Craniovertebral Region Flashcards
Cervical ROM
Rotation: __ - __ degrees
Sidebending: __ degrees
Flexion: __ degrees
Extension: __-__ degrees
80-90
45
40
70-80
Cervical ROM decreases approximately _ degrees over every 10 year period
4
What ligaments attach to the pair of tubercles on the anterior surface of the foramen magnum?
alar ligament
What aspect of the foramen magnum are the occipital condyles?
the anterolateral aspect
The atlas does not have a spinous process which results in increased ______.
extension
The superolateral aspect of the atlas has a transverse foramen to accommodate for what?
the vertebral artery
Why is the axis considered a transitional vertebra?
Because it is the link between the cervical spine and the craniovertebral region
Describe the anterior and posterior aspects of the dens
Anteriorly there is a hyaline cartilage-covered midline facet that articulates with the anterior tubercle of the atlas
Posteriorly it is marked with a groove where the transverse ligament passes
What are the 2 functions of the dens?
- serves as a pivot for the upper cervical joints
- serves as a center of rotation for the A-A joint
The A-A joint consists of how many joints?
4:
Two lateral facet joints between the inferior articular processes of the atlas and the superior processes of the axis
Two medial joints one between the anterior surface of the dens and the anterior surface of the atlas and the other between the posterior surface of the dens and the anterior hyalinated surface of the transverse ligament
The superior surfaces of the bodies of vertebrae C3-6 and marked with bilateral lips called what?
uncinate processes
The uncinate processes guide what movements? What movements do they limit?
Guide flexion and extension
Limit side bending
In what direction do the transverse processes of C3-6 face?
lateral, anterior, and inferior
Which cervical vertebra is considered the transitional vertebra?
C7
Because it connects the mobile c-spine to the table t-spine
What is the difference between cervical and lumber IVDs?
Cervical discs have less soft nuclear material which means they bear less weight than lumbar
Where does the apical ligament run from?
From the apex of the dens to the anterior rim of the foramen magnum
What is the anterior O-A membrane thought to be a continuation of? What is its function?
the ALL
It connects the anterior arch of C1 to the anterior aspect of the foramen magnum
What is the posterior O-A membrane thought to be a continuation of? What is its function?
the ligamentum flavum
It interconnects the posterior arch of the atlas and the posterior aspect of the foramen magnum
Which membrane is the most superficial of the 3 membranes?
tectorial
What is the tectorial membrane thought to be a continuation of? What is its function?
PLL
It interconnects the occipital bone and the axis and holds the occiput off the atlas
What motions does the tectorial membrane limit?
UCS flexion, extension, and vertical translation
Where is the alar ligament attached to?
The superior part of the dens to the medial aspect of the occipital condyles
What motions does the alar ligament limit?
Rotation and SB of the occiput on the axis
Which ligament is considered the most important stabilizing ligament in the UCS?
the transverse portion of the cruciform ligament
What is the function of the transverse ligament?
It keeps the dens in contact with the anterior arch of C1
Where is the nuchal ligament’s attachment points? What is its function?
Occiput to the spinous process of C7
It provides a proprioceptive role for the erector spinae and may also provide AP stability at C1-C4
What provides stability to the O-A joint?
The cup shaped joints and capsules, O-A membranes, alar ligament, apical ligament
What do dislocations of the O-A joint result in?
death
What provides mechanical stability to the A-A joint?
the dens and transverse ligament
The UCS is responsible for approximately __% of the motion through the entire cervical spine
50
Rotation and side bending at the O-A joint occur in _____ directions
opposite
Describe the arthrokinematics at the O-A joint during flexion and extension
anterior roll; posterior slide
posterior roll; anterior slide
What direction does the right occiput move during right SB? What direction does the left occiput move?
in a medial, inferior, and anterior direction
In a lateral, superior, and posterior direction
MIA has nice LPS: Right SB = R condyle MlA and L condyle LPS
What is the main movement at C1-C2?
rotation
Describe the arthrokinematics at the A-A joint during right rotation
Right facet of C1 glides posterior Left facet of C1 glides anterior
Describe the arthrokinematics at the A-A joint during flexion
both facet surfaces of C1 roll anterior and slide posterior
The superior articular facets of C2 and C3 behave like the ____ cervical spine whereas the inferior articular facets behave like the ____ cervical spine
upper
lower
The superior articular facets of vertebra C2-C7 are slightly con___ whereas the inferior articular facets are slightly con___
convex
concave
What direction do the articular facets of vertebra C2-C7 face?
