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ax final > Cervical Ax > Flashcards

Cervical Ax Flashcards

1
Q

What are the principal motions of the atlanto-occipital joint (C0-C1)?

A

flexion, extension (15-20 degree)
rotation and SB are not physiological motions of the joint

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2
Q

What are the C0-C1 mechanics?

A

Flexion: anterior roll, backward glide
Extension: posterior roll, anterior glide
Flexion limited by: posterior structures, submandibular tissues
Extension limited by: occiput compressing sub occipitals

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3
Q

What are the characteristics of C1-C2?

A

Atlas-Axis, most mobile articulation, axis most weight bearing of C/S

Biconvex joint: rotation is 50degrees
Flex/ext: 10 degrees (no lig restriction)
Odontoid process (dens) of C2 acts as a pivot point (transverse ligament holds it in place)

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4
Q

What can pathology in the lower cervical spine lead to?

A

Lower C/S= C3-C7
pathology in the region can lead to a combo of neck and arm pain

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5
Q

Which fryette’s law does the lower cervical spine follow?

A

Law 2, rotation= side bend

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6
Q

Where does the greatest cervical flexion extension of facet joints occur?

A

between C5-C6 (most common area for disc herniation in C/S

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7
Q

What can affect the vertebral artery and its blood supply?

A

part of vertebrobasilar system, passes through TPs starting at C6
Affected by extension, rotation, osteophyte formation, facet joint injury

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8
Q

What are S/S of an affected vertebral artery?

A

vertigo, nausea, tinnitus, drop attacks, visual disturbances, rarely stroke or death

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9
Q

What stresses the internal carotid artery?

A

80% of blood supply to the brain
Stressed mainly with rotation, extension and traction motions
muscle tightness: subclavius, SCM, platysma, any muscle attached to hyoid

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10
Q

How much of the cervical height do the intervertebral discs make up?

A

25%
No disc b/n C0-C1 and C1-C2

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11
Q

How many nerve roots are there in the C/S?

A

8 nerve roots
nerve root is named for cervical vertebrae below it

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12
Q

What is the cervical plexus?

A

C1-C5
common cranial nerves: accessory nerve, hypoglossal nerve

Phrenic nerve (C3-C4-C5) keeps diaphragm alive

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13
Q

What are the 12 cranial nerves?

A

Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Vestibulocochlear
Glossopharyngeal
Vagus
Accessory
Hypoglossal

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14
Q

What is the brachial plexus?

A

C5-T1 nerve roots
Runs between scalenes, pec minor, first rib, clavicle
Numbness/tingling/burning common s/s of brachial plexus compression
disc degeneration, TOS, cervical stenosis, upper cross syndrome might affect the brachial plexus

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15
Q

What structures make up the anterior and posterior triangles of the neck?

A

Anterior: Mandible, SCM, Sternum
Posterior: SCM, clavicle, trapezius

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16
Q

What is the anterior cervical fascia called?

A

the platysma

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17
Q

What are common conditions of the c/s?

A

fractures
Cervicogenic headaches
Stenosis
DDD
Disc herniation
OA (spondylosis)

18
Q

What is a jefferson’s fracture?

A

burst fracture
Fx of C1in three places

19
Q

What is hangman’s fracture?

A

Fx of C2 on both sides of the pars interarticularis

20
Q

What are flexion and extension Tear drop Fractures?

A

MOI: hyperflexion ==> Fx of anterior vertebral body
MOI: hyperextension==> displaced anterolateral aspect of body, avulsion of all

21
Q

What is a clay shoveler’s fracture?

A

Fracture of SP C6-T1

22
Q

What are some different causes of spinal stenosis?

A

bone growth
disc herniation
inflammation

23
Q

What is a torticollis?

A

Congenital
Acute (sleeping awkward, neck muscle, injury that causes heavy scarring, neck muscle spasm, secondary to slipped facets, herniated disc, infection)
Neck ROM limitations

24
Q

What is upper cross syndrome?

A

inhibited neck flexors
inhibited rhomboids and serratus anterior
Tight pecs
Tight UFT and levator scap

25
Q

What happens with a reversed cervical curve?

A

Reverse curve cannot hold the cervical load, limited extension, longer neck (muscles lengthened)

26
Q

What is the deep cervical flexors endurance test?

