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COMP ORTHO > Cervical > Flashcards

Cervical Flashcards

1
Q

Cervical biomechanics - mechanical function of C spine

A

Structural support for torso
flexibility of motion for activity
protect spinal cord

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2
Q

Cervical biomechanics - Mechanical stability - active vs pasive

A

active - mm (they produce force)

passive - vertebrae, ligaments, disc, facets

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3
Q

Cervical biomechanics - disturbances

A 
Biological factors (obese, age, weakness, pregnancy) 
Fatigue injuries, surgeries
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4
Q

Anatomy - pillars

A

Triangular column of support - 3 pillars

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5
Q

Anatomy - ant pillar

A

made up of vertebral bodies - starts between C2/3

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6
Q

Anatomy - post pillar

A

made up of bilateral facets, starts at C1

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7
Q

Anatomy - weight distribution at pillar

A

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

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8
Q

Anatomy - where is injury more likely

A

upper cervical

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9
Q

Anatomy - occipital condyles articulate with

A

sup facet of atlas (C1)

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10
Q

Anatomy - occipital condyles - shape

A

oval - convex

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11
Q

Anatomy - typical vertebrae

A

C3-C7

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12
Q

Anatomy - atypical vertebrae

A

C1 (atlas)

C2 (axis)

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13
Q

Anatomy - bodies of C vertebrae are

A

tilted forward, facets are opposite

uncinate processes are higher on lateral edge to prevent sup vert from moving forward or back

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14
Q

Anatomy - membrane tectoria

A

wide sheet of collagen fibers in dense CT, covers AA lig complex

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15
Q

Anatomy - apical ligament

A

odontoid process to ant rim of foramen magnum

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16
Q

Anatomy - alar ligament

A

dens to lateral foramen magnum

control contralateral rot and side to side motion

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17
Q

Anatomy - transverse ligament

A

occipital tubercles to lateral mass of C1

limits translation of C1 on dens

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18
Q

Anatomy - cruciform ligament

A

limits flex and ext

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19
Q

Cervical IVD - made of

A

annulus and nucleus

NO NP

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20
Q

Cervical IVD - thicker where

A

anteriorly (creates lordosis)

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21
Q

Cervical facet joints - capsule is

A

thick! except post is thin

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22
Q

Cervical facet joints - capsule in neutral is

A

very lax - creates a lot of ROM

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23
Q

Cervical facet joints - at end range capsules are

A

taut - act as stabilizing ligaments

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24
Q

Cervical facet joints - orientation throughout C spine

A

Changes from sup/post/medial at C3 to lateral at C5/6

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25
Q

Ant long lig

A

attaches to skull and vertebral body

loose att to discs

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26
Q

Post long lig

A

attaches to disc and body

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27
Q

Lig nuchae

A

continuation of supraspinous lig
connects SP
resists flex

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28
Q

lig flava

A

between laminar part of vertebrae

resists flex

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29
Q

Kinematics - flex ROM

A

40! (goni)

35-70

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30
Q

Kinematics - ext ROM

A

50! (goni)

50-77

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31
Q

Kinematics - LF

A

22 (goni)

38-53

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32
Q

Kinematics - Rot

A

50 (goni)

66-93 with 50% occuring at AA

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33
Q

Kinematics - first motion occurs where

A

OA!

34
Q

Kinematics of OA with flex

A

Flex - Condyles glide post on atlas

35
Q

Kinematics of OA with ext

A

condyles glide ant on atlas

36
Q

Kinematics of OA with LF and rot

A

LIMITED!

