C-spine APTA Flashcards
What % of outpatient practice pts are neck pain patients?
- ~25%
Neck pain occurs at the highest rates in what decade of life?
- 5th decade
What % of people will have neck pain in their lives?
- 22-70%….that’s a stupid range
T or F
Men have neck pain more commonly than women.
- F
What is more common; acute or chronic neck pain?
- acute. Chronic is much lower in prevalence (2-11% over a 12 month period, compared to 30-50%)
A pt comes in with neck pain. It’s been getting better, but they’re worried that it could come back later. Is this a valid concern?
- yes. ~26% will experience recurrence within one year.
A pt comes in with neck pain. It’s been taking a while to improve and they still have symptoms after 3 months. Is this expected?
- ~30% of neck pain patients will have ongoing symptoms with pain that lasts longer than 6 months
T or F;
Economic cost associated with neck pain is 2nd only to low back pain.
- T
What articulations make up the upper and lower cervical spine?
- upper: C0-1, C1-2
- lower: C3-7
Which vertebra is the “atlas” and which is the “axis”? Which has the dens?
- C1 is atlas
- C2 is axis, and has the dens
The vertebral artery branches from the ________ artery, and then becomes the _______ artery after passing through the foramen magnum.
- vertebral a. branches from the subclavian a., becoming the basilar a.
The alar ligaments connect what to what?
- the dens of C2 to the occipital condyles of the cranium
What ligaments make up the cruciform ligament? What is its function?
- the transverse and longitudinal ligaments
- they cover the dens, attaching C1 and C2, keeping the two vertebrae closely approximated and away from the spinal canal during motion
What are the articulations that occur between vertebrae of the lower C-spine?
- vertebral bodies
- zygopophyseal joints
- uncovertebral joints
What articulations may play a role with degenerative changes in cervical spondylosis?
- the uncovertebral joints
What does the ligamentum nuchae span?
- spinous px of C7 through the occipital protuberance
What are 2 functions of the ligamentum nuchae?
- limits cervical flexion
- deepens cervical spinous pxs allowing for more muscle attachment
What are the 4 short suboccipital muscles of the upper C-spine?
- rectus capitus posterior major
- rectus capitus posterior minor
- obliquus capitus inferior
- obliquus capitus superior
Where are the attachments of the rectus capitus posterior major and minor? What do they do?
- major: spinous px of C2 and lateral portion of nuchal line of occipital bone. It extends and rotates ipsilaterally
- minor: posterior tubercle of atlas and medial inferior nuchal line of occipital bone. Extends the head at the C0-1 joint.
What are the attachments of the obliquus capitis inferior and superior? What do they do?
- inferior: C2 spinous px to C1 transverse px. Rotates ipsilaterally
- superior: transverse px of C1 and in between the inferior and superior nuchal lines. Ipsilateral extension and rotation.
What are the 3-ish small anterior muscles of the upper c-spine?
- rectus capitus anterior
- rectus captius lateralis
- some fibers of the longus colli cervicis
What are the attachments of the rectus capitus anterior and lateralis? What do they do?
- anterior: lateral mass of C1/root of transverse px of C1 and base of occipital bone. Flexes.
- lateralis: transverse px of C1 to the occipital bone. Rotates ipsilaterally.
What are the varied actions of the SCM?
- unilaterally: rotation contralaterally and side bend ipsilaterally
- bilaterally: extension
- can assist respiration when the head is fixed
What are the attachments and actions of the longus capitis?
- anterior tubercles of transverse px of C3-6, and inferior surface of basilar part of occipital bone. Flexes, with slight assist for rotation ipsilaterally
What are the attachments and actions of the longus colli?
- multiple attachments to bodies and transverse pxs of C3-T3. Flexes and rotates.
What are the attachments and actions of the anterior scalene?
- anterior tubercles of transverse px of C3-6 and scalene tubercle/ridge on upper surface of 1st rib
- if neck is fixed, elevates the 1st rib. If rib is fixed, laterally flexes ipsilaterally and rotates contralaterally
What are the attachments and actions of the middle scalene?
- posterior tubercles of transverse pxs of C2-7 and upper surface of 1st rib behind subclavian groove.
