Cervical Flashcards
Cervical biomechanics - mechanical function of C spine
Structural support for torso
flexibility of motion for activity
protect spinal cord
Cervical biomechanics - Mechanical stability - active vs pasive
active - mm (they produce force)
passive - vertebrae, ligaments, disc, facets
Cervical biomechanics - disturbances
Biological factors (obese, age, weakness, pregnancy) Fatigue injuries, surgeries
Anatomy - pillars
Triangular column of support - 3 pillars
Anatomy - ant pillar
made up of vertebral bodies - starts between C2/3
Anatomy - post pillar
made up of bilateral facets, starts at C1
Anatomy - weight distribution at pillar
Starts with 50-50 weight distribution between pillars and then becomes NWB as you get lower
Middle C spine has more weight on the facets
Anatomy - where is injury more likely
upper cervical
Anatomy - occipital condyles articulate with
sup facet of atlas (C1)
Anatomy - occipital condyles - shape
oval - convex
Anatomy - typical vertebrae
C3-C7
Anatomy - atypical vertebrae
C1 (atlas)
C2 (axis)
Anatomy - bodies of C vertebrae are
tilted forward, facets are opposite
uncinate processes are higher on lateral edge to prevent sup vert from moving forward or back
Anatomy - membrane tectoria
wide sheet of collagen fibers in dense CT, covers AA lig complex
Anatomy - apical ligament
odontoid process to ant rim of foramen magnum
Anatomy - alar ligament
dens to lateral foramen magnum
control contralateral rot and side to side motion
Anatomy - transverse ligament
occipital tubercles to lateral mass of C1
limits translation of C1 on dens
Anatomy - cruciform ligament
limits flex and ext
Cervical IVD - made of
annulus and nucleus
NO NP
Cervical IVD - thicker where
anteriorly (creates lordosis)
Cervical facet joints - capsule is
thick! except post is thin
Cervical facet joints - capsule in neutral is
very lax - creates a lot of ROM
Cervical facet joints - at end range capsules are
taut - act as stabilizing ligaments
Cervical facet joints - orientation throughout C spine
Changes from sup/post/medial at C3 to lateral at C5/6
Ant long lig
attaches to skull and vertebral body
loose att to discs
Post long lig
attaches to disc and body
Lig nuchae
continuation of supraspinous lig
connects SP
resists flex
lig flava
between laminar part of vertebrae
resists flex
Kinematics - flex ROM
40! (goni)
35-70
Kinematics - ext ROM
50! (goni)
50-77
Kinematics - LF
22 (goni)
38-53
Kinematics - Rot
50 (goni)
66-93 with 50% occuring at AA
Kinematics - first motion occurs where
OA!
Kinematics of OA with flex
Flex - Condyles glide post on atlas
Kinematics of OA with ext
condyles glide ant on atlas
Kinematics of OA with LF and rot
LIMITED!
Primary is ‘yes’
Kinmatics of AA - what motion occurs here first
rot!
NO
limited in all other motion
Kinematics of typical - how many DOF
6
entire c spine moves as unit guided by facets
kinematics of typical - during flexion
upper vertebrae glides ant and sup
kinematics of typical - during extension
upper vertebrae glides post and inf
kinematics of typical - lateral flex is coupled with
ipsilateral rotation
Ligament strain pattern - if flexion strain
lig nuchae, lig flavum, post long lig
Ligament strain pattern - if ext strain
ant long lig, ant OA membrane
SCM action
isolate motion at OA to extend head
flex C region, ipsilateral LF, contralateral rot
Ant scalene mm action
flex
LF toward and rotate away
(same as SCM)
Mid scalene mm action
flex and LF toward
Post scalene mm action
flexion
LF toward and rot toward
Neutral zone is where
head is moved passively without resistance where compression and tissue loads are at a min (10 LF, flex, ext, and 30 rot)
Whiplash - most dangerous if
structures are stretched apart in horizontal setting - soft tissue will be injured first but if all other structures fail, will eventually go down into spinal cord
VBI - s/s
5 Ds, 3 Ns
Dizzy, diplopia, dysphagia, dysarthria, drop attack
Nystagmus, nauseous, numbness
VBI - compromising position
contralateral rot, end range ext, extreme motions
VBI - gold standard to diagnose
doppler US
Cranio-vertebral ligament injuries - MOI
trauma
Cranio-vertebral ligament injuries - S/s
same as VBI (5 Ds, 3Ns)
also might have mouth/lip pareesthesias and feeling of lump in throat if dens involved
Cervical myelopathy is what
UMN lesion (to SC)
Cervical myelopathy s/s
UMN signs - spasticity, hyerreflexia, visual/balance disturbance, ataxia, b/b changes, paresthesias
Facet movement - typical - close packed in
full extension
Facet movement - typical - coupled motion
LF and Rot in SAME
Ipsilateral facet closes with L
Ipsilateral facet opens with rot
Facet - OA coupled motion
LF and rot in OPP direction
Cervical sponylosis (DDD) - capsular pattern - OA
extension and LF B
contralateral LF unilaterally
Cervical spondylosis (DDD) - capsular pattern - Typical
extension then rot and LF B, contralateral flex and rot unilaterally
IV disc is stressed with
rotation
will have pain with rotation if IVD are injured
IVD herniation s/s - agg and rel
agg - with sustained postures, compression, repeated flex
rel - activity, traction
rim lesion is what
horizontal tear of AF
usually from hyperextension or whiplash
Pain with compression and distraction - think
rim lesion as a possibility
What will show tear of AF for diagnosis of rim lesion
MRI
Cervical nerve roots are numbered for
the vertebrae below it
IV foramen does what with flex and ext
widens with flex
narrows with ext
Cervical radiculopathy - exam will show
pos neurodynamic testing
cervical rot less than 60 to painful side
relief with distraction
pain with Spurlings test
Post functional load testing
prone in neutral, hold 15 sec without fatigue
Ant functional load testing
supine in neutral for ____ ?
Deep neck flexor strengthening with pressure biofeedback
20 mmHg, increase 6-10 mmHg
hold for 10 sec with no substitutions
Hoffman’s sign
UMN
flick distal phalanx of middle finger and if thumb moves is positive
Spurlings
flex, ext, LF
Upper trap length
Flex
LF away
Rot towards
Levator length
Flex
LF away
Rot away
Scalene - ant, middle, post
ant = LF toward, rotate away middle = LF toward, neutral rotation post = LF toward, rotate toward
All flex too
Spurling
Compression with varying motion
Spurling when you add LF and extension
Transverse ligament special test
Sharp Puser Stabilize forehead and C2 Glide head and C1 post (relocation test) May hear clunk, see excessive mvmnt, or pt will have dec in lip numbness POS = MED EMERGENCY
Alar ligament special test
Stabilize C2
LF and rot head to assess mobility of C2
Tectorial membrane special test
Stabilize C2
apply traction
Reassess with flex/ext
Pos if reproduce sx or if distraction of more than 1-2mm
