Cervical Flashcards
the 1st cervical nerve is in between what vertebrae?
above C1
between C1 and the occiput
the 8th cervical nerve is in between what vertebrae?
between C7 and T1
what muscles form the suboccipital triangle?
what a key role of these muscles?
- rectus capitus posterior major and minor
- obliquus capitus superior and inferior
keep the head level when neck is turned/sidebent
sternocleidomastoid - propireceptive role
tells CNS where head it in relationship to the body
actions of transversospinalis
extends head
contralaterally rotates head
actions of semispinalis capitis
extends head
ispilaterally rotates head
palpation of semispinalis capitis locates what bony feature
the articular columns
actions of longus coli
FLEXES cervical spine on anterior surface
anterior, middle and posterior scalenes
attachments
all of them:
one end attaches to tubercles of transverse processes of the cervical vertebrae
other attachment:
anterior scalene: to 1st rib
middle scalene: to 1st rib
posterior scalene: to 2nd rib
actions of the scalene muscle
contralateral flexion
contralateral rotation
most superficial cervical muscle
trapezius
what cervical muscle has two heads of insertion
sternocleidomastoid
features of spinous processes of cervical vertebrae
C1 = no spinous process
C3 - C6 are bifid
C7 spinous process is the longest - hence its called vertebrae prominens
C2-C7
list the characteristics of their vertebral bodies
- bodies have saddle shaped superior surface
- their lateral edges have marked elevations called uncinate processes: fit into inferior surfaces of cervical vertebrae above (this articulation = joint of luscka)
joints of luschka:
- what forms these joints?
- what motion do they permit?
formed by articulation of the uncinate processes (raised lateral edges) of C2-C7 with the vertebrae above
they guide:
- sidebending and rotation towards the same side
transverse processes of vertebrae C2-C7
- why are they tender
- key anatomical relations
the TPs of C2-C7:
- cradle respective cervical nerve (hence they’re tender)
- passes posterior to vertebral artery, which runs thru the transverse foramina
cervical herniation
- prevented by what structures?
- posterior herniation prevented by posterior longitudinal ligament
- lateral herniation prevented by right & left uncinate processes
how does the nucleus pulposus of intervertebral disc move in response to spinal motion?
moves “away” from side of spinal motion
ex: if cervical spine flexes, nucleus pulposis moves posteriorly
most common causes of cervical nerve root compression
- degeneration of joints of lushka
2. osteoarthritis of synovial joints forming the intervertebral foramen
what motions place the most challenge to vertebral artery
- backward bending (extension)
- ipsilateral side bending/rotation
these motions stress vascular flow of the vertebral artery on the OPPOSITE side
DeKleyn’s test
- how is it done
- what is its purpose
patient’s neck is
- extended
- rotated
assesses vascular adequacy of the vertebral artery prior to treatment
R and L articular columns
- what creates them
- pertinent landmarks
- made by articular processes
can be palpated:
- 2-3 cm (1.5-3 fingers width) from spinous processes
- at lateral edge of semispinalis capitus
motion seen at vertebrae C2-C7
whether flexed or extended: sibebending and rotation of C2-C7 occur in the SAME DIRECTION
what forms the occipital= atlanto (OA) joint
articulation between
occipital condyle
atlas (C1)
specifically, the occipital condyles converge anteriorly and fit into the superior facets of C1
motion at the OA
primarily allows for flexion and extension (20-25 degrees)
sibebend/rotates in OPPOSITE direction (unlike C2-C7)
C1 (atlas)
characteristics
- no spinous process: instead has a posterior arch with a tubercle
- no vertebral body: instead has large lateral mass bridged by anterior arch
- transverse processes: long, anterior to mastoid process of temporal bone
transverse ligament
- where does it attach
- what “joint” does it form
attaches C1 (atlas) to dens (odontoid process) of C2 aka the atlando-odontal joint
C2 (axis)
characteristics
- has a vertebral body, from which the odontoid (dens) protrudes superiorly
- bifid spinous process
articulations that form the AA joint
- 1 &2: right and left aa synovial joints: convex inferior facets of C1 sit on the convex superior facets of C2
- 3 & 4: atlanto-odontal joints
3. between anterior arch of C1 and dens of C2
4. between transverse ligament and dens of C2
motion at the AA joint
ONLY rotation
motions at
- AO joint
- AA Joint
- C2-C7
AO:
flex, extend
rotate & sidebend OPPOSITE direction
AA:
rotation ONLY
C2-C7:
flex, estend
rotate and side-bend in the SAME direction
how to diagnose AA joint
- diagnose rotation only
- patient lays supine
- either
1. flex head to 90 degrees (to lock out lower cervicals) and rotate L, R to determine preference
2. use V hold to stabilize C2, rotate L, R to determine preference
how to diagnose OA joint
- patients lies supine
- diagnosing F, E, SB, R
- use V hold to stabilized C1, then test for all motion preference
how should the direct barrier feel
should have a slight springiness
C2-C7 HVLA
- what kind of thrust does each vertebrae respond to?
