cervical spine Flashcards
C0-C1 is what type of joint and is a stable or unstable joint
stable, antlanto-occipital joint
principal motion of antlanto-occipital joint
Principle motion of this joint is flexion-extension (15-20°)
Nodding of the head
is rotation and SB physiological motion of C0-C1
no
C0-C1 mechanic in flexion, extension
flexion: ant roll, backward slide
extension: backward roll, ant slide
flexion of C0-C1 is limited by
posterior structure, submandibular tissue
extension of C0-C1 is limited by
occiput compressing sub occipitals
how does rotation and SB C0-C1 occurs
Condyles must slide out/lift out of their socket tension on atlanto-occipital ligaments and joint capsule
what is the most mobile articulation of neck
C1-C2
axis most weight bearing in C-spine
C1-C2
C1-C2 is which type of joint
biconvex
how munch rotation occurs at C1-C2
Rotation is ~50° contralateral alar ligaments, capsules, impaction of anterior arch of atlas on dens of axis
how munch flexion/ext occurs at C1-C2 joint
Flex-ext ~10° restricted when post arch hits occiput or C2 not ligament restriction
what is the role of odontoid process
Odontoid process of C2 acts as pivot point
Transverse ligament
Pain in this area commonly referred to upper extremity
cervico-brachial area (C3-C7)
pathology in C3-C7 area can lead to what
combination of neck and arm pain
C1-C2 have rotation, SB or both
rotation only
C3-C7 follow which rule
law 2 -> rotation and SB same direction
Greatest flexion and extension of facet joints occurs between
C5-C6
Almost as much movement at C4-C5 and C6-C7
vertebral artery passed where and role
Vertebral artery- part of vertebrobasilar system
Passes through TPs of C-spine
Starting at C6
20% blood supply to brain (hindbrain
vertebral artery affected which ROM of C-spine
extension + rotation
symptom of vertebral artery
Symptoms- vertigo, nausea, tinnitus, “drop attacks”, visual disturbances, or rarely stroke or death
internal carotid is mainly stressed with which ROM
with rotation, extension and traction motions
where in C-spine there’s no disc
btw C0-C1 and C1-C2
intervetrebral disc take how many % of height of cervical spine
25%
how does nerve root is named
from cervical vertebra below it
how many cervical root is there
8 cervical nerve roots
Nerve root existing between C0-C1
Names C1 nerve root
what act on atlas
muscle that act on the head
What muscles does the brachial plexus run between/under?
- scalene, pec minor
- 1st ribs, clavicle
What are common signs/symptoms of compression of brachial plexus?
N/T/B
What pathologies will affect the brachial plexus?
disc degeneration, cervical stenosis, TOS, upper cross syndrome
what is multifactorial disease risk factor
Risk factors: lack of physical activity, duration of daily computer use, perceived stress, lack of social support and being female
2x risk of neck/back pain with people with mental disorders compared to people without mental disorders
Subjective History for cervical spine
- age
-radicular symptom - weaknes, numbness, burning, tingling
- headache/pain partern
- dizziness, faitness, seizure
- sympathetic symptom
- mouth breather
- sleeping position
- cognitive or behavioural change
- glasse/contact
type of cervical fracture
Jefferson fracture (burst fracture), hangman fracture, flexion/extension tear drop fracture, clay shoveler fracture
MOI of extension tear drop fracture and what happen
hyperextension
Displaced anterolateral aspect of body
Avulsion of ALL
MOI of flexion tear drop fracture and what happen
hyperflexion
fracture of anterior vertebral body
what is clay shoveler fracture. + Moi
fracture of SP C6-T1, hyperextension
ROM deficit with DDD
extension, SB and rotation
different cause of spinal stenosis
Bone growth
Disc herniation
Inflammation
torticolis acute cause
Sleeping awkward, neck muscle, injury that causes heavy scarring, neck muscle spasm
Secondary to slipped facets, herniated disc, infection
what is upper cross syndrome
tight upper trap + levator scap + pec
inhibited rhomboid + serratus anterior + neck flexor
what are the clinical criteria for diagnosis of cervicogenic headache
neck extensor endurance test positive
Loss of chin tuck=dominance of superficial extensor muscles
Neck flexion=weakness of deep and superficial extensors
Special Tests- For Neurological Symptoms
ULTT
Brachial plexus traction test
Tinel’s@ brachial plexus
Shoulder depression test
Shoulder abduction test
Spurling’s test (Foraminal Compression)
Distraction test
which test is the best to use for cervical radiculopathy
foramina compression (spuling test)
+ve of foraminal compression test
Positive: pain radiates into arm toward side in which the head is side flexed
Pain without radiating pain into arm is NOT A POSITIVE
when do you do foramina compression test
Performed if patient is complaining of nerve root symptoms
At time of test should be diminished or absent
Provoke symptoms
when do you do distraction test and +ve
Patients who complain of radicular symptoms in history and show radicular signs during examination
+ve: pain is relieved or decrease
ULTT 1 test which nerve
median nerve, anterior interosseous nerve, C5-C6-C7
ULTT 2 test what
median nerve, musculocutaneous nerve, axillary nerve
ULTT 3 test which nerve
radial
ultt 4 test what
ulnar nerve, C8-T1 nerve roots
which test would you use to rule in cervicalradiculopathy
the Spurling’s test, traction/neck distraction, and Valsalva’s manoeuvre
which test would you use to rule out cervical radiculopathy
ULTT
brachial plexus tension test is a modification of which test
ULTT 4
shoulder depression test evaluate what + +ve
brachial plexus tension, Positive: pain increases compressed or distracted side
Osteophytes?
Adhesions around dural sheaths, hypomobility of joint capsule
what shoulder abduction test indicate
radicular symptom especially C4 or C5 nerve root,Cervical extradural compression (herniated disc), nerve root compression
vascular clearing test
Vertebral Artery test
Dizziness Test
Hautant’s test (pronator drift)
how to differentiated dizziness
Vascular- check BP
Vestibular- head and neck movement
Cervicogenic-AROM, lig test etc
when should vascular clearing test should be done
before doing PROM
+ve finding with vertebral artery quadrant test
Positive: provokes referred symptoms (if opposite artery affected)
Dizziness, nystagmus (eyes jumping, twitching), light-headedness, visual disturbances, artery is being compressed
if dizziness test produce symptom only with head movement what does it means
inner ear problem
if dizziness test is positive with both head and shoulder movement what does it indicate
vertebral artery dysfunction
pronator drift test help to differentiate what
Help to differentiate between dizziness caused by articular problem vs vascular problems
in which case pronator drift test indicate a vascular problem or doesnt indicate a vascular problem
If arm moves= non vascular
Pt then rotates, or extend and rotates the neck, and maintain position with eyes closed again
Wavering of arms=dysfunction caused by vascular impairment
positive sharp-purser test
Positive: examiner feels the head slide backward during movement
Reduction of atlas, may feel “clunk”
-> transverse ligament of atlas on axis
which test do you completed if sharp-purse is negative
Aspinall’s tranverse ligament
positive test with Aspinall tranverse ligament
Positive: lump in throat as atlas moves toward esophagus
positive rotational alar ligament stress test
If more than 20-30° of rotation is possible without moving C2
=positive for injury to contralateral alar ligament
-> can be do with SB also
