cervical spine Flashcards
C3 to C7
cervical spine
serves as attachment site for neck muscles
MOI: MVA, posture, poor breathing pattern
first rib
joints of the CS
IVJ
Z jt
U jt
saddle shaped, diarthrodial jts
extend from c3 to t1
formed between uncinate processes
thought to prevent disc herniation
unconvertebral joints/joints of von luschka (u joints)
neck pain origins
whiplash/MVA
Collisions
Spondylosis
infection, tumor or disease processes
a restriction of cervical extension, side bending and rotation to the same side as the pain is
closing restriction
a restriction of cervical flexion, sidebending and rotation to the opposite side of the pain is
opening restriction
patients with mechanical neck pain benefit from
thoracic spine manipulation
referred pain areas of discs into the scapular region from the CS
Cloward signs
deep, dull ache
focal pain areasin the middle of back and scapular boarder from timulation of anterior/anterolat disc
spread out over the scapula and into the upper arm with post/postlat disc
induced by local pressure
associated with muscle spasms
cloward sign
CS disc herniation patient presentation
20-30 years of age
less common than lumbar
C6-7 and C5-6 most common
can result in localized pain, referred pain, radiculopathy or myelopaty
disc herniation, subjective
ache/stiffness
cloward signs
may or may not have distal symptoms
UCS DH pain pattern
base of the neck, head and face
C4-5 DH pain pattern
base of the neck and top of the shoulder
C5-6, C6-7 DH pain pattern
scapula, across the shoulder jt, and post/lat aspect of upper arm
CS DH agg
looking down, turning head
ADLs may be limited
speed of movement may be altered
driving, sitting, work
DH history
not associated with incident
may be related to sustained posture
slow onset or wake with pain
may have history of MVA
DH objective
ROM: limited flexion/extension
Painful ipsilateral ROM: SB and rot
Painful CPA’s
Positive spurling
DH intervention
traction posture modalities ergonomics body mechanics mckenzie's repeated motion
spondylosis of discs
30-55 y/o
spondylosis of facet jts
> 55 yrs of age
spondylosis of u jts
> 55 yrs of age
common levels of disc degeneration
C4-5
C5-6
C6-7
Disappearance of NP by age of
40-45
loss of disc height
loss of normal lordosis
results in intersegmental hypermobility and instability/subluxation
Disc degeneration
spondylosis subjective
cloward sign diffuse symptoms, unilat or bilat presence of radiculopathy long history of neck pain may have history or MVA
Spondylosis agg
sustained flexion
quick movements
end of range movements
Spondylosis objective
Posture ROM may be limited with pain Palpation: central and unilat segmental exam: sensory loss, motor loss, hyporeflexia upper limb neural tension
spondylosis intervention
joint mobs traction posture education ergonomics exercise: scapular stabiliation, thoracic extension
MOI acute cervical facet syndrome
sudden neck movement
result of synovial capsule impingement within a facet
localized pain with or without muscle spasms
acute torticollis
MOI chronic cervical facet syndrome
caused by chronic inflammation due to arthritis/injury
cervical facet syndrome objective
limited ROM w/wo muscle guarding side flexion is limited to both sides PPIVM: segmental motion limited PAIVM: limited, painful Lack of neurological signs palpable point tenderness and muscle spasm
cervical facet syndrome intervention
think of specific techniques rather than global approaches
manual therapy: unilat PA, contract-relax, joint specific traction
HEP
posture
ANR subjective
pain worse distally in dermatomal pattern
possible cloward sign
can be constant and/or latent
ANR objective
posture looks uncomfortable attempt to correct deformity increases symptoms ROM: only able to test 1-2 motions Palpation may not be able to do this neuro +
ANR intervention
education
ice/modalities
manual traction
joint mobilization:only when decreased severity and irritability
CNR subjective
patchy distribution
usually intermittent
can be nagging, able to sleep at night
CNR agg
sustained flexion
movements that narrow foramen
CNR objective
postural changes \+/- neuro signs ROM: limited in closing movments possible GH limitations Central PA \+spurling \+ neurodynamic findings
CNR intervention
joint mob traction neurodynamic treatment ergonomic modification of activities joint protection
stenosis objective
neck pain my be absent initially neck and arm pain painful and restricted ROM presence of sensory and motor deficits wasting of intrinsic muscles of hands resulting in loss of hand dexterity segmental and central neuro exam
stenosis intervention
patient education Ther-ex manual therapy: specific level traction, unilat pa cervical collar surgery
