Cervical Spine Flashcards
What is the natural curve of the cervical spine called?
The lordotic curve
What is the 3-joint complex in the spine?
The articulation of two facet joints and the intervertebral disc
What structures provide dense support to the spine?
Ligaments and muscles
What is the significance of the transverse foramina in the cervical vertebrae?
They allow passage of the vertebral arteries
What is the significance of the transverse foramina in the cervical vertebrae?
They allow passage of the vertebral arteries
Why are spine movements described as combined or coupled?
Pure movements rarely occur; for example, rotation and side bending often happen in flexed or extended positions.
Why is understanding coupled movements important in assessments?
Positive tests may not be evident when only testing for pure movements.
What defines a motion segment in the spine?
The articulation between two adjacent vertebrae
When defining movement at a specific motion segment, how is it referenced?
Both vertebrae are referenced, e.g., right rotation of C3 on C4
When describing spinal rotation, which part of the vertebra is referenced?
The anterior vertebral body
What is the normal cervical range of motion (ROM) for flexion?
45-50 degrees total, with the chin within 2 finger widths from the chest
What is the normal cervical ROM for extension?
85 degrees total; the patient should look up at the ceiling with the front of the neck vertical
What is the normal cervical ROM for lateral flexion?
40 degrees total
What is the normal cervical ROM for rotation?
90 degrees total; the chin should align with the anterior shoulder
What percentage of cervical rotation occurs at the C1-C2 segment?
50% of cervical rotation
How can you tailor rotation testing to focus on the C1-C2 segment?
Place the neck in flexion
How can you tailor rotation testing to focus on C3-C7?
Position the neck in upper cervical extension to lock out C1-C2
What type of joint are facet joints?
Synovial joints
What is the orientation of cervical facet joints?
45 degrees posterior to anterior
How do the superior articular facets of cervical vertebrae face?
Superiorly, posteriorly, and medially
How do the inferior articular facets of cervical vertebrae face?
Inferiorly, anteriorly, and laterally
How does the orientation of cervical facet joints affect movement?
It facilitates flexion and extension, but prevents simple rotation or lateral flexion without coupling.
What is coupled movement in the cervical spine?
Rotation and lateral flexion occur together.
How is lateral flexion coupled with axial rotation in the cervical spine (C2-C7)?
Lateral flexion is coupled with axial rotation in the same direction.
Are there intervertebral discs in the upper cervical spine?
No, there are no discs present in the upper cervical spine.
What are the functions of intervertebral discs?
To absorb shock and provide stability to the spine.
What structures make up the 3-Joint Complex?
Two facet (zygapophyseal) joints and one intervertebral joint (the disc between two vertebral bodies).
How does dysfunction in the 3-Joint Complex affect the spine?
Dysfunction at one segment affects the motion segments above and below.
What is the resting position of the spine?
Midway between flexion and extension.
What is the close-packed position of the spine?
Full extension.
How do facet joints move during neck flexion?
The facet joints move away from each other in an upward/forward direction (they “open”).
How do facet joints move during neck extension?
The facet joints move closer together, gliding in a posterior/inferior motion (they “close”).
What happens to facet joints during neck rotation?
• On the ipsilateral side: Facets glide downward and posteriorly (close).
• On the contralateral side: Facets glide upward and anteriorly (open).
How do facet joints move during lateral flexion?
The same movements occur as with rotation (lateral flexion and rotation are coupled movements).
How do you improve flexion in a motion segment?
Perform an anterior/superior glide of the superior vertebra while stabilizing the inferior vertebra.
How do you improve extension in a motion segment?
Perform an anterior/superior glide of the inferior vertebra while stabilizing the superior vertebra.
How do you improve rotation in a motion segment?
• Perform a lateral glide using the spinous process toward the contralateral side.
• OR, perform an anterior glide of the contralateral facet.
How do you improve lateral flexion in a motion segment?
Use the same mobilizations as for improving rotation.
