Cervical spine Flashcards by Marilou Gélinas

Name C0-C1

Atlanto-occipital joint

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Principle motion of C0-C1

Flexion-extension (nodding of the head)

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Which motion are not possible at atlanto-occipital joint?

Rotation and SB

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Biomechanics of flexion at C0-C1

anterior roll/backward slide

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extension at C0-C1 is limited by

occiput compressing sub occipitals

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What happens at the condyles C0-C1 when rotation and SB occurs?

Condyles must slide out/lift out of their socket = tension on atlanto-occipital ligaments and joint capsule

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Most mobile articulation

C1-C2

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Most weight bearing in cx-spine

Axis - C2

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Atlas

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Axis

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Which structure acts as a pivot point on C2?

Odontoid process (transverse ligament)

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Dens (odontoid process) is on ant or post aspect of C2?

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45-50d cervical spine rotation comes from where

C1-C2

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Lower cervical spine

C3-C7

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coupled mvts (law) - C1-C2

rotation only

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coupled mvts (law) - C3-C7

follow R=S mechanics

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greatest flexion and extension of facet joints occurs between ____

C5-C6

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Symptoms of vertebral artery occlusion

vertigo
nausea
tinnitus
drop attacks
visual disturbances
rarely stroke or death

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where does the vertebral artery passes in the Cx-spine

through the TPs

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Vertebral artery is affected by which mvt

extension and rotation

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80% of blood supply

Internal carotid artery

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Internal carotid artery is stressed mainly with which 3 motions

rotation
extension
traction motions

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Internal carotid artery passes under which structures

subclavius
SCM
platysma
muscles attached to hyoid b.

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25% of height of the cervical spine

intervertebral discs

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there is no intervertebral discs where

between C0-C1 and C1-C2

Accessory nerve number

CN XI (6)

Hypoglossal nerve number

CN XII (12)

Nerve roots of phrenic nerve

C3-C4-C5

Phrenic nerve innervate what important structure?

Diaphragm

What muscles does the brachial plexus run between or under?

Scalenes SCM Pec minor WHAT ELSE

Brachial plexus can be compressed by what

Clavicle First rib

S/S of brachial plexus compression

N/T/B

What pathologies will affect the brachial plexus?

DDD Thoracic outlet Cervical stenosis

Muscles attached to hyoid bone help with what functional movement?

chewing

Risk factors for cx-spine pathologies

lack of physical activity duration of daily computer use perceived stress lack of social support being a female 2x risk if mental disorders

Subjective hx questions

Age Radicular symptoms Weakness/numbness/burning/tingling Headaches/pain patterns Dizziness/faintness/seizures Sympatethic symptoms Cranial nerve symptoms Mouth breather Sleeping position Cognitive or behavioral changes Glasses? contacts?

Common conditions of the cervical spine

various fx cervocigenic headaches stenosis DDD disc herniation OA (spondylosis)

what is a jefferson fracture

Burst fracture = bilateral fracture of anterior and posterior arch of C1 (atlas) due to axial load

what is a hangman's fracture

bilateral fracture of the pars interarticularis name comes from the hangman's rope going around the neck at C2

Flexion tear drop fx

MOI: hyperflexion Fracture of anterior vertebral body

Extension tear drop fx

MOI: hyperextension Displaced anterolateral aspect of body Avulsion of ALL

what is a clay shoveler's fx

fracture of SP C6-T1 no neurological implications presents with pain on palpation of the SP

what is a transverse atlantal ligament tear

rupture of the transverse ligament of C1 will cause C1 to move forward on C2

what test would be positive for a transverse atlantal ligament tear

sharp purser aspinall

capsular pattern of the cx-spine

extension SB rotation

what is DDD

degenerative disc disease ROM deficits in capsular pattern

what is a spinal stenosis

narrowing of vertebral canal

causes of spinal stenosis (3)

bone growth disc herniation inflammation

what is a torticollis and what are the possible causes

neck ROM limitations either congenital or acute (sleeping awkward, neck muscles injury, neck muscles spasm)

components of upper cross syndrome

tight traps/levator scap tight pectorals weak neck flexors weak rhomboids/serratus anterior

for the neck extensor endurance test, loss of chin tuck indicates what

dominance of superficial extensors muscles

for the neck extensor endurance test, neck flexion indicates what

weakness of deep and superficial neck extensors

name the special tests for neuro sx

ULTT brachial plexus traction test tinel's at brachial plexus shoulder depression test shoulder abduction test spurling's test (foraminal compression) distraction test

test performed if patient is complaining of nerve root symptoms

foraminal compression (spurling's)

+Ve foraminal compression

pain radiates into arm toward side in which the head is flexed

test for patients who complain of radicular symptoms in history and show radicular signs during examination

distraction test

SN and SP of distraction test

specificity 90-97% sensitivity 44%

SN and SP of foraminal compression

specificity 75-100% sensitivity 30-100% when rotn and SB combined

SN and SP of ULTTs

sensitivity 72-83% specificity 11-33%

test to use to rule out cervical radiculopathy given its high SN

negative ULTT

+ve brachial plexus tension test

reproduction of radicular symptoms with elbow flexion *ulnar nerve primarily

which test reproduces the MOI and evaluate brachial plexus lesions

shoulder depression test

+ve shoulder depression test

pain increase compressed or distracted side

test if you suspect radicular sx especially in C4-C5

shoulder abduction test

+ve shoulder abduction test

decrease in pain or relief of symptoms

+ve tinel's sign for brachial plexus lesions

tingling sensation along nerve distribution when tapping

vascular clearing tests

vertebral artery test dizziness test pronator drift (hautant's test)

dizziness differentiation

vascular = check BP vestibular = head and neck movement cervicogenic = AROM, ligament test, etc.

+ve vertebral artery (quadrant test)

provokes reffered symptoms (if opposite artery affected)

2 steps of dizziness test

1. rotate head/no torso mvt 2. rotate torso/no head mvt

goal of pronator drift test

differentiate between dizziness caused by articular problem vs vascular problems

if head movement only causes dizziness during dizziness test, indicates what

inner ear problem

wavering of arms during pronator drift test indicates what

dysfunction caused by vascular impairment

+ve sharp-purser test

examiner feels the head slide backward during movement

sharp purser test for what

subluxation of atlas on axis (C1 on C2)

+ve aspinall's transverse ligament test

lump in throat as atlas moves toward esophagus

is the force applied anteriorly or posteriorly for aspinall's

examiner applies an ANTERIORLY directed force to the posterior aspect of atlas (C1)

rotational alar ligament stress test, describe

pt supine or seated grip on C2 + stabilize passively rotate head left/right +ve if more than 20-30 of rotation is possible without moving C2