2 Cervical Spine Flashcards
What (additional) facet joints are often included in the examination of the C-Spine?
four facet joints in 2 upper thoracic vertebrae (T1-T2)
In which direction do superior facets of C-spine face? Inferior facets?
- sup: superiorly, posterior and medially
- inf: inferiorly, anterior and laterally
rotation and side flexion in the c-spine requires ___ ___ between bilateral facet joints
coupled movement
What’s normal lordotic curve of c-spine?
30°-40°
Where does greatest flexion-extension occur in c-spine?
C5-C6 (hence most commonly injured/degenerated level)
TVPs of c-spine are made up of 2 parts. These are:
- anterior portion: provides the foramen for the vertebral artery
- posterior portion: containing articular facets
What’s the aka for the upper cervical spine?
cervicoencephalic spine
Which segments have no discs in the c-spine?
C0-C2
What are the movement ranges for the atlanto-occipital joint (C0-C1)?
- flexion-extension: 15°-20°
- lateral flexion 10°
What are the movement ranges for the atlanto-axial joint (C1-C2)?
- flexion-extension: 10°
- lateral flx: 5°
- rotation: 50°
What’s the aka for a pivot joint?
trochoid joint
What’s the first palpable SP of the c-spine?
C2
What’s the aka for lower cervical spine?
cervicobrachial spine
What vertebrae are included in the cervicobrachial/lower c-spine?
C3-C7
What are available movements of the atlanto-occipital joint?
- flx
- ext
- lat flx
What are available movements of the atlanto-axial joint?
- flx
- ext
- rotation
What are available movements of the intracervical region joints (C2-C7)?
- flx
- ext
- rotation
- lat flx
What’s resting position of the c-spine?
midway between flexion and extension
What’s close packed position of the c-spine?
full extension
What’s the capsular pattern for the c-spine (in order of most to least limited motions)?
- side flexion and rotation (equally limited)
- extension
Radicular symptoms do not go down the arm for a __ nerve root injury and above
C4
What are the Grades of the Watkins Severity Scale: Neurological Deficit?
- Unilateral arm numbness or dysesthesia; loss of strength
- Bilateral upper extremity loss of motor and sensory function
- Ipsilateral arm, leg, and trunk loss of motor and sensory function
- Transient quadraparesis (temporary sensory loss in all 4 limbs)
- Transient quadriplegia (temporary motor loss in all 4 limbs)
What are the Grades of the Watkins Severity Scale: Time Symptoms Present?
- Less than 5 mins
- Less than 1 hour
- Less than 24 hours
- Less than 1 week
- Greater than 1 week
What are the Grades of the Watkins Severity Scale: Central Canal Diameter
- > 12 mm
- Between 10-12 mm
- 10 mm
- 8-10 mm
- < 8 mm
What are rule outs for the c-spine?
- TMJ: 3 knuckle test
- Shoulder tests (just flexion and abduction [palm down until 90° then palm up for rest of abduction]) with overpressure
- VBA (vertebral basilar artery)
How is the vertebral basilar artery test performed?
Px supine, passively extend, laterally flex and ipsilaterally rotate head and have them count to 30. Watch eyes for abnormal movements and listen for alterations in verbal count. (or can do with patient seated doing neck movements actively)
What’s average flexion range for the c-spine?
80°-90°
What’s average extension range for the c-spine?
70°
What’s average lateral flexion range for the c-spine?
20°-45° each way
What’s average rotation range for the c-spine?
70°-90° each way
Overpressure is applied at end of all c-spine movements except…
extension
Where are the best places to palpate the neck during flexion?
- C0-C1: between mastoid process and TVP of C1
- C1-C2: palpate arch of C1 and SP of C2
- Rest of cervical spine: between SP at each level
What’s normal end feel for neck flexion, extension, lateral flexion and rotation?
all: tissue stretch
During ARROM, weakness without pain suggests:
nerve root problems (myotome)
What muscles perform flexion at the head?
- rectus capitis anterior
- rectus capitis lateralis
- longus capitis
- hyoid muscles
What muscles perform flexion at the neck?
- longus colli
- longus capitis
- infrahyoids
- suprahyoids
- scalenes ant/post/med
What muscles perform extension at the head?
- splenius capitis
- semispinalis capitis
- longissimus capitis
- spinalis capitis
- trapezius
- RCP min/maj
- obliquus capitis sup/inf
What muscles perform extension at the neck?
- splenius cervicis/capitis
- semispinalis cervicis
- longissimus cervicis
- illiocostalis cervicis
- spinalis cervicis
- interspinalis cervicis
- trapezius
- RCP Maj
- Rotatores
What muscles perform lateral flexion at the head?
- trapezius
- splenius capitis
- longissimus capitis
- semispinalis capitis
- obliquus capitis inferior
- rectus capitis lateralis
- longus capitis
- SCM
What muscles perform lateral flexion at the neck?
- levator scapulae
- splenius cervicis
- iliocostalis cervicis
- longissimus cervicis
- semispinalis cervicis
- multifidus
- intertransversarii
- scalene
- SCM
- obliquus capitis inferior
- rotatores breves/longi
- longus colli
What muscles perform rotation at the head?
- trapezius
- splenius capitis
- longissimus capitis
- semispinalis capitis
- obliquus capitis inferior
- SCM
What muscles perform rotation at the neck?
- levator scapulae
- illiocostalis cervicis
- longissimus cervicis
- semispinalis cervicis
- multifidus
- intertransversarii
- scalene
- SCM
- obliquus capitis inferior
- rotatores brevis/longi
What does Spurling’s test for?
tests for possible cervical radiculopathy
What’s the aka for Spurling’s test?
