_3-11\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<ul>\n<li>trouver l&rsquo;apophyse \u00e9pineuse de C2 et se d\u00e9placer cr\u00e2niallement, c&rsquo;est l\u00e0 que se trouve C1 (c&rsquo;est-\u00e0-dire l&rsquo;atlas);<\/li>\n<li>une mobilisation post\u00e9ro-ant\u00e9rieure sur C1 peut \u00eatre effectu\u00e9e pour recr\u00e9er et traiter les c\u00e9phal\u00e9es<\/li>\n<\/ul>\n<h3><span id=\"Exercise_Therapy\" class=\"mw-headline\">Exercices th\u00e9rapeutiques <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Exercise Therapy\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=16\">\u00e9diter<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Exercise Therapy\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=16\">source d&rsquo;\u00e9dition<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Il est important de prescrire des exercices qui renforceront les techniques manuelles.<sup id=\"cite_ref-:0_3-12\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<h4><span id=\"AA_Self-SNAG\" class=\"mw-headline\">Auto-SNAG \u00e0 l&rsquo;AA <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: AA Self-SNAG\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=17\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: AA Self-SNAG\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=17\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Placer une serviette ou un objet similaire au niveau de l&rsquo;atlas pour mobiliser l&rsquo;articulation AA (ou l\u00e9g\u00e8rement plus bas pour C2-3). Utiliser la serviette pour guider le cou dans la rotation.<sup id=\"cite_ref-:0_3-13\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<p>NB : la pression exerc\u00e9e par la serviette ne doit pas \u00eatre trop forte. Au contraire, la serviette doit simplement faciliter le mouvement. Il est important de pratiquer d&rsquo;abord les techniques dans la clinique pour s&rsquo;assurer que le patient comprend comment faire cet \u00e9tirement correctement.<sup id=\"cite_ref-:0_3-14\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/p>\n<p>La vid\u00e9o suivante montre comment la technique d&rsquo;auto-SNAG (glissements naturels apophysaires soutenus) pour l&rsquo;articulation AA est r\u00e9alis\u00e9e (en anglais original).<\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 648px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 640px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/NPl3u2-dixE?\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-21\" class=\"reference\"><a href=\"#cite_note-21\">(21)<\/a><\/sup><\/p>\n<h4><span id=\"Evidence\" class=\"mw-headline\">\u00c9vidences scientifiques<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Evidence\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=18\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Evidence\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=18\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>Il a \u00e9t\u00e9 d\u00e9montr\u00e9 que les SNAG de l&rsquo;articulation AA am\u00e9liorent la flexion-rotation cervicale. <sup id=\"cite_ref-:7_4-1\" class=\"reference\"><a href=\"#cite_note-:7-4\">(4) <\/a><\/sup><sup id=\"cite_ref-22\" class=\"reference\"><a href=\"#cite_note-22\">(22)<\/a><\/sup> Une \u00e9tude r\u00e9cente men\u00e9e par Mohamed et ses coll\u00e8gues a montr\u00e9 que lorsque la mobilisation SNAG pour l&rsquo;articulation AA \u00e9tait utilis\u00e9e en combinaison avec une mobilisation SNAG pour c\u00e9phal\u00e9e, il y avait une r\u00e9duction encore plus importante des sympt\u00f4mes de c\u00e9phal\u00e9es et d&rsquo;\u00e9tourdissements. <sup id=\"cite_ref-:7_4-2\" class=\"reference\"><a href=\"#cite_note-:7-4\">(4)<\/a><\/sup><\/p>\n<ul>\n<li>SNAG pour c\u00e9phal\u00e9e = glissement ant\u00e9rieur sur C2 alors que le patient est assis sur une chaise.<\/li>\n<\/ul>\n<p>Les patients qui ont pratiqu\u00e9 l&rsquo;auto-SNAG d\u00e9crite ci-dessus deux fois par jour pendant 12 mois ont obtenu une r\u00e9duction de 54 % des scores de l&rsquo;indice des c\u00e9phal\u00e9es \u00e0 12 mois, contre une r\u00e9duction de 13 % dans le groupe t\u00e9moin.