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Cervical Spine I > Cervical Spine I > Flashcards

Cervical Spine I Flashcards

1
Q

Describe the vertebral artery anatomy

A

Arises from subclavian artery and passes upward on longus colli to enter C6 foramen up to C1 to 1st cervical nerve and veins piercing post OA membrane and then foramen magnum to join basilar artery

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2
Q

Percentages of vertebral vs carotid cerebral blood flow

A

Vertebral is 11% and carotid is 89%

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3
Q

Name the AO ligaments

A

Anterior and posterior Atlanto occipital membranes

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4
Q

Name the C2 with occiput ligaments

A

Tectorial membrane
Alar ligament
Apical ligament

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5
Q

Name the AA joint ligaments

A

Anterior and posterior atlantoaxial membrane
Transverse/cruciate ligament

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6
Q

Anterior Atlanto Occipital Membrane

Connects
Provides

A

Anterior foramen magnum to anterior arch C1

AP stability

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7
Q

What ligament is a continuation of the ALL ligament?

A

Anterior Atlanto Occipital membrane

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8
Q

Posterior Atlanto Occipital Membrane

Connects
Provides

A

Occiput to post ring of C1

Prevents anterior and vertical translation of C1/C2

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9
Q

Which ligament is analogous to posterior Atlanto occipital membrane in cervical spine?

A

Yellow ligament

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10
Q

Tectorial Membrane

Connects
Provides

A

C2 body to foramen magnum
Limits flx, ext, vertical translation

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11
Q

Alar Ligament

Connects
Provides

A

Dens obliquely to occipital condyles
Rotation
(L LIMITS C1 ROTATION OF HEAD TO R)

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12
Q

Which C2 with oxxiput ligament has no major significance?

A

Apical

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13
Q

Which cervical ligament is continuation of PLL

A

Tectorial membrane

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14
Q

Anterior Atlanto Axial Membrane

Connects

A

C1 to C2 anteriorly

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15
Q

Posterior Atlanto Axial Membrane

Connects

A

Post ring of atlas and axis

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16
Q

Which AA ligament is continuation/analogous to yellow lig?

A

Posterior Atlanto Axial membrane

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17
Q

When is true yellow ligament (lig flavum) present and why?

A

Not present until C2/C3 to allow UCS rotation. Compromises stability for mobility

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18
Q

Transverse ligament

Connects

A

Dens in tact with anterior arch C1

MOST IMPORTANT LIG IN UCS

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19
Q

Nuchal ligament

Connects
Function

A

Posterior occipit to C7
No major sig

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20
Q

ALL

Connects
Function

A

Entire length of spine
Little known

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21
Q

Name the suboccipital muscles

A

Recurs capitus post major/minor
Oblique capitus superior/inferior

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22
Q

The sub occipital muscles all produce what functions?

A

B/L extension and unilateral SB and rot of UCS

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23
Q

Rectus capitis posterior major connects?

A

C2 SP to inf nuchal line on occiput

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24
Q

Rectus capitis posterior minor connects?

A

C1 post tubercle to inferior nuchal line on occiput

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25
Q

Oblique capitis superior connects

A

C1 TP to lateral inferior nuchal line

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26
Q

Obliques capitus inferior connects

A

C2 SP to C1 TP

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27
Q

Name the lower cervical flexors

A

SCM
Longus Colli
Hyoids
Scalenes

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28
Q

Name the upper cervical flexors

A

Longus capitus
Rectus capitis anterior and lateralis

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29
Q

Longus colli

Connects
Function

A

Anterior arch atlas to T3 vertebral body

Deepest anterior cervical muscle, provides cervical flexion and important stabilization

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30
Q

Hyoids

Connect
Function

A

Hyoid bone to mandible and thorax
Neck flexion and stability, open mouth

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31
Q

Scalenes

Connects
Function

A

Anterior: C3-C6 TPs to 1st rib
Middle: C2-C7 TPs to 1st rib
Posterior: C4-C6 TPs to 2nd rib

