Assessment and treatment of the Cervical Spine

Question 1

What are the three components of Panjabi’s Model of Stability?

Answer 1

Control subsystem (neural)
Passive subsystem (spinal column)
Active subsystem (spinal muscles)

Question 2

Name the movements that occur in the cervical spine (C2-T2)

Answer 2

Flexion
Extension
Side bending with ipsilateral conjunct rotation (helps to reduce the forces on the vertebral artery)
Rotation with ipsilateral sidebending

Question 3

What are the arthrokinematics of the z- joint during flexion and extension?

Answer 3

Flexion = superio-anterior glide
Extension = Infero-posterior glide

Question 4

What are the arthrokinematics of the U-joint during flexion and extension?

Answer 4

Flexion = superio-anterior glide
Extension = Infero-posterior glide

Question 5

What can go wrong with the neck?

Answer 5

Trauma
Poor Posture
Degeneration/ age

Question 6

If a muscle strain in the c-spine region was suspected, what effect would traction and compression have on the symptoms?

Answer 6

Traction and compression would result in no change in symptoms

Question 7

If an acute joint sprain in the c-spine was suspected, Would you perform mobility and stability tests?

Answer 7

No we would not if it was acute; however if it was in its proliferative or remodelling phase we would.

Question 8

What are the Sites of pain for disc injuries in the neck?

Answer 8

Either in the neck and/or medial border of the scapula

Question 9

How do you differentiate between nerve root traction vs. nerve root compression?

Answer 9

You tell the difference between traction and compression by the MOI. Traction is usually caused by a sudden pull on the arm. Also in a nerve root traction there is no palsy.

Question 10

What is Thoracic Outlet syndrome?

Answer 10

It is when the subclavian artery and vein and/or brachial plexus is compressed between the first rib and the clavicle due to tight scalenes

Question 11

Name 3 common symptoms of Thoracic Outlet syndrome?

Answer 11

• Mild to limb threatening pain
• Diffuse arm and shoulder pain especially when the arm is elevated over 90 degrees
• Sensory changes most commonly in C8 T1 distribution
• Vascular changes in the arm (swelling of fingers or hand)

Question 12

Name 3 things that you could educate someone on for z-joint pain caused by trauma.

Answer 12

Avoid compression
Avoid extremes of ROM
Keep joint moving in safe ranges
Neutral spine for work and sleep

Question 13

Name 2 things that you could educate someone on for z-joint pain caused by trauma.

Answer 13

• Neutral spine

- Change work positions frequently

Question 14

Name 3 things that you could educate someone on for z-joint pain caused by degeneration.

Answer 14

• Move frequently to move joints
• Avoid compression
• Stretch into flexion
• Proper posture

Question 15

Name 3 things that you could educate someone on for disc pain caused by trauma.

Answer 15

• Unload the disc
• Avoid prolonged flexion
• Avoid heavy lifting/pulling (cutting or chopping food, scrubbing pots)

Question 16

Name 1 thing that you could educate someone on for disc pain caused by posture and degeneration.

Answer 16

• Neutral spine

- Distribute weight of head evenly over multiple segments

Question 17

Name 3 things that you could educate someone on for nerve root issues.

Answer 17

• Teach positions that open the intervertebral foramen
• Relate these positions to activities
• Teach positions that traction/tension the nerve root vs. slackening the nerve root