Cervical Spine Flashcards
The cervical spine consists of how many joints?
37
Which cervical vertebrae are considered typical and which atypical?
C3-C6 are typical
C7 is atypical
How does C7 differ from the rest of the cervical spine?
It has a much longer spinous process to allow attachment of the nuchal ligament.
It also has a wider transverse process, no inferior facet, and not transverse process
What structures bear a significant portion of axial loading throughout the cervical spine?
the articular pillars
How many IVDs are there in the cervical spine?
5 (the first one being between C2-C3)
The cervical nucleus pulposus constitutes __% of the IVD
25
The IVDs make up approximately __% of the height of the cervical spine. What does this allow for?
25
Greater ROM
What are the 2 types of articulations in the cervical spine?
- Facet Joints
- Uncovertebral Joints
How many intervertebral foramina are there in the cervical spine? Explain why…
8, because there is a nerve root existing between the occiput and the atlas
Describe the arthrokinematics of the cervical spine during flexion
- Anterior osteokinematic roll
- Superoanterior glide
- Anterior translation slide
What restrains the anterior osteokinematic roll that occurs during flexion?
the extensor muscles and the posterior ligaments
What restrains the superoanterior glide that occurs during flexion?
the joint capsule
What restrains the anterior translation slide that occurs during flexion?
the IVDs and the nuchal ligament
Flexion produces an _____ compression and a ______ distraction of the IVD
anterior
posterior
Describe the arthrokinematics of the cervical spine during extension
- Posterior osteokinematic roll
- Inferoposterior glide
- Posterior translation slide
What restrains the posterior osteokinematic roll that occurs during flexion?
the anterior prevertebral muscles and the ALL
What restrains the inferoanterior glide that occurs during flexion?
the joint capsule
What restrains the posterior translation slide that occurs during flexion?
the IVDs
The superior facets _____ during extension
approximate
What limits sidebending in the cervical spine?
the contralateral scalenes and intertransverse ligaments
What direction does the contralateral facet glide during sidebending?
superoanterior
What direction does the ipsilateral facet glide during sidebending?
posteroinferior
What direction does the contralateral uncovertebral joint glide during sidebending?
superolateral
What direction does the ipsilateral uncovertebral joint glide during sidebending?
inferomedial
Uncovertebral and facet arthrokinematic motion is limited by what?
the joint capsule
The vertebra translate _______ on the disk during sidebending
contralaterally
Contralateral translation of the vertebra on the disk is limited by what?
The IVD
What are 2 primary causes of neck complaints?
- IVD herniation
- whiplash
What are 2 secondary causes of neck complaints?
- DDD
- DJD
What is Cervicobrachial Syndrome?
A syndrome in which the patient experiences pain, numbness, weakness, and/or swelling in the neck AND in one or both UEs
What is Cervicocephalic Syndrome?
A syndrome in which the patient experiences pain, numbness, weakness, and/or swelling in the neck AND the head
What is Cervicomedulary Syndrome?
A syndrome in which the patient experiences pain, numbness, weakness, and/or swelling in the neck AND spinal cord symtpoms
What are the cervical spine red flags?
- Unexplained weight loss
- Compromise to multiple spinal nerve roots
- Gradual increase in pain over time
- Regional expansion of pain
- Spasm with PROM
- Visual disturbances
- Painful and weak resistive testing
- Hoarseness
- Limited scapular elevation
- Horner’s Syndrome
- T1 palsy (weakness of hand intrinsics)
- Arm pain in patients less than 35 years old or if it is greater than 6 months in duration
What are the cervical spine yellow flags?
- Recent trauma (occurring up to 6 weeks earlier)
- Acute capsular pattern
- Severe movement loss
- Strong spasm
- Paresthesia
- Segmental paresis
- Segmental or multisegmental hyporeflexia or areflexia
- UMN signs and symptoms
- Constant or continuous pain - Moderate-to-severe radiating pain
- Moderate-to-severe headaches
- Tinnitus
- History of LOC
- Memory loss or forgetfulness
- Difficulties with problem solving
- Reduced motivation
- Irritability
- Anxiety or depression
- Insomnia
Describe the safest order for the objective examination (1-7)
1) Structural Examination
2) Craniovertebral (UCS) Scan
3) Stability Testing/VBI Testing
4) Neurological Examination
5) Cardinal Plane Movements
6) Special Testing
7) Segmental Mobility Testing
What are the 6 components involved in a cervical scan?
- Neck rotation
- Upper Cervical Sidebending
- Upper Cervical Flexion
- Upper Cervical Extension
- Compression
- Distraction
Which tests are performed to assess c-spine stability?
- alar ligament test
- transverse ligament test
- Jefferson fracture test
- distraction test
- Sharp-Purser test
The distraction test asses ______ plane stability
longitudinal
The Sharp-Purser test asses ______ stability
translational
What does Spurling’s test assess?
the possibility of cervical radiculopathy
What is indicated if a patient’s symptoms are relieved during the should abduction test?
A cervical extradural compression problem, such as a herniated disc or nerve root compression
What is indicated if a patient’s symptoms are worsened during the should abduction test?
The pressure is increasing in the interscalene triangle
What are the 3 thoracic outlet tests?
- Adson’s test
- Costoclavicular Test
- Roos Test
If 3 of the following 4 tests are positive there is a __% prediction rate of cervical radiculopathy
+Spurlings Test
< 60 degrees of rotation
+Distraction Test
+ULNT
65
If all 4 of the following tests are positive there is a __% prediction rate of cervical radiculopathy
+Spurlings Test
< 60 degrees of rotation
+Distraction Test
+ULNT
90
Cervical ROM
Flexion = \_\_ degrees Extension = \_\_-\_\_ degrees Sidebending = \_\_ degrees Rotation = \_\_-\_\_ degrees
40
70-80
45
80-90
What is the key to anterior stabilization of the cervical spine?
Retraining the deep neck flexors
When performing joint mobilizations what must be done before releasing pressure?
Always come back to neutral before releasing pressure
What are NAGs?
Natural apophyseal accessory glides applied to the cervical spine with the patient passive
What are SNAGs?
Sustained natural apophyseal accessory glides where the patient attempts to actively move a painful or stiff joint through its ROM while the therapist overlays an accessory glide parallel with the treatment plane
