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MSK 2 > 1f - Upper Cervical Spine > Flashcards

1f - Upper Cervical Spine Flashcards

1
Q

what is the structure of C1 and how does this lend to its functions

A

no real body
giant superior facets
- articulate w occiput
inferior facets flatter but on angle
- orientation allows for rotation

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2
Q

describe the orientation of C2

A

dens sits ant against C1
SC is posterior

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3
Q

what is the function of the transverse ligament

A

hold position of C2 forward so that C1 can spin around it

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4
Q

what is a characteristic of the transverse ligament which lends to its primary function

A

fibers have very low coefficient of friction to allow for a lot of movement as C1 spins around dens

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5
Q

what is the result if the transverse ligament is injured

A

can’t stop C2 from moving posteriorly against SC

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6
Q

what are 3 major risk factors that can lead to transverse/alar ligament damage/insufficiency

A

trauma (MVA, trauma, fall)
RA
connective tissue disorder

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7
Q

what is the function of the alar ligament

A

comes off the head of dens to attach it to occiput

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8
Q

how does the alar ligament’s function influence movement at upper cervical spine

A

occiput and C2 will have correlation w each other
- see some rotation when SB occiput (getting movement at C2)

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9
Q

in SBing the occiput to the R, the R rotation at C2 is the result of what 2 things:

A
  1. tension of alar ligament
  2. geometry of facet joints
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10
Q

describe the movements happening at the occiput condyles, C1, and C2 during SB R

A

occiput condyles roll right and glide L on C1 (vex on cave)

alar lig becomes taut and induces R rotation of C2

C1 is shaped like a wedge b/w occiput and C2 + the position of dens + strong transverse ligament = C1 can’t SB & is still

C2 is rotating R under C1 (which is still), C1 rotates L relative to C2

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11
Q

path of vertebral artery and where is it at greatest risk for an injury

A

travels thru transverse foramen

at C1, there is a hook shape where you can get cervical arterial dissections and need to be careful of any manipulation at this level

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12
Q

what is a (+) alar ligament test

A

no IMMEDIATE contralateral mvmt of C2 spinous process

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13
Q

what is a (+) modified sharp purser test and what is the indication

A

dec in myelopathic sx

good specificity, worth taking time to stabilize w hard collar and send to ER

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14
Q

describe the anatomy of what is happening during a (+) modified sharp purser test and why it would mean a dec in sx

A

when flex forward, occiput falls of edge of cliff and dens moves to posterior portion of arch
- presses SC against dens, resulting in sx down arms, legs, unstable head

when ext head, get a clunk as dens clunks against arch and relocates
- relief in sx

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15
Q

what is the anterior shear transverse ligament safety test

A

pt supine and PT presses C1 anteriorly hold 10-15sec

(+) reproduction of myelopathic sx (not pain)

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16
Q

what is an alternate method for an anterior shear transverse ligament safety test if pt is already having myelopathic sx lying in supine

A

in supine, PT presses ant on C2
nose should elevate immediately

(+) some dec in sx as taking pressure off

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17
Q

what is the purpose of a lateral shear test

A

assess integrity of dens and osseous portion of C1 and its alar ligamentous attachment

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18
Q

what is procedure of a lateral shear test

A

stabilize occiput and C1
laterally shear C2

pain isn’t necessarily (+)

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19
Q

what is an important consideration when doing a cervical safety test

A

use in conjunction w clinical hx
- trauma, RA, down syndrome, connective tissue disorder

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20
Q

what is indicated if clinical tests and tests implicate upper cervical instability

A

immediate referral to MD for further assessment w c-collar
- want orthopedic surgeon to make the decision ab treatment

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21
Q

what are vertebral artery insufficiency sx similar to

A

myelopathic sx seen w SC

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22
Q

what are clinical s/sx of vertebral artery insufficiency

A

5Ds
- dizziness
- diplopia
- dysarthria
- dysphagia
- drop attacks

Ataxia of gait

3Ns
- nausea
- nystagmus
- numbness of face

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23
Q

what is a consideration of the ataxia of gait s/sx of vertebral artery insufficiency

A

might not show up immediately in gait
- might see it as do balance tests

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24
Q

what is the procedure of vertebral artery screening and why

A

sustained rotation
- puts pressure on hooked part of vertebral artery

don’t let them close eyes and keep them talking so see if vision/speech changes

extension w rotation to be more provocative

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25
Q

what do the results of vertebral artery screening indicate

A

if (-), not enough to r/o vertebral insufficiency

good (+) test result validity

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26
Q

25yo F exercise physiologist w PMH of lyme dz and neck/back pain and went to chiropractor for 1st time. Onset of dizziness/lightheadedness 1wk ago secondary to chiropractic C and T manip. No immediate sx, but develop the next day. XR, EKG, and CBC all neg in ED. Virtual appt w PCP suggested PT.

