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
2
Q
Why is the angle of the articular process?
A
45 degrees
3
Q
Foramen Transverasum
A
6th vert entry, and 1st very exit for vertebral artery
4
Q
C/T junction level
A
C6
5
Q
Transition to upper c/s
A
C2-3
6
Q
Uncovertebral joints/Joint of vonlushka
A
Uncinated process to protect disc and stabilize c/s. Saddle joints. decrease disc herniations
7
Q
Intra-articular inclusions
A
- Intra-articular fat pads (AO jt)
- Fibro-adipose meniscoid (not in AO)
- Capsular rims: wedge shapped
8
Q
Function of zygapophysial joints
A
- Compensate for incongruency
- Distribute synovial fluid
- Preservation of articular edges
- Transmission of forces
- Fill space
9
Q
Acute neck pain like due to
A
Zygapopgysial Joint dysfunction
10
Q
Uncovertebral joints
A
- limit lateral bending
- guide flexion and extension
11
Q
Bogduk: U joints
A
clefts facilitate rotation and SB in plain facet
12
Q
Panjabi: U joints
A
Uncinate process protects against disc herniation
13
Q
C1-3 anastamose with…
A
CN9 and 10.
Can refer up to C2-3, creating cervicogenic HA
14
Q
C4 and below refer to
A
scapula
15
Q
C7 refers to
A
top of 1st rib
16
Q
McKenzie: Dysfunction
A
aberrant function of musculoskeletal system
17
Q
McKenzie: Derangement
A
disc
18
Q
McKenzie: Postural
A
time dependent
19
Q
PLL
A
becomes thicker and forms the tectoral membrane in the upper c/s
20
Q
Intratransverse lig
A
Stabilize AA segment and protects spinal cord from dens
21
Q
Alar Lig
A
- Dens to occiput, stabilize dens.
- tightens with side cocking
22
Q
Apical lig
A
- dens to occiput, holds dens to foramen magnum
- Has proprioceptive properties
23
Q
Cruiciform lig
A
- transverse and longitudinal portions
- holds axis tight against atlas
- prevents anterior shear of axis
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
25
Snell: lig nuchae
C1 and C5-6: nuchal lig convergence prevents anterior shear
26
Nerves: Facet degeneration
Sensory problems more common
27
Nerves: disc herniation
motor problems more common
28
Posterior Scalenes
TP C5-7 to 2nd rib
29
Middle Scalenes
TP C2-7 to 1st rib
30
Anterior Scalenes
TP C3-6 to 1st rib
31
Longus Coli
Bodies C5-T3 to ant arch of atlas
| -Can flatten lordosis
32
Rec cap post minor
- SP of axis to inf nuchal line
| - HAs, O/AA control
33
Rec cap post major
- post arch of atlas to inf nuchal line
| - Extension/rotation, AO stability
34
Obliquus sup
-TP of atlas to occipital bone
35
Obliquus inf
- SP of axis to TP of atlas
| - largest suboccipital
36
SCM
manubrium to mastoid
| -SCM fires because ant cervical m. are weak
37
Levator scap
TP C1-4 to sup med border of scap.
38
Dvorak: Inclination of lower facets
- 45 deg to horizontal
| - lower segments steeper than upper
39
Mercer: angular vs linear displacement
- Upper cervical: anterior linear motion
| - lower cervical: anterior angular displacement
40
Bogduk arthrokinematics
-SB and rotation occurs around an oblique axis, perpendicular to plane of z-joints
41
Craniovertebral region (C0-3) anatomy
- 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
42
Fryette's 1st law: c/s
In the UPPER cervical spine, C1-2 = contralatearl SB and rotation always.
43
Fryette's 2nd law: c/s
In the MID and LOWER c/s, C2-6 = ALWAYS ipsilatearl SB and rotation.
44
Fryettet's 3rd law
Motion introduced into any motion segment, available motion in other planes is reduced
45
Why is the mid-lower c/s ALWAYS type 2 motion?
