Cervical Spine Flashcards
Cervical spine roots
Above vertebrae
Discs in our C spine?
No disk in the upper C spine
Disc shape
Thin (for greater mobility)
Thicker anterior (for lordosis)
Cervical radiculopathy- etiology
Disc herniation
Stenosis
Swelling/ inflammation
Dynamic disc theory
Disc contents can move do to movements
Nucleus paplposis move posterio lateral (weakest part of the annulus)
Cervical myelopathy
When the disc compresses onto the spinal cord
Stenosis definition
Narrowing
Stenosis causes
Osteophytes- lateral stenosis, degeneration of the spine (spodylosis)- lateral stenosis ,ligamentum flavum thickening (central stenosis)
Neuro scan
Dermatome
Myotome
Reflexes
Special tests
Perform when you see any S & S, or want to rule out
Dermatome procedure
1) get comfy
2) expose (not over clothing)
3) confirm understanding by testing sensation on another area
4) ask patient to close eyes
5) test entire Dermatome (proximal to distal)
6) bilateral
7) start light
8) if impaired test further with sharp blunt
Dermatome Tricks
Star Trek sign (C5 radial- T1 ulnar)
Cervical myotomes
Hold position and don’t let me move you (therapist should resis 5-8 sec)
Test bilaterally
Cervical myotomes
C1,2- neck flexion S
C3- side flexion
4- shoulder elevation
5- shoulder abduction
6- elbow flexion, wrist extension
7- elbow extension, wrist flexion
8- thumb extension, ulnar deviation
T1- finger abduction/ adduction
Important to know alternatives as sometimes someone is limited abilities (comorbidities)
Cervical reflexes
Deep tendon reflexes
If unable to get response- distract
- Jendrassik Maneuver( sit cross legged and try to pull apart)
- or count down from 99
Cervical reflexes- areas
C5- deltoid
C6- biceps/ brachioradialis
C7- Triceps
C8- Pronator quadratics
T1- Abductor digit Minimi
Reflex grades
0- no response
1- decreased response
2- normal response
3- exaggerated response
4- highteed
UMN reflexes test - possible lesion of spinal cord, brain stem or brain
Clonus
Babinski
Cervical special tests
Cervical distraction test (positive- if symptoms reduced)
Spurling’s (reproduction of symptoms)
Upper limb tension test- procedure
Supine
Test unaffected side first
Shoulder- forearm- wrist- fingers- ELBOW
Sensitize
Positive- reproduction of symptoms
Median nerve test (ULTT1)
Shoulder depression, abduction (110 ULTT1, 40 ULTT1)
Supination forearm
Wrist extension
Finger thumb extension
Elbow extension
Radial nerve
Shoulder depression abduction
Forearm pronation
Wrist flexion and ulnar deviation
Fingers and thumb flexion
Elbow extension
Ulnar (C8- T1 nerve roots)
Depression abduction (10-90)
Forearm pronation
Wrist extension and radial deviation
Fingers and thumb ext
Elbow flexion
Stenosis intervention
Open up intervertebral forman (flexion, traction, ipsilateral side flex and rotation)
Herniation interventions
Retraction progressions
Ebb-Duchene paralysis
Brachial plexus injury (upper)
Upper nerve root c5-6.
waiters tip position
Shoulder elbow paralysis
Deltoid and radial surface and hand
Shoulder dystopia during birth
Klumke’s Paralysis
C8, T1 lower brachial plexus.
Forearm, hand, triceps paralysis
Looks like an arm in a cast and a claw hand deformity
From childbirth due to traction on an abducted arms as child being pulled out of birth
Facet Syndrome
Pain is worse with compression stress on the facet joint
Pain in neck and/ or scapula region
Cervical facet arthrokinetmatics
Cervical facet joints are angle towards the eyes
Side bending and rotation occur towards the same side
Coupled mints into extension may be used to rule out facet joint involvement
Non-physiocological coupled movements (C spine)
Side flexion and rotation are performed i the opposite side
Vetebrobasilar insufficiency (VBI)- 5Ds 3Ns
Dizziness
Diplopia
Drop attacks
Dysphagia (NOT dysphasia as that is a learning impairment)
Dysarthria
Nystagmus
Nausea or vomiting
Other neurological symptoms
Vertebral artery test (Cervical Quadrant test)
Patient supine position
Take head into extension and side flexion and hold for 10-30 secs (eyes open )
If no symptoms, ipsilateral side flexion for another 10-30 secs
Positive test- dizziness or nystagmus, indicates that the contalateral side is obstructed
Torticollis (congenital or acquired)
Unlateral shortening of the SCM muscle: ipsilateral side flexion and contra lateral rotation of the C-spine causing decreased AROM and PROM in the opposite side
Rx: stretch the affected side SCM, strengthening exercises to improve balance between both sides
Congenital torticollis
Positional in uterus or trauma in childbirth
Handling can help.
Positional plagiocephaly- flat head syndrome when laying on one side and get flatter
Upper crossed syndrome
Chin poking (forward head)
Tight- pec and upper trap and lev scap
Weak- deep flexor and lower trap, rhomboids and serratus anterior
May lead to alignment issues due to stress (ex. Facet joints and posterior discs)
Upper crossed- treatments
Postural correction
Stretch tight
Strengthen weak
Cervical instability
Excessive motion b/w two adjacent vertebrae
Due to ligament damage, #, dislocation, joint damage, or weak muscles- from trauma, congenital malformations, long term corticosteroids, or secondary to other pathologies (ie. RA, or Down syndrome)
If instability is suspected, no mobs or manipulations
S&S of cervical instability
Dizzy
Lip or facial parenthesis
Lump in throat
Nausea/ vomiting
Nystagmus
Patient hesitant to move head or neck
Pupil changes
Severe headache
Severe muscle spasm
Soft end feel
Cervical spine tests
Antior shear or Sagittarius stress test
Lateral flexion alar ligamanet stress test
Lateral shear test
Sharp-purser test
Cervical flexion rotation test
Cervical spine muscular control
Inner unit muscles
- attach segmentally and are tonic muscles that maintain posture
- includes deep neck flexors, deep neck extensors, and suboccipital S
- can often become weak and result in compensation from elsewhere
Special test for segmental stability
Craniocervical flexion test (increase pressure cuff)
Hold for 10 secs
Shoulder get at least 26 mmHg when starting at 20mmHg
How to improve segmental instability
Deep neck flexors training
- aids in coordination and timing
- analgesic effect
