Cervical Spine

Question 1

What bony structures make up the spinal colum?

Answer 1

the transverse foramen, atlas, and axis

Question 2

how many nerves in the cervical vertebrae?

Answer 2

there are 7 pairs of vertebrae with eight nerve roots

Question 3

cervical plexus:

Answer 3

C1-C4
these nerve roots innervate the occipital, supraclavicular, shoulder, and upper thoracic region

Question 4

brachial plexus:

Answer 4

C5-C8
C4 and T1 and T2 may also contribute
these nerve roots innervate parts of the shoulder, arm, an hand

Question 5

history of the patient:

Answer 5

histoiry of spinal pathology, recurrent brachial plexus trauma, chest or breast pain, headcahes, eye examination, psychosocial factors

Question 6

history of the present condition:

Answer 6

location of pain, MOI (insidous onset or acute), consistency of pain, postural influences, other symptoms

Question 7

C2

Answer 7

sensory complaints of the jaw and occipital headaches.
no motor defecit

Question 8

C3

Answer 8

sonsory complaints of headaches, posterior cervical spine pain, occipital pain, ear pain.
no motor defecits

Question 9

C4

Answer 9

cervical spine pain, trap pain, superior/proximal shoulder pain.
no skeletal muscle defecits, dysfunctionof the diaphragm possible.

Question 10

C5

Answer 10

pain in the superior aspect of the shoulder or lateral aspect of the upper arm.
muscle weakness in deltoid muscle group, biceps brachii. impingment test may be negative.

Question 11

C6

Answer 11

pain in the cervical spine,m area over the biceps brachii, back fo the hand between the thumb and index finger.
weak wrist elbow, and thumb extension.

Question 12

C7

Answer 12

posterior aspect of the arm, posterolateral forearm, and middle finger.
weaknedd in the triceps brachii, wrist extensor, finger extensor, and wrist pronator.

Question 13

C8

Answer 13

pain in the fourth or fifth finger.
weak interossei.

Question 14

inspection of the lateral structures:

Answer 14

-cervical curvature: lordotic curve, flattenning of the curve, spasm of the cervical muscles, increased curvature, forward head position, lateral bending, posturing to decrese pressure on nerve roots.
-forward head posture: accompanied by excessive flexion of the cervical spine, caused by postural chnages, muscle spasms, or weakness

Question 15

level of the shoulders:

Answer 15

Ac joint, deltoid, and clavicle should be level

Question 16

position of the head on the shoulders:

Answer 16

-head should be symmetrical with shoulders.
-lateral flexion: unilateral spasm
-chin rotation: torticollis/wry neck

Question 17

bilateral soft tissue comparison:

Answer 17

cervical musclulature:
-equality of mass, tone, and texture
-atrophy may be caused by impingement
-dominant side may be hypertrophied

Question 18

for isometric tests:

Answer 18

avoid stressing other tissues

Question 19

stress testing is

Answer 19

passive range of motion stressing the spinal ligaments

Question 20

joint play:

Answer 20

hypomobility at one segment may result in hypermobility at the segment above or below

Question 21

mechanism of injury:

Answer 21

compression or forces past its normal range of motion

Question 22

disk herniation and osteophyte formation are common causes of

Answer 22

pressure placed on cerviacala nevre roots causing pain and felt through the affected dermatomes

Question 23

common sites for cervical disk herniation:

Answer 23

C5-C6, C6-C7

Question 24

degenrative joint and disk disease:

Answer 24

begins with disk degenration
joint pain, cervical stiffness, arom and prom limited

Question 25

clinicla cervical instability

Answer 25

tender to palpate, muscle spasm, poos control in mid-range of active movements.
causes: poor posture, repetitive movement, muscular weakness, damage to passive restrians

Question 26

facet joint syndrome

Answer 26

MOI: acute trauma-whiplash or repetitive motion
symptoms: posterior neck pain with extension and rotation, clicking or catching, localized pain that is lateral to spinous process

