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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
What happens with a reversed cervical curve?
Reverse curve cannot hold the cervical load, limited extension, longer neck (muscles lengthened)
26
What is the deep cervical flexors endurance test?
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
What is the neck extensor endurance test?
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
What is the foraminal compression test? (Spurling's)
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
What is the distraction test?
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
What do each ULTT test?
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
Which tests show a high specificity and which a high sensitivity?
High specificity: spurling's, neck distraction, Valsalva maneuver High sensitivity: ULTT
32
Which combo of tests when positive suggest a cervical radiculopathy?
spurling's, neck distraction, and Valsalva
33
What is the brachial plexus tension test?
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
What is the shoulder depression test?
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
What is the shoulder abduction test?
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
What is Tinel's sign for brachial plexus lesions?
sits with head slightly flexed examiner taps on area of brachial plexus with finger along nerve trunks +ve: tingling sensation along nerve distribution
37
What is the vertebral artery quadrant test?
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
What is the dizziness test?
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
What is the pronator drift test?
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
What is the sharp-purser test?
subluxation of atlas on axis Palpate C2, do resisted neck flexion +ve: if clunks and feel C1 shift back
41
What is Aspinall's Transverse ligament test?
Completed if Sharp-Purser negative Pt supine Stabilize occiput and push C1 anteriorly +ve: lump in throat as atlas moves toward esophagus
42
What is the rotational Alar ligament stress test?
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

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