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foundations > cervical > Flashcards

cervical Flashcards

1
Q

Why is there a bifid spinous process in the mid cervical spine?

A

For attachement of ligamentum nuchae - except the transition to tpsine

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2
Q

Why is the angle of the articular process?

A

45 degrees

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3
Q

Foramen Transverasum

A

6th vert entry, and 1st very exit for vertebral artery

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4
Q

C/T junction level

A

C6

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5
Q

Transition to upper c/s

A

C2-3

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6
Q

Uncovertebral joints/Joint of vonlushka

A

Uncinated process to protect disc and stabilize c/s. Saddle joints. decrease disc herniations

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7
Q

Intra-articular inclusions

A
  • Intra-articular fat pads (AO jt)
  • Fibro-adipose meniscoid (not in AO)
  • Capsular rims: wedge shapped
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8
Q

Function of zygapophysial joints

A
  • Compensate for incongruency
  • Distribute synovial fluid
  • Preservation of articular edges
  • Transmission of forces
  • Fill space
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9
Q

Acute neck pain like due to

A

Zygapopgysial Joint dysfunction

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10
Q

Uncovertebral joints

A
  • limit lateral bending

- guide flexion and extension

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11
Q

Bogduk: U joints

A

clefts facilitate rotation and SB in plain facet

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12
Q

Panjabi: U joints

A

Uncinate process protects against disc herniation

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13
Q

C1-3 anastamose with…

A

CN9 and 10.

Can refer up to C2-3, creating cervicogenic HA

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14
Q

C4 and below refer to

A

scapula

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15
Q

C7 refers to

A

top of 1st rib

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16
Q

McKenzie: Dysfunction

A

aberrant function of musculoskeletal system

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17
Q

McKenzie: Derangement

A

disc

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18
Q

McKenzie: Postural

A

time dependent

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19
Q

PLL

A

becomes thicker and forms the tectoral membrane in the upper c/s

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20
Q

Intratransverse lig

A

Stabilize AA segment and protects spinal cord from dens

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21
Q

Alar Lig

A
  • Dens to occiput, stabilize dens.

- tightens with side cocking

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22
Q

Apical lig

A
  • dens to occiput, holds dens to foramen magnum

- Has proprioceptive properties

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23
Q

Cruiciform lig

A
  • transverse and longitudinal portions
  • holds axis tight against atlas
  • prevents anterior shear of axis
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24
Q

Ligamentum Nuchae

A
  • Connections to spinal dura between Occiput-C2
  • Innervated by upper c/s nerves
  • Dense, bilaminar, tiangular midline fibroelastic intermuscular septum
  • Occipital protuberence to spine of C7
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25
Q

Snell: lig nuchae

A

C1 and C5-6: nuchal lig convergence prevents anterior shear

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26
Q

Nerves: Facet degeneration

A

Sensory problems more common

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27
Q

Nerves: disc herniation

A

motor problems more common

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28
Q

Posterior Scalenes

A

TP C5-7 to 2nd rib

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29
Q

Middle Scalenes

A

TP C2-7 to 1st rib

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30
Q

Anterior Scalenes

A

TP C3-6 to 1st rib

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31
Q

Longus Coli

A

Bodies C5-T3 to ant arch of atlas

-Can flatten lordosis

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32
Q

Rec cap post minor

A
  • SP of axis to inf nuchal line

- HAs, O/AA control

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33
Q

Rec cap post major

A
  • post arch of atlas to inf nuchal line

- Extension/rotation, AO stability

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34
Q

Obliquus sup

A

-TP of atlas to occipital bone

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35
Q

Obliquus inf

A
  • SP of axis to TP of atlas

- largest suboccipital

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36
Q

SCM

A

manubrium to mastoid

-SCM fires because ant cervical m. are weak

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37
Q

Levator scap

A

TP C1-4 to sup med border of scap.