Foraminal Compression Test
What’s a positive sign for Spurling’s test?
pain radiating into the arm toward which the head is side flexed during compression
What are the implications of Spurling’s test? What impairments might symptoms suggest?
- test positions narrow the IVFs so may lead to symptoms: stenosis, cervical spondylosis, osteophytes, trophic, arthritic or inflamed joints, herniated disc or vertebral fractures
What does the Cervical Compression test for?
tests for possible cervical radiculopathy
What’s the positive sign for Cervical Compression test?
pain radiating into the arm(s)
What are the implications of the Cervical Compression test?
- intervertebral foramen closes maximally during the test
What’s the purpose of the Distraction test?
to alleviate symptoms of radicular nature
What’s a positive sign for the distraction test?
pain relieved or decreased when head is lifted or distracted
What are the implications of the distraction test? What can I ask px to do that would increase test effects?
- if px abducts arms while traction is applied, symptoms often further alleviate, especially C4/C5 nerve root involvement
- can be done if radicular symptoms arise following radicular testing
What’s the purpose of the cervical upper quadrant test?
evaluate facet joint irritation C0-C2
What’s a positive for cervical upper quadrant test?
- local pin-point pain at the cervical vertebra(e) in the upper cervical region
- referral pain that follows the apophyseal joint referred pain patterns
What are implications of the Cervical Upper Quadrant test?
- testing action maximally closes the intervertebral foramen which can lead to radicular symptoms
- test is highly dependent on px’s reported symptoms
- at any point of the test, stop if pain is reported
What’s the purpose of the Cervical Lower Quadrant test?
evaluate facet joint irritation C2-C7
What’s a positive sign for the Cervical Lower Quadrant test?
- local pin-point pain at the cervical vertebra(e) in the lower cervical region
- referral pain that follows the apophyseal joint referred pain patterns
What are the implications of the Cervical Lower Quadrant test?
- testing action maximally closes the intervertebral foramen which can lead to radicular symptoms
- test is highly dependent on px’s reported symptoms
- at any point of the test, stop if pain is reported
What’s the purpose of the valsalva test?
to determine the effect of increased pressure on the spinal cord
What’s a positive sign for the valsalva test?
- increased pain due to increased intrathecal pressure
- radicular pain symptoms travelling down the arm(s)
What are implications of the valsalva test?
- space-occupying lesion, such as a herniated disc, tumor, stenosis, or osteophytes
- perform with care and caution because px may become dizzy during or shortly after the procedure
What’s the purpose of Tinel’s sign?
check for brachial plexus lesion
What’s a positive sign for Tinel’s sign?
tingling sensation in the distribution of a nerve on the ipsilateral side
What are the implications of Tinel’s sign?
- means a lesion is anatomically intact, and some recovery is occurring
- if pain is elicited in the distribution of a peripheral nerve, may indicate neuroma (disruption of the continuity of the nerve)
What’s the purpose of Hautant’s test?
used to differentiate dizziness or vertigo caused by vascular problems from non-vascular
What’s a positive sign for Hautant’s test?
- if arms move without neck rotation and extension, the cause is nonvascular
- if arms move while neck is rotated and extended, the cause is vascular impairment to the brain
What are implications of Hautant’s test?
another way to check for possible VBA occlusion
What’s the purpose of Sharp-Purser test?
to determine subluxation of the atlas on the axis (transverse ligament tear)
What’s a positive sign for Sharp-Purser test?
- therapist feels the head slide backward during the movement
- may hear a “clunk”
What are implications of Sharp-Purser test?
transverse ligament maintains the position of the odontoid process relative to the anterior arch of C1, with a subluxation, px may be apprehensive to do forward flexion during functional testing
What does the C5 dermatome supply?
Lateral shoulder
What does the C6 dermatome supply?
Thumb and index finger
What does the C7 dermatome supply?
Middle Finger
What does the C8 dermatome supply?
4th and little finger
What does the T1 dermatome supply?
Medial elbow
What action does nn roots C1-C2 supply?
Neck flexion
What action does nn root C3 supply?
Neck side flexion
What action does nn root C4 supply?
shoulder elevation
What action does nn root C5 supply?
shoulder abduction
What action does nn root C6 supply?
elbow flexion and wrist extension
What action does nn root C7 supply?
elbow extension and wrist flexion
What action does nn root C8 supply?
thumb extension and ulnar deviation
What action does nn root T1 supply?
hand intrinsics
What’s the DTR for C5?
bicepital reflex
What’s the DTR for C6?
brachioradialis relex
What’s the DTR for C7?
triceps reflex
What is a WAD injury?
Whiplash Associated Disorder
At what vertebral level is the hyoid bone located?
C3
How much resistance should be applied during AR neck movements?
10% (all except extension)
What are tests for Radiculopathy in the Cervical Spine?
- Myotome/Dermatome/DTR
- Spurling’s
- Cervical Compression
- Distraction
What are tests for Facets in the Cervical Spine?
- Cervical Upper Quadrant
- Cervical Lower Quadrant
What are tests for Disc Herniation/Lesion in the Cervical Spine?
- Valsalva
- Tinel’s Sign
What are tests for Vascular in the Cervical Spine?
- Hautant’s
What are tests for Instability/Muscle Weakness in the Cervical Spine?
- Sharp-Purser
- Muscle tests
What are the grades of the Quebec severity of WAD scale?
How is cervical upper quadrant test performed?
- passively extend head
- ipsilateral laterally flex head
- contralaterally rotate
How is cervical lower quadrant test performed?
- passively extend neck
- ipsilateral laterally flex
- ipsilaterally rotate