<sup id=\"cite_ref-:5_18-1\" class=\"reference\"><a href=\"#cite_note-:5-18\">(18)<\/a><\/sup><\/p>\n<h4><span id=\"Deep_Neck_Flexor_Training\" class=\"mw-headline\">Entra\u00eenement des fl\u00e9chisseurs profonds du cou <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Deep Neck Flexor Training\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=19\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Deep Neck Flexor Training\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=19\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h4>\n<p>L&rsquo;entra\u00eenement des fl\u00e9chisseurs profonds cervicaux peut \u00e9galement contribuer \u00e0 consolider les am\u00e9liorations, en particulier au niveau de l&rsquo;articulation AO. Jull et ses coll\u00e8gues ont constat\u00e9 que six semaines d&rsquo;exercices de flexion cr\u00e2niocervicale \u00e9taient aussi efficaces que la manipulation vert\u00e9brale pour r\u00e9duire la douleur cervicale ainsi que la fr\u00e9quence et l&rsquo;intensit\u00e9 des c\u00e9phal\u00e9es pendant une p\u00e9riode pouvant aller jusqu&rsquo;\u00e0 un an.<sup id=\"cite_ref-:8_19-1\" class=\"reference\"><a href=\"#cite_note-:8-19\">(19)<\/a><\/sup> Ce programme d&rsquo;exercices est pr\u00e9sent\u00e9 plus en d\u00e9tail <a title=\"C\u00e9phal\u00e9e cervicog\u00e8ne\" href=\"\/Cervicogenic_Headache\">ici<\/a>.<\/p>\n<p>Veuillez regarder cette vid\u00e9o pour une d\u00e9monstration de l&rsquo;ex\u00e9cution de ces exercices (en anglais original).<\/p>\n<div class=\"thumb embedvideo autoResize\" style=\"width: 648px;\">\n<div class=\"embedvideo autoResize\">\n<div class=\"embedvideowrap\" style=\"width: 640px;\"><iframe loading=\"lazy\" title=\"Play video\" src=\"\/\/www.youtube.com\/embed\/okmuO_6TT0s?\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<p><sup id=\"cite_ref-23\" class=\"reference\"><a href=\"#cite_note-23\">(23)<\/a><\/sup><\/p>\n<h3><span id=\"Soft_Tissue_Techniques\" class=\"mw-headline\">Techniques de traitement des tissus mous <\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span> <a class=\"mw-editsection-visualeditor\" title=\"Edit section: Soft Tissue Techniques\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=20\">edit<\/a> <span class=\"mw-editsection-divider\"> | <\/span> <a title=\"Edit section: Soft Tissue Techniques\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=20\">edit source<\/a> <span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h3>\n<p>Il existe une vari\u00e9t\u00e9 de techniques de traitement des tissus mous qui peuvent \u00eatre utiles en cas de dysfonctionnement des muscles sous-occipitaux :<\/p>\n<ul>\n<li>techniques d&rsquo;\u00e9nergie musculaire; <sup id=\"cite_ref-:0_3-15\" class=\"reference\"><a href=\"#cite_note-:0-3\">(3)<\/a><\/sup><\/li>\n<li><a title=\"Instrument Assisted Soft Tissue Mobilization\" href=\"\/Instrument_Assisted_Soft_Tissue_Mobilization\">mobilisation des tissus mous assist\u00e9e par instrument; <\/a><sup id=\"cite_ref-:6_17-4\" class=\"reference\"><a href=\"#cite_note-:6-17\">(17)<\/a><\/sup><\/li>\n<li>\u00e9tirement musculaire; <sup id=\"cite_ref-:6_17-5\" class=\"reference\"><a href=\"#cite_note-:6-17\">(17)<\/a><\/sup><\/li>\n<li><sup id=\"cite_ref-:9_20-1\" class=\"reference\">traitement des points g\u00e2chettes.<a href=\"#cite_note-:9-20\">(20)<\/a><\/sup><\/li>\n<\/ul>\n<h2><span id=\"Summary\" class=\"mw-headline\">R\u00e9sum\u00e9<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: Summary\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=21\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: Summary\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=21\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<ul>\n<li>La c\u00e9phal\u00e9e cervicog\u00e8ne a son origine dans la r\u00e9gion cervicale ou occipitale. Les sources sp\u00e9cifiques de la c\u00e9phal\u00e9e cervicog\u00e8ne sont toutes les structures innerv\u00e9es par les racines nerveuses C1 \u00e0 C3.<\/li>\n<li>Le physioth\u00e9rapeute doit proc\u00e9der \u00e0 une \u00e9valuation subjective et objective d\u00e9taill\u00e9e, en recherchant notamment les signaux d&rsquo;alerte.<\/li>\n<li>L&rsquo;\u00e9valuation objective doit mettre en \u00e9vidence la ou les r\u00e9gions(s) qui cause(nt) la c\u00e9phal\u00e9e.