Cervical Thoracic Spine Flashcards
Atlas and axis articulation allows for what movement of the head? Atlas and occiput articulation allows for what movement of the head?
Atlas andd axis articulation allows from the shaking head no movement. (side to side)
Atlas and occiput articulation allows for the shaking head yes (up and down)
T/F, vertebral disks are extremely strong in compressive force but not strong with shear force?
Describe the make up of a vertebral body.
True.
Center = nucleus pulposis
Outter edges = annulus fibrosis, fibers are oblique
Which ligaments are responsible for keeping the dense and atlas from sliding too far forward?
Cruciform ligament: made up of the superior longitudinal fibers, transverse ligaments of atlas, inferior longitudinal fibers
Alar ligaments
What are two nerves we need to be concerned with around the neck?
What vertebrae does the spinal cord stop?
Greater and lesser auricular nerves.
Cord stops generally L1-L2
Nerve Root Nomenclature:
- nerve root exits above/below the pedicle with the same number in the cervical spine?
- where does C8 nerve root exit?
- nerve root exits above/below the pedicle with the same number in the thoracic and lumbar spine?
The nerve root exits ABOVE the pedicle with the same number in the cervical spine.
ex. C4 nerve comes out above the C4 pedicle.
C8 nerve root exits above the T1 pedicle.
Nerve root exits BELOW the pedicle with the same number in the thoracic and lumbar spine. ex. T1 nerve goes below the T1 pedicle.
What portions of the spine are mobile?
What are the normal curvatures of the spine?
Where does 50% of the cervical range of motion come from?
Cervical and lumbar spine are mobile.
Lumbar = lordosis Thoracic = kyphosis Cervical = lordosis
50% of cervical ROM comes from C1-C2.
Axial Pain:
- are pain fibers are located in each of the following?
- -annulus
- -joint (uncovertebral, facet)
- -ligaments
- -periosteum
- -muscle/fascia
Yes, there is pain fibers located in all of them.
Radicular pain
- where is this?
- causes
- describe the pain
- associated PE findings
Where: nerve root mediated, associated with the spinal nerves.
Causes:
- compression
- chemical/inflammatory
Pain description:
-dermatomal sharp pain, numbness, paresthesias
Associated PE findings:
- weakness
- hyporeflexia
Referred Pain:
- what is this?
- describe this pain sensation
What: axial or external pain localized to a site remote from location of nocioceptors
Pain description:
-dull, achy, nondermatomal pain
Describe the normal effects of aging on the vertebral disks?
Aging of vertebral disks:
- universal but occurs at different rates in different individuals
- disk dehydration and narrowing occurs
- there is increased strain on annulus leading to diffuse bulging, annular tears, and focal disc herniation.
- stress is transferred to uncovertebral and facet joints (athrosis=bone spurs)
- instability
Myelopathy:
-cause?
Cause: pressure on the spinal cord, large disk herniation, spurs, congenitally narrow canal.
How are disks numbered?
WHere is the first disk located?
Disk space C3-4, which nerve root is involved??
Disk space C7-T1, which nerve root is involved?
Disks are numbered by the disks they are between. ex. C3-4.
First disk is located between C2-3
Disk space C3-4, Nerve root involved is C4.
Disk Space C7-T1, never root involved is C8
When testing motor strength what do each of the following mean:
- 5/5
- 4/5
- 3/5
- 2/5
- 1/5
5/5 cant break it
4/5 can break it
3/5 can bring arm up against gravity but falls without support
2/5 cant lift it against gravity
1/5 twitch
0/5 cannot move at all
Dropping from 5/5 to 4/5 is like losing 50% of muscle strength.
Which DTR is associated with each of the following levels:
- C5
- C6
- C7
WHat is indicated if a pts DTR is hyporeflexive? hyperreflexive?
C5 = biceps
C6 = brachioradialis
C7 = triceps
Hyporeflexic DTR = root lesion, radiculopathy
Hyperreflexic = cord lesion, myelopathy
Describe each of the following PE signs:
- Hoffman Sign
- Babinski
- Spurlings
- Reverse spurlings
- Adson test
Hoffman: flick the finger and the hand will contract.
Babinski: you know this.
Spurlings: ipsilateral lateral bending + extension
Reverse spurlings: contralateral bending
Adson:
-stand behind pt and place hand on shoulder, pull arm back behind the patient and have the pt turn their head, an absent or diminished pulse indicates compression of the subclavian artery.