- Universal joint: J of VL = saddle joint
- Presence of disc and its location
- Muscle pulls
- 45 deg facet orientation
46
Arthrokinematics of mid-lower c/s motion
- 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
Arthrokinematics of upper c/s: AO joint
Concave condyles on concave atlas:
- Opposite roll and glide
- Flex = ant roll, post glide
48
Arthokinematics of upper c/s" AA joint
convex on convex:
- rolls and slides in same direction
- 45 degrees of rotation
49
Atypical vertebrae
- T1 (10, 11, 12) = transitional verts
| - T1 only attached to 1st rib
50
Atypical ribs
- Rib 1 and 2
| - Ribs 11 and 12
51
Rib 1
-most curved, most inf oriented, only articulates with T1
52
Rib 2
-lack of twist through shaft and small facet on tubercle
53
Rib 1 and 2 function
Rib 1-2 move slightly during quiet respiration
| -maintain stability of top of thoracic cavity, prevent collapse as air pressure is reduced
54
Neck tongue syndrome
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
Vertebro-basilar ischemia causes
- Intrinsic: atherosclerosis, embolithrombus, dissection/pseudo aneurysm
- Extrinsic: osteophytosis, instability, subluxation, disc prolapse (c4-6), motion (traction, ext, rot)
56
Reasons to test for VBI
- hx of: trauma, dizziness, nausea, severe HAs, blurred vision, drop attacks
- prior to performing c/s mob/manip/tx
57
When to d/c tx in regards to VBI
- cardinal signs elicited
- drop attack
- distal paresthesias (feet/hands/lips)
- lateral nystagmus
58
Anatomy of vertebrobasilar system
- 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
Stress on vertebrobasialar system
- Rotate C1-2 = major shear of VA
- R rot = occlude L, elongate R VA
- Extension = occlude both, tests carotid as well
60
Highest incidence of VBI (age)
35-42 y/o
61
Incidence of VBI
1 in a million (haldeman)
| 3 in a million (gutman and dvorak)
62
Mechanism of VBI
- 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
VBI signs and symptoms: 7 Ds
- Dizziness
- Distress
- Diploplia
- Dysarthria
- Distal paresthesias
- Drop attacks
- Uneven pupil dilation
64
Spondyloarthropathies affecting upper c/s
- RA, juvenile RA
- Ankylosing spondylosis
- psoriasis
- reiter's syndrome
- degenerative jt disease
- gout
- systemic lupus erythematosis SLE
- septic arthritis
65
Pathomechanics of OA joint:
| Anterior dysfunction
More evident with extension
66
Pathomechanics of OA joint:
| Posterior dysfunction
More evident with flexion
67
Pathomechanics of OA joint:
| FOES
Flexion: chin deviate opposite side of posterior joint that is restricted
Extension: chin deviates to same side of posterior joint that is restriced
68
Pathology: C8 root lesion
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
Pathology: T1 root lesion
- Pain in lower pec/scap region to medial upper and lower arm to wrist.
