Cervical Spine Flashcards
What bony structures make up the spinal colum?
the transverse foramen, atlas, and axis
how many nerves in the cervical vertebrae?
there are 7 pairs of vertebrae with eight nerve roots
cervical plexus:
C1-C4
these nerve roots innervate the occipital, supraclavicular, shoulder, and upper thoracic region
brachial plexus:
C5-C8
C4 and T1 and T2 may also contribute
these nerve roots innervate parts of the shoulder, arm, an hand
history of the patient:
histoiry of spinal pathology, recurrent brachial plexus trauma, chest or breast pain, headcahes, eye examination, psychosocial factors
history of the present condition:
location of pain, MOI (insidous onset or acute), consistency of pain, postural influences, other symptoms
C2
sensory complaints of the jaw and occipital headaches.
no motor defecit
C3
sonsory complaints of headaches, posterior cervical spine pain, occipital pain, ear pain.
no motor defecits
C4
cervical spine pain, trap pain, superior/proximal shoulder pain.
no skeletal muscle defecits, dysfunctionof the diaphragm possible.
C5
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.
C6
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.
C7
posterior aspect of the arm, posterolateral forearm, and middle finger.
weaknedd in the triceps brachii, wrist extensor, finger extensor, and wrist pronator.
C8
pain in the fourth or fifth finger.
weak interossei.
inspection of the lateral structures:
-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
level of the shoulders:
Ac joint, deltoid, and clavicle should be level
position of the head on the shoulders:
-head should be symmetrical with shoulders.
-lateral flexion: unilateral spasm
-chin rotation: torticollis/wry neck
bilateral soft tissue comparison:
cervical musclulature:
-equality of mass, tone, and texture
-atrophy may be caused by impingement
-dominant side may be hypertrophied
for isometric tests:
avoid stressing other tissues
stress testing is
passive range of motion stressing the spinal ligaments
joint play:
hypomobility at one segment may result in hypermobility at the segment above or below
mechanism of injury:
compression or forces past its normal range of motion
disk herniation and osteophyte formation are common causes of
pressure placed on cerviacala nevre roots causing pain and felt through the affected dermatomes
common sites for cervical disk herniation:
C5-C6, C6-C7
degenrative joint and disk disease:
begins with disk degenration
joint pain, cervical stiffness, arom and prom limited
clinicla cervical instability
tender to palpate, muscle spasm, poos control in mid-range of active movements.
causes: poor posture, repetitive movement, muscular weakness, damage to passive restrians
facet joint syndrome
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
brachial plexus pathology
burner or stinger, moi: traction or impingement, erb’s point
thoracic outlet syndrome:
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
brachial plexus injury:
-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
flexion PROM test:
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
extention PROM test:
paintent prone. shoulders adbucted arms 90 degrees. hand on supeior aspect of cervical spine and head. pateints lifts up against pressure on head.
lateral flextion PROM
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
rotation and flexion PROM
supine. head rottaed to opposite side being tested. stabilize the sternum. hand on head. patient rotates to side being tested.
oppenheim test
-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
babinski test
-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
cervical compression test
-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
spurling test
-seated
-same as compression test but patient laterally flexes the spine then force is applied.
positive test if syptoms radiate down the arm
cervical distraction test
-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
vertebral artery test
-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
shoulder abduction test
-seated or standing
-adbuct arm and place hand on head. hlold for 30 seconds
-positive if decrease in symptoms
brachial lexus traction test
-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
allens test for thoracic outlet syndrome
-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
adsons test for thoracic outlet syndrome
-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
military brace test:
-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
roos test for thoracic outlet syndrome
-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
