Cervical Spine Flashcards
Joints of the Cervical Spine (4)
1.) Atlanto-occipital joints (C0-C1)
2.) Atlanto-axial joints (C1-C2)
3.) Facet joints (14 in total)
4.) Intervertebral discs
Atlanto-occipital joints (C0-C1)
Principle motion = flexion/extension (15-20 degrees)
Rotation is negligible
stabilized by several ligaments
Atlanto-axial joints (C1-C2)
Most mobile articulation of the spine
main supporting ligament is the transverse ligament holding the dens of the axis against the anterior arch of the atlas
this ligament weakens or ruptures in rheumatoid arthritis
two projections of the ligament go superior to the occiput and inferior to the axis, together with the transverse is know as the cruciform ligament movements
Flexion
Extension
Lateral Flexion
Rotation
Facet joints (14 in total)
Facilitates flexion and extension
Limited rotation or side flexion
Greatest flex/ext occurs at C5-C6 and next between C4-C5 and C6-C7
Because of this mobility degeneration is more likely to be seen at these levels
Intervertebral discs
Make up 25% of the height of the C/S
No disc between C0-C1 and C1-C2
Nucleus pulposus buffers axial compression
Annulus fibrosis withstands tension within the disc
Cervical Roots
Although there are 7 cervical vertebrae there are 8 cervical nerve roots, each is named for the vertebrae ABOVE it
Ex. C5 nerve root is between C4 and C5, rest of the spine the root is named for the vertebrae BELOW, eg: L4 nerve root is between L4 and L5
Cervical Spine Assessment: Bony Palpation
Anterior aspect
Thyroid cartilage (C4-C5)
Cricoid Cartilage(C6)
Posterior aspect
Occiput
Inion (EOP)
Mastoid process
SP of the cervical vertebrae (C2-7)
Facet joints
Cervical Spine Assessment: Soft tissue palpation (anterior)
Anterior
SCM
Involved in torticollis
Note discrepancies in size, tone\damaged
Hyperextension damages
May cause torticollis
Lymph Node Chain
Along medial border of SCM
Enlarged nodes in SCM region indicate URTI
Supraclavicular fossa
Palpate for unusual swellings or lumps
Swelling in the fossa might be secondary to trauma
Small lumps may be due to enlarged lymph nodes
Cervical Spine Assessment: Soft tissue palpation (posterior)
Posterior
Trapezius Muscle
Origin = Inion to T12
Insertion = clavicle, acromion, spine of scapula
Action = elevate retract, and depress shoulders
Lymph Nodes
Anterolateral aspect of traps
Enlarged with infection
Levator Scapulae
Origin = Upper cervical TVP’s
Insertion = Superior angle of the scapulae
Action = Shrug shoulders
Splenius and semispinalis capitus (Deep Muscles)
Scalenes (Anterior, Middle, Posterior)
Multiple attachments including ribs 1 and 2
RANGE OF MOTION (CERVICAL SPINE/MUSCLES/JOINTS)
Active ROM (AROM) - Patient copies movement of practitioner or is told to move in particular direction
Movements should be done in an order such that expected painful ones are done last and no residual pain is carried over from the previous movement.
If very acute, some movements may be left out to avoid exacerbation of symptoms.
Flexion = 45-50 Degrees
Bring the chin to the chest
can divide the flexion into two parts C0-C2 gives nodding, C2-C7 gives flexion
if problem with nodding is upper restriction
for lower normal can be chin touching chest with mouth closed or up to 2 finger width space between chest and chin
Extension = 70 Degrees
Bend the head backwards, lift the chin up without moving the neck
normally the nose and forehead can go nearly horizontal
tingling, loss of balance etc.. suggest serious complication of cord compression
Rotation = 70-90 Degrees
Look over your left and right shoulders
usually the chin does not quite reach the plane of the shoulder
Lateral flexion = 20 - 45 Degrees
Bring each ear to the shoulder
Be sure ear is moving to shoulder and not the reverse
Neurological Testing
Dermatomes
Myotomes
DTR’s
MYOTOMES (UPPER LIMBS)
Must be held for 5 seconds
MYOTOMES (LOWER LIMBS)
Must be held for 5 seconds
DTR’s
Cervical Degenerative Joint Disease (DJD)
Definition:
Cervical facet (zygapophyseal joint) irritation or damage that may cause cranial, cervical or upper shoulder & back pain referral; often difficult to differentiate from other neck issues
Differential Diagnosis:
Discogenic pain syndrome or sprain/strain
Cervical radiculopathy
Fibromyalgia, myofascial pain syndrome
Infection, neoplasm, aneurysm
History:
Dull, achy localized pain, although may be sharp during acute episodes, headaches and limited ROM – patient will often have pinpoint pain, neck muscle spasm/torticollis
Sometimes radiates to the shoulder or mid back regions, although does not often radiate beyond the elbow or upper thoracic spine
Patient may report a history of whiplash injury
Pain is reduced when supine
Physical:
Increased pain on extension & rotation (due to facet approximation)
Antalgia is typically away from the facet in acute patients resulting in slight flexion and lateral flexion position (torticollis like position)
Possible muscle splinting and guarded ROM
No neurological deficit (DTRs, motor, sensation)
Special Tests:
Cervical Compression Test
(+) local pain with compression
Cervical Distraction Test
(+) DECREASED pain with distraction
Spurlings or Maximal Compression Test
(+) Local pain with compression
Whiplash (What is it? What causes it? 2 common scenarios?)
Injury to the neck due to sudden acceleration or deceleration
Results in a flexion or extension deformation of the spine
2 common scenarios for whiplash
A body at rest suddenly put in motion (E.g. quarterback being hit from behind)
A moving body suddenly stopped (E.g. hockey player absorbing a hit in open ice)
Quebec Severity Classification of Whiplash Associated Disorders CHART
