Cervical Spine

Question 1

C-spine vertebral anatomy

Answer 1

C1 and C2 - atypical

• C1 - no spinous process or vertebral body
• C2 - dense

C2-C6 have bifid spinous processes

Foramen transversarium in C1-C6 - vertebral artery

Question 2

C-Spine palpable landmarks

Answer 2

TP of C1 between angle of mandible and mastoid process

C2 highest palpable SP

C2-C7 have articular pillars “string of pearls”

Question 3

Insertion points of scalene muscles

Answer 3

Rib 1 - anterior and middle scalenes
Rib 2 - posterior

“I get up at 1AM 2P”

Question 4

Scalenes relationship to brachial plexus

Answer 4

branchial plexus runs between anterior and middle

Tight scalenes can compress branchial plexus and give neuro sx in ipsilateral arm
-Thoracic outlet syndrome

Question 5

Suboccipital muscles

Answer 5

Rectus capitis posterior major
Rectus capitis posterior minor
Obliquus capitis inferior
Obliquus capitis superior

Connect occiput, C1, C2
Insert at superior nuchal line
involved in OA movement

Hypertonicity - tension headache
Tx: suboccipital release

Question 6

Trapezius

Answer 6

Origin: external occipital protuberance - inion

Question 7

Levator scapulae

Answer 7

Origin C1-C4

Sidebends C-spine

Question 8

Alar and transverse ligaments

Answer 8

Alar: sides of dens to lateral margins of foramen magnum

Transverse: attaches to lateral masses of C1 to hold dens in place

RA and Down’s weaken ligaments -> atlanto-axial subluxation
Rupture -> catastrophic neurologic damage

Question 9

Spinal ligaments

Answer 9

Ligamentum nuchae - spinous processes of cervical spine

Ligamentum flavum - C2 to sacrum

Posterior longitudinal ligament - C2 to sacrum, narrower as it goes down. prevents posterior herniation of vertebral disk, thin in lumbar = more herniations at that location

Anterior longitudinal ligament - anterior surface of vertebral bodies to sacrum

• injured in whiplash
• prevents anterior displacement of cervical vertebrae on each other

Question 10

Joint of Luschka

Answer 10

C2-C7
articulate with vertebrae below

Uncinate processes - superior projection limits lateral disc herniation to protect cervical nerve roots

Question 11

OA motion

Answer 11

Side bending and rotation opposite ALWAYS!

Influence of Vagus N.

Question 12

AA motion

Answer 12

C1 motion on C2
Rotation

Sidebending and rotation opposite

Question 13

C2-C7 motion

Answer 13

flexion, extension, side bending, rotation

SB and Rotation to same side ALWAYS on boards

Can have flexion, extension, neutral component

C2-C4 - main motion rotation
C5-C7 main motion sidebending

Question 14

OA diagnosis

Answer 14

Translation: use fingers trick.

• right translation = force from left to right = left side bending
• check in flexion and extension as well as neutral

Sidebending and rotation always opposite

Question 15

AA diagnosis

Answer 15

flex neck up to 45 degrees then test rotation

Question 16

C2-C7 diagnosis

Answer 16

Translation - use fingers trick
-right translation = force from left to right = left side bending

Rotation is coupled with sidebending, ALWAYS the same on boards

Check in flexion and extension

Question 17

Spurling’s test

Answer 17

Foraminal stenosis - radiates down arm

Ipsilateral localized pain: facet arthropathy

Contralateral pain: muscle spasm

Question 18

Distraction test

Answer 18

cervical traction alleviates radiating pain in foraminal stenosis

Question 19

Foraminal stenosis

Answer 19

Degenerative changes in joints of Luschka, hypertrophic changes in intervertebral (facet) joints, osteophyte formation assoc w/ arthritis
-> intervertebral foraminal narrowing

Pain radiates down arm (positive Spurlings)