Cervical Spine Flashcards
What are symptoms of vertebral artery compromise?
- Vertigo
- nausea
- tinnitus
- fainting,
- visual disturbances
How are C1’s facets shaped?
Superior - face cranially to accept occipital condyles
Inferior - flat to slightly concave, lateral edges sloped downward approximately 30 degrees
How are C2’s facets shaped?
Superior - large, flat to slightly convex processes that generally face cranially, with 30* slope
What vertebrae is vertebral prominent?
C7
- large single pointed spinous process
What is the most important ligament of upper Spine complex?
Cruciform ligament
- prevents atlas from translating anterior on axis during flexion
- protects SC, medulla, and VAs
ROM at OA joint: flex, ext, rotation, lat flex
Flex = 5
Ext = 10
Rot = negligible
Lat flex = 5 per side
ROM at AA joint: flex, ext, rotation, lat flex
Flex = 5
Ext = 10
Rot = 40-45 each side*
Lat flex = negligible
ROM at C2-7 joints: flex, ext, rotation, lat flex
Flex = 35*
Ext = 70*
Rot = 45 each side
Lat flex = 35 each side*
Total ROM in the craniocervical region: flex, ext, rotation, lat flex
Flex = 45- 50
Ext = 85
Rot = 90 each side
Lat flex = 40 each side
Where does most degenerative changes occur in the Cspine?
C4-7
Coupling pattern in upper Cspine: Side flexion and rotation generally thought to occur to the ______ side
Opposite
- i.e., left lateral flexion is coupled with right rotation
Coupling pattern in lower Cspine (C2-7): Side bending and rotation occur to the ___ side
Same
What actions does protraction and retraction have on the Cspine?
- Protraction = Flexes the lower-to-mid cervical spine and extends the upper craniocervical region
- Retraction = Extends or straightens the lower-to-mid cervical spine and flexes the upper craniocervical region
What are symptoms of neoplastic conditions?
- Age over 50 years
- Previous history of cancer
- Unexplained weight loss
- Constant pain, no relief with bed rest
- Night pain
10 item self report functional outcome measure; Change of 6 points a clinician can be 90% confident a change has occurred
Neck disability index
- disability assessment
Pain type: presents with varying symptoms
intensity varies with different postures and positions; caused by placing abnormal stress and strain on anatomy
Mechanical pain
Pain type: more constant with no change in intensity or symptoms with change in position
Inflammatory pain
What 5 findings are consistent in ruling in compression fx?
- Age > 52 yrs
- No presence leg pain
- BMI < or = 22
- Doesn’t exercise regularly
- F gender
What are S and S of cervical myelopathy?
- Wide-based spastic gait
- Clumsy hands
- Visible change in handwriting
- Difficulty manipulating buttons or handling coins
- Hyperreflexia
- Positive Babinski test
- Positive Hoffman sign
- Lhermitte’s sign - Lighting rod feeling down UE as there is spinal flexion
- Urinary retention followed by overflow incontinence (severe myelopathy
What are the 5 findings that are consistent in ruling in cervical myelopathy?
- Gait deviation
- +Hoffmann’s
- Hyperreflexia of Brachioradialis
- +Babinski
- Age > 45 yrs
What are the S and S of VA insufficiency?
- Drop attacks*
- Dizziness* or lightheadedness related to neck movement
- Dysphasia*
- Dysarthria*
- Diplopia*
- Malaise and nausea*
- Vomiting
- Severe headaches
- Unsteadiness in walking, incoordination
- Weakness in extremities
- Sensory changes in face or body
- Hearing difficulties
- Facial paralysis
Pain from VA damage is referred to which side of the neck?
ipsilateral neck and head
- 5 D’s and 3 N’s
What is contraindicated if a patient has symptoms that are present during patient history?
Placing pt in ANY vertebral artery test position
What are the tests for VA insufficiency?
- Prayer position test
2. Traditional VA test in quadrant position
How do you tell the difference between vestibular symptoms and VBI?
Vestibular symptoms will be different in sitting vs supine, where VBI will remain unchanged
OA of facets and facet joints
Presentation; Extension reproduces pain; Foraminal closure tests may be positive; Unilateral pain into affected dermatomes; Slow onset, pain usually not relieved with rest; Most common C5-C6, C6-C7
Cervical Spondylosis
Central spinal canal narrowing; Unilateral or bilateral; Usually several dermatomes affected; Most common 30 – 60 yrs old; Pain increases with extension; Pain relieved by rest; Slow onset
Cervical spinal stenosis
More common unilateral pain; Pain into affected dermatomes; Flexion may increase pain; Pain provocation tests positive; Foraminal closure tests may be positive; Pain not relieved by rest; Sudden onset
Cervical Disc herniation
Acceleration and deceleration forces; Hyperflexion and extension injuries to cervical spine; Worse if no head rest to reduce extension range; Chin hits chest to break flexion; Anterior structures and TMJ take the force; Present with posterior pain
Whiplash Signs and symptoms: - Neck pain - Headaches – occipital area - Dizziness and nausea - Muscle Weakness 20-40% of patients have symptoms that are debilitating and persist for years
What are signs of cervicogenic headaches?
