Cervical Spine Flashcards
‘Typical’ Cervical vertebrae
C3-C6
Cranio-cervical region of spine
Occiput, C1 and C2
Midcervical region of spine
C3-C6
Cervico-Thoracic region of spine
C7-T2
“transition zone” - experiences more wear and tear
Atlas
Role: Support the head
Anterior Arch:
- Tubercle for attachment of ant. longitudinal lig.
- Where dens of axis makes contact
Posterior Arch: Larger than anterior
Large transverse processess for ligaments that connect spine to cranium
Articular Facets of Atlas (C1)
Both are concave
Dens
Rigid vertical axis of rotation on axis (C2)
Makes contact with anterior arch of atlas
Transverse ligament
Holds dens to anterior arch - attaches to lateral masses of atlas
Role: Horizontal stability of the atlanto-axial articulation
Superior articular facets of C2
Convex
Uncovertebral joints
Lip of bone on lateral side of vertebral bodies in C3-C6
AKA Joints of Luschka
Atlanto-Occipital Joint
Primary Motion: Flexion/Extension
Minimal side bend
Rotational motion limited
Atlanto-Axial Joint
Accounts for 50% of all cervical rotation (averages 40-45 degrees each direction)
Right rotation: Posterior-Inferior movement of right lateral mass with anterior-superior movement of left lateral mass (airplane analogy)
Isolating AA Joint
Slowly take up full cervical flexion,
Maintain full flexion while gently rotating to either side
Angle of cervical facet joints
45 degrees
Nuchal Ligament
Limits cervical flexion
Continuation of the suprasinous ligaments
Tectorial Membrane
Extension of the posterior longitudinal ligament
Attaches to the basilar portion of the occipital bone
Role: Generalized multidirectional stability
Disruption of the Transverse Ligament
Often with trauma
Can occur with congenital conditions such as Down Syndrome or RA
Diagnostic image: Open Mouth films
- Look at distance between lateral mass of C1- want dens to be evenly spaced between the two.
Test for Transverse Ligament
Modified Sharp Purser Test
- Pt sitting
- Slight cervical flexion
- **Assess resting symptoms
- C2 spinous process stabilized with a pincer grip
- Gently apply force at forehead (posterior, NOT into extension)
- Assess Symptoms
Positive Test: Decrease in symptoms with AP motion of the head OR excessive displacement with AP movement
Alar Ligaments
Attach the apex of the dens to the medial sides of the occipital condyles
Resist excessive rotation of the head and atlas relative to the dens/C2 - C2 should move a bit with C1 during rotation
Alar Ligament Test
- Patient in sitting
- Slight flexion to further engage the alar ligament
- Examiner stabilizes the C2 spinous process with pincher grip
- Initiate passive side flexion or rotation (just 5-10 degrees)
- Feel the movement of C2 during these movements
Positive test: Failure to feel the movement of C2 (when rotation the head to the left, you should feel the right side of the spinous process pop up a bit)
Why do the alar ligament and transverse ligament tests?
Easy, no equipment needed
Shows that you’ve assessed C-spine for documentation purposes
**BUT can cause more harm - assess symptoms, history, presentation first
Vertebral Artery
Blood flow can be limited on one side with contralateral rotation
Vertebrobasilar Artery Insufficiency test
**Need to do this before any C-spine manual therapy
Subjective history: Dizziness, diplopia, dysarthria, dysphagia, drop attacks, N/V, HA, Nystagmus
AKA VBI Test
Maitland:
Pt is seated - keep their eyes open
- Extension, 10 second hold
- Rotation, both directions, 10 second hold each way
- Extension+Rotation, both directions, 10 second hold each way
Deep Short Neck Flexors
Rectus Capitus Anterior
Rectus Capitus Lateralis
-Attach from transverse processes/ anterolateral vertebral body of C1 to occipital bone
Deep Long Neck Flexors
Longus Capitus
Longus Colli
Superficial Neck Flexors
SCM
Scalenes
Hypertonic Tendencies
–> Potential vascular and neural compromise when scalenes are hypertonic because Brachial Plexus and Subclavian artery are running right here
(Scalenes also elevate ribs 1 and 2)
How to use pelvis to facilitate head retraction (upper cervical flexion)
Anterior pelvic tilt? (in supine)
Levator Scapulae
Area of frequent trigger points
Shoulder and cervical pain with decreased rotation
Upper Trapezius
Area of frequent trigger points
Compressess C1-C2
Posterior Intrinsic Extensors
Multifidus Semispinalis Capitus Semispinalis Cervicus Rotatores Splenus Capitus and Cervicus
Suboccipitals
Rectus Capitus Posterior Major
Rectus Capitus Posterior Minor - More problems
- Spinous process to occiput
Obliquus Capitus Superior
- Transverse Process C1 to occiput
Obliquus Capitus Inferior
- Spinous Process C2 to Transverse Process C1
Suboccipital Release
Maintain release with goal of contact with posterior rim of C1
Note any asymmetries
What does the tendency for hypomobility at the cranio-cervical and cervico-thoracic regions contribute to?
Overuse of mid-cervical levels and common pathology of C5,6,7
