3- Craniovertebral Flashcards
What is the function of the upper cervical spine? Lower cervical spine?
UCS positions the head on the neck
LCS positions in the head in space
What is the expected ROM for cervical rotation?
80-90 degrees
What is the expected ROM for cervical sidebending?
45 degrees
What is the expected ROM for cervical flexion?
40 degrees
What is the expected ROM for cervical extension?
70-80 degrees
How is cervical ROM affected as we age?
Decreases 4-5 degrees over every 10 year period
Where do the alar ligaments attach?
to a pair of anterior tubercles on the foramen magnum
Where are the brain-stem-spinal cord junction housed?
Posterior of the foramen magnum
Which cervical vertebrae are typical?
C3-6
How are C3-6 oriented superiorly? Inferiorly?
Superiorly: concave transversely, convex A-P
Inferiorly: Convex transversely, concave A-P
Where do the transverse processes of C3-6 face?
Lateral, anterior, Inferior
What houses the vertebral artery C3-6?
Transverse foramen
Which directions for the superior and inferior facets face C3-6?
Superior: posterior and cranial
Inferior: anterior and caudal
What is different about C7?
Transitional vertebra that connects the mobile C-spine to the stable T-spine. It has a long spinous process with a single tuberacle at the end
What is different about cervical discs?
They have less soft nuclear material because they bear less weight
Where does the alar ligament run? What does it do?
- dorsolateral dens to medial occipital condyles
- limits rotation and SB of the occiput on the axis
The UCS is responsible for approximately _____% of the motion throughout the entire C-spine
50%
SB and rotation are couple to the ______ side in O-A joint, UCS
Opposite
SB and rotation are couple to the ______ side in the LCS
Same
During right sidebending, the right occiput moves _____. The left?
R= medial, inferior,anterior
L= LPS
Which directions to the superior articular facets of C1 face?
superior and medial
How many degrees of freedom does the O-A joint have?
2 (flex/ext, SB)
What is special about C2-3?
It is a transitional vertebra. The superior articulat facets behave like UCS. The inferior articular facets behave like LCS
How are the superior articular facets of C2-C7 oriented?
slightly convex, face cranial and posterior
How are the inferior articular facets oriented?
Slightly concave, face caudal and anterior
What is the facet orientation in the LCS?
approximately 45 degrees to horizontal
What are some indicators of neoplastic conditions?
- Age >50 yrs
- Previous history of cancer
- Unexplained weight loss
- Constant pain
- Night pain
- Unexplained capsular patterns
What temperature can be an indicator of inflammatory or systemic disease?
>100 F
What BP can be an indicator of inflammatory or systemic disease?
> 160/95 mmHg
What resting pulse can be an indicator of inflammatory or systemic disease?
>100
What resting respiration can be an indicator of inflammatory or systemic disease?
>25 bpm
What else can be an indictor of systemic or inflammatory disease?
Fatigue
What are some high risk factors that indicate X-Ray?
> 65 y.o.
Dangerous MOI
Limb paresthesias
What are some low risk factors that may indicate X-Ray?
Rear-end MVA
Delayed onset neck pain
Absence of midline tenderness
What is the neck step in indication for Xray?
Check if the patient is able to rotate 45 degrees to both sides
What are some indicators of cervical cord compression?
- Bilateral or quadrilateral limb paresthesias with cervical motion
- Hyper-reflexia
- Clonus
- Babinski’s or + Hoffman’s
What are some indicators of cervical myelopathy
B or Q limb paresthesias and/or weaknesses
+ Hoffman’s and/or + Babinski’s
Hyperreflexia
Sensory disturbance of the hands
Muscle wasting of the hand intrinsics
Unsteady gait
Bowel and bladder disturbances
How is cervical myelopathy graded?
1-5 based on gait disturbances
1= normal gait, mild
How long must you wait after a whiplash injury to test vertebral artery?
4-6 weeks
What are some outcome predictors for whiplash?
Post-traumatic stress
High NDI score
Cold hyperalgesia
Age
What are the most commonly involved root levels of cervical radiculopathy?
C6 and 7
When is peak incidence for cervical radiculopathy?
4th and 5th decades
What is a medical emergency?
Acute torticollis caused by a facet joint dislocation
What should you ask regarding VBI?
Hx or neck trauma
5Ds And 3 Ns
Hx or RA, HTN, Stroke
Steroid use
Increasing symptoms with specific movements
What does the alar ligament test test?
Frontal plane stability (alar ligament integrity)
What does the Transverse ligament test test for?
Saggital plane stability (transverse ligament integrity)
What does the Jefferson Fracture Test test for?
Transverse plane stability
What does the distraction test test for?
Longitudinal stability
What does the Sharp-Purser Test test for?
integrity of the transverse ligament, UCS translational stability
