Ch. 37 Neck Problems Flashcards
The antlantoocipital (C0-1) articulation permits ___
10 degrees flexion and 25 degrees extension
The C1-2 antlantoaxial joint is responsible for
40-50% cervical axial rotation
Below C2-3 level, ____ is coulpled with ____
lateral flexion coupled with rotation in same direction
Greatest amount of cervical flexion occurs at
C4-5 and C5-6
Lateral bending occurs primarly at
C3-4 and C4-5
Cervical joints most commonly to develop OA
Uncoverebral joints or joints of Luschka
Joints of Luschka are located ___
Between the uncinate processes of C3-7
OA of joints of Luschka narrow ___
intervertebral foramina
Intervertebral formina are widest at ___ and narrow to level __
C2-3 narrow to C6-7
Annulus fibrosis is innervated posterolaterally but the ___ and anteriorly by the ___
Posteriorlateral: sinuvertebral nerve
Anterior: vertebral nerve
Referred pain pattern of C1-2 and C2-3 zygapophyseal joints
Refer rostrally to the occiput
Referred pain pattern of C3-4 and C4-5 zygapophyseal joints
Symptoms over posterior neck
Referred pain pattern of C5-6 zygapophyseal joint
Supraspinatus fossa of the scapula
Referred pain pattern of C6-7 zygapophyseal joint
Spreads caudally over the scapula
Bilateral paramidline upper neck pain without associated headaches is secodnary to ___
Cervical intervertebral disc disruption (CIDD)
Cervical radicular pain presents as ___ pain >___ pain
upper limb pain > axial pain
MCC of cervical radiculopathy
herniated cervical intervertebral disc
Cervical strain
Musculotendinous injury from overload injury to spine
Cervical Sprain
Overstretching or tearin injuries of spinal ligaments
Whiplash treatment
NSAIDs, TENS, soft collar during sleep for 72 hours after injury, gradual return to activities in 2-4 weeks
Cervical Radiculopathy
Neurodysfunction of the nerve root
Cervical Radiculopathy Sx
Reflex and strength deficits
Exacerbating factors for radiculopathy
Inc subarchnoid pressure: coughing, sneezing, valsalva; Cervical Extension
Bakody’s Sign
Shoulder abduction relief sign: alleviates radicular pain by ispislateral elevation of the humerus
C5-6 involvement produces muscle wasting in __
Suprascapular or infrascapular fossa or deltoid
C7 injury produces muscle wasting in ___
Triceps
C8 injury produces muscle wasting in___
thenar eminence
T1 injury produces muscle wasting in ___
first dorsal interossei
L’hermitte’s sign
Rapid passive cervical flexion while patient is seated can produce an electric shock sensation down the spine
What can L’hermitte’s sign indicate?
Cervical cord involvement as a result of tumor, spondylosis, or MS
Guidelines for diagnosing radiculopathy on EMG
ABN in 2 or more muscles innervated by the same root but different peripheral nerves with normal findings in muscles of adjacent nerve roots
What can US treatment do to cervical radiculopathy?
Inc metabolic response and inflammation further aggravating nerve root injury
How is TENS beleived to act?
Gate theory
What is the Gate theory?
pain modulation by stimulating large myelinated fibers blocking nocicpetive transmission in smaller fibers at level of spinothalamic neurons
What is the functional restoration of spinal biomechanics?
Cervicothoracic stabilization
Cervicothoracic stabilization includes
spinal flexibility, postural reeducation and conditioning
What is Nucleoplasty?
Coblation energy to vaporize nuclear tissue into gaseous elementary elements
What are indications for surgical treatment of CIDH?
Intractable pain, severe myotomal deficit or progression to myelopathy
What is provocation discography?
positive test corrobrates production of patient pain pattern with structurally derranged disc