What cervical safety tests should be performed?
a. alar lig in supine & sitting
b. transverse lig test
c. lateral shear test
d. sustained rotation
e. all of the above

A

all of the above
- 5Ds, emphasis on sustained rotation

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27
Q

25yo F exercise physiologist w PMH of lyme dz and neck/back pain and went to chiropractor for 1st time. Onset of dizziness/lightheadedness 1wk ago secondary to chiropractic C and T manip. No immediate sx, but develop the next day. XR, EKG, and CBC all neg in ED. Virtual appt w PCP suggested PT.

cerv ext reproduce sx
L rotation reproduce, worsen in prolonged
(-) alar, transverse, lateral shear

keeping in mind that avery has been to ER and spoken to PCP, is she currently safe to treat?

A

no
- in ER just did XR and EKG but those wouldn’t tell you anything

wouldn’t have been looking for this before and might have missed it

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28
Q

what are common locations for pain in UCS paths

A

base of skull
unilateral
ear/jaw/TMJ pain
HA/ram’s horn pattern

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29
Q

what is commonly injured if the UCS is

A

TMJ

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30
Q

what are common MOI for UCS path

A

often insidious, long standing
slept funny
MVA (WAD)

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31
Q

what are MAPS to the pt’s pain

A

Movements
Activities
Positions
Situations

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32
Q

what are 5 common MAPS for UCS path

A

computer work
sleeping
looking a phone
turning head
driving

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33
Q

what should be observed during a UCS eval

A

position of head on neck
reposition in neutral as needed

34
Q

how should you examine UCS ROM in an eval

A

cardinal planes (bias upper vs lower Cspine)

pre- flex upper w nose nod, assess lower c spine
pre- flex lower to assess C1/C2
- FRT in supine

regionalization

35
Q

what is a (+) FRT and what does this indicate

A

(+) ROM dec by 10deg +
- normal ROM is 44deg

indicate cervicogenic headache w C1/C2 restriction

36
Q

what is FRT assessing

A

passive full cervical flex then rotation
- how much C1 rotates on C2 (should be ~1/2 of cervical rotation from this segment)

37
Q

what ms have a large influence on how the upper cspine moves

A

upper trap
levator scap
SCMS

superficial ms are prime movers

38
Q

what are the 4 main deep neck flexors

A

rectus capitis lateralis
rectus capitis anterior
longus capitis
longus colli

39
Q

what are the functions of deep neck flexors

A

maintain stability and position
endurance ms
not prime movers

40
Q

norm for CCFT

A

24-28mmHg

41
Q

what compensation do you look for during the neck flexor endurance test

A

see engaged SCM - extends UCS and flexes lower cspine
- upper cervical flexors fight this

42
Q

function of rectus capitus posterior major and minor

A

head ext and ipsilateral rotation

43
Q

functions of obliquus capitus superior

A

head ext and side bending

44
Q

functions of obliquus capitus inferior

A

ipsilateral head on neck rotation

45
Q

what was noted in a muscle control assessment for pts w neck pain

A

inc activation of superficial neck extensors (ie upper traps, levator scap) and delayed activity in deep neck extensors (ie semispinalis cervicis, multifidi)

46
Q

what was noted in motor control of pts w post-concussional HAs

A

overactive superficial ms, acting tonically

47
Q

what was noted in motor control in WAD

A

dec deep cervical ms tonic hold
- poor patterning, dec kinesthesia, and proprioception

48
Q

what is a compensation for scapular winging

A

use upper trap which creates upper cervical extension

49
Q

what is the significance of extra upper trap activity

A

impacts c spine bc of attachments

50
Q

what are (+) findings of scapular dyskinesis

A

winging
loss/lack of control when lifting
loss/lack of control when lowering
scapular asymmetry

