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Clinical Assessment T3 > Cervical Spine (Week 3) > Flashcards

Cervical Spine (Week 3) Flashcards

1
Q

Why is the cervical spine prone to injury?

A

Stability is sacrificed for mobility in the cervical spine, making it prone to injury.

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2
Q

How many vertebrae and facet joints are in the cervical spine?

A

7 vertebrae and 14 facet (synovial) joints.

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3
Q

How many cervical nerve roots are there, and where do they exit?

A

There are 8 cervical nerve roots that exit above the vertebral bodies.

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4
Q

What type of movement requires coupled motion between bilateral facet joints in the cervical spine?

A

Rotation and side flexion.

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5
Q

What is the normal lordotic curve of the cervical spine?

A

30° - 40°

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6
Q

Which cervical vertebrae have the greatest flexion-extension, and why is this significant?

A

C5-C6, making it the most commonly injured or degenerated level.

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7
Q

List possible symptoms of injury in the C5-C6 area.

A

Headache, fatigue, vertigo, poor concentration, hypertonia of the sympathetic nervous system, irritability, cognitive dysfunction, and cranial nerve dysfunction.

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8
Q

Which vertebrae make up the upper cervical spine?

A

C0 - C2

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9
Q

Are there discs in the upper cervical spine?

A

No, there are no discs between C0 and C2.

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10
Q

What are the principal motions of the atlanto-occipital joint (C0-C1)?

A

Flexion and extension (15°-20°), also called the “yes” motion, with side flexion of 10°.

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11
Q

What are the principal motions of the atlanto-axial joint (C1-C2)?

A

Rotation (50°), known as the “no” motion, and it is the most mobile articulation of the spine. It also allows 10° of flexion + extension and 5° of side flexion.

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12
Q

Describe the pivot (trochoidal) joint in the upper cervical spine.

A

It is the articulation between the anterior arch of the atlas (C1) and the odontoid process, supported by the transverse ligament.

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13
Q

What is the clinical significance of the first palpable spinous process, C2?

A

C2 is significant due to its relation to the vertebral-basilar artery (VBA), os odontoideum, and its vulnerability to rheumatoid arthritis.

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14
Q

Which vertebrae make up the lower cervical spine?

A

C3 - C7

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15
Q

What is the primary purpose of the cervical spinous and transverse processes?

A

They are present strictly for muscle attachment purposes.

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16
Q

How is lateral cervical musculature related to the brachial plexus?

A

It is closely involved with the brachial plexus, meaning issues in these muscles can affect brachial plexus pathology.

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17
Q

What can muscle imbalances in the cervical spine lead to?

A

They can cause pain and contribute to secondary headaches.

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18
Q

They can cause pain and contribute to secondary headaches.

A

Flexion, extension, and lateral flexion.

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19
Q

What are the available movements at the atlanto-axial joint (C1-C2)?

A

Flexion, extension, and rotation.

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20
Q

What movements are possible in the intracervical region (C2-C7)?

A

Flexion, extension, rotation, and lateral flexion.

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21
Q

What are the total available movements across the craniocervical region (C0-C7)?

A

Flexion, extension, rotation, and lateral flexion.

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22
Q

What is the resting position of the cervical spine?

A

Midway between flexion and extension.

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23
Q

What is the close-packed position of the cervical spine?

A

Full extension.

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24
Q

What is the capsular pattern of the cervical spine?

A

Side flexion and rotation are equally limited, followed by extension.

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25
Q

Do radicular symptoms extend down the arm in cases of C4 nerve root injury and above?

A

No, radicular symptoms do not go down the arm for C4 nerve root injury and above.

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26
Q

What type of headaches can originate from the cervical spine?

A

Cervicogenic headaches.

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27
Q

What is a primary headache disorder?

A

A disorder where the headache itself is the primary issue rather than a symptom of another underlying problem.

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28
Q

What role do some cervical spine muscles play in respiration?

A

They act as accessory respiratory muscles.

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29
Q

How does bone pain typically present in terms of onset?

A

Bone pain usually comes on immediately.

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30
Q

When can muscle or ligamentous pain appear after an injury?

