Cervical Spine SD Diagnosis Flashcards
Describe the anatomy of the spine
Cervical: 7 vertebrae (typical are #3-6)
Thoracic: 12 vertebrae
Lumbar: 5 vertebrae
Describe the nerve distribution in the spine
Cervical: nerves exit ABOVE vertebral body
Thoracic & lumbar: nerves exit BELOW vertebral body
On an exam of a football player, you find that his C6 dermatome seems to be affected. Which spinal segment is likely affected?
C5 to C6 b/c nerves of cervical spine exit ABOVE spinal segment
Important features of C1/atlas
NO vertebral body
rotates around dens of C2
bounded anteriorly on dens by anterior arch & posteriorly by transverse atlantal ligament
Important features of C2/axis
vertebral body of C2 extends superiorly to form the dens
What is the myodural bridge?
true connections between the rectus capitis posterior major & dura mater
What are the purposes of the myodural bridge?
monitor dural tension
anchors muscle
role in cervicogenic pathologies
What is a hangman’s fracture?
anterior displacement of body of C2 vertebra
hyperextension causes traumatic spondylolisthesis of C2 w/ fracture of vertebral arch of C2 (also tears ligaments btwn C2 & C3)
What are the atypical articulations of the cervical spine?
OA
AA
What are the typical articulations of the cervical spine?
C2-C7
What are the typical biomechanics of C2-C7?
rotation & sidebending occur in SAME direction
What are common SD for C2-C7?
occur in sagittal plane
SD may be in flexion or extension
**pain in neutral position common in severely arthritic patients
What are the major motions of OA joint?
flexion & extension
What type of biomechanics is the OA joint?
Type 1 like (sidebending & rotation occur in opposite directions)
What is the primary motion of the AA joint?
ROTATION!
atlas rotates about the dens (almost NO sidebending or flexion/extension)
What are the major parts for a cervical TART exam?
Tissue texture changes
Asymmetry of tissues/structure
ROM (restricted?)
Tenderness
Normal ROM for cervical spine
Flexion (45-90)
Extension (45-90)
SB (45)
Rotation (70-90)
Cervical Segmental Exam for rotation testing
rotation LEFT is induced by anterior pressure on posterior aspect of RIGHT lateral mass
rotation RIGHT is induced by anterior pressure on posterior aspect of LEFT lateral mass
Cervical segmental exam for translation/side bend testing
translation from left to right is SB L
translation from right to left is SB R
If the movements are more restricted in flexion, what would be the SD?
extension SD
Contraindications to soft tissue treatment in cervical spine
fractures open wounds infection DVT coagulopathy neoplasm
Contraindications to MET in cervical spine
undiagnosed joint swelling severe osteoporosis neoplasm infection hematoma RA fracture dislocation
Contraindications to HVLA (esp in cervical area)
RA or Down Syndrome (alar ligament unstable)
Vertebral artery disease
Advanced carotid disease
Contraindications of HVLA
inflammatory arthritis malignancy acute radiculopathy Klippel Feil syndrome Chiari malformation Dwarfism Osteogensis Imperfecta