A

Chin tuck lift head 2.5cm from table and hold.
Errors: loss of chin tuck, resting head on examiner’s fingers, raising head further

27
Q

What is the neck extensor endurance test?

A

Sustain chin tuck in neutral for 20sec
Loss of chin tuck= dominance of superficial extensor muscles
Neck flexion= weakness of deep and superficial extensors

28
Q

What is the foraminal compression test? (Spurling’s)

A

performed if Pt complaining of nerve root symptoms
Pt side flexes the head to unaffected side first
or done in stages:
compression in neutral
compression with head in extension
compression with extension and rotation
Positive: pain radiates into arm toward side in which head is side flexed (pain without radiating pain into arm is not a positive

29
Q

What is the distraction test?

A

pt who complain of radicular symptoms in history and show radicular signs during exam
Place on hand under chin and other behind occiput and slowly lift

Positive: if pain is relieved or decreased

30
Q

What do each ULTT test?

A

ULTT 1: C5-C6-C7 nerve roots, median nerve and anterior interosseous nerve

ULTT2: median nerve, musculocutaneous nerve, axillary nerve

ULTT3: Radial nerve

ULTT4: ulnar nerve, C8-T1 nerve roots

31
Q

Which tests show a high specificity and which a high sensitivity?

A

High specificity: spurling’s, neck distraction, Valsalva maneuver

High sensitivity: ULTT

32
Q

Which combo of tests when positive suggest a cervical radiculopathy?

A

spurling’s, neck distraction, and Valsalva

33
Q

What is the brachial plexus tension test?

A

Mod of ULTT4

Patient abducts arms, elbows extended laterally rotates arm, examiner holds in this position.
Pt then bends elbows so that the hand lies behind the head

Positive: reproduction of radicular symptoms with elbow flexion

34
Q

What is the shoulder depression test?

A

Eval brachial plexus lesions
Reproduce MOI
Examiner side flexes the pt’s head to one side, while applying a downward pressure on opp SH

+ve: P! inc. compressed or distracted side
Could be due to osteophytes, adhesions around dural sheaths, hypomobility of joint capsule

35
Q

What is the shoulder abduction test?

A

Radicular symptoms of C4-C5 nerve roots
Pt lying or sitting
Examiner passively or pt actively elevates arm through abduction so forearm is on top of head
+ve: decrease in pain or relief of symptoms

36
Q

What is Tinel’s sign for brachial plexus lesions?

A

sits with head slightly flexed
examiner taps on area of brachial plexus with finger along nerve trunks
+ve: tingling sensation along nerve distribution

37
Q

What is the vertebral artery quadrant test?

A

Pt supine
Examiner passively takes patient’s head and neck into extension and side flexion then into rotation to same side and hold for 30sec

+ve: provokes referred symptoms (if opposite artery affected)

38
Q

What is the dizziness test?

A

Pt sits, examiner grasps patients head rotate head right then left, holding head at extreme ROM for short time (10-30sec)
return to neutral
rotate patients shoulders to right the left (holding 10-30sec each) while keeping head neutral

+ve: vertebral artery: dizziness with both movements
Inner ear problem: head movement only

39
Q

What is the pronator drift test?

A

helps differentiate between dizziness caused by articular problem vs vascular problems

Pt sits and flexes arms to 90 and supinates
eyes closed ==> examiner watches for loss of arm position
If arm moves= non vascular
Pt then rotates, or extends and rotates neck and maintains position with eyes closed again
Wavering of arms= dysfunction caused by vascular impairment

40
Q

What is the sharp-purser test?

A

subluxation of atlas on axis
Palpate C2, do resisted neck flexion
+ve: if clunks and feel C1 shift back

41
Q

What is Aspinall’s Transverse ligament test?

A

Completed if Sharp-Purser negative
Pt supine
Stabilize occiput and push C1 anteriorly
+ve: lump in throat as atlas moves toward esophagus

42
Q

What is the rotational Alar ligament stress test?

A

Pt supine or seated
Examiner pincer grips the C2
While stabilizing C2 examiner passively rotates the Pt’s head left or right
if more than 20-30 degrees of rotation is possible without moving C2 ==> Positive for injury to contralateral alar ligament

ax final (5 decks)

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