A

It can appear immediately or occur several hours or days later.

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31
Q

Why is age relevant in case history for cervical issues?

A

Spondylosis is more common in individuals over 25, and osteoarthritis (OA) is prevalent in those over 65.

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32
Q

What should be considered when assessing symptom severity in the cervical spine?

A

Neurological severity should be considered.

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33
Q

What are WAD, “burners,” and “stingers” in relation to the cervical spine?

A

They are mechanisms of injury (MOI) that can indicate whiplash-associated disorders (WAD 1-4) and specific types of nerve trauma.

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34
Q

What are possible sources of referral pain in the cervical spine?

A

Cervicogenic headache and facet irritation (medial branch of dorsal primary rami).

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35
Q

What characterizes radiculopathy in the cervical spine?

A

Injury to nerve roots with unilateral motor and sensory symptoms in the upper limb, muscle weakness, sensory alteration, reflex hypoactivity, and sometimes focal activity.

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36
Q

What symptoms are associated with cervical disc herniations?

A

Severe neck pain, shoulder/scapula/arm pain, limited ROM, and increased pain with coughing, sneezing, jarring, or straining.

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37
Q

What symptoms suggest autonomic relevance in cervical spine assessment?

A

Sympathetic symptoms in the soft tissue of the neck lateral/anterior to the cervical vertebrae.

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38
Q

What are signs of cervical myelopathy?

A

Spastic weakness, paresthesia, possible incoordination in one or both lower limbs, and proprioceptive and/or sphincter dysfunction.

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39
Q

What additional symptoms may indicate dizziness, nausea, or visual disturbances in cervical assessment?

A

Primary headache, vertebrobasilar artery (VBA) obstruction, vestibular issues, or TIA/stroke.

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40
Q

What postural issues should be observed in the head and neck?

A

Look for upper crossed syndrome and head forward carriage (HFC).

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41
Q

What is the normal cervical spine curvature?

A

Typically 30°-40° lordotic curve.

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42
Q

What aspects of shoulder alignment should be checked in cervical assessment?

A

Observe shoulder levels for asymmetry.

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43
Q

What muscular issues might be observed in the cervical region?

A

Muscle spasm or asymmetry, torticollis, and nerve palsy.

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44
Q

What should be noted regarding bony or soft tissue contours?

A

Check for any abnormalities or asymmetries in contour.

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45
Q

What might ischemia in the cervical area indicate?

A

Possible restricted blood flow or vascular compromise.

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46
Q

Why is ergonomics important in cervical spine assessment?

A

Poor ergonomics can contribute to or exacerbate cervical spine issues.

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47
Q

What should be checked for during palpation in cervical assessment?

A

Inflammation, heat, and any deformities.

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48
Q

Why is the hyoid bone relevant in cervical spine palpation?

A

It is at the level of C3 and should move with swallowing.

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49
Q

What might muscle spasm or hypertonicity indicate in cervical palpation?

A

Potential overactivity or guarding in the muscles due to pain or injury.

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50
Q

Which vascular structure should be palpated in the cervical spine assessment?

A

The carotid artery.

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51
Q

Why are lymph nodes palpated in a cervical assessment?

A

Enlarged or tender lymph nodes may indicate infection or inflammation.

52
Q

What should be assessed when palpating spinous processes (SPs) and transverse processes (TVPs)?

A

Look for any misalignment or tenderness that may indicate injury.

53
Q

Where is the external occipital protuberance, and why is it significant?

A

Located at the back of the skull; used as a landmark in cervical assessment.

54
Q

What are common conditions associated with a traumatic mechanism of injury (MOI) in the cervical spine?

A

Common strains/sprains, fractures/dislocations, cervical nerve root injury (herniation, laceration, hemorrhage), contusion, burners, and stingers.

55
Q

What conditions are commonly associated with a non-traumatic mechanism of injury (MOI) in the cervical spine?

A

Radiculopathy, arthritis, and primary or secondary headaches.

56
Q

Name other conditions to consider when testing a hypothesis for cervical spine issues.

A

Rheumatoid arthritis, cervical myelopathy, impingement, and torticollis.