How many cervical nerve roots are there?
8 cervical nerve roots, despite only 7 cervical vertebrae.
Where do cervical nerve roots exit relative to the vertebrae?
• C1-C7 nerve roots exit above their corresponding vertebra.
• C8 nerve root exits below C7.
What is radiculopathy?
Compression of a nerve root as it exits the intervertebral foramen (IVF), causing:
• Sensory deficits
• Motor weakness (without pain)
• Reduced reflexes
What does the brachial plexus do?
It is formed by the cervical nerve roots and can become compressed, causing neurological symptoms in the arm and hand.
How does brachial plexus compression differ from radiculopathy or peripheral nerve compression?
• Brachial plexus compression affects the entire arm/hand.
• Radiculopathy follows a specific dermatome/myotome path.
• Peripheral nerve compression follows a specific peripheral nerve path (e.g., median nerve).
What are common spinal nerve compression tests?
• Dermatomes, Myotomes, Deep tendon reflexes
• Valsalva
• Spurling’s test
• Compression test
• Distraction test
What are common tests for Thoracic Outlet Syndrome (TOS)?
• Travell’s test: Scalene compression
• Adson’s test: Scalene compression
• Military test: 1st rib-clavicle compression
• Hyperabduction test: Pec minor compression
What test is used to assess nerve entrapment along a nerve pathway?
Tinel’s Sign.
How can you test for median nerve entrapment at the pronator teres?
Perform pronator teres activation.
What tests assess median nerve entrapment at the carpal tunnel?
Phalen’s Test and Reverse Phalen’s Test.
What test assesses generalized myofascial restriction along a nerve pathway?
Nerve tension tests.
What tests should you prioritize if a patient has post-traumatic, bilateral neurological symptoms or suspected instability?
Sharp-Purser and Transverse Ligament Tests.
What should you always test if there are neurological signs or symptoms?
The entire nerve pathway.
What is the pain referral for the C2-3 joint?
Back of the head.
Which joint refers pain to the back of the neck?
C3-4 and C4-5 joints.
Where does the C5-6 joint refer pain?
Suprascapular area.
What is the referral area for the C6-7 joint?
Scapula/thorax.
Name some muscles that commonly have trigger point referrals in the cervical spine.
Scalenes, levator scapula, upper trapezius, splenius capitis, splenius cervicis, SCM, suboccipitals, longissimus capitis, semispinalis capitis, cervical multifidus.
How can you differentiate between joint and trigger point referral pain?
Assess for trigger point activity and joint involvement as both impairments may coexist.
What is whiplash?
A soft tissue traumatic injury of the cervical spine caused by an acceleration-deceleration mechanism.
What are common causes of whiplash?
Motor vehicle accidents (MVAs), slips/falls, contact sports.
What are the classifications of Whiplash Associated Disorders (WAD)?
• Grade 1: No physical neck/upper back signs.
• Grade 2: Musculoskeletal signs (e.g., decreased ROM, point tenderness).
• Grade 3: Neurological signs (e.g., decreased reflexes, sensation, strength).
• Grade 4: Fracture or dislocation.
What type of cervical injury results from a front impact?
Hyperflexion injury followed by rebound extension.
What type of cervical injury results from a side impact?
Ipsilateral flexion injury.
What type of cervical injury results from a rear impact?
Hyperextension injury followed by rebound hyperflexion.
What are some factors that complicate whiplash injuries?
• Concussion or head injury.
• Head/neck position at the time of impact.
• Pre-existing conditions or tissue integrity.
• Improper seatbelt placement or airbag deployment.
What additional history questions should you ask a whiplash patient?
• Headaches?
• Loss of consciousness?
• Difficulty concentrating or swallowing?
• Problems with vision, hearing, or balance?
• Severe pain, swelling, or limited ROM?
Why is it important to educate patients about delayed symptom onset after a head injury?
Symptoms like those from a subdural hemorrhage may take time to appear, necessitating physician referral.
