CERVICAL Flashcards
Cervicocephalic
C0-C2
upper cervical spine
Cervicobrachial
C3-C7
lower cervical spine
Where greatest flexion-extension occurs
C5-C6
OPP
midway between flexion and extension
CPP
full extension
CP
side flexion and rotation> extension
Joints of Luschka or Uncinate Process
limits extension
IV discs
makes 25% of height
none in C1-C2
gives lordotic shape
Nucleus Pulposus
inner layer
compressive forces
Annulus Fibrosus
outer layer
tension
Atlanto-occipital Joint
yes joint
C0-C2 (occipital condyles and atlas)
Atlanto-Occipital Joint Actions
side flexion: 10
flexion-extension: 15-20
negligible rotation
ellipsoid
Alar Ligaments
limits flexion and rotation
major stabilizing ligament of C1-C2
Atlanto-axial Joint
no joint
C1-C2
Atlanto-axial Actions
flexion-extension: 10 deg
side flexion: 5 deg
rotation: 50 deg
pivot joint
Vertebral Artery
passes transverse process, starting at C6, entering as high as C4
20% of blood along with ICA (80%)
Movements stressing the Vertebral Artery
rotation and extension: 20
significant decrease in blood flow
4 areas where vertebral artery is greatly stressed
- transverse process of C1
- bony canals of vertebral transverse processes
- between C1-C2
- C1 going to the skull
Cervical Spondylosis
> 25 y/o
inc to 60%= 45 y/o
inc to 85%= >65 y/o
Cervical Disc Herniation
17-60
Cervical Spinal Stenosis
11-60 (30-60)
Hypertension
vertebrobasilar insufficiency
big red flag
Diabetes affecting blood
thickened blood causes nerve ischemia
Asthma (muscles)
tightness of scalenes
hypertrophy of SCM
Headaches
cervicogenic, unilateral; C1-C3
muscle tightness in the occiput
Bilateral Headache
systemic
What to ask when headache is present?
how long does it last
what triggers
relieving factors in postural change
check for temporal pattern, behavior, medications
Headache + Vomiting
vertigo
vestibular system
fluids are not balanced
Dizziness
vertebrobasilar affectation
Headache secondary to trauma
positional change won’t cause relief= normal
Atraumatic headache
positional change won’t relief= systemic/ malignancy
Assumed position in cervical spondylosis
flexion (to increase disc space since it is narrowed)
Assumed position in cervical disc herniation
extension (bring disc back to its place)
Assumed position in radiculating pain
lowered head
Cervical Radiculopathy
unilateral affectation (myotomal, dermatomal, hyporeflexia)
acute: disc herniation
chronic: spondylosis
Cervical Neuropathy
ipsilateral
secondary to disc herniations
Myofascial Pain Syndrome
diffused, generalized, aching pain
atleast 3 trigger points for atleast 3 months
Persistent pain not resolved in supination
space occupying lesions= tumors
Referred pain for thoracic spine
medial scapular border
Referred pain for C3-C4
cervicothoracic spine and ipsilateral upper trapezius
Referred pain for C4-C5
superomedial border of scapula
Referred pain for C5-C6
medial border of scapula
Referred pain for C6-C7
lower scapular area and midscapular boder
5Ds of Vertebrobasilar Insufficiency
dizziness
diplopia: double vision
drop attack: falls without provocation
dysarthia: difficulty speaking
dysphagia: difficulty swallowing
Cancer and Weight loss
sudden weight loss, no stress, and neck pain
Psychosocial Environment
stress factors can produce symptoms of upper back pain
Rust’s Sign
protective posturing of the head and neck (holding and supporting due to apprehension/ instability)
Klippel Feil Syndrome
congenital fusion of the cervical vertebra; C3-C5
Torticollis
SCM
constant full aching/ congenital/ acquired
ipsilateral flexion and contralateral rotation
Shoulder Asymmetry
atrophy of upper trapz (spinal accessory palsy) and deltoids (axillary nerve palsy)
Position where maximum relaxation of the neck is achieved
supination
Position when cervical spine is injured
head is tilted away from the pain and face tilted upwards
also seen in wry neck
Position when the pt is hysterical
head is tilted and rotated toward the pain
face is tilted downward
Protraction of the cranium
upper craniocervical: extended
lower cervical: flexed
Retraction
upper craniocervical: flexed
lower to mid cervical: extended
Upper Crossed Syndrome
tight: pectoralis major and minor; levator scapulae and upper trapezius
weak: deep neck flexors, rhomboids, serratus anterior, and lower trapezius
Habitual Chin Poking
adaptive shortening of occipital muscles
increased stress of facet joints and posterior discs
weakness of the deep neck flexors
rounded shoulders
Rounded Posture
protracted scapula, IR humerus, tight anterior structures, lengthened posterior structures
Habitual Posture
postural compensation, weak muscles, hearing loss, temporomandibular problems, wearing bifocals or trifocals
End feel
tissue stretch
Passive Physiological Intervertebral Movements
between each pair of vertebrae
check for segmental ranges
stabilizing the movement of the distal vertebrae and passively moving the head
Pain in flexion
meningitis, tumor, fracture of dens
Forward Bending
lower cervical spine (80-90 deg)
Pain in extension
vertebral vascular dysfunction, spinal cord compression
ROM of side flexion
20-45
ROM of rotation
70-90
Movement restriction in extension and right side bending
right extension hypomobility
left flexor muscle tightness
anterior capsular adhesions
right subluxation
right small disc protrusion
Movement restriction of flexion and right side bending
left extensor muscle tightness
left flexion hypomobility
Movement restriction of extension and right side bending restriction greater than extension and left side bending
left posterior capsular adhesions
left subluxations
left capsular pattern
flexion and right side bending restriction equal to extension and left side bending
left arthrofibrosis
side bending in neutral, flexion, and extension
uncovertebral hypomobility or anomaly
Myotomal Distribution
C1-C2: cervical flexion
C3 and C11: side flexion
C4 and C11: shoulder shrug
C5: shoulder abduction and er
C6: elbow flexion and wrist extension
C7: elbow extension and wrist flexion
C8: ulnar deviation and thumb extension
T1: abduction/ adduction
Hoffmann Sign
involuntary flexion movement of the thumb and or index finger when the examiner flicks the fingernail of the middle finger down
ULTT 1
median nerve, anterior interosseous nerve, C5-C7
ULTT 2
median nerve, musculocutaneous nerve, axillary nerve
ULTT 3
radial nerve
ULTT 4
ulnar nerve, C8-T1
Functional ROM Neck flexion
60-70
Functional ROM of Neck Extension
40-50
