Cervical Spine Flashcards
Name C0-C1
Atlanto-occipital joint
Principle motion of C0-C1
Flexion-extension (nodding of the head)
Which ROMs are not possible at atlanto-occipital joint?
Rotation and SB
Biomechanics of flexion at C0-C1
anterior roll/backward slide
extension at C0-C1 is limited by
occiput compressing sub occipitals
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
Most mobile articulation
C1-C2
Most weight bearing in cx-spine
Axis - C2
Atlas
C1
Axis
C2
Which structure acts as a pivot point on C2?
Odontoid process/dens (transverse ligament)
Dens (odontoid process) is on ant or post aspect of C2?
anterior
45-50d cervical spine rotation comes from where
C1-C2
Lower cervical spine
C3-C7
coupled mvts (law) - C1-C2
rotation only
actually C1-C2 is a biconvex joint
meaning it does primarily rotation (50d) but also flex/ext (10d)
coupled mvts (law) - C3-C7
follow R=S mechanics
(Law 2: SB and Rot. to the same direction)
greatest flexion and extension of facet joints occurs between ____
C5-C6
Symptoms of vertebral artery occlusion
vertigo
nausea
tinnitus
drop attacks
visual disturbances
rarely stroke or death
where does the vertebral artery passes in the Cx-spine
through the TPs
Vertebral artery is affected by which mvt
extension and rotation
80% of blood supply from
Internal carotid artery
Internal carotid artery is stressed mainly with which 3 motions
rotation
extension
traction motions
Internal carotid artery passes under which structures
subclavius
SCM
platysma muscles attached to hyoid b.
25% of height of the cervical spine
intervertebral discs
there is no intervertebral discs where
between C0-C1 and C1-C2
Accessory nerve number
CN XI (11)
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
Pec minor
1st rib
clavicle
SCM
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?
Disc Herniation
Thoracic outlet
Cervical stenosis
Upper Cross Syndrome
Posture
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 of C2 + a subluxation of C2 onto C3
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, causing C1 to move forward on C2 (instable)
often fatal / needs urgent hospitalization
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)
secondary to slipped facets, herniated discs, infection
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 tests
shoulder abduction tests
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 (quandrant test/ext+rot)
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
- rotate head/no torso mvt
- rotate torso/no head mvt
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
“clunk”
sharp purser test for what
integrity of the transverse ligament
trying to cause a 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 seatedgrip on C2 + stabilize
passively rotate head left/right
+ve if more than 20-30 of rotation is possible without moving C2
goal of pronator drift test
differentiate between dizziness caused by articular problem vs vascular problems
what muscle can shut down following injury and cause segmental instability
longus colli muscle
Cervical spine pathologie
multifactorial disease
acute trauma (whiplash, extreme ROM, axial loading)
insidious onset (posture, age related)
common complaints of C-spine pathologies
neck stiffness
loss of ROM
headaches
dizziness
pain in the cervicobrachial area refers where?
the upper extremity (combination of neck and arm pain)
what is the order or ROM deficits with DDD
extension
SB
ROT
cervical disc herniation
most common posterior
Cranial nerves