Unilateral: IPS SB and Rotation
B/L: inspiration

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32
Q

Name the cervical extensors

A

Splenius capitis
Semispinalis capitis

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33
Q

Splenius capitis

Connects
Function

A

T1-T3 SPs and nuchal lig C5-C7 to superior nuchal line and mastoid

Ipsilateral rotation

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34
Q

Semispinalis capitis

Connects
Function

A

C4-C6 TPs and C7-T1 SPs to lat EOP
B/L extension
U/L contralateral SB

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35
Q

Levator

Connects
Function

A

C1-C4 TP to superior angle scap
Elevates and downwardly rotates scap

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36
Q

Platysma

Connects
Function

A

Most superficial anterior cervical muscle
Wide mouth opening

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37
Q

Cricoid

Connects
Function

A

Vertebral artery entered transverse foramen of C6 here

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38
Q

Total C spine flexion/extension

A

Flx: 45-50
Ext: 75-80

39
Q

Total C spine SB/Rot

A

SB: 35-40
Rot: 65-75

40
Q

C0-C1 flx/ext

A

Flx: 5
Ext: 10

41
Q

C0/C1SB and rot

A

SB: 5
Rot: 0

42
Q

C1-C2 flex/ext

A

Flx: 5
Ext: 10

43
Q

C1-C2 SB and rot AROM

A

SB: 0
Rotation: 35-40

44
Q

C2-C7 flx/ext

A

Flx: 35-40
Ext: 55-60

45
Q

C2-C7 rot/SB AROM

A

Rotation: 30-35
SB: 30-35

46
Q

Upper vs lower cervical spine arthros

A

Upper: SB and rot opp
Lower: SB and rot same

47
Q

OA arthros flx/ext/SB

A

Flx: Convex occipital condyles glide posterior

Ext: convex occipital condyles glide anterior

SB to R: R C0 MIA, L C0 LPS with conjunct L rot

48
Q

AA arthros flx, ext, rotation

A

Flx: vex C1 facets roll ant and glide post

Ext: vex C1 facets roll post and glide ant

R rot: C1 R facet glides post and C1 L facet glides anterior

49
Q

Mid cervical spine arthros

A

Flx: glide up and forward
Ext: glide down and back
R SB: R down and back, L up and forward
R ROT: R down and back, L up and forward

50
Q

L UCS rotation and alar ligament

A

L UCS rotation will tighten the R alar ligament, moving R occipital condyle left, producing R SB

51
Q

Canadian C Spine Rules
Automatic radiograph

A

Automatic radiograph:
Age>65
Fall over 1 meter or 5 stairs
Axial load to head
MVA > 100km/hr
Bike collision
Paresthesias in extremities

52
Q

Canadian C spine Rules 2nd tier

A

If no to automatic radiographs section:

Injury was rear end collision
Delayed onset neck pain
Absence of midline tenderness of c spine
Ambulatory at any time
Able to sit in ER

53
Q

Canadian C spine rules last tier

A

Able to AROM rotate 45 each way
If no: radiograph

54
Q

Cervical Spine Stenosis
- define
- associated with

A

Narrowing of spinal canal, central or lateral
Spondylosis

55
Q

What is most common cause of cervical spinal disorders in those > 55 yrs old

A

Stenosis

56
Q

Names the 3 kinds of cervical spine stenosis

A

Traumatic
Congenital
Degenerative

57
Q

Degenerative cervical spine stenosis can be due to?

A

Osteophytes, lig flavum hypertrophy, DDD

58
Q

Cervical spine flx opens canal by how much and ext closes canal by how much

A

Flx opens 31%
Ext closes 26%

59
Q

Best PT rec for short term relief for cervical spine stenosis

A

Acupuncture and cervical collar

60
Q

Best PT rec for cervical spine stenosis

A

Traction
Thoracic manipulation
Flx based protocol

61
Q

Traction guidelines for cervical spine stenosis

A

15-20m at 16-24# in 24 degrees cervical flexion

62
Q

Cervical myelopathy
- definition
- classified by

A

Cervical cord compression
Gait dysfunction

63
Q

Cervical myelopathy sx

A

Unsteady gait
+ Hoffman’s / + babinksi
B/L or Q/L parasthesias
Hyper reflexia
B/B issues
Intrinsic muscle wasting of hands

64
Q

Cervical myelopathy cluster

A

Gait deviations
+ Hoffman’s
+ inverted Supinator
+ babinski
Age > 45

3/5 = +30.9 LR
1/5 = -.18 LR

65
Q

Whiplash
Do not test what
Tx

A

Can be either flexion or ext based, ext worse
Vertebral artery for first 4-6 weeks
Cervical collar 3 weeks or until capsular pattern reduces

66
Q

Median recovery time for whiplash

A

31 days

67
Q

Whiplash prognostic factors for full recovery

A

<35 yrs old
NDI < 32%

68
Q

Whiplash prognostic factors for ongoing pain

A

Age > 35
NDI > 40%
Hyperalgesia sx and cold intolerance

69
Q

Percentage of patients who do well in PT for whiplash

A

40% do well
40% mod well
20% no improvement

70
Q

Cervical radiculopathy

Common nerve and age

A

C6/C7
40-50

71
Q

Cluster to identify cervical radic

A

+ULTT
< 60 degrees towards painful side
+ spurlings
+ distraction

2/4 21%
3/4 65%
4/4 90%

72
Q

PT tx for cervical radic

A

Mixed but usually involves

Cervical side glides
Cervical traction
Thoracic manipulation
Deep neck flx strengthening