57
Q

How is the TMJ (temporomandibular joint) ruled out in a cervical assessment?

A

With the 3-knuckle test. TMJ dysfunction can lead to head forward carriage (HFC) and adaptive shoulder problems.

58
Q

How is the shoulder ruled out during cervical assessment?

A

Using Active Functional Range of Motion (AFROM) for abduction and flexion with overpressure.

59
Q

How is the thoracic spine ruled out during cervical assessment?

A

By performing Active Functional Range of Motion (AFROM) in all movements with overpressure.

60
Q

What is the purpose of the vascular “clearing” test in cervical spine assessment?

A

To assess the vertebral-basilar artery (VBA) for potential compression or restriction.

61
Q

How is the VBA test performed in the supine position?

A

The therapist passively sustains full neck and head extension, ipsilateral rotation, and ipsilateral lateral flexion for 30 seconds. The patient is asked to look at the therapist and count backward from 30.

62
Q

Describe how the VBA test is performed in a high-seated position (Hautant’s Test).

A

The patient actively flexes their shoulders to 90 degrees, closes their eyes, and sustains full neck and head rotation with extension bilaterally for 30 seconds.

63
Q

What are positive signs of VBA impairment during the vascular clearing test?

A

Dizziness, diplopia, dysarthria, dysphagia, drop attack (5 D’s), vomiting, nausea, nystagmus, loss of consciousness, facial numbness, and headache.

64
Q

What position should a patient be in when performing Active Free (AF) range of motion tests?

A

The patient should be in a high-seated position.

65
Q

What does the Active Free (AF) range of motion assess?

A

The range of motion is the summation of all movements of the entire cervical spine.

66
Q

What are important considerations when performing the Active Free (AF) test?

A

Pain can come from the contraction or stretch of an injured structure, and typically stretch pain is felt at the end range.

67
Q

What is the average range of motion for cervical spine flexion?

A

The average range is 80° - 90°.

68
Q

How far should the chin reach in cervical spine flexion?

A

The chin should reach up to 2 finger widths of the chest.

69
Q

What compensatory motions should be watched for during cervical spine flexion?

A

Compensatory motions such as an open mouth.

70
Q

What does posterior bulging of the spinous process (SP) of C2 indicate during flexion?

A

It indicates forward subluxation of C2.

71
Q

What is the average range of motion for cervical spine extension?

A

The average range is 70°.

72
Q

How should the plane of the nose and forehead be positioned during cervical spine extension?

A

The plane of the nose and forehead should be near horizontal.

73
Q

What compensatory motion should be watched for during cervical spine extension?

A

Compensatory motions such as elevation of the shoulder.

74
Q

What is the average range of motion for cervical spine side flexion?

A

The average range is 20°-45° to the right and left.

75
Q

In which plane should cervical spine side flexion be performed?

A

Side flexion should be performed in the frontal plane.

76
Q

What compensatory motion should be watched for during cervical spine side flexion?

A

Compensatory motions such as the shoulder moving toward the ear.

77
Q

What is the average range of motion for cervical spine rotation?

A

The average range is 70°-90° to the right and left.

78
Q

How is cervical spine rotation coupled with lateral flexion?

A

Rotation is arthrokinematically coupled with lateral flexion, though not necessarily in the same direction.

79
Q

What is the typical end feel for all Passive Relaxed (PR) cervical spine movements?

A

Tissue stretch.

80
Q

How does PROM compare to AF/AROM?

A

PROM almost always achieves slightly more range than AF/AROM.

81
Q

What can cause pain during Passive Relaxed (PR) movements?

A

Pain can result from the stretch on antagonist muscles, mostly at the end range.

82
Q

What technique can be used to assess relative movement between adjacent vertebrae during Passive Relaxed (PR) testing?

A

Motion palpation between adjacent vertebrae.

83
Q

When is overpressure applied in Passive Relaxed (PR) movements?

A

Overpressure is applied to every motion if pain is absent at the end of passive relaxed movement, except for extension.

84
Q

Where do you palpate during cervical flexion in Passive Relaxed (PR) movements?

