Cervical I Flashcards
Neck pain epidemiology
. More females than males
. Lifetime prevalence: 70%
. Incidence peaks 20-40 y/o
. Incidence higher in patients w/ multiple medical problems, high job stress, and occupational factors
Neck pain complaint causes
. Poor posture . Repetitive use and strain . Degenerative spine/disc . Trauma . Rheumatic conditions . Head and neck infections . Psychological stress . Respiratory problems . Compensatory
Atlas
. No vertebral body
. Rotates around dens of C2
. Heavy lat. mass palpable just inf./post to mastoid processes
. Small post. Tubercle instead of spinous process
Axis
. Dens (odontoid process)
. Larger palpable, bifid spinous process
What contributes to stability of cervical spine
. Unique uncinate (uncovertebral) joints of Luschka on lat. vertebral body
Uncinate joints
. Allow fl/extension but limit segmental sidebending
. Potentially reduce disc herniation
. Shearing stresses can cause degenerative spurs as early as teen yrs
Degenerative arthritis in uncinate and facet joints are causes of what?
.cervical nerve root compression
Z joints of cervical spine
. 45 degree angle toward the eye
Cervical transverse processes
. Ant. Part is modified rib
. Post. Part is true transverse process
. Ant. And post. Parts are fused but maintain a foramen for vertebral a. Starting at C6
Vertebral aa.
. Provide circulation to post. Brain
. Extension and sidebending/rotation of c spine can put vertebral aa. At risk for occlusion in some patients
Lateral masses/articular pillars of c spine
. Facet joints form bony column on lat. aspect of cervical column (lat. mass)
. Key landmark
. Palpable masses are not transverse processes
Cervical landmarks for palpation
. Occiput . Lat. mass of atlas . Spinous process of axis . Hyoid bone . Thyroid . Cricoid . Vertebra prominens, large spinous process
Neuro testing C5, 6, 7
. C5: motor: deltoid, biceps, bicep reflex, lat. arm dermatome
. C6: motor: bicep, wrist extensors, extensor reflex, lat. forearm dermatome
. C7: motor: tricep, wrist flexors, finger extensors, flexor reflex, middle finger dermatome
Neuro testing C8 and T1
. C8: motor: interossei, finger flexors, no reflex, 4-5 fingers and forearm dermatome
. T1: motor: interossei, no reflex, med. elbow dermatome
Fascia of neck
. Superficial, intermediate, deep
. Follows tube w/in tube structure
. Continues into mediastinum to blend into pericardium and great vessels
. Superficial fascia splits to invest the t rap and SCM mm.
. Superficial lymph penetrates investing fascia to gain access to deep lymph
Cervical lymphatic
. Divided into superficial and deep chains
. Stretching neck mm. And fascia helps lymph drain
Paravertebral mm.
. Longus colli (C1-T3)
. Longus capitus (occiput to C3-6)
. Traps: primary connection btw head, neck, and upper extremity
Ant. Neck mm.
. Strap mm. Attach to sternum to hyoid and hyoid to skull
. Scalenes and deep paravertebrals stabilize head and neck
. Provide proprioceptive feedback
Sternocleidomastoid m.
. Divides neck into ant. And post. Triangles
. Attaches to clavicle and sternum
. Innervated by CN XI
. Unilaterally sidebends beck to ipsilateral side, rotates away
. Bilaterally: flexor of neck, extender at OA joints
. Elevates amnubrium and med. ends of clavicle to assist in pump-handle motion in deep respiration
Congenital torticollis
. Infants present w/ neck sidebent and rotated in opposite directions
;evaporated scapula
. From transverse processes of C1-4
. Insert: upper med. scapula
. Elevates scapula and rotates med.
Suboccipital mm.
. Stabilize head and act as proprioceptive sensors
. Irritability leads to headache that penetrates deep in skull
Post. Spinal mm.
. Semispinalis, cervicis, and longissimus
. Can cause extension dysfunctions
Ant. Spinal mm.
. Longus colli/rectus capitus
. Can cause flexion dysfunctions
Deep layer post. Mm.
. Multifidae and rotators cervicis . Receive segmental innervation . Palpation of tart is best indication of segmental somatic dysfunction . Short mm. . Essential mm. Of proprioception
Accessory mm. Of respiration
. SCM
. Scalenes
Scalene mm.
. Connect cervical transverse processes to ribs 1 and 2
. Bilaterally flex neck
. Unilaterally sidebend neck ipsilaterally, rotate away
. Brachial plexus and subclavian a. Lie btw not. And middle scalene mm.
. Scalene dysfunction can cause dysfunction of cervical spine and affect neurovascular components of upper extremity
Thoracic outlet syndrome
. Neurovascular compression btw ant. And middle scalenes, clavicle and 1st rib OR bite pec minor and upper ribs
. Result of trauma, repetitive movements, tumors, pregnancy, or cervical rib
. N. Compression causes pain, weakness,
. Arterial compression causes pallor and coldness in arm
. Venous compression causes swelling and pain in arm
Adson’s maneuver
. Tests for subclavian a. Compression
. Compression: loss of radial pulse w/. Ipsilateral sidebending of neck, abducting and externally rotating arm, extending neck and holding breath
. Test position tenses ant. And middle scalenes to narrow interscalene space
. Pos test: radial pulse obliterated and symptoms reproduced
Standing exam for neck pain
. Standing structural for posture, symmetry, relationship of head to weight, amt of lordosis
Seated exam for neck pain
. AROM/PROM for cervical and thoracic regions,
. Neurovascular exam
. Exam of thoracic spine and ribs
Active ROm of neck
. Flexion: 90 degrees . Extension 70 . Sidebending 35-45 . Rotation 90 . 50% of rotation occurs at atlantoaxial joint
Wallenberg test
. Tests for vertebral insufficiency
. Cervical spine is extended and then gently rotated side to side
. If nystagmus develops or patient is nauseous or dizzy then cervical articulatory techniques contraindicated
OA in c spine
. Hypertrophic changes of z joints and vertebral bodies
. Treat w./ specific mobilization of restricted areas
. Strengthen cervical musculature and facilitate stability
RA and down’s in c spine
. Ligamentous laxity of C2 causing C1 and C2 instability
. Contraindication of thirst techniques