- Occipital or suboccipital component to HA
- Neck movement alters HA
- Painful limitation of neck movements
- Poor head or neck posture
- Hypomobility at OA joint
- Sensory deficits in occipital and suboccipital areas
Subjects instructed to “tuck in their chins” then to raise their heads; Measure time between assuming the test position until the chin begins to thrust
Deep Cervical Flexor Endurance test
- hold for 30 sec
Combined movements of extension, sidebending and rotation to R, L direction + overpressure; Provocation of symptoms; Radicular pain – nerve root involvement; Localized pain – facet joint pathology
Quadrant testing
- foraminal closure test
Pt. side bends; Press straight down through head; Positive test – radicular pain; Implication – cervical radiculopathy
Spurling’s test (foraminal compression)
One hand under chin and other hand under occiput; Slowly lift pt.’s head applying traction; Positive test – radicular pain is decreased or relieved; Implication – nerve root pressure has been relieved
Distraction test
What cluster of tests indicate cervical radiculopathy?
- (+) ULTT (median)
- Cervical rotation less than 60 degrees
- (+) Spurlings test
- (+) Distraction test
- (+) LR of 30.3 if all 4 tests are positive
Symptoms include: numbness or tingling in your fingers, pain in your shoulder and neck, weakening grip, arm pain and swelling, achiness, bluish color (pallor) in fingers or hand, weak or no pulse, wasting in the fleshy base of your thumb
Thoracic outlet syndrome
direct Pressure over scalenes
Brachial plexus compression test (TOS test)
Turn head towards symptomatic shoulder while extending UE slightly away from body. Pt should inhale, while PT checks for a pulse; + test - diminished pulse or reproduction of symptoms
Adson maneuvar (TOS test)
Pt abducts arms to 90 deg, ER the shoulder, flexes elbows to 90 deg. Pt then opens and closes the hands slowly for 3 min; + test – pt is unable to keep arms in starting position or reproduction of symptoms
Roos Test (TOS test)
One hand over forehead and one thumb over spinous process of axis to stabilize it; Pt. slowly flexes head while examiner presses backward with palm; Positive test – feel head slide backward; Implication – injury to transverse ligament
Sharp-Purser test
what should a pt with neck pain as a result of trauma be assessed for?
Alar ligament integrity
- lateral flex alar lig stress test
Patient in supine, PT palpates spinous process of C2; Side bend head (R side bend tightens L alar ligament); Spinous process of C2 should move in Contralateral direction of side bend, rotation; + test – delay or absence in SP movement of C2 may indicate pathology, ligamentous instability of alar ligament
Lat flex alar ligament stress test
What are the 5 neck pain tx based classifications?
- Pain control
- Centrilization
- Mobility
- Conditioning and increase exercise tolerance
- Reduce HA
What TBC do the following examination findings fall into?
- Very recent onset of symptoms
- Symptoms precipitated by trauma
- Referred or radiating symptoms extending into the upper quarter
- Poor tolerance for examination or most interventions
What is the proposed matched intervention?
Pain control - always start here if pt fits multiple TBC
Intervention:
1. Gentle active ROM within pain tolerance
2. ROM exercises for adjacent regions
3. Physical modalities as needed
4. Activity modification to control pain
What TBC do the following examination findings fall into?
- Radicular/referred symptoms in the upper quarter
- Peripheralization and/or centralization of symptoms with ROM
- Signs of nerve root compression present
- May have diagnosis of cervical radiculopathy
What is the proposed matched intervention?
Centrilization
Intervention:
1. Mechanical/manual cervical traction
2. Repeated movements to centralize symptoms
What TBC do the following examination findings fall into?
- Recent onset of symptoms
- No radicular/referred symptoms in the upper quarter
- Restricted ROM with rotation and/or discrepancy in lateral flexion ROM
- No signs of nerve root compression or peripheralization in the upper quarter with cervical ROM
What is the proposed matched intervention?
Mobility
Intervention:
1. Cervical and thoracic spine mobilization/ manipulation
2. Active range of motion exercises
What TBC do the following examination findings fall into?
- Unilateral headache with onset preceded by neck pain
- Headache pain triggered by neck movement or positions
- Headache pain elicited by pressure on posterior neck
What is the proposed matched intervention?
Reduce HA
Intervention:
1. Cervical spine manipulation/ mobilization
2. Strengthening of neck and upper quarter muscles
3. Postural education