Superior: cranial and posterior
Inferior: caudal and anterior
Describe the arthrokinematics at C2-C7 during flexion and extension
Facets move up and forward during flexion and down and back during extension
Rotation and side bending in the LCS occur in _____ direction
the same
Describe the arthrokinematics at C2-C7 during right sidebending
Right facet moves down and back while the left facet moves up and forward
Describe the arthrokinematics at C2-C7 during right rotation
Right facet moves down and back while the left facet moves up and forward
What are the 6 indicators of neoplastic conditions?
- Age >50 years
- Previous history of cancer
- Unexplained weight loss
- Constant pain
- Night pain
- Unexplained capsular patterns
What are the 4 indicators of cervical pathologies?
- Temperature >100 F
- BP >160/95 mmHg
- Resting pulse >100
- Resting respiration >25 bpm
- Fatigue
What are the clinical indicators of cervical fracture?
- Trauma
- Immediate post-traumatic onset of severe pain
- Cracking noise at time of injury
- Post-traumatic hemarthrosis - Crepitus
- Strong multidirectional spasm
- Severe pain on compression
- Bone tenderness
- Pain on vibration
- Painful weakness on isometric testing
- Severe bruising
- Loss of normal contour
What are the 3 high risk factors that indicate cervical X-ray?
- > 65 years old
- Dangerous MOl (fall from > 1 meter, axial load to the head, MVA>100km/hr, or bike accidents)
- Limb paresthesias
What are the 3 low risk factors that indicate cervical X-ray?
- rear end MVA
- Delayed onset of neck pain - Absence of midline tenderness
If the patient is unable to rotate the c-spine __ degrees to the left or to the right they will need an x-ray
45
What is the MOI for a Jefferson fracture?
blow to the top of the head
Describe a Clay Shoveler’s fracture
Fracture of the spinous process in the lower C-spine in which flexion and extension is very painful
What injuries can lead to a cervical dislocation?
- dens fracture
- transverse ligament rupture
What are the signs associated with cervical cord compression?
- Bilateral or quadrilateral limb paresthesias brought on with cervical motion
- Hyper-reflexia
- Clonus
- Positive Babinski or Hoffman’s sign
What are the signs associated with cervical myelopathy?
- Bilateral or quadrilateral limb paresthesia and/or weakness
- Positive Babinski or Hoffman’s sign
- Sensory disturbance of the hands
- Muscle wasting of the hand intrinsics
- Unsteady gait
- Bowel and bladder disturbances
What are cervical myelopathy grades determined from?
gait disturbances
True or False
Whiplash injury is a diagnosis by itself
False
How long after a whiplash injury should you wait to test the vertebral artery?
4-6 weeks
How long should a patient wear a soft collar after a whiplash injury?
Until the capsular pattern disappears, usually 3 weeks
What is the median time to improvement for recalcitrant whiplash?
31 days
__% of whiplash injury patients do well
__% do moderately ok
__% do poorly
40
40
20
What are some causes of cervical radiculopathy?
- Arthritic conditions
- Discogenic disorders
- Segmental instabilities
- Tumors
In what age group is the peak incidence of cervical radiculopathy?
40-50
What nerve root levels are the most involved in cervical radiculopathy?
C6 and C7
What spinal level is most commonly associated with acute torticollis?
C2-C3
Patients with mechanical joint dysfunction are aggravated most by what motions?
Coupled motions at end range
What is the alar ligament test also know as?
the frontal plane test
What is the transverse ligament test also know as?
sagittal plane test
What does the Sharp-Purser Test assess?
The integrity of the transverse ligament/UCS stability
True or False
Craniovertebral flexion and extension have an effect on A-A rotation
True
What movements will be limited if the right O-A joint cannot glide posteriorly?
flexion and right rotation
What movements will be limited if the right O-A joint cannot glide anteriorly?
extension and left rotation
In the combined motion tests, the right rotation restriction will be more evident when combined with craniovertebral ____ but will be less evident when combined with craniovertebral ______.
flexion
extension
What 4 movements are assessed when performing AROM, PROM, overpressure, and resistance testing?
- Short neck flexion
- Short neck extension
- Side bending
- Rotation
What are the goals of craniovertebral dysfunction during the acute phase?
- reduce pain, inflammation, and muscle spasms
- reestablish a non-painful ROM
- improve neuromuscular postural control
What are the goals of craniovertebral dysfunction during the functional phase?
- establish normal and pain-free AROM
- regain strength
