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MSK T3 > Cervical Spine > Flashcards

Cervical Spine Flashcards

1
Q

What is the natural curve of the cervical spine called?

A

The lordotic curve

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2
Q

What is the 3-joint complex in the spine?

A

The articulation of two facet joints and the intervertebral disc

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3
Q

What structures provide dense support to the spine?

A

Ligaments and muscles

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4
Q

What is the significance of the transverse foramina in the cervical vertebrae?

A

They allow passage of the vertebral arteries

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5
Q

What is the significance of the transverse foramina in the cervical vertebrae?

A

They allow passage of the vertebral arteries

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6
Q

Why are spine movements described as combined or coupled?

A

Pure movements rarely occur; for example, rotation and side bending often happen in flexed or extended positions.

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7
Q

Why is understanding coupled movements important in assessments?

A

Positive tests may not be evident when only testing for pure movements.

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8
Q

What defines a motion segment in the spine?

A

The articulation between two adjacent vertebrae

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9
Q

When defining movement at a specific motion segment, how is it referenced?

A

Both vertebrae are referenced, e.g., right rotation of C3 on C4

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10
Q

When describing spinal rotation, which part of the vertebra is referenced?

A

The anterior vertebral body

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11
Q

What is the normal cervical range of motion (ROM) for flexion?

A

45-50 degrees total, with the chin within 2 finger widths from the chest

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12
Q

What is the normal cervical ROM for extension?

A

85 degrees total; the patient should look up at the ceiling with the front of the neck vertical

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13
Q

What is the normal cervical ROM for lateral flexion?

A

40 degrees total

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14
Q

What is the normal cervical ROM for rotation?

A

90 degrees total; the chin should align with the anterior shoulder

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15
Q

What percentage of cervical rotation occurs at the C1-C2 segment?

A

50% of cervical rotation

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16
Q

How can you tailor rotation testing to focus on the C1-C2 segment?

A

Place the neck in flexion

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17
Q

How can you tailor rotation testing to focus on C3-C7?

A

Position the neck in upper cervical extension to lock out C1-C2

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18
Q

What type of joint are facet joints?

A

Synovial joints

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19
Q

What is the orientation of cervical facet joints?

A

45 degrees posterior to anterior

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20
Q

How do the superior articular facets of cervical vertebrae face?

A

Superiorly, posteriorly, and medially

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21
Q

How do the inferior articular facets of cervical vertebrae face?

A

Inferiorly, anteriorly, and laterally

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22
Q

How does the orientation of cervical facet joints affect movement?

A

It facilitates flexion and extension, but prevents simple rotation or lateral flexion without coupling.

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23
Q

What is coupled movement in the cervical spine?

A

Rotation and lateral flexion occur together.

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24
Q

How is lateral flexion coupled with axial rotation in the cervical spine (C2-C7)?

A

Lateral flexion is coupled with axial rotation in the same direction.

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25
Q

Are there intervertebral discs in the upper cervical spine?

A

No, there are no discs present in the upper cervical spine.

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26
Q

What are the functions of intervertebral discs?

A

To absorb shock and provide stability to the spine.

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27
Q

What structures make up the 3-Joint Complex?

A

Two facet (zygapophyseal) joints and one intervertebral joint (the disc between two vertebral bodies).

28
Q

How does dysfunction in the 3-Joint Complex affect the spine?

A

Dysfunction at one segment affects the motion segments above and below.

29
Q

What is the resting position of the spine?

A

Midway between flexion and extension.

30
Q

What is the close-packed position of the spine?

A

Full extension.

31
Q

How do facet joints move during neck flexion?

A

The facet joints move away from each other in an upward/forward direction (they “open”).

32
Q

How do facet joints move during neck extension?

A

The facet joints move closer together, gliding in a posterior/inferior motion (they “close”).

33
Q

What happens to facet joints during neck rotation?

A

• On the ipsilateral side: Facets glide downward and posteriorly (close).

• On the contralateral side: Facets glide upward and anteriorly (open).

34
Q

How do facet joints move during lateral flexion?

A

The same movements occur as with rotation (lateral flexion and rotation are coupled movements).

35
Q

How do you improve flexion in a motion segment?

A

Perform an anterior/superior glide of the superior vertebra while stabilizing the inferior vertebra.

36
Q

How do you improve extension in a motion segment?