<\/li>\n<li>Le traitement doit cibler les dysfonctionnements sp\u00e9cifiques de l&rsquo;individu, mais une approche multimodale de techniques manuelles et d&rsquo;exercices th\u00e9rapeutiques s&rsquo;est av\u00e9r\u00e9e b\u00e9n\u00e9fique dans le traitement de ces c\u00e9phal\u00e9es.<\/li>\n<\/ul>\n<h2><span id=\"References\" class=\"mw-headline\">R\u00e9f\u00e9rences<\/span><span class=\"mw-editsection\"><span class=\"mw-editsection-bracket\">(<\/span><a class=\"mw-editsection-visualeditor\" title=\"Edit section: References\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;veaction=edit&amp;section=22\">edit<\/a><span class=\"mw-editsection-divider\"> | <\/span><a title=\"Edit section: References\" href=\"\/index.php?title=The_Upper_Cervical_Spine_and_Cervicogenic_Headaches&amp;action=edit&amp;section=22\">edit source<\/a><span class=\"mw-editsection-bracket\">)<\/span><\/span><\/h2>\n<div class=\"mw-references-wrap mw-references-columns\">\n<ol class=\"references\">\n<li id=\"cite_note-1\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-1\">\u2191<\/a><\/span> <span class=\"reference-text\">Fernandez M, Moore C, Tan J, Lian D, Nguyen J, Bacon A et al. Spinal manipulation for the management of cervicogenic headache: A systematic review and meta\u2010analysis. Eur J Pain. 2020; 24(9): 1687-702.<\/span><\/li>\n<li id=\"cite_note-2\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-2\">\u2191<\/a><\/span> <span class=\"reference-text\">Biondi DM. Cervicogenic headache: mechanisms, evaluation, and treatment strategies. J Am Osteopath Assoc. 2000;100(9 Suppl): S7-14.<\/span><\/li>\n<li id=\"cite_note-:0-3\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:0_3-0\">3.00<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-1\">3.01<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-2\">3.02<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-3\">3.03<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-4\">3.04<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-5\">3.05<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-6\">3.06<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-7\">3.07<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-8\">3.08<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-9\">3.09<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-10\">3.10<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-11\">3.11<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-12\">3.12<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-13\">3.13<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-14\">3.14<\/a><\/sup> <sup><a href=\"#cite_ref-:0_3-15\">3.15<\/a><\/sup><\/span> <span class=\"reference-text\">Kaplan A. Cervicogenic Headache &#8211; Upper Cervical Course. Plus , 2020. <\/span><\/li>\n<li id=\"cite_note-:7-4\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:7_4-0\">4.0<\/a><\/sup> <sup><a href=\"#cite_ref-:7_4-1\">4.1<\/a><\/sup> <sup><a href=\"#cite_ref-:7_4-2\">4.2<\/a><\/sup><\/span> <span class=\"reference-text\">Mohamed AA, Shendy WS, Semary M, Mourad HS, Battecha KH, Soliman ES et al. Combined use of cervical headache snag and cervical snag half rotation techniques in the treatment of cervicogenic headache. J Phys Ther Sci. 2019; 31(4): 376-381. <\/span><\/li>\n<li id=\"cite_note-5\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-5\">\u2191<\/a><\/span> <span class=\"reference-text\">Hall T, Briffa K, Hopper D. Clinical evaluation of cervicogenic headache: a clinical perspective. J Man Manip Ther. 2008; 16(2): 73-80.<\/span><\/li>\n<li id=\"cite_note-:1-6\"><span class=\"mw-cite-backlink\">\u2191 <sup><a href=\"#cite_ref-:1_6-0\">6.0<\/a><\/sup> <sup><a href=\"#cite_ref-:1_6-1\">6.1<\/a><\/sup><\/span> <span class=\"reference-text\">Hutting N, Scholten-Peeters GG, Vijverman V, Keesenberg MD, Verhagen AP. Diagnostic accuracy of upper cervical spine instability tests: a systematic review. Phys Ther. 2013; 93(12): 1686-95. <\/span><\/li>\n<li id=\"cite_note-7\"><span class=\"mw-cite-backlink\"><a href=\"#cite_ref-7\">\u2191<\/a><\/span> <span class=\"reference-text\">Takahashi S, Suzuki A, Koike T, Yamada K, Yasuda H, Tada M, Sugioka Y et al. Current prevalence and characteristics of cervical spine instability in patients with rheumatoid arthritis in the era of biologics. 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