A

• C0-C1: Between the mastoid process and TVP of C1.
• C1-C2: Between the arch of C1 and SP of C2.
• Rest of Cervical Spine: Between spinous processes at each level.

85
Q

What is the normal end feel for cervical extension, side flexion, and rotation in Passive Relaxed (PR) testing?

A

Tissue stretch.

86
Q

What position should the patient be in for Active Resisted (AR) testing?

A

High-seated position.

87
Q

What could weakness without pain indicate during Active Resisted (AR) movements?

A

It may suggest nerve root problems (myotome).

88
Q

Which muscles are involved in flexion at the head during Active Resisted (AR) testing?

A

Rectus capitis anterior, Rectus capitis lateralis, longus capitis, hyoid muscles.

89
Q

Which muscles are involved in flexion at the neck during Active Resisted (AR) testing?

A

Longus colli, longus capitis, infrahyoid, suprahyoid, scalenus anterior, posterior, and medius.

90
Q

Which muscles are involved in extension at the head during Active Resisted (AR) testing?

A

Splenius capitis, semispinalis capitis, longissimus capitis, spinalis capitis, trapezius, Rectus Capitis Posterior (RCP) minor/major, Obliquus capitis superior/inferior.

91
Q

Which muscles are involved in extension at the neck during Active Resisted (AR) testing?

A

Splenius cervicis/capitis, semispinalis cervicis, longissimus cervicis, iliocostalis cervicis, spinalis cervicis, interspinalis cervicis, trapezius, RCP major, rotatores.

92
Q

Which muscles are involved in side flexion at the head during Active Resisted (AR) testing?

A

Trapezius, splenius capitis, longissimus capitis, semispinalis capitis, obliquus capitis inferior, rectus capitis lateralis, longus capitis, SCM.

93
Q

Which muscles are involved in side flexion at the neck during Active Resisted (AR) testing?

A

Levator scapulae, splenius cervicis, iliocostalis cervicis, longissimus cervicis, semispinalis cervicis, multifidus, intertransversarii, scalene, SCM, obliquus capitis inferior, rotatores breves/longi, longus colli.

94
Q

Which muscles are involved in rotation at the head during Active Resisted (AR) testing?

A

Trapezius, splenius capitis, longissimus capitis, semispinalis capitis, obliquus capitis inferior, SCM (trapezius and SCM rotate to the opposite side).

95
Q

Which muscles are involved in rotation at the neck during Active Resisted (AR) testing?

A

Levator scapulae, iliocostalis cervicis, longissimus cervicis, semispinalis cervicis, multifidus, intertransversarii, scalene, SCM, obliquus capitis inferior, rotatores brevis/longi (multifidus, scalene, SCM rotate to the opposite side).

96
Q

What is the purpose of Spurling’s Test (Foraminal Compression Test)?

A

To test for possible cervical radiculopathy.

97
Q

What is the procedure for Spurling’s Test?

A
  1. Therapist passively extends, laterally flexes, and ipsilaterally rotates the patient’s head and neck (in supine).
  2. Therapist applies direct axial (coronal) pressure on the head.
98
Q

What indicates a positive Spurling’s Test?

A

Pain radiating into the arm toward which the head is side-flexed during compression.

99
Q

What are the implications of a positive Spurling’s Test?

A

Narrowing of the intervertebral foramen, possibly indicating stenosis, cervical spondylosis, osteophytes, trophic, arthritic, or inflamed facet joints, herniated disc, or vertebral fractures. (Magee shows this high seated)

100
Q

What is the purpose of the Cervical Compression Test?

A

To test for possible cervical radiculopathy.

101
Q

What is the procedure for the Cervical Compression Test?

A
  1. Patient’s head and neck are in neutral (supine).
  2. Therapist applies axial (coronal) pressure on the patient’s head.
102
Q

What indicates a positive Cervical Compression Test?

A

Pain radiating into the arm(s).

103
Q

What are the implications of a positive Cervical Compression Test?

A

Intervertebral foramen closes maximally during the test. (May also be done in high seated)

104
Q

What is the purpose of the Distraction Test?

A

To alleviate symptoms of radicular nature.

