7 Cervical Spine Flashcards
What are the spine stabilizing subsystems?
- Passive subsystem – vertebrae, discs, ligs
- Active subsystem – muscles and tendons surrounding spinal column
- Neural subsystem – nerves and CNS which determine the requirements for spinal stability and directs the active (mm) subsystem to provide the needed stability
What’s the Neutral Zone and Elastic Zone?
The neutral zone is a region of high flexibility. The elastic zone is a region of high stiffness. The two zones together constitute the physiological range of motion of joint. The neutral zone is where spinal motion encounters minimal resistance. A joint with increased laxity will have an increased neutral zone.
What are the global muscles of the trunk?
- Rectus abdominus
- External and Internal obliques
- Quadratus lumborum (lateral portion)
- Erector spinae
- Iliopsoas
What are the deep segmental muscles of the trunk?
- Transversus abdominis
- Multifidus
- Quadratus lumborum (deep portion)
- Deep rotators
What are the global muscles of the cervical spine?
- Sternocleidomastoid
- Scalenes
- Levator Scapulae
- Upper Trapezius
- Erector Spinae
What are the deep segmental muscles of the cervical spine?
- Deep neck flexors
- Multifidus
Where in the cervical spine is the most likely location of degeneration?
C5-C6: most of the flexion/extension of the cervical spine happens at this segment. Almost as much movement occurs at C4-C5 and C6-C7. Because of this mobility, degeneration is more likely to be seen at these levels.
What kind of joints are the facet joints of the cervical spine?
synovial plane
At what degree of orientation do the facet joint face?
45° posterior to anterior
In which direction to the superior particular facets of the C-spine face?
Superiorly, posteriorly, medially
What movement is coupled with C2-C7 lateral flexion?
Axial rotation in same direction
Where in the C-spine are there no intervertebral discs?
upper C-spine
What’s the aka for facet joints?
zygapophyseal joints
What mobes should be used to improve lateral flexion?
Same as with rotation: i.e. lateral glide using spinous process toward contralateral side OR ant glide of contralateral facet
What’s it called when nerve roots are compressed as they leave the IVF?
radiculopathy
What symptoms can present with radiculopathy at the C-spine?
- sensory deficits
- motor weakness (without pain)
- reduced reflexes
At what point would compression of Brachial Plexus lead to S/S usually affecting the entire arm?
When trapped between ant and mid scalenes.
What point of compression along the nerve path would likely result in specific dermatome/myotome S/S present?
radiculopathy (nerve root compression)
What are the facet joint referral patterns of the C-spine?
- C2-3: back of head
- C3-4: back of neck
- C4-5: back of neck
- C5-6: suprascapular
- C6-7: scapula/thorax
What mm TrP referrals are associated with the C-Spine?
- scalenes
- levator scapula
- upper trapezius
- splenius capitis
- splenius cervicis
- SCM
- suboccipitals
- longissimus capitis
- semispinalis capitis
- cervical multifidus
What’s the definition of whiplash?
soft tissue traumatic injury (strain/sprain) of the cervical spine resulting from an acceleration-deceleration mechanism
What are the grades of whiplash-associated disorders under the Quebec task Force system?
What “red flags” questions are important to ask following a whiplash injury? i.e. any yes to the questions would result in referral to doctor
- headaches?
- loss of consciousness?
- difficulty concentrating?
- difficulty swallowing?
- problems with vision, hearing or balance?
- severe pain, swelling, limited ROM?
What are the akas for Torticollis?
aka wry neck, cervical scoliosis
What are the three types of Torticollis?
- acquired/acute
- congenital
- spasmosdic/”cervical dystonia”
What’s the typical presentation of Torticollis?
- Ipsilateral lateral flexion with contralateral rotation
- Increased tone in the muscles that do actions
- Usually pain in the associated muscles
- Joint restrictions
What are some causes/contributing factors to acquired/acute Torticollis?
- Often idiopathic
- Neck trauma (subluxation, whiplash)
- Facet irritation
- Trigger points
- Prolonged faulty posture
- Quick sudden movements
- Throat infections
- Nerve irritation
** these are all painful presentations–one of the body’s responses to pain is spasm
What are some interventions for acquired/acute Torticollis?
- Reduce spasm/pain cycle–spasm techniques, massage, hydrotherapy
- Address/correct causative factors
- Meds: muscle relaxants, analgesics
What are causes/contributing factors for congenital Torticollis?
- No clear cause (not a spasm of SCM)
- Contracture/fibrosis of the SCM within days/weeks of birth
- Possibly due to the position of baby in womb or from trauma during birth
Does there seem to be pain with congenital torticollis?
No
What are some treatment interventions for congenital torticollis?
- Stretch, stretch, stretch
- Teach parents to stretch
- Referral to physio?
- May require surgery
What’s spasmodic a.k.a. cervical dystonia a.k.a. intermittent torticollis? What are causes/contributing factors for it? What exacerbates it? What’s its character?
- Intermittent or sustained spasm of the neck (especially SCM)
- CNS driven
- Painful
- Stressed/emotional stress tends to exasperate symptoms
What are some interventions for spasmodic a.k.a. cervical dystonia a.k.a. intermittent torticollis?