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38
Q

Dvorak: Inclination of lower facets

A
  • 45 deg to horizontal

- lower segments steeper than upper

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39
Q

Mercer: angular vs linear displacement

A
  • Upper cervical: anterior linear motion

- lower cervical: anterior angular displacement

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40
Q

Bogduk arthrokinematics

A

-SB and rotation occurs around an oblique axis, perpendicular to plane of z-joints

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41
Q

Craniovertebral region (C0-3) anatomy

A
  • No discs
  • apophyseal joints do weight bearing
  • no vertebral body C1. C2 has dens
  • VA runs through TP, back and around. Ant trans of atlas can compress VA
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42
Q

Fryette’s 1st law: c/s

A

In the UPPER cervical spine, C1-2 = contralatearl SB and rotation always.

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43
Q

Fryette’s 2nd law: c/s

A

In the MID and LOWER c/s, C2-6 = ALWAYS ipsilatearl SB and rotation.

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44
Q

Fryettet’s 3rd law

A

Motion introduced into any motion segment, available motion in other planes is reduced

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45
Q

Why is the mid-lower c/s ALWAYS type 2 motion?

A
  • Universal joint: J of VL = saddle joint
  • Presence of disc and its location
  • Muscle pulls
  • 45 deg facet orientation
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46
Q

Arthrokinematics of mid-lower c/s motion

A
  • Flexion = facets open/sup glide
  • extension = facets close/inf glide
  • SB R: R facet close, L facet open
  • Rot R: R facet close, L facet open
47
Q

Arthrokinematics of upper c/s: AO joint

A

Concave condyles on concave atlas:

  • Opposite roll and glide
  • Flex = ant roll, post glide
48
Q

Arthokinematics of upper c/s” AA joint

A

convex on convex:

  • rolls and slides in same direction
  • 45 degrees of rotation
49
Q

Atypical vertebrae

A
  • T1 (10, 11, 12) = transitional verts

- T1 only attached to 1st rib

50
Q

Atypical ribs

A
  • Rib 1 and 2

- Ribs 11 and 12

51
Q

Rib 1

A

-most curved, most inf oriented, only articulates with T1

52
Q

Rib 2

A

-lack of twist through shaft and small facet on tubercle

53
Q

Rib 1 and 2 function

A

Rib 1-2 move slightly during quiet respiration

-maintain stability of top of thoracic cavity, prevent collapse as air pressure is reduced

54
Q

Neck tongue syndrome

A

Cyriax: C3 root pain with neck rotation and ipsilatearl tongue and palate tingling/numbness
-Lane/anthony: compression of C2 nerve in atlantoaxial space on sharp neck rotation. Afferent nerves from lingual nerve travel to hypoglossal to C2 and 3rd root

55
Q

Vertebro-basilar ischemia causes

A
  • Intrinsic: atherosclerosis, embolithrombus, dissection/pseudo aneurysm
  • Extrinsic: osteophytosis, instability, subluxation, disc prolapse (c4-6), motion (traction, ext, rot)
56
Q

Reasons to test for VBI

A
  • hx of: trauma, dizziness, nausea, severe HAs, blurred vision, drop attacks
  • prior to performing c/s mob/manip/tx
57
Q

When to d/c tx in regards to VBI

A
  • cardinal signs elicited
  • drop attack
  • distal paresthesias (feet/hands/lips)
  • lateral nystagmus
58
Q

Anatomy of vertebrobasilar system

A
  • Enters costotransverse foramen at C6
  • cranially to axis
  • post lat to costotransverse foramen of atlas
  • Forms post-sup directed loop, enters atlanto-occipital membrane and dura mater at foramen magnum
59
Q

Stress on vertebrobasialar system

A
  • Rotate C1-2 = major shear of VA
  • R rot = occlude L, elongate R VA
  • Extension = occlude both, tests carotid as well
60
Q

Highest incidence of VBI (age)

61
Q

Incidence of VBI

A

1 in a million (haldeman)

3 in a million (gutman and dvorak)

62
Q

Mechanism of VBI

A
  • Variation in caliber of vert art
  • fragility of VAs at occipitocervical junction
  • Susceptibility of VA to compression
  • Effect of head movement on VA
  • Influence of degenerative joint changes on VA flow
  • VA aneurysm
63
Q

VBI signs and symptoms: 7 Ds

A
  • Dizziness
  • Distress
  • Diploplia
  • Dysarthria
  • Distal paresthesias
  • Drop attacks
  • Uneven pupil dilation
64
Q