Primary is ‘yes’

37
Q

Kinmatics of AA - what motion occurs here first

A

rot!
NO
limited in all other motion

38
Q

Kinematics of typical - how many DOF

A

6

entire c spine moves as unit guided by facets

39
Q

kinematics of typical - during flexion

A

upper vertebrae glides ant and sup

40
Q

kinematics of typical - during extension

A

upper vertebrae glides post and inf

41
Q

kinematics of typical - lateral flex is coupled with

A

ipsilateral rotation

42
Q

Ligament strain pattern - if flexion strain

A

lig nuchae, lig flavum, post long lig

43
Q

Ligament strain pattern - if ext strain

A

ant long lig, ant OA membrane

44
Q

SCM action

A

isolate motion at OA to extend head

flex C region, ipsilateral LF, contralateral rot

45
Q

Ant scalene mm action

A

flex
LF toward and rotate away
(same as SCM)

46
Q

Mid scalene mm action

A

flex and LF toward

47
Q

Post scalene mm action

A

flexion

LF toward and rot toward

48
Q

Neutral zone is where

A

head is moved passively without resistance where compression and tissue loads are at a min (10 LF, flex, ext, and 30 rot)

49
Q

Whiplash - most dangerous if

A

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

50
Q

VBI - s/s

A

5 Ds, 3 Ns
Dizzy, diplopia, dysphagia, dysarthria, drop attack
Nystagmus, nauseous, numbness

51
Q

VBI - compromising position

A

contralateral rot, end range ext, extreme motions

52
Q

VBI - gold standard to diagnose

A

doppler US

53
Q

Cranio-vertebral ligament injuries - MOI

A

trauma

54
Q

Cranio-vertebral ligament injuries - S/s

A

same as VBI (5 Ds, 3Ns)

also might have mouth/lip pareesthesias and feeling of lump in throat if dens involved

55
Q

Cervical myelopathy is what

A

UMN lesion (to SC)

56
Q

Cervical myelopathy s/s

A

UMN signs - spasticity, hyerreflexia, visual/balance disturbance, ataxia, b/b changes, paresthesias

57
Q

Facet movement - typical - close packed in

A

full extension

58
Q

Facet movement - typical - coupled motion

A

LF and Rot in SAME
Ipsilateral facet closes with L
Ipsilateral facet opens with rot

59
Q

Facet - OA coupled motion

A

LF and rot in OPP direction

60
Q

Cervical sponylosis (DDD) - capsular pattern - OA

A

extension and LF B

contralateral LF unilaterally

61
Q

Cervical spondylosis (DDD) - capsular pattern - Typical

A

extension then rot and LF B, contralateral flex and rot unilaterally

62
Q

IV disc is stressed with

A

rotation

will have pain with rotation if IVD are injured

63
Q

IVD herniation s/s - agg and rel

A

agg - with sustained postures, compression, repeated flex

rel - activity, traction

64
Q

rim lesion is what

A

horizontal tear of AF

usually from hyperextension or whiplash

65
Q

Pain with compression and distraction - think

A

rim lesion as a possibility

66
Q

What will show tear of AF for diagnosis of rim lesion

A

MRI

67
Q

Cervical nerve roots are numbered for

A

the vertebrae below it

68
Q

IV foramen does what with flex and ext

A

widens with flex

narrows with ext

69
Q

Cervical radiculopathy - exam will show

A

pos neurodynamic testing
cervical rot less than 60 to painful side
relief with distraction
pain with Spurlings test

70
Q

Post functional load testing

A

prone in neutral, hold 15 sec without fatigue

71
Q

Ant functional load testing

A

supine in neutral for ____ ?

72
Q

Deep neck flexor strengthening with pressure biofeedback

A

20 mmHg, increase 6-10 mmHg

hold for 10 sec with no substitutions

73
Q

Hoffman’s sign

A

UMN

flick distal phalanx of middle finger and if thumb moves is positive

74
Q

Spurlings

A

flex, ext, LF

75
Q

Upper trap length

A

Flex
LF away
Rot towards

76
Q

Levator length

A

Flex
LF away
Rot away

77
Q

Scalene - ant, middle, post

A 
ant = LF toward, rotate away
middle = LF toward, neutral rotation
post = LF toward, rotate toward

All flex too

78
Q

Spurling

A

Compression with varying motion

Spurling when you add LF and extension

79
Q

Transverse ligament special test

A 
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
80
Q

Alar ligament special test

A

Stabilize C2

LF and rot head to assess mobility of C2

81
Q

Tectorial membrane special test

A

Stabilize C2
apply traction
Reassess with flex/ext
Pos if reproduce sx or if distraction of more than 1-2mm

COMP ORTHO (11 decks)

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