- Reduce stress
- Botox/CNS meds
What’s cervical joints are most commonly affected with degenerative disc disease (DDD)?
C4-C7
What signs and symptoms tend to present with mild degeneration (DDD)?
Asymptomatic, mild stiffness
What signs and symptoms tend to present with moderate degeneration (DDD)?
Increased muscle tone, occasional episodes of muscle spasm
What signs and symptoms tend to present with severe degeneration (DDD)?
Increased tone/episodes of spasm, IVF stenosis and neurological symptoms can present, bony changes occur to stabilize
What are some symptoms of facet irritation?
- Unilateral pain with associated stiffness/spasm
- typically ‘catching’, local pain
- Associated muscle and CT restrictions
What’s a cervicogenic headache?
Simply name for a headache which originates from the neck
What sorts of things typically cause cervicogenic headaches?
- Typically occur due to damage to one or more joints, muscles, ligaments or nerves of the top three vertebrae of the neck
- May occur traumatically due to a specific incident (e.g. whiplash or heavy lifting) or more commonly, due to repetitive for prolonged activities such as prolonged slouching, poor posture, lifting or carrying (especially in poor posture), excessive bending or twisting of the neck, working at a computer, or activities using the arms in front of the body (e.g. housework)
What are signs and symptoms of cervicogenic headaches?
- Gradual onset of neck pain and headache during the causative activity
- Common for patients to experience pain and stiffness after the provocative activity, particularly upon waking the next morning
- Presents as a constant dull ache, normally situated at the back of the head, although sometimes behind the eyes or temple region, and less commonly, on the top of the head, forehead or ear region
- Pain is usually felt on one side, but occasionally, both sides of the head and face may be affected
- Patients may also experience tenderness on firm palpation of the upper part of the neck just below the base of the skull along with muscle tightness in this region
- Occasionally patients may experience lightheadedness, dizziness, nausea, tinnitis, decrease in concentration, inability to function normally, and depression
What are treatment techniques for cervicogenic headaches?
- Joint mobilization/traction (RMTs)
- Joint manipulation (Chiros)
- Massage
- Acupuncture
- Self-care techniques for body awareness, improved posture (remex)
- Ergonomic advice
- Education regarding optimal pillow use when sleeping
What’s the ratio females to males affected by:
- cervicogenic headaches?
- migraines?
- tension-type headaches?
F-M
- cervicogenic: 50-50
- migraines: 75-25
- tension-type headaches: 60-40
What’s the lateralization of the following headache types? (i.e. BL? UL?)
- cervicogenic
- migraines
- tension-type
- cervicogenic: unilateral without sideshift
- migraines: 60% unilateral with sideshift
- tension-type headaches: diffuse BL
What’s the location of the following headache types?
- cervicogenic
- migraines
- tension-type
- cervicogenic: occipital to frontoparietal and orbital
- migraines: frontal, periorbital, tempporal
- tension-type: diffuse
What’s the frequency of the following headache types?
- cervicogenic
- migraines
- tension-type
- cervicogenic: chronic, episodic
- migraines: 1-4 per month
- tension-type: 1-30 per month
What’s the severity of the following headache types?
- cervicogenic
- migraines
- tension-type
- cervicogenic: moderate to severe
- migraines: moderate to severe
- tension-type: mild to moderate
What’s the duration of the following headache types?
- cervicogenic
- migraines
- tension-type
- cervicogenic: 1 hour to weeks
- migraines: 4-72h
- tension-type: days to weeks
What’s the pain character of the following headache types?
- cervicogenic
- migraines
- tension-type
- cervicogenic: non-throbbing, and non-lancinating (non-stabbing), pain usually starts in the neck
- migraines: driving, pulsating
- tension-type: dull
What are the triggers of the following headache types?
- cervicogenic
- migraines
- tension-type
- cervicogenic: neck movement, and postures, limited ROM, pressure over C0-C3
- migraines: multiple, neck movement not typical
- tension-type: multiple, neck movement not typical
What are the associated symptoms of the following headache types?
- cervicogenic
- migraines
- tension-type
- cervicogenic: usually absent or similar to migraine but milder, decreased ROM
- migraines: nausea, vomiting, visual changes, phonophobia, photophobia
- tension-type: occasionally decreased appetite, phonophobia or photophobia
What are some headache red flags? (i.e. In what circumstances would I refer to physician?)
- Sudden onset of a new severe headache
- A worsening pattern of a pre-existing headache in the absence of obvious predisposing factors
- Headache associated with fever, neck stiffness, skin rash, and with a history of cancer, HIV, or other systemic illness
- Headache associated with focal neurologic signs other than typical aura
- Moderate or severe headache triggered by cough, exertion, or bearing down
- A change in personality or behavior is reported
What’s orthopedics?
the medical specialty concerned with correction of deformities or functional impairments of the skeletal system, especially the extremities and the spine, and associated structures, as muscles and ligaments
What facet joint referrals mimic common TrP referrals?
- C2-C3: upper traps, suboccipitals
- C4-C5: levator scapulae