Question 27

brachial plexus pathology

Answer 27

burner or stinger, moi: traction or impingement, erb’s point

Question 28

thoracic outlet syndrome:

Answer 28

cause: pressure on the trunks and medical cord of the brachial plecus, subclavian artery, or subclavian vein
3 types: vascular, neurogenic, nonspecific
maganged: correct posture, correct muscle testing

Question 29

brachial plexus injury:

Answer 29

-runs off field, arm danlging, symptoms transient
-manage: rule out cervical trauma, ice
-return to play: normal neurologic exam, no weakness, full ROM no pain

Question 30

flexion PROM test:

Answer 30

patient supine. arms abducted elbows at 90 degrees. trainer hand on trunk and forehead. patients lifts against force of hand on head. weakness assoicated with cervical pain

Question 31

extention PROM test:

Answer 31

paintent prone. shoulders adbucted arms 90 degrees. hand on supeior aspect of cervical spine and head. pateints lifts up against pressure on head.

Question 32

lateral flextion PROM

Answer 32

patient seated. stabilize AC joint and lateral side of head. pateint resists push of head to opposite side. hand pushes out head goes in toward other hand

Question 33

rotation and flexion PROM

Answer 33

supine. head rottaed to opposite side being tested. stabilize the sternum. hand on head. patient rotates to side being tested.

Question 34

oppenheim test

Answer 34

-for motor neuron lesions
-supine
-run an object along crst of the anteromedial tibia.
-posiitve test: big toes extends or toes splay or hypersensitivity to the test

Question 35

babinski test

Answer 35

-cervical spine or acute head injury
-supine.
-blunt device run up plantar aspect of the foot from the calcanus curved towards the big toes.
positive test: toes spay or big toe curls

Question 36

cervical compression test

Answer 36

-sitting
-hands interlocked over pateints head
-press down on top of the head
-if pain occurs or symptoms reproduced in cervical spine or upper extremity, positive test

Question 37

spurling test

Answer 37

-seated
-same as compression test but patient laterally flexes the spine then force is applied.
positive test if syptoms radiate down the arm

Question 38

cervical distraction test

Answer 38

-attemps to releive symptoms
-supine
-hands at top and bottom of head
-head off the table
-examiner pulls towards themselves
-positive test is symptoms releived or reduced

Question 39

vertebral artery test

Answer 39

-supine
-hands under the occipit
-head off the table
-extend cervical spine, rotate to one side and hold. repeat for other side
-watch pupil activity
-posiitve if dizzy, confusion, nystagmus, unilateral pupil changes, nausea

Question 40

shoulder abduction test

Answer 40

-seated or standing
-adbuct arm and place hand on head. hlold for 30 seconds
-positive if decrease in symptoms

Question 41

brachial lexus traction test

Answer 41

-seated or standing
-place hand on shoulder/trap/AC joint. other hand on inside of head.
-push head to opposite shoulder
-positive test if reproduction of symptoms

Question 42

allens test for thoracic outlet syndrome

Answer 42

-sitting w head forward
-arm at 90 degrees. feel radial pulse.
externally rotate the shoulder and have pateint rotate head opposite direction
-positive if pulse disappears or symptoms reproduced

Question 43

adsons test for thoracic outlet syndrome

Answer 43

-sitting. shoulder abducted to 30 degrres. elbow extended with thumb pointing upward. humerus externally rotated
-place hand on radial pulse
-externally rotate and extend shoulder and have pateint rotate head twoards you and extend neck. hold breath
-positive if pulse disappears

Question 44

military brace test:

Answer 44

-standing looking forward
-one hand positioned to locate radial pulse
-depress shoulder, extend humerus backwards 30 degrees, heck and head hyperextended.
-positive if pulse disappears

Question 45

roos test for thoracic outlet syndrome

Answer 45

-sitting or standing, shoulders adbucted to 90 degrees and humerus externally rotated, elbows flexed at 90 degrees
-rapidly open and close both hands for 30 minutes
0positive tst if inability to maintain testing position