CSpine Flashcards
Describe three things about the atlas
no vertebral body
no IV disc
No IV foramen
What does the transverse process run?
odontoid to the anterior arch of atlas
How to palpate transverse process of C1
What attaches here
go to mastoid and angle of mandible and find in between
Transverse foramen
only in the Cspine, for the vertebral artery to snake up
IV foramen
Behind?
In front?
created by one vertebrae on top of another/two gutters (of transverse process) this is where spinal nerves sit in the gutter.
Behind: facet joints
In front: vertebral disc and bodies
Vertebral foramen:
houses SC
transverse ligament in relation to the SC
anterior
Alar ligament contributes to what?
coupling behavior of C1 and C2
What x-ray view would you look at if someone had trauma or you’re concerned about stability?
Why this view?
Lateral! this way you can see the interval between C1 and C2. If its widened (>2mm) this shows there was attenuation of the transverse ligament
C1 has slipped anteriorly causing a gap and possibly shearing the SC
What attaches to the nuchal ligament?
trap and splenius capitis
Where do the vertebral arteries travel?
through the transverse foramen
Crappy vertebral artery test
end range rotation and a little extension, hold here for 20ish seconds and look fr symptoms or nystagmus.
probably poses more harm than good
What structure is very susceptible to degenerative processes bc of its location?
the vertebral arteries traveling up the transverse foramen
created by two gutters
IV foramen
Where the spinal nerve actually lies
transverse process/gutter
if the vertebral body was a rectangle what part would the articular pillar be?
posterior lateral corner
What is a key thing that happens at the uncovertebral joint?
degenerative changes
Unocovertebral joint is where on the uncinate process?
posterior lateral corner
Where is the nerve in relation to the uncovertebral joint and the facet joint and pedicles?
posterior to the unocovertebral joint
anterior to the facet joint
above and below are pedicles
Describe the location of the nerves sitting within the transverse processes
behind the uncovertebral joint
in front of the facet joints
above and below are the pedicles
uncinate process limit what?
lateral bending
canal narrowing is called what
stenosis
C spine disc is mostly what in nature?
fibrous
What part of the cspine discs are pain sensitive?
posterior 1/3
When do cspine discs start loosing water?
20’s
What are the two key functions of discs?
Stability and spacer function
What happens when you lose the spacer function of the IV disc?
you lose the vertical component to the vertebrae therefore making the IV foramen that the nerve is traveling through smaller. AND the ligaments are on slack (passive stabilizers of the system)
What is the wrinkles of the Cspine? where specifically is this most likely to occur?
transverse fissures
most likely to occur/predictable feature in the posterior 1/2 of discs
Are the ligaments of the Cspine pain sensitive?
YES!
Ligamentum flavum travels where?
lamina to lamina
what travels from medial spinous process to spinous process?
interspinous ligament
Posterior spinous process to spinous process is what ligament?
Suraspinous ligament –> ligamentum nuchae
Thickening of what two structures can cause impingement of spinal nerves
Ligamentum flavum and facet capsules
Describe the predictable degenerative cascade of Cspine discs.
Dysfunction: starts in 20’s
Instability: 30-40’s
Restabilization: 50-70’s
When are we most susceptible to instability in the Cspine? and why?
30-40’s because there has been dysfunction due to disc changes but the body hasn’t caught up to making osteophytes to try to stabilize it yet.
Before you start seeing degenerative changes what happens?
GAGS are lost
is isolated testing of the cspine musculature possible?
No
To assess length of the muscles how do you need to move? Why?
in 3D plane because muscles are obliquely oriented
Stretching the semispinalis
super close to midline so mostly just flexion but also a little rotation contralaterally
Stretch the SCM
chin tuck, opposite side lateral bend, ipsilateral rotation
What are like the mini splenius muscles in how you stretch them/their muscle action
Rectus capitus major and minor
Flex, contralateral side bend and rotation
Action and origin and insertion of Oblique capitis inferior
rotation!
Origin: spinous process of C2 , insertion is transverse process of C1
Action of oblique capitis superior
ipsilateral side bending
What are the triangular muscles critical for PT’s to be thinking about?
cervicogenic HA! These are critical muscles of head posture
Where do we do the fine tuning of head positioning?
Upper C spine
Where does most rotation in the Cspine occur
50% occurs btwn C1 and C2
Where does rectus capitis major run to and from
From spinous process of C2 to occiput
Anterior border is the SCM and posterior border is upper trap are what muscles?
What are their primeary action?
Scalenes
Lateral bending
Where are longus coli and capitis muscles?
Function?
anterior
Cervical flexors but not a big moment arm, work to compress and stabilize
What are the active stabilizers of the Cspine?
muscles! just the osteoligamentous structure of Cspine will collapse under just 2.5 lbs.