- No motor weakness
70
Pathology: T2 root lesion
RARE
| Pec/scap pain to medial upper arm, no weakness
71
Pathology: horner's syndrome
Cause = interference of cervicothoracic outflow at T1, pancoast tumor, pulmonary sulcus
-pupil constriction, eye recession, facial flushing, dec/absent sweating, ptosis
72
Pathology: visceral
heart, lungs, breast, thyroud, esophagus/throat, lymph glands, parotid gland
73
Pathology: vascular
VBI, TIA, cervical myelopathy secondary to segmental vascular deprivation, vascular HAs
74
Pathology: neurogenic:
brain, spinal cord, nerve root, dural sheath, foraminal compression, traction injury, brachial plexus (nerve trunk)
75
Pathology: psychogenic
whiplash, tension HA, anxiety
76
Pathology: Spondylogenic
osseus, osteoporosis, fracture/fracture dislocaiton, structural defects, ligamentous, muscular, cervical disc, discitis, chordoma, systemic hypertension, hodgin's disease, zygopophyseal joints, uncovertebral joints
77
Cervical scan/screen:
| Observation
Deformity, scars, muscle wasting, skin redness/marks, facial asymmetry, forward head posture etc
78
Cervical scan/screen:
| Active c/s mvmt with OP
- 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
Cervical scan/screen:
| Isometric resisted head movements
flex, ext, SB, rot
80
Cervical scan/screen:
| Compression test
-Disc vs fracture
81
Cervical scan/screen:
| Traction test
-disc vs fracture
82
Cervical scan/screen:
| Neurological
- MMT C4-T1
- Sensation
- UMN signs (increased DTR, increased tone)
- Neural mobility, dural stretch, neural tension, slump
83
Scan analysis: Myelopathy
Spinal cord issue, stop and contact doctor
84
Scan analysis: neuropathy
nerve roots/trunks:
>1 = caution
1-2 non adjacent = STOP
85
Scan analysis: spinal dysfunction
Do biomechanical eval
- presents with altered spinal motion, position, and tissue tension
- derangement, dysfunction,postural
86
Scan analysis: medical problem
contact MD
87
Scan analysis: alternate problems
shoulder, elbow, wrist, etc
88
Biomechanical assessment:
| Soft tissue palpation
- Muscles (spasm, hypertonus, etc)
| - Joint capsules (fluctuant, fibrotic, bony)
89
Biomechanical assessment:
| positional tests
-Assess relative position of adjacent laminae and articular processes: neutral, flex, ext
90
Biomechanical assessment:
articular motion testing:
lateral translation
- 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
Biomechanical assessment:
articular motion testing:
PIVM in flex and ext
-Assessment of angular joint motion
92
Biomechanical assessment:
articular motion testing:
Combined motion testing: clover leaf
- Mobility/instability
- Looking for consistent block to motion that indicates hypomobility.
- Inconsistent findings -> consider instability
93
Biomechanical assessment:
articular motion testing:
Lee - Stress/stability tests: anterior/ventral
-Anterior shear with simple lift. can block inf vert
94
Biomechanical assessment:
articular motion testing:
Lee - Stress/stability tests: posterior/dorsal
dorsal pressure
95
Biomechanical assessment:
articular motion testing:
Lee - Stress/stability tests: longitudinal disraction/traction
Block inf vert with mama cat grip
96
Linear Stress test:
| Anterior
- Both fingertips at posterior articular pillar of sup vert of motion segment.
- glide sup segment anterior
97
Linear Stress test:
| Posterior
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
Linear Stress test:
| Lateral
Stabilize lower segment at articular pillar, other hand translates upper segment in opposite direction
99
Linear Stress test:
| Rotation
Stabilize posterior articular pillar of inf vert, other hand trans sup vert opposite pillar forward
100
SCAAT testing
- Sharp-purser's test
- Cranial-atlas lift
- Atlas-axis shear
- Alar lig test: cranial tilt
- Tectorial 3 stage test
101
Sharp-purser's test
transverse ligament
- Reduction test - start with symptoms and if they go away its +
- Posterior hand blocks C2, hand on forehead pushes C1 posteirorly
102
Cranial-Atlas Lift
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
Atlas-axis shear
transverse ligament
| -prox phalanx of one hand stabilize C2 at articular pillar, other hand on TP of C1 shearing it in opposite direction
104
Alar ligament test: cranial tilt #1
Option 1: stabilize post arch of C2 and use opposite hand to SB head R or L, should be almost NO motion
105
Alar ligament test: cranial tilt #2
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
Tectorial "3 stage" test
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
Cv lig stress test
1. traction
2. anterior shear C1/2
3. ant/post shear C0/1
4. Transverse/coronal stress test
5. SBing
108
VBI testing
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
Segmental mobility: O/A joint
OA and AA movement is contralateral
1. traction/compression
2. flex
3. ext
4. SB/rot
5. lateral translation
110
OA movement with lateral shear
- 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
C1-2 rotation test
1: fully flex, rotate either direction.
2. Fully SB, rotate opposite SB.
~45 deg rot from C1-2
112
Segmental mobility AA joint
1. ext
2. rot
3. SB
4. combined motion
113
AA movement with lateral translation
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
