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Cervical Spine Flashcards

1
Q

How many vertebrae in the Cervical Region?

A

7

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2
Q

What are the names of C1 and C2?

A

Atlas (C1), Axis (C2)

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3
Q

What structure does Vertebral Artery travel through?

A

Transverse Processes of Spine

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4
Q

What structures do nerve roots travel through?

A

Intervertebral foramen

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5
Q

What is the Craniovertebral Region made up of?

A

Cranium, C1 and C2

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6
Q

What are the names of the two major ligaments in our skull region?

A

Alar ligament and Transverse Atlantal Ligament

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7
Q

Where does Alar Ligament attach?

A

Arises from sides of odontoid process (dens) and it passes laterally to attach to occiput

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8
Q

What does the Alar ligament prevent?

A

Flexion and rotation

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9
Q

Roles of Transverse Atlantal Ligament

A

Keeps the dens in contact with the anterior arch of the atlas and keeps dens away from the spinal cord

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10
Q

What would happen with a Transverse Atlantal Ligament sprain?

A

Dens could migrate posteriorly within the central foramen and could impinge spinal cord

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11
Q

What are the 4 parts of the Vertebral Artery?

A
  1. Proximal
  2. Transverse
  3. Suboccipital
  4. Intracranial
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12
Q

What part of the vertebral artery is more susceptible to injury?

A

Laterally bending/ continuous bending. It has two 90 degree bends due to C1 being so much further so large ROM, already under stress from the weaving, rotation causes pinching

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13
Q

Where does proximal vertebral artery start and enter?

A

It runs off the origin of the artery (subclavian) and travels up entering at approximately C6

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14
Q

Where is the point of entry for the transverse vertebral artery?

A

Point of entry from C6 and runs to C2. This is the straight vertical part of the artery.

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15
Q

Where does the suboccipital vertebral artery run?

A

Runs from the transverse foramen of C2 to point of penetration in the foramen magnum to enter brian.

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16
Q

Where does the Intracranial vertebral artery run?

A

Penetration of dura mater at the level of the foramen magnum to the lower border of the pons.

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17
Q

Vertebrobasilar Insufficiency Internal Causes

A

Atherosclerosis and Thrombosis

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18
Q

What is thrombosis?

A

Thrombosis is a blood clot where we have occlusion of the artery

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19
Q

What is atherosclerosis?

A

Fatty deposit within the artery causing a slight blockage of blood flow; limits blood flow due to less surface area

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20
Q

What portions of the vertebral artery are more commonly affected by vertebrobasilar insufficiency internal cause?

A

Proximal and Transverse

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21
Q

Vertebrobasilar Insufficiency External Cause: Dissection.

A

Tearing of the artery

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22
Q

What does a vertebral artery dissection consist of?

A

Tearing of tunica intima which decreases lumen size and we get less blood flow and blood fills between the inner and outer layer of the artery instead. (can lead to blood clot)

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23
Q

What can happen with dissection and cervical instability?

A

instability can disrupt ligaments causing larger ROM that is unfavourable

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24
Q

What happens if the alar ligament is ruptured?

A

we get a 30% increase in rotation causing a dramatic strain on artery with increased rotation

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25
Q

Vertebral Artery Dissection- what motions would be dangerous in this case?

A

Flexion and extension of neck, need to avoid aggressive rotation when treating C1, C2 injury

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26
Q

Subjective Assessment for Vertebral Artery Dissection

A
  • dizziness, virtual disturbances, paraesthesia, motor disturbance, deafness, swallowing, tinnitus,
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27
Q

What would you observe if someone had vertebral artery dissection?

A
  • slurred speech, ataxic gait
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28
Q

What ligaments would you assess for Craniovertebral Stability?

A

Alar ligament, Transverse Ligament

–> test if they are stretched

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29
Q

Vertebral Artery Testing?

A

test by rotation, rotation and extension, (not done in clinics anymore)

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30
Q

Neck Region Red Flag Screening: Vertebrobasilar Insufficiency

A

5D’s and 3N’s

  • dizziness,
  • diplopia (double vision)
  • dysphagia (trouble swallowing)
  • dysarthria (trouble speaking)
  • drop attacks (fainting spells)
  • nausea
  • numbness (mostly around mouth)
  • nystagmus (uncontrolled eye movements)
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31
Q

12 cranial nerves:

A 
I: Olfactory
II: Optic
III: Oculomotor 
IV: Trochlear 
V: Trigeminal (V1, V2, V3) 
VI: Abducens 
VII: Facial 
VIII: Vestibulocochlear (auditory)
IX: Glossopharyngeal 
X: Vagus
XI: spinal accessory nerve 
XII: Hypoglossal
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32
Q

Cranial Nerve I: Olfactory; sensory, motor or both? testing?

A

Sensory: smell
Test: close a nostril and ask if they can smell something; alcohol, coffee grinds, etc

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33
Q

Cranial Nerve II: Optic; sensory, motor or both? testing?