73
Q

Disc lesions in C spine

Sx

A

Limited flx, scapular/arm pain

Traction helps, posterolateral prolapse rare in C spine

74
Q

Acute Torticollis causes

A

Disc derangement
Facet it dislocation
SCM spasms
Facet impingement c2/c3

75
Q

Tx for acute toeticollis from disc derangement and facet impingement

A

Disc derangement: traction with ext

Impingement: mobs

76
Q

4 categories for differential diagnoses

A
  1. Movement
  2. Neuro
  3. Compression/distraction
  4. Segmental tests/stress
77
Q

When is it good to use sustained postures for testing?

A

When AROM, PROM, resistance not producing sx

78
Q

Shoulder abduction test

A

Patient sitting or standing, have patient put arm on top of their head

+ test is reduction in sx for C5/C6 compression

79
Q

Dizziness test

A

Seated, PROM to head rotation, then head stable and rotate trunk. If sx with both then possible vertebral A

If sx only with head rotation, possible inner ear

80
Q

Cervical reflexes

A

C5: biceps
C6: brachioradialis
C7: triceps

81
Q

Cervical cutaneous innervation

A

C1: vertex of head
C2: post auricular
C3: lateral neck
C4: upper trap
C5: lateral arm/deltoid
C6: post thumb
C7: post mid finger
C8: post pinky finger
T1: medial forearm
T2: axilla

82
Q

Cervical myotomes

A

C1: head flx - Rectus capitis ant and lat
C2: head ext - Rectus capitis post
C3: neck SB: scaleni
C4: shld elevate: UT and levator
C5: shld abd: deltoid, Supra
C6: elbow flx, wrist ext: biceps, ECRL/B
C7: elbow ext, wrist flx: triceps, FCR
C8: thumb ext: EPL/EPB
T1: finger add/abd: interrosseous

83
Q

C5/C6/C7/C8/T1 root syndrome pain referrals

A

C5 - scap, arm down to radial wrist/hand no fingers
C6 - to index finger and thumb
C7 - index/mid/ring finger, back of arm
C8 - 4th/5th fingers
T- - no scap or finger pain, medial arm and forearm

84
Q

C8 diff diagnosis

A

TOS
PANCOST TUMOR

85
Q

Craniovertebral scan

What order to screen

A

Test UCS first and then vertebral artery

86
Q

Cervical cord compression/myelopathy cardinal sx

A

B/L or Q/L parasthesias
Hyper reflexia below lesion level (@ or above lesion level will be hypo)
+ clonus, babinski, Hoffman’s, inverted supinator
Arm/leg weak
B/L lack coordination

87
Q

Shimizu reflex or scapulohumeral reflex

A

Apply caudal direction force to tip of spine of scap and acromion

+ is elevation of scap or abd humerus

+ UMN above C3

88
Q

Most common C spine adverse event

A

Craniovertebral artery dissection (57%)

89
Q

SAEs under 50 age usually due to

A

Trauma

90
Q

Risk factors for arterial dysfunction

A

Diabetes
Hypertension
High cholesterol
Corticosteroid use
Migraines
Trauma
Cardiac disease
Vascular disease
Blood clotting disorders
Anticoagulants
Smoker
Recent infection
Immediately post partum
Absence of mechanical source for sx

91
Q

Early presentation sx for vascular adverse event

A

Mid upper cervical pain
Pain around ear/jaw
Frontotemporoparietal head pain
Occipital headache
Pain “unlike any other” (main finding)

92
Q

Besides HVLA, what else do you want to stay away from for vascular compromise?

A

Any end range techniques

93
Q

Cranial nerve scan

A

1: olfactory: smell
2/3: optic/occulomotor: pen light on pupil to constrict
3/4/6: occulomotor, torchlear, abducens: follow H pattern
5: trigrminal: clench teeth for massater palpation
7: facial: smile, puff cheeks, raise eyebrows
8: acoustic: can follow commands
9/10: glossooharyngeal/vagus: stick out tongue and say ah tongue midline
11: spinal acc, resist shld shrug and rot head
12: hypoglossal: tongue stick out and side to side

Cervical Spine I (1 decks)

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