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722: Clinical Management of the Musculoskeletal System II > Craniovertebral Region > Flashcards

Craniovertebral Region Flashcards

1
Q

Cervical ROM

Rotation: __ - __ degrees
Sidebending: __ degrees
Flexion: __ degrees
Extension: __-__ degrees

A

80-90

45

40

70-80

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2
Q

Cervical ROM decreases approximately _ degrees over every 10 year period

A

4

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3
Q

What ligaments attach to the pair of tubercles on the anterior surface of the foramen magnum?

A

alar ligament

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4
Q

What aspect of the foramen magnum are the occipital condyles?

A

the anterolateral aspect

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5
Q

The atlas does not have a spinous process which results in increased ______.

A

extension

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6
Q

The superolateral aspect of the atlas has a transverse foramen to accommodate for what?

A

the vertebral artery

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7
Q

Why is the axis considered a transitional vertebra?

A

Because it is the link between the cervical spine and the craniovertebral region

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8
Q

Describe the anterior and posterior aspects of the dens

A

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

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9
Q

What are the 2 functions of the dens?

A
  • serves as a pivot for the upper cervical joints

- serves as a center of rotation for the A-A joint

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10
Q

The A-A joint consists of how many joints?

A

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

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11
Q

The superior surfaces of the bodies of vertebrae C3-6 and marked with bilateral lips called what?

A

uncinate processes

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12
Q

The uncinate processes guide what movements? What movements do they limit?

A

Guide flexion and extension

Limit side bending

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13
Q

In what direction do the transverse processes of C3-6 face?

A

lateral, anterior, and inferior

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14
Q

Which cervical vertebra is considered the transitional vertebra?

A

C7

Because it connects the mobile c-spine to the table t-spine

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15
Q

What is the difference between cervical and lumber IVDs?

A

Cervical discs have less soft nuclear material which means they bear less weight than lumbar

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16
Q

Where does the apical ligament run from?

A

From the apex of the dens to the anterior rim of the foramen magnum

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17
Q

What is the anterior O-A membrane thought to be a continuation of? What is its function?

A

the ALL

It connects the anterior arch of C1 to the anterior aspect of the foramen magnum

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18
Q

What is the posterior O-A membrane thought to be a continuation of? What is its function?

A

the ligamentum flavum

It interconnects the posterior arch of the atlas and the posterior aspect of the foramen magnum

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19
Q

Which membrane is the most superficial of the 3 membranes?

A

tectorial

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20
Q

What is the tectorial membrane thought to be a continuation of? What is its function?

A

PLL

It interconnects the occipital bone and the axis and holds the occiput off the atlas

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21
Q

What motions does the tectorial membrane limit?

A

UCS flexion, extension, and vertical translation

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22
Q

Where is the alar ligament attached to?

A

The superior part of the dens to the medial aspect of the occipital condyles

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23
Q

What motions does the alar ligament limit?

A

Rotation and SB of the occiput on the axis

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24
Q

Which ligament is considered the most important stabilizing ligament in the UCS?

A

the transverse portion of the cruciform ligament

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25
Q

What is the function of the transverse ligament?

A

It keeps the dens in contact with the anterior arch of C1

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26
Q

Where is the nuchal ligament’s attachment points? What is its function?

A

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

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27
Q

What provides stability to the O-A joint?

A

The cup shaped joints and capsules, O-A membranes, alar ligament, apical ligament

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28
Q

What do dislocations of the O-A joint result in?

A

death

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29
Q

What provides mechanical stability to the A-A joint?

A

the dens and transverse ligament

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30
Q

The UCS is responsible for approximately __% of the motion through the entire cervical spine

A

50

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31
Q

Rotation and side bending at the O-A joint occur in _____ directions

A

opposite

32
Q

Describe the arthrokinematics at the O-A joint during flexion and extension

A

anterior roll; posterior slide

posterior roll; anterior slide

33
Q

What direction does the right occiput move during right SB? What direction does the left occiput move?

A

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

34
Q

What is the main movement at C1-C2?

A

rotation

35
Q

Describe the arthrokinematics at the A-A joint during right rotation

A

Right facet of C1 glides posterior Left facet of C1 glides anterior

36
Q

Describe the arthrokinematics at the A-A joint during flexion

A

both facet surfaces of C1 roll anterior and slide posterior

37
Q

The superior articular facets of C2 and C3 behave like the ____ cervical spine whereas the inferior articular facets behave like the ____ cervical spine

A

upper

lower

38
Q

The superior articular facets of vertebra C2-C7 are slightly con___ whereas the inferior articular facets are slightly con___

A

convex

concave

39
Q

What direction do the articular facets of vertebra C2-C7 face?