A

Perform an anterior/superior glide of the inferior vertebra while stabilizing the superior vertebra.

37
Q

How do you improve rotation in a motion segment?

A

• Perform a lateral glide using the spinous process toward the contralateral side.

• OR, perform an anterior glide of the contralateral facet.

38
Q

How do you improve lateral flexion in a motion segment?

A

Use the same mobilizations as for improving rotation.

39
Q

How many cervical nerve roots are there?

A

8 cervical nerve roots, despite only 7 cervical vertebrae.

40
Q

Where do cervical nerve roots exit relative to the vertebrae?

A

• C1-C7 nerve roots exit above their corresponding vertebra.

• C8 nerve root exits below C7.

41
Q

What is radiculopathy?

A

Compression of a nerve root as it exits the intervertebral foramen (IVF), causing:

• Sensory deficits
• Motor weakness (without pain)
• Reduced reflexes

42
Q

What does the brachial plexus do?

A

It is formed by the cervical nerve roots and can become compressed, causing neurological symptoms in the arm and hand.

43
Q

How does brachial plexus compression differ from radiculopathy or peripheral nerve compression?

A

• 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).

44
Q

What are common spinal nerve compression tests?

A

• Dermatomes, Myotomes, Deep tendon reflexes
• Valsalva
• Spurling’s test
• Compression test
• Distraction test

45
Q

What are common tests for Thoracic Outlet Syndrome (TOS)?

A

• Travell’s test: Scalene compression
• Adson’s test: Scalene compression
• Military test: 1st rib-clavicle compression
• Hyperabduction test: Pec minor compression

46
Q

What test is used to assess nerve entrapment along a nerve pathway?

A

Tinel’s Sign.

47
Q

How can you test for median nerve entrapment at the pronator teres?

A

Perform pronator teres activation.

48
Q

What tests assess median nerve entrapment at the carpal tunnel?

A

Phalen’s Test and Reverse Phalen’s Test.

49
Q

What test assesses generalized myofascial restriction along a nerve pathway?

A

Nerve tension tests.

50
Q

What tests should you prioritize if a patient has post-traumatic, bilateral neurological symptoms or suspected instability?

A

Sharp-Purser and Transverse Ligament Tests.

51
Q

What should you always test if there are neurological signs or symptoms?

A

The entire nerve pathway.

52
Q

What is the pain referral for the C2-3 joint?

A

Back of the head.

53
Q

Which joint refers pain to the back of the neck?

A

C3-4 and C4-5 joints.

54
Q

Where does the C5-6 joint refer pain?

A

Suprascapular area.

55
Q

What is the referral area for the C6-7 joint?

A

Scapula/thorax.

56
Q

Name some muscles that commonly have trigger point referrals in the cervical spine.

A

Scalenes, levator scapula, upper trapezius, splenius capitis, splenius cervicis, SCM, suboccipitals, longissimus capitis, semispinalis capitis, cervical multifidus.

57
Q

How can you differentiate between joint and trigger point referral pain?

A

Assess for trigger point activity and joint involvement as both impairments may coexist.

58
Q

What is whiplash?

A

A soft tissue traumatic injury of the cervical spine caused by an acceleration-deceleration mechanism.

59
Q

What are common causes of whiplash?

A

Motor vehicle accidents (MVAs), slips/falls, contact sports.

60
Q

What are the classifications of Whiplash Associated Disorders (WAD)?

A

• 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.

61
Q

What type of cervical injury results from a front impact?

A

Hyperflexion injury followed by rebound extension.

62
Q

What type of cervical injury results from a side impact?

A

Ipsilateral flexion injury.

63
Q

What type of cervical injury results from a rear impact?

A

Hyperextension injury followed by rebound hyperflexion.

64
Q

What are some factors that complicate whiplash injuries?

A

• Concussion or head injury.
• Head/neck position at the time of impact.
• Pre-existing conditions or tissue integrity.
• Improper seatbelt placement or airbag deployment.

65
Q

What additional history questions should you ask a whiplash patient?

A

• Headaches?
• Loss of consciousness?
• Difficulty concentrating or swallowing?
• Problems with vision, hearing, or balance?
• Severe pain, swelling, or limited ROM?

66
Q

Why is it important to educate patients about delayed symptom onset after a head injury?

A

Symptoms like those from a subdural hemorrhage may take time to appear, necessitating physician referral.

MSK T3 (9 decks)

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