- if neck is fixed, elevates the 1st rib. If rib is fixed, laterally flexes ipsilaterally and rotates contralaterally (same as anterior scalene)
What are the attachments and actions of the posterior scalene?
- posterior tubercles of the transverse pxs of C4-6 and outer surface of the 2nd rib behind the serratus anterior
- if neck is fixed, elevates the 2nd rib. If rib is fixed, laterally flexes ipsilaterally
What are the muscles of the anterior lower c-spine? (8)
- SCM, A/M/P scalenes, longus colli, longus capitis, splenius capitis, splenius cervicus
(a couple of these are actually kind of posterior)
What are the attachments and actions of the splenius capitis?
- ligamentum nuchae lower half/spinous pxs of C7-T3 to lateral nuchal line and mastoid px
- Bilaterally: extends
- unilaterally: laterally flex and rotate ipsilaterally
What are the attachments and actions of the splenius cervicus?
- spinous pxs of T3-6 to the posterior tubercles of C1-3 immediately anterior to the levator scapulae attachment
- Bilaterally: extends
- unilaterally laterally flexes and rotates ipsilaterally
Greater occipital neuralgia is associated with nerve compression where?
- the greater occipital nerve (C2) pierces the semispinalis cervicus. If entrapped, it can lead to greater occipital neuralgia.
What other muscles have attachments to the C-spine that can alter mechanics? What are their general attachments?
- Upper traps: nuchal line, external occipital protuberance, ligamentum nuchae, spinous px of C7
- levator scap: transverse px of C1-4
- rhomboids minor: ligamentum nuchae and spinous pxs of C7-T1
T or F;
There is not consensus about what happens arthrokinematically in the C-spine.
- T
- weird
What are the two models for arthrokinematics of the C-spine?
- When in a neutral position, the upper C-spine will sidebend/rotate in opposite directions. When either flexed or extended, then sidebend and rotation will occur ipsilaterally. Lower C-spine always sidbends/rotates ipsilaterally.
- Other model: lower c-spine sidebend/rotation is ipsilaterally when flexed, opposite when extended.
…I feel like we should know this
What are 3 appropriate intake outcome measure forms per this author?
- NDI
- patient-specific functional scale (PSFS)
- Fear-avoidance beliefs questionnaire (FABQ)
What questionnaire can be helpful to help screen for medical conditions? What conditions is it designed to help the clinician be aware of the potential for?
What should the clinician do if the pt answers positively to some of the questions?
- Head and Neck Medical Screening Questionnaire
- subarachnoid hemorrhage/stroke
- vertebrobasilar insufficiency
- meningitis
- primary brain tumor
- mild TBI/postconcussion syndrome/subdural hematoma
It’s meant as a screen. If they answer yes to some of them, and it can’t be ruled out in the clinic, they should get a consult or immediate workup depending on which diagnosis is of concern
What is the Neck and Shoulder Screening Questionnaire designed to help with? Which diagnoses are associated?
- screening for:
- cervical fx or ligamentous lesions
- cervical cord lesion
- Pancoast tumor
- septic arthritis (SC joint)
T or F;
Zygapophyseal irritation/sources of C-spine pain create pain in predictable patterns.
- T
- One study found a fairly consistent pattern of pain. Use of segmental pain charts to help localize the source of pain was found reliable on another study.
- It’s probably worth it to note more precisely where pain is, per pt report.
(This is in the section on NPRS and diagram for intake)
T or F;
Diagnosis by a trained manual manipulative therapist can be as accurate as radiologically controlled diagnostic blocks.
- T
- too early to make assumptions about inter-rater reliability though; this was off of one study, with one therapist.
What is the MDC and MCID for the NPRS?
- MDC: 2.1 (minimum amount of change that exceeds measurement error)
- MCID: 1.3 (minimum amount of change that the pts perceive as beneficial)
If a pt demonstrates desynchronized pain relationships (e.g., stating 9/10 pain, but not demonstrating being very uncomfortable) what may be the driver?
- should be questioning fear avoidance beliefs/behaviors
What is the MDC and MCID for the NDI?
- MDC: 5.0-9.5 points depending on the study. 5 is likely to be standard though; the 9.5 is newer from a larger study
- MCID: 5-10 points. Standard is 10 (20 percentage points).