A

Sensory: vision
Test: eye test/exam, see how far they can see, peripheral vision, examine expansive visual field

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34
Q

Cranial Nerve III: Oculomotor

A

Motor: movements of the eyes, pupil dilation
Test: superior, inferior, medial, superolateral, pupillary reaction to light

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35
Q

Cranial Nerve IV: Trochlear; sensory, motor or both? testing?

A

Motor: controls eye movement of ONE eye muscle- superior oblique
Test: inferomedial; look towards nose

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36
Q

Cranial Nerve V: Trigeminal VI; sensory, motor or both?

A

Both

V1- opthalmic; sensation to the forehead

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37
Q

Cranial Nerve V: Trigeminal V2; sensory, motor or both?

A

Both
V2: maxillary
Sensation to upper lip

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38
Q

Cranial Nerve V: Trigeminal V3; sensory, motor or both?

A

Both
V3: mandibular
Sensory to chin

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39
Q

Motor controls for Trigeminal Nerve and how to test Trigeminal Nerve

A

Motor: muscles of mastication
Test: the sensation of the face, clench jaw

40
Q

Cranial Nerve VI: Abducens; sensory, motor or both? testing?

A

Motor: Controls eye movement with ONE muscle- lateral rectus
Test: lateral (abduct)

41
Q

Cranial Nerve VII: Facial; sensory, motor or both?

A

Both
Sensory: tongue, anterior 2/3 of tongue
Motor: fascial muscles
Test: fascial expressions

42
Q

Cranial Nerve VIII: Vestibulocochlear; sensory, motor or both?

A

Sensory
Auditory (hearing), vestibular system (equilibrium)
Test: hearing of each ear, can they hear fingers rub together with eyes closed?

43
Q

Cranial Nerve IX: Glossopharyngeal; sensory, motor or both?

A

Both
Sensory: taste with posterior 1/3 of tongue
Motor: swallowing
Test: uvula elevation, gag reflexes, swallowing, can you feel larynx move?

44
Q

Cranial Nerve X: Vagus; sensory, motor or both?

A

Both:
Sensory: visceral sensation (lungs, GI tract)
Motor: pharynx, larynx, soft palate, heart (RHR), involuntary muscles of the digestive tract
Test: uvula elevation, gag reflex, swallowing,

45
Q

Cranial Nerve XII: Spinal Accessory Nerve; sensory, motor or both?

A

Motor
- trapezius and sternocleidomastoid
Test: scapular elevation

46
Q

Cranial Nerve XII: Hypoglossal; sensory, motor or both?

A

Motor
- muscles of the tongue (intrinsic and extrinsic)
Test: tongue protrusion; if injured, tongue will lean towards affected side

47
Q

What Nerves Control Eye Muscle Movement?

A

Abducens- lateral rectus
Trochlear- superior oblique
Oculomotor- inferior oblique, superior rectus, medial rectus and inferior rectus

48
Q

What is Bells Palsy?

A

idiopathic onset of facial pain- temporary facial paralysis or weakness on one side of the face
- dysfunction of nerve VII - fascial nerve
- due to swelling and inflammation of VII
85% of cases recover in 3 weeks

49
Q

What does a neuro exam look at?

A

myotomes, dermatomes, reflexes

50
Q

What are Dermatomes?

A

A localized area of skin that has sensation primarily via one single nerve root

  • can provide good approximation for cord levels but some overlap occurs
  • dermatome pattern begins with C2 dermatome.
  • pins and needles or impaired sensation of back of the neck would cause suspicion of C2 being impinged
51
Q

Dermatome Testing

A
  • use reference point (like cheek)
  • touch cheek and ask them to remember how it feels and then do the same touch on dermatome areas and ask what they feel in regards to reference touch
  • test each dermatome using different stimuli on both left and right side
52
Q

C2 Dermatome- body level

A

mastoid process

53
Q

C3 Dermatome- body level

A

supraclavicular fossa

54
Q

C4 Dermatome- body level

A

Acromioclavicular Joint

55
Q

C5 Dermatome- body level

A

Radial side of Antecubital Fossa

56
Q

C6 Dermatome- body level

A

Thumb (dorsal side)

57
Q

C7 Dermatome- body level

A

Middle Finger (dorsal side)

58
Q

C8 Dermatome- body level

A

Little finger (dorsal side)

59
Q

T1 Dermatome- body level

A

Medial Epicondyle

60
Q

What is a myotome?