Spondyloarthropathies affecting upper c/s

A
  • RA, juvenile RA
  • Ankylosing spondylosis
  • psoriasis
  • reiter’s syndrome
  • degenerative jt disease
  • gout
  • systemic lupus erythematosis SLE
  • septic arthritis
65
Q

Pathomechanics of OA joint:

Anterior dysfunction

A

More evident with extension

66
Q

Pathomechanics of OA joint:

Posterior dysfunction

A

More evident with flexion

67
Q

Pathomechanics of OA joint:

FOES

A

Flexion: chin deviate opposite side of posterior joint that is restricted
Extension: chin deviates to same side of posterior joint that is restriced

68
Q

Pathology: C8 root lesion

A

lower scap pain, radiates down back or medial arm and forearm with paresthesisas and pain in ulnar 2 digits
-weak ulnar deviation, ext and abd of thumb, tricep

69
Q

Pathology: T1 root lesion

A
  • Pain in lower pec/scap region to medial upper and lower arm to wrist.
  • No motor weakness
70
Q

Pathology: T2 root lesion

A

RARE

Pec/scap pain to medial upper arm, no weakness

71
Q

Pathology: horner’s syndrome

A

Cause = interference of cervicothoracic outflow at T1, pancoast tumor, pulmonary sulcus
-pupil constriction, eye recession, facial flushing, dec/absent sweating, ptosis

72
Q

Pathology: visceral

A

heart, lungs, breast, thyroud, esophagus/throat, lymph glands, parotid gland

73
Q

Pathology: vascular

A

VBI, TIA, cervical myelopathy secondary to segmental vascular deprivation, vascular HAs

74
Q

Pathology: neurogenic:

A

brain, spinal cord, nerve root, dural sheath, foraminal compression, traction injury, brachial plexus (nerve trunk)

75
Q

Pathology: psychogenic

A

whiplash, tension HA, anxiety

76
Q

Pathology: Spondylogenic

A

osseus, osteoporosis, fracture/fracture dislocaiton, structural defects, ligamentous, muscular, cervical disc, discitis, chordoma, systemic hypertension, hodgin’s disease, zygopophyseal joints, uncovertebral joints

77
Q

Cervical scan/screen:

Observation

A

Deformity, scars, muscle wasting, skin redness/marks, facial asymmetry, forward head posture etc

78
Q

Cervical scan/screen:

Active c/s mvmt with OP

A
  • Planar motion: range, symptoms, ease of motion, symmetry. Upper vs lower
  • Axial flex: poke chin forward
  • Flexion: chin to throat, to chest
  • Ext: lift chin, face to ceiling
  • SB: axis through nose & lift one ear, ear to shoulder
79
Q

Cervical scan/screen:

Isometric resisted head movements

A

flex, ext, SB, rot

80
Q

Cervical scan/screen:

Compression test

A

-Disc vs fracture

81
Q

Cervical scan/screen:

Traction test

A

-disc vs fracture

82
Q

Cervical scan/screen:

Neurological

A
  • MMT C4-T1
  • Sensation
  • UMN signs (increased DTR, increased tone)
  • Neural mobility, dural stretch, neural tension, slump
83
Q

Scan analysis: Myelopathy

A

Spinal cord issue, stop and contact doctor

84
Q

Scan analysis: neuropathy

A

nerve roots/trunks:
>1 = caution
1-2 non adjacent = STOP

85
Q

Scan analysis: spinal dysfunction

A

Do biomechanical eval

  • presents with altered spinal motion, position, and tissue tension
  • derangement, dysfunction,postural
86
Q

Scan analysis: medical problem

A

contact MD

87
Q

Scan analysis: alternate problems

A

shoulder, elbow, wrist, etc

88
Q

Biomechanical assessment:

Soft tissue palpation

A
  • Muscles (spasm, hypertonus, etc)

- Joint capsules (fluctuant, fibrotic, bony)

89
Q

Biomechanical assessment:

positional tests

A

-Assess relative position of adjacent laminae and articular processes: neutral, flex, ext

90
Q

Biomechanical assessment:
articular motion testing:
lateral translation

A
  • Hard EF in neutral and flex = lack of sup-ant glide on contralateral side of SB
  • Hard EF in neutral and ex = lack of inf-post glide on ipsilateral side of SB
91
Q