105
Q

What is the procedure for the Distraction Test?

A
  1. Therapist places hands under the patient’s occiput (in supine).
  2. Slowly distracts (or pulls) the patient’s head away from the body.
106
Q

What indicates a positive Distraction Test?

A

Pain relieved or decreased when the head is distracted.

107
Q

What are the implications of a positive Distraction Test?

A

• Relief with arm abduction, particularly indicating C4/C5 nerve root involvement.
• Can be used if radicular symptoms arise following radicular testing. (May also be done in high seated)

108
Q

What is the purpose of the Valsalva Test?

A

To determine the effect of increased pressure on the spinal cord.

109
Q

What is the procedure for the Valsalva Test?

A

Therapist instructs the patient to take a deep breath, hold it, and bear down.

110
Q

What indicates a positive Valsalva Test?

A

• Increased pain due to increased intrathecal pressure.
• Radicular pain symptoms traveling down the arm(s).

111
Q

What are the implications of a positive Valsalva Test?

A

Space-occupying lesion, such as a herniated disc, tumor, stenosis, or osteophytes. (Perform with caution due to risk of dizziness)

112
Q

What is the purpose of Tinel’s Sign?

A

To check for a brachial plexus lesion.

113
Q

What is the procedure for Tinel’s Sign?

A

1.Patient has neck slightly laterally flexed.
2. Therapist taps the area of the brachial plexus (TVPs of C5-T1) with a finger.

114
Q

What indicates a positive Tinel’s Sign?

A

Tingling sensation in the distribution of a nerve on the ipsilateral side.

115
Q

What are the implications of a positive Tinel’s Sign?

A

• Indicates an anatomically intact lesion with possible recovery.
• Pain in a peripheral nerve distribution may indicate a neuroma.

116
Q

What is the purpose of Chvostek’s Sign?

A

To test for hyper-excitability of the facial nerves.

117
Q

What is the procedure for Chvostek’s Sign?

A
  1. Patient seated or supine.
  2. Therapist taps the masseter muscle near the parotid gland (angle of the mandible).
118
Q

What indicates a positive Chvostek’s Sign?

A

Twitch of the masseter muscle or lateral lip.

119
Q

What are the implications of a positive Chvostek’s Sign?

A

May indicate hypocalcemia. (Low reliability: negative in 30% of patients with hypocalcemia, positive in 10%-25% of healthy adults)

120
Q

What is the purpose of the Cervical Upper Quadrant Test?

A

To evaluate facet joint irritation at C0-C2.

121
Q

What is the procedure for the Cervical Upper Quadrant Test?

A
  1. Patient’s head is passively extended (in supine).
  2. Therapist laterally flexes the head ipsilaterally.
  3. Followed by contralateral rotation.
122
Q

What indicates a positive Cervical Upper Quadrant Test?

A

• Local pin-point pain at the cervical vertebra(e) in the upper cervical region.
• Referral pain following the apophyseal joint referred pain patterns.

123
Q

What are the implications of a positive Cervical Upper Quadrant Test?

A

• The test maximally closes the intervertebral foramen, possibly causing radicular symptoms.
• Test results are highly dependent on the patient’s reported symptoms.
• Stop the test immediately if pain is reported at any point.

124
Q

What is the purpose of the Cervical Lower Quadrant Test?

A

To evaluate facet joint irritation at C2-C7.

125
Q

What is the procedure for the Cervical Lower Quadrant Test?

A
  1. Patient’s neck is passively extended.
  2. Therapist laterally flexes the neck ipsilaterally.
  3. Followed by ipsilateral rotation.
126
Q

What indicates a positive Cervical Lower Quadrant Test?

A

• Local pin-point pain at the cervical vertebra(e) in the lower cervical region.
• Referral pain following the apophyseal joint referred pain patterns

127
Q

What are the implications of a positive Cervical Lower Quadrant Test?

A

• The test maximally closes the intervertebral foramen, potentially causing radicular symptoms.
• The test outcome relies heavily on the patient’s reported symptoms.
• Stop the test if pain is reported at any stage.

Clinical Assessment T3 (4 decks)

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