A

Superior: cranial and posterior

Inferior: caudal and anterior

40
Q

Describe the arthrokinematics at C2-C7 during flexion and extension

A

Facets move up and forward during flexion and down and back during extension

41
Q

Rotation and side bending in the LCS occur in _____ direction

A

the same

42
Q

Describe the arthrokinematics at C2-C7 during right sidebending

A

Right facet moves down and back while the left facet moves up and forward

43
Q

Describe the arthrokinematics at C2-C7 during right rotation

A

Right facet moves down and back while the left facet moves up and forward

44
Q

What are the 6 indicators of neoplastic conditions?

A
  • Age >50 years
  • Previous history of cancer
  • Unexplained weight loss
  • Constant pain
  • Night pain
  • Unexplained capsular patterns
45
Q

What are the 4 indicators of cervical pathologies?

A
  • Temperature >100 F
  • BP >160/95 mmHg
  • Resting pulse >100
  • Resting respiration >25 bpm
  • Fatigue
46
Q

What are the clinical indicators of cervical fracture?

A
  • 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
47
Q

What are the 3 high risk factors that indicate cervical X-ray?

A
  • > 65 years old
  • Dangerous MOl (fall from > 1 meter, axial load to the head, MVA>100km/hr, or bike accidents)
  • Limb paresthesias
48
Q

What are the 3 low risk factors that indicate cervical X-ray?

A
  • rear end MVA

- Delayed onset of neck pain - Absence of midline tenderness

49
Q

If the patient is unable to rotate the c-spine __ degrees to the left or to the right they will need an x-ray

A

45

50
Q

What is the MOI for a Jefferson fracture?

A

blow to the top of the head

51
Q

Describe a Clay Shoveler’s fracture

A

Fracture of the spinous process in the lower C-spine in which flexion and extension is very painful

52
Q

What injuries can lead to a cervical dislocation?

A
  • dens fracture

- transverse ligament rupture

53
Q

What are the signs associated with cervical cord compression?

A
  • Bilateral or quadrilateral limb paresthesias brought on with cervical motion
  • Hyper-reflexia
  • Clonus
  • Positive Babinski or Hoffman’s sign
54
Q

What are the signs associated with cervical myelopathy?

A
  • 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
55
Q

What are cervical myelopathy grades determined from?

A

gait disturbances

56
Q

True or False

Whiplash injury is a diagnosis by itself

A

False

57
Q

How long after a whiplash injury should you wait to test the vertebral artery?

A

4-6 weeks

58
Q

How long should a patient wear a soft collar after a whiplash injury?

A

Until the capsular pattern disappears, usually 3 weeks

59
Q

What is the median time to improvement for recalcitrant whiplash?

A

31 days

60
Q

__% of whiplash injury patients do well
__% do moderately ok
__% do poorly

A

40

40

20

61
Q

What are some causes of cervical radiculopathy?

A
  • Arthritic conditions
  • Discogenic disorders
  • Segmental instabilities
  • Tumors
62
Q

In what age group is the peak incidence of cervical radiculopathy?

A

40-50

63
Q

What nerve root levels are the most involved in cervical radiculopathy?

A

C6 and C7

64
Q

What spinal level is most commonly associated with acute torticollis?

A

C2-C3

65
Q

Patients with mechanical joint dysfunction are aggravated most by what motions?

A

Coupled motions at end range

66
Q

What is the alar ligament test also know as?

A

the frontal plane test

67
Q

What is the transverse ligament test also know as?

A

sagittal plane test

68
Q

What does the Sharp-Purser Test assess?

A

The integrity of the transverse ligament/UCS stability

69
Q

True or False

Craniovertebral flexion and extension have an effect on A-A rotation

A

True

70
Q

What movements will be limited if the right O-A joint cannot glide posteriorly?

A

flexion and right rotation

71
Q

What movements will be limited if the right O-A joint cannot glide anteriorly?

A

extension and left rotation

72
Q

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 ______.

A

flexion

extension

73
Q

What 4 movements are assessed when performing AROM, PROM, overpressure, and resistance testing?

A
  • Short neck flexion
  • Short neck extension
  • Side bending
  • Rotation
74
Q

What are the goals of craniovertebral dysfunction during the acute phase?

A
  • reduce pain, inflammation, and muscle spasms
  • reestablish a non-painful ROM
  • improve neuromuscular postural control
75
Q

What are the goals of craniovertebral dysfunction during the functional phase?

A
  • establish normal and pain-free AROM

- regain strength

722: Clinical Management of the Musculoskeletal System II (12 decks)

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