Upper cervical motion is _____ relative to ____
head relative to neck
lower cspine motion is _____ relative to ______
neck relative to trunk
What moves first in flexion and extension upper or lower cspine
upper: think about nodding
True or false, the upper and lower cspine can move independently from one another as well as together?
true
Chin tuck
Upper cspine
Lower cspine
Upper: flexion
Lower: extension
What movements have the most motion in the cspine. Where does it occur t/o? where does it peak?
flexion and extension
motion is distributed t/o
A lot in upper cspine as well as C4,5,6 (4,5,6 is the most common area for degeneration)
what actions does the least total motion happen with in the cspine
What level does it happen the most at?
lateral bending
Occurs at all levels but mostly middle of the c-spine
Where does the most rotation occur in the Cspine?
Where does it minimally occur?
50% between C1 and C2 but happens at all levels
Minimally at occiput and C1
Upper thoracic spine is an extension what?
lower cspine: however in thoracic flexion and extension is limited due to rib cage
what should you see with the lordosis of the spine when someone flexes their head?
curve reversal
When you flex, what happens to the inferior facet in comparison to the superior fact?
sliding up the hill
in flexion or extension is the INFERIOR facet sliding up the hill of the corresponding superior facet?
flexion
What is the motion that should be seen most at the cpspine if the individual is not unstable?
rotation rather than translation. Excessive translation is a sign of instability.
Biomechanics of flexion
Upper segment rotates: anteriorly or posteriorly
Slides: forward or back?
IV foramen and spinal canal widen or collapse?
Posterior elements compressed or tensed?
FLEXION
upper segment rotates anteriorly and slides forward
IV foramen and spinal canal widen
Posterior elements are put on compression stress
Extension biomechanics
upper segment in relation to lower segment
Rotates: anteriorly, posterior?
Slides: forward or back?
IV foramen and spinal canal widen or collapse?
Posterior elements compressed or tensed?
EXTENSION
Upper segment rotates posteriorly and slides back
IV foramen and spinal canal collapse
Posterior elements have compression stress
What is the axis of motion in a normal neck?
when does this change
posterior 1/3 of the disc
this changes when there are degenerative changes
In flexion and extension as a posterior structure unit what is going on
muscles, nerves, ligaments etc are all going for the ride, its like an accordion
flexion: tension
extension: slack
In the LOWER cspine what motions are coupled?
lateral bending and rotation
What part of the cspine are rotation and lateral bending coupled?
Lower Cspine
Why are we able to keep our eyes facing forward when we side bend if rotation and lateral bending are coupled int he lower Cspine
upper cspine compensates and rotates the opposite direction
If a pt cannot rotate to the L what could you ask them to do to determine if its a limitation in upper or lower cspine?
have them side bend to the R, if they cannot keep their eyes forward then you know its the upper cspine limiting them because it should be compensating for the R sidebend and rotation being coupled in the lower cspine
Test to isolate the upper cspine:
flexion rotation test, maximally flex them then rotate
Vertebral body degeneration is called what?
spondylosis
At what age is spondylosis incredibly common
> age of 60
What should there be with compressive syndromes other than a radiograph that shows spondylosis we know doesn’t correlate?
there should be neurologic symptoms! just pressure on a nerve doesn’t hurt, it can cause numbness and parenthesia but not pain. Inflammation hurts
True or false: pain is evidence of nerve compression?
False! there need to be neurologic symptoms (parensthesia, anesthesia, loss of motor function or reflex, clonus)
What has decent correlation with degenerative changes on imaging?
someone experiencing neurological symptoms
Bright white margins on x ray you’re looking at what?
subchondral sclerosis
no clear margins btwn uncovertebral bodies telling you what?
uncovertebral bodies are sclerotic
referred pain due to convergence or divergence in the dorsal or ventral gray?
Convergence in the dorsal gray matter!
Referred pain along border of scapula likely to be from what?
disc
referred pain in C5,6,7 likely to be from what?
interspinous ligaments
what is referred pain generally described as?
dull and achy, poorly localized, deep
upper cspine refers to what?
lower cspine refers to what?
upper: head, neck, shoulder
Lower: neck, shoulder, arm
True or false: referred pain means nerve root compression
NOOOOO. no need to focus on “decompressing” NR
You think you’re on C6 and C7, what can you do to check
Ask the pt to extend, C6 should disappear with moderate extension, C7 should disappear after excessive extension.
Adams apple is what?
thyroid cartilage
+ Flexion rotation test
> 10 degrees of lost motion side to side OR
<35 degrees
What are the four classifications of neck pain
Neck pain w/
- mobility deficits
- movement coordination impairment
- HA
- radiating pain