Biomechanical assessment:
articular motion testing:
PIVM in flex and ext

A

-Assessment of angular joint motion

92
Q

Biomechanical assessment:
articular motion testing:
Combined motion testing: clover leaf

A
  • Mobility/instability
  • Looking for consistent block to motion that indicates hypomobility.
  • Inconsistent findings -> consider instability
93
Q

Biomechanical assessment:
articular motion testing:
Lee - Stress/stability tests: anterior/ventral

A

-Anterior shear with simple lift. can block inf vert

94
Q

Biomechanical assessment:
articular motion testing:
Lee - Stress/stability tests: posterior/dorsal

A

dorsal pressure

95
Q

Biomechanical assessment:
articular motion testing:
Lee - Stress/stability tests: longitudinal disraction/traction

A

Block inf vert with mama cat grip

96
Q

Linear Stress test:

Anterior

A
  • Both fingertips at posterior articular pillar of sup vert of motion segment.
  • glide sup segment anterior
97
Q

Linear Stress test:

Posterior

A

both fingertips on post articular pillar of inf vert of motion segment, thumbs on anterior articular pillar of sup vert.
Tips stabilize, thumbs glide sup seg posterior

98
Q

Linear Stress test:

Lateral

A

Stabilize lower segment at articular pillar, other hand translates upper segment in opposite direction

99
Q

Linear Stress test:

Rotation

A

Stabilize posterior articular pillar of inf vert, other hand trans sup vert opposite pillar forward

100
Q

SCAAT testing

A
  • Sharp-purser’s test
  • Cranial-atlas lift
  • Atlas-axis shear
  • Alar lig test: cranial tilt
  • Tectorial 3 stage test
101
Q

Sharp-purser’s test

A

transverse ligament

  • Reduction test - start with symptoms and if they go away its +
  • Posterior hand blocks C2, hand on forehead pushes C1 posteirorly
102
Q

Cranial-Atlas Lift

A

Transverse ligament
-Cradle occiput with palms and use finger tips along post arch of C1- translate C1 ant in relation to C2
+ = reproduction of cardinal signs, clunking, crepitus, excess mobility

103
Q

Atlas-axis shear

A

transverse ligament

-prox phalanx of one hand stabilize C2 at articular pillar, other hand on TP of C1 shearing it in opposite direction

104
Q

Alar ligament test: cranial tilt #1

A

Option 1: stabilize post arch of C2 and use opposite hand to SB head R or L, should be almost NO motion

105
Q

Alar ligament test: cranial tilt #2

A

Option 2: C@ SP contacted with middle digit, head side tilted R, feel for SP contact on L finger. Repeat to L, in neutral, flex, and ext

106
Q

Tectorial “3 stage” test

A
  1. Traction of cranium in neutral
  2. Traction of cranium in upper c/s flex
  3. Hold C2 with mama cat grip, traction occiput/C1
107
Q

Cv lig stress test

A
  1. traction
  2. anterior shear C1/2
  3. ant/post shear C0/1
  4. Transverse/coronal stress test
  5. SBing
108
Q

VBI testing

A

Both upp and lower c/s:

  1. traction
  2. rotation
  3. extension
  4. extension with traction
  5. extension with rotation
  6. extension with rotation and traction
109
Q

Segmental mobility: O/A joint

A

OA and AA movement is contralateral

  1. traction/compression
  2. flex
  3. ext
  4. SB/rot
  5. lateral translation
110
Q

OA movement with lateral shear

A
  • Hard EF in neutral and flex = lack of post/lat glide/roll on contralateral side of SB (same side as shear)
  • Hard EF in neutral and ext = lack of ant/med glide/roll on ipsilat side
  • NO uncovertebral joints
111
Q

C1-2 rotation test

A

1: fully flex, rotate either direction.
2. Fully SB, rotate opposite SB.
~45 deg rot from C1-2

112
Q

Segmental mobility AA joint

A
  1. ext
  2. rot
  3. SB
  4. combined motion
113
Q

AA movement with lateral translation

A

AA movement contralateral

  • Hard EF in neutral and flex = lack of sup.ant glide on contralateral side of SB
  • Hard EF in neutral and ext = lack of inf/post glide on ipsilat side of SB

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