Cervical Biomechanics

Question 1

Which cervical vertebra are atypical?

Answer 1

C1, C2 and C7

Question 2

Where do nerves exit in the cervical spine?*

Answer 2

Nerves exit above vertebral body

Question 3

Where do nerves exit in the thoracic and lumbar spines?*

Answer 3

Nerves exit below vertebral body

Question 4

What passes through the transverse foramen?

Answer 4

Vertebral A

Question 5

Describe the atlas (C1)

Answer 5

No vertebral body
Rotates around the dens of C2 (joint surface on anterior arch and held by transverse alar ligament which is part of the cruciform ligaments)

Question 6

Describe the axis (C2)

Answer 6

Vertebral body extends superiorly to form the dens (odontoid process)

Question 7

What is the myodural bridge?

Answer 7

True connection b/w rectus capitis posterior major and dura mater
Contains a neural component
May have function aside from anchoring the muscle like monitor dural tension and a role in cervciogenic pathologies

Question 8

What is a hangman’s fracture?

Answer 8

Fractured vertebral arch of C2 and anterior displacement of body of C2
Distorts the anterior vertebral line
Caused by hyperextension which results in traumatic spondylolisthesis of C2 tearing the ligaments between C2 and 3 + fracture of vertebral arch of C2

Question 9

Look at radiographs on slides

Answer 9

-

Question 10

What are the atypical articulations?

Answer 10

OA and AA

C2-7 are typical articulations

Question 11

In C2-7 rotation and side bending occur in what direction?*

Answer 11

In the same direction due to the uncinate processes

Question 12

Describe C2-7 sagittal plane somatic dysfunction

Answer 12

Somatic dysfunctions can be in flexion, extension or neutral (F/E commonly painful inciting pt eval)
Induced traumatically and present with simultaneous anterior and posterior muscle spasm
Common in arthritic spines

Question 13

What are the major motions of the OA joint?

Answer 13

Flexion and extension

Shape of the joint allows for more sagittal plane motion

Question 14

Due to the shape of the OA side bending and rotation occur in what directions?

Answer 14

Occur in opposite directions

SB and rotation are minor motions

Question 15

What is the primary motion of the AA joint?

Answer 15

C1 on C2
Rotation is primary (atlas rotates about the dens)
almost no side bending, flexion or extension

Question 16

Somatic dysfunction of OA/AA is commonly associated with what?

Answer 16

A cervicogenic HA

Question 17

What is the ROM for flexion of the neck?

Answer 17

45-90

Question 18

What is the ROM for extension of the neck?

Answer 18

45-90

Question 19

What is the ROM for sidebending of the neck?

Answer 19

45 degrees

Question 20

What is the ROM for rotation of the neck?

Answer 20

70-90 degrees

Question 21

Describe rotational testing for left rotation (transverse plane)

Answer 21

Induced by anterior pressure on posterior aspect of right lateral mass

Question 22

Describe rotational testing for rotation to the right

Answer 22

Induced by anterior pressure on posterior aspect of L lateral mass

Question 23

Translation from left to right inducing what kind of sidebending?

Answer 23

Left

The pressure side is the side towards which you are inducing sidebending

Question 24

Translation from right to left induces side bending to what?

Answer 24

The right

Question 25

Which components should be tested separately?

Answer 25

Side bending and rotation

Find which one is more restricted and treat that one

Question 26

What are some soft tissue cervical contraindications?

Answer 26

Fractures, open wounds or recent surgical site, local infection (bony or soft tissue), coagulopathy and neoplasm

Question 27

What are cervical contraindications for muscle energy?

Answer 27

Undiagnosed joint swelling*, severe osteoporosis, neoplasm, infection, hematoma, arthritis (including RA), fracture, ligament disruption including dislocation

Question 28

What are the contraindications for cervical HVLA?

Answer 28

Acute radiculopathy (undiagnosed), Klippel-Feil syndrome, Chiari malformation, achondroplastic dwarfism, osteogenesis imperfecta, RA/Down’s syndrome for AA forces

Question 29

Describe the advanced RA and Down syndrome contraindications for cervical HVLA

Answer 29

Both are associated with alar ligament instability
Dislocation of the dens associated with rupture or laxity of the transverse ligament of the atlas can cause death or quadriplegia
Avoid any forces that transmit from the head into the cervical area

Question 30

Vertebral artery disease and advanced carotid disease are associated with what?

Answer 30

Thrombosis (want to avoid extension and rotation in the area bc it can lead to stroke)