Cervical Spine Flashcards
Cervical Anatomy
7 vertebrae
C1- atlas. In shape of a washer. Skull rests on it
C2- axis. Has Odontoid process.
C1 and C2 provide great mobility to skull
Thinnest and most delicate
Role= supporting head, protection of spinal cord and providing mobility to head and neck
C3-C7 are more classic. They have a body, pedicels, laminae, spinous processes and facet joints
Cervical muscles
Sternocleidmastoid Lavator scapulae Trapezius Splenius cervicis Splenius capitis Scalenes anterior Scalenes posterior Erector spinae
Cervical pathology-initial testing
What movements are painful? What are the general patterns? What is the V a S? Are they on any medication? Are they presenting any red flags?
Cervical Pathologies
Degenerative or postural
Initial assessment
Take out the initial assessment in setting.
– Look at posture. Do they have normal curves? Lordosis, kyphosis, lordosis is normal.
– Ears should roughly be in line with shoulders
– Active range of movement. Flexion/extension, rotation, Side flexion, retraction and pro traction. Looking for pain, quality, resistance, range, spasm
– Then carry out these movements passively. OVERPRESSURES
What comes after initial assessment?
Palpation– Begin by sweeping the skin
-Warmth/sweating may indicate inflammation or inflammatory disorder
– Dry skin may denote autonomic changes
– Palpate the spine looking for the position of the vertebrae. Is there any undue prominence?
-PQRRS
-P –> tender? Painful? Normal? Stiff? Spasm?
-R –> normal? Hypomobile? Hyper mobile? Stiff?
– Are there any abnormalities? Prominent or depressed segments
-PAIVMS
Neurological testing…
Dematomes= area of skin supplied by a single nerve. Gently brush skin on both sides.
Myotomes= muscle blocks along either side of the vertebrae. Remember the dance.
Reflexes= automatic response to stimulus
Lumbar muscles
Erector Spinae Quadratus Lumborum Lattissimus Dorsi Multifidus Internal Abdominal Oblique External Abdominal Oblique Rectus Abdomanis Transversus Abdominis
Lumbar Anatomy
5 vertebrae
Provide stability, control of movement and protection of intervertebral discs.
Incredibly strong
Two articulating surfaces: superior articular facets and inferior articular facets
Articular surfaces facilitate flexion, extension and prevent rotation
Spondylosis
The first thing to degenerate is the disc (becomes thinner and spongy)
Water content decreases- annular fibrosis is weakened
Decrease in water content means that some height will be lost
Loss of a shock absorption, vertebrae will move closer together
This increases the risk of a disc prolapse
This increases the pressure on the facet joints causing postural changes, increasing ligament laxity meaning that the overall joints are less stable.
This can cause irritation and inflammation of the spinal root nerves
Hypermobility occurs in the facet joints causing osteophytes to form (bony projection)
Osteophytes developed to increase surface area in vertebral bodies to stabilise the joint and reduce hypermobility.
Risk factors of spondylosis
Previous injuries Carrying heavy items Sports that require persistent hyperextension of lumbar spine 40+ Any region of spine
Clinical presentation of spondylosis
– Spinal stenosis
– Disc herniation
– Spondylolysis
Signs and symptoms of pathologies
ADD LATER
Postural dysfunction
Posture
– Kyphosis= excessive outward curvature – hunchback
– Lordosis= excessive inward curvature
- scoliosis= abnormal lateral curvature of spine
Effects – Inefficient sitting or standing – Sedentary lifestyle, obesity, diabetes – Slumped position, bad habits – Neck and back pain
Anatomical and physiological effects of poor posture
– Spinal ligaments elongate
– Muscular imbalances occur.some muscles are in constant contraction while opposing muscles are weak and overstretched leading to pain
– Abdominal muscles – a hunch position will cause abdominal muscles to shorten, encouraging a further hunched position
– Potential constriction of blood vessels and nerves
– Poor circulation increases the pressure of gases and fluids moving through the body
– Potential vertebral subluxation
– Nerve construction – movements of subluxations can put pressure on the surroundings spinal nerves
Red flags
Signs
- altered bowel habits
- unexplained weight loss
- night sweats/night pain
- constant relentless pain
- saddle anaesthesia
- altered gait pattern
- bi-lateral symptoms
- dysphasia, dysarthria, dizziness, diplopia, drop attacks
- nausea, nystagmus, numbness
Cervical= UCI, CAD Lumbar= Cauda Equina
CAD
Coronary Artery Dysfunction
Blockage of one or more of the arteries supplying blood to the heart
Subclavian artery enters spine at C6/7
Vertebral artery is close to uncovertebral joint and facet joints meaning that any osteophytic changes could impair movement of artery
Risks
– Extreme rotation – could cause vertebral artery injury. C1 and C2 are the most vulnerable
-Contralateral side is more likely to be damaged during rotation
– Vertebral artery can go into spasm during manipulative techniques
Signs
- 5D’s and 3N’s
- nausea, vomiting, ataxic gait, weakness, tingling or numbness of face, hearing disturbances, headache, past history of trauma
Cauda Equina
Affecting bundle of nerve roots at the lower end of the spinal cord
CE provides innervation to lower limbs, sphincter, bladder retention/overflow, sensation to skin around bottom and back passage
Most common cause is a prolapsed lumbar disc
Spinal cord ends at L1, with the caudal roots starting below
Symptoms
- lower back pain, saddle anaesthesia, bowel and bladder disturbances, reduced or absent lower reflexes, sciatica
Clinical presentation
-bilateral neurogenic sciatica, reduced perineal sensation, altered bladder function, loss of anal tone, sexual dysfunction
UCI
Upper Cervical Instability
Instability of the craniovertebral ligaments can compromise the vascular and neurological structures in upper cervical region
Loss of Osteo-ligamentous integrity between occiput, C1 and C2 can cause impingement on spinal cord
Signs and symptoms
- facial paraesthesia, drop attacks, nystagmus, nausea, motor defects
Myotomes Cervical
1- neck Flexion 2-neck extension 3- head tilt 4- shoulder elevation 5- shoulder abduction 6- elbow flexion/wrist extension 7- elbow extension/ wrist flexion/ thumb
Reflexes for cervical
5= biceps tendon 6= thumb 7= arm
Cervical sensory
1- front of face 2- front of face 3- lateral face 4- supra scapula 5-lateral shoulder and upper arm 6-lateral lower arm and hand (thumb and index) 7- palmar aspect of hand (middle 3)
Lumbar Myotome Testing
1+2= hip flexors
3- knee extensors
4- ankle dorsiflexor
5- long toe extensor
Dermatome Testing Lumbar
1- inguinal area 2- anterior superior thigh 3- anterior middle thigh 4- anterior knee suprapatellar 5- 1st and 2nd web space
Lumbar reflexes
Both L3 and L4 reflexes are the patellar
Herniated disc
Symptoms -most common in lumbar but do occur in cervical -arm and leg pain Numbness or tingling Weakness
Risk factors
- overweight
- occupation
- genetics
Causes
- wear and tear
- decrease in water content causes discs to be less flexible and more prone to tearing or rupturing