51
Q

what are the 4 main UCS dx

A

neck pain w mobility deficits
wry neck (acute facet lock) / torticollis
cervicogenic HA
concussion

52
Q

what does wry neck deformity describe

A

posture

53
Q

what are other terms for wry neck deformity

A

acute facet joint lock
acquired torticollis

54
Q

what will the pt complain of if they have a wry neck deformity

A

neck pain/stiffness w loss of ROM
- often accompanies by spasm of surrounding ms (UT or SCM)

55
Q

what are the 4 types of acquired torticollis

A

traumatic micro induced
sudden onset/acute
muscular
post viral

56
Q

traumatic micro induced acquired torticollis: common pt pop, sx, treatment and resolution

A

young hypermobile females
motor control deficit
several episodes quickly resolve
restore ROM, address MC

57
Q

sudden onset/acute acquired torticollis: MOI, treatment and resolution

A

facet or disc dysfunction that created inflammatory response

facet: restore ROM, address MC
disc: no manip, soft collar 2-3 days

self resolve 1-2 weeks, PT speeds up process

58
Q

muscular acquired torticollis: MOI, treatment

A

spasm SCM and stuck is SCM ms action: lat flex and contralateral rotation

STM, ms lengthening, functional adapt, ROM

59
Q

post viral acquired torticollis: pt pop/MOI, treatment

A

spontaneous onset in child or adolescent after URI causing temp insufficiency of UCS ligaments

manual therapy contraindicated

60
Q

what are wry neck deformities that should be referred and what are examples

A

if no ms involvement, concern for CNS/PNS signs

spasmodic torticollis
drug induced
hysterical

61
Q

what is spasmodic torticollis

A

neurological conditions w or w/o a tick, can be transient

62
Q

what might cause drug induced torticollis

A

antipsychotics

63
Q

what is hysterical torticollis

A

psychological
no objective signs

64
Q

what are 8 research informed UCS interventions

A
  1. modify function at work, ergonomics
  2. change ROM disturbances
  3. address motor control deficit (feed forward mech)
  4. sensory motor function
  5. change pain processing
  6. psychosocial distress
  7. sensory motor processing
  8. multimodal approach
65
Q

what are the 3 main ways to change ROM disturbances in UCS

A

joint mob
traction
ms length

66
Q

how can you address motor control deficits in UCS

A

change patterning

67
Q

how can you intervene on sensory motor function in UCS (3)

A

joint position sense
balance response
endurance and strength deficits

68
Q

what intervention is the “low hanging fruit” for UCS

A

ergonomics

69
Q

what is the ideal sitting posture and why

A

hip above knee to get slight lumbar ext and then put thoracic and cervical spines in neutral

if you flex lumbar spine, flexes thoracic and ext cspine

70
Q

why is thoracic spine an important thing to address when addressing cervical spine

A

if thoracic segments not moving well, inc work thru cspine

71
Q

typical initial prescription and the progression for joint mobs in UCS

A

initial:
5-10 reps, 3-5 hold, grade 2-4

progression:
10-15reps, 3-10hold, grade 4

72
Q

what are 6 things that the joint mob prescription depends on

A

pt tolerance in moment
pt tolerance after treatment
chronicity of mobility deficits
hx w manual therapy
grade of mobility deficits
pt psychosocial factors/beliefs

73
Q

what does a feed forward mechanism have to do with motor control interventions

A

anticipatory/automatic ms that brace for movement

w pain and loss of activity, motor planning has been altered and changed
- start by doing them in isolation and then function

74
Q

what are 3 components to interventions to change motor control patterns/progressions

A
  1. patterning in isolation then co-contraction
  2. endurance strength and function
  3. retrain normal movement patterns (ROM)
75
Q

as a rule, for pts who sx are more irritated, what type of exercises are good to strengthen DNE or DNF

A

isometric

76
Q

what should be integrated w sensory motor function

A

strength and endurance training

77
Q

if you at retraining sensory motor function, what feedback to do you give for joint position sense

A

external cue for cervical position

78
Q

what type of intervention is used to treat sensory motor function

A

cervical kineasthetic treatment

79
Q

what is a common piece of equipment used when improving motor control

A

laser on head

80
Q

what is it important to educate the patient on

A

to change pain processing and psychosocial distress
- address fear avoidance
- desensitize movement

*importance of aerobic exercise

MSK 2 (20 decks)

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