C2-C3:
respond best to rotational thrust (in horizontal plane)
C4-C7:
respond best to sidebending (in coronal plane)
how to set up cervical HVLA
will either both rotation OR sidebending to restrive barrier:
if SB: (C4-C7)
- SB away from preference (towards restrictive bairrer)
- rotate TOWARDS preference (so in the opp. direction of SB)
- the thrust towards the restrictive barrier treats both SB and rotation
if rotation (C2-C3) - set up opposite
how to set up AA HVLA
rotate towards barrier (away from preference) and thrust
how to set up OA HVLA
rotate AND sidebend TOWARDS the barrier (away from preference) and thrust
PC1 inion tenderpoint location
1 cm inferior and lateral to ion
PC1 occiput tenderpoint location
on occiput
3-4 cm lateral to midline
PC2 tenderpoint locations:
medial PC2:
on/immediately lateral to C2 spinous process
lateral PC2:
2 cm lateral to midline
just below and in between PC1 inion (1 cm from midline) and PC1 occiput (2-4 cm from midline)
PC3-7 tenderpoint locations
on midline/just lateral to spinous processes (C2-C6) of the vertebrae one number above
ex: PC3 is on spinous process of C2
PC8 tenderpoint locations
medial PC8:
at midline or inferolateral aspect of C7 spinous process
lateral PC8:
on posterior tip of C7 spinous processes
(this is also just anterior to the trapezius muscle below)
counterstrain for PC1 inion
FStRa
counterstrain for PC1 occiput
E with SaRa as needed
counterstrain for medial and lateral PC2
E with SaRa as needed
counterstrain PC3-7
ESaRa
- for tenderpoints on midline of C2-C6 spinous processes (rather than the inferolateral aspects), they may require pure extension instead
- PC3 (on C2) may require cervical flexion
counterstrain for PC3
either
- ESaRa
- FSaRa
counterstrain for medial and lateral PC8
EsaRa
- midline points may require pure extension
these would be medial PC8 tenderpoints found on the midline
overview of posterior cervical tenderpoint set ups
almost all are ESaRa
exceptions:
- PC1 inion is FStRa
- PC3: can be FSaRa or ESaRa
- midline tender points of PC3-PC8 could be pure extension
AC1
tenderpoint locations
mandibular AC1: posterior surface of mandible
transverse process AC1: midway between ramus and mastoid process, which is also on the TP of C1
AC2-6 tenderpoint locations
anterior surfaces of TPs C2-C6
AC7 tenderpoint locations
clavicular head of SCM
2cm lateral to medical clavicle
AC8 tenderpoint locations
sternal head of SCM
medial end of clavicle
what anterior tenderpoints are associated with the rectus capitis muscles?
ACI and AC2
AC1 to rectus capitus anterior
AC2 to rectus capitus anterior & lateral
what anterior tenderpoints are associated with the longus muscles?
AC3-4: longus capitis muscle
AC5-6: longus coli muscle
what anterior tenderpoints are associated with the SCM?
AC7 - with clavicular attachment
AC8 - with sternal attachment
treatment of AC1 tenderpoints?
SaRa for both
AC1 on TP: push lateral to medial
AC1 on mandible: push posterior to anterior
treatment of anterior C2-C6 tenderpoints
FSaRa, push anterior to posterior
sometimes AC3 may need ESaRa
treatment of AC3 tenderpoint
push anterior to posterior
either:
FSaRa
ESaRa
treatment of AC7
FStRa
push superior to inferior
treatment of AC8
FsaRa
push superiormedial to inferolateral
anterior tenderpoints FSaRa except for?
AC3 can be ESaRa
AC7 is FStRa
flexed somatic dysfunction
- how do SPs move toward SPs above/below
- motion preference
- rotation/sidebending
- approximates to SP above
- separates from SP below
- prefers flexion
- extension restricted
- sidebending/rotation restricted bilaterally
extended somatic dysfunction
- how do SPs move toward SPs above/below
- motion preference
- rotation/sidebending
- separates from SP above
- approximates towards SP below
- prefers flexion
- extension restricted
- sidebending/rotation restricted bilaterally
cervical vertebrae - what motion predominate
C2-C3: rotation predominates
C4-C7: sidebending predominates
R/SB to same side
figure 8 test
- how to perform
- Hand placement: fingers on dysfunctional articular pillars and pt’s head resting on Dr’s forearms
- Use abdomen to provide pressure ONLY to level of
dysfunctional segment - extension phase at the top of figure eight, flexion phase at the bottom
C2-C3 RLSL diagnosis
- where would SP, left & right articular pillars be prominent
- what motions are restricted
► Left articular pillar is prominent posteriorly
► Right articular pillar is prominent laterally
► Spinous Process shifted to the right
► Left rotation and sidebending is present
► Right rotation and sidebending is restricted
- either flexion or extension may be restricted
C2-C3 RLSL treatment - direct muscle energy
- push method
- pull method
- you will contact right articular pillar for this diagnosis
push method:
sidebend the dysfunctional segment by contacting it’s right articular pillar with the pad of your THUMB & translate it left to the RB
(also used for C4-C7)
pull method:
Sidebend the dysfunctional segment by contacting it’s right articular pillar with the pad of your INDEX finger & translate it left to the RB
C2-C3 HVLA
- what kind of thrust
- set-up
rotation predominates at C2-C3, so rotational thrust is applied - in a horizantal barrier, around a verticle axis
- rotate head towards barrier
- sidebend head in opposite direction (towards preference)
- thrust towards barrier in horizantal plane
C4-C7 HVLA
sidebending predominates at C4-C7, so sidebending thust is applied - in a conronal plane
- sidebent head towards barrier
- rotate cervicals in opposite direction
OA diagnosis set up
- Shelf method - pull base of skull superiorly on each side with alternating motion
- Stabilizing Atlas (C1) using V-hold
- assess SB, R, F/E
AA diagnosis set up
either
- flex head to 90, or
- use V hold to stabilize C2,
then rotate head L, R for preference
OA HVLA set up
- occiput contact posterior to mastoid process
- SB towards barrier
- rotate towards barrier
AA HVLA set up
- contact both lateral masses of atlas with index/middle finger
- extend head
- rotate against restrictive barrier
- have patient rotate head in opposite direction (towards preference)