A

A muscle or group of muscles supplied by a single nerve root

61
Q

Myotome: muscle weakness

A

Fatigued right away when force is applied and you can break force right away

62
Q

Myotome: fatiguable weakness

A

can hold muscle contraction for a prolonged period, however, when you repeat it it becomes weaker each time you do it.
- a positive myotome will fatigue with repeated reps

63
Q

C2 myotome: action

A

neck flexion

64
Q

C3 myotome: action

A

neck side-bend

65
Q

C4 myotome: action

A

shoulder shrug

66
Q

C5 myotome: action

A

shoulder abduction

67
Q

C6 myotome: action

A

elbow flexion, wrist extension

68
Q

C7 myotome: action

A

elbow extension, wrist flexion

69
Q

C8 myotome: action

A

thumb extension

70
Q

T1 myotome: action

A

finger splay

71
Q

What is a deep tendon reflex? (DTR)

A

a brisk tap to a partially stretched muscle tendon near its point of insertion - elicits a DTR

72
Q

Reflexes depend on:

A
  • intact afferent nerve fibres (sensory)
  • intact efferent nerve fibres (motor)
  • normal functioning synapses in the spine
  • normal functioning neuromuscular junctions on the tapped muscle
  • normal muscle functioning (contraction)
73
Q

Reflex Tips:

A
  • ensure the patient is fully relaxed

- distract patient if they cannot relax fully themselves

74
Q

Jendrassik Maneuvers

A
  • Upper extremity reflexes: clench teeth, squeeze thighs, cross feet
  • Lower extremity reflexes: lock fingers together and pull one against the other
  • increases drive of reflex
75
Q

C5 Nerve: reflex target

76
Q

C6 Nerve: reflex target

A

brachioradialis

77
Q

C7 Nerve: reflex target

78
Q

Grade 0 DTR:

A

absent, (arereflexia)

79
Q

Grade 1 DTR

A

diminished reflexes (hyporeflexia), reflex but not as dramatic as you hope

80
Q

Grade 2 DTR

81
Q

Grade 3 DTR

A

Exaggerated reflex (hyper-reflexive) without clonus

82
Q

Grade 4 DTR

A

Hyperactive with clonus (rhythmic oscillations between flexion and extension)

83
Q

C5: reflex, sensory, motor

A
  • Abduction of the shoulder, sensation is anterior medial bicep, and we have bicep reflex
84
Q

C6: reflex, sensory, motor

A
  • Free throw position
  • bicep flexion, wrist extension,
  • sensory is over thumb on the dorsal aspect
  • decreased brachioradialis reflex
85
Q

C7: reflex, sensory, motor

A
  • impingement at neck,
  • fatigable weakness with elbow extension (triceps) and wrist flexion
  • sensation down the backside of the middle finger
  • impaired tricep reflex
86
Q

C8: sensory, reflex, motor

A
  • thumb extension
  • numbness in the pinky
  • associated reflex
87
Q

T1: sensory, reflex, motor

A
  • finger splay

- an impaired sensation of inside of bicep (no reflex)

88
Q

Intervertebral Foramen

A
  • Between every pair of vertebrae are two apertures (openings), the intervertebral foramina
  • The foramen allows for the passage of the spinal nerve root, dorsal root ganglion, the spinal artery of the segmental artery, communicating veins
  • Increase in the volume with flexion (flexion opens and makes room)
  • Decrease in the volume with extension
89
Q

What can cause decreased space in Intervertebral Foramen

A
  • disc hernia, or osteophyte formation, inflammation, or spinal tumour (can all cause impingement on nerve)
90
Q

Cervical Radiculopathy

A
  • impingement of cervical spinal nerve or nerve root
  • commonly worse with extension, ipsilateral side-bending/rotation
  • unilateral neuropathic pain
  • dermatome and/or myotome reflex deficits where the nerve is compressed
  • may be relieved with the head flexed forward or looking towards oppposite side
91
Q

C6 Radiculopathy

A
  • fatigable weakness with elbow flexion (bicep) or wrist extension
  • sensation in lateral arm
  • reflex 1/4: hypo-reflexive brachioradialis
  • aggravated with neck extension, ipsilateral side flexion/rotation,
  • easing; neck flexion
  • motor deficit in myotomes
  • most ocmmonly affected ; levada curve - segment is already in the most amount of extension
92
Q

Etiology

A

narrowing (stenosis) of IVF (decreased disc height)

  • IVF dis herniation
  • infection
  • inflammatory exudate
  • physical injury or trauma
  • spinal tumours
93
Q

Treatment for Cervical Radiculopathy: Education

A
  • posture
  • medication; NSAIDs, neuropathic
  • avoidance of aggravating positions (extension, ipsilateral rotation, side-flexion)
  • encourage alleviating postiions (flexion, contralateral rotation)
94
Q

Treatment for Cervical Radiculopathy: Manual Therapy

A
  • global and local cervical spine traction
  • segmental SAL mobilizations
  • Soft tissue techniques (i.e., massage, stretching) of the mechanical interface of C6
95
Q

Treatment for Cervical Radiculopathy: Exercise

A
  • neurodynamic flossing (median, radial)

- encourage nerve to wiggle itself free

Injuries (6 decks)

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