Lower Cervical Spine Flashcards
Describe the location of the lower cervical spine
From C3-C7
Describe the primary muscle dysfunction associated with neck pain
- Less force production
- Reduced endurance of neck flexors
- Alteration of tone of postural mm
- decreased in: mid/low trap, serratus anterior
- increased in: upper trap, levator scap, neck extensors
Describe how you can test the endurance of neck musculature
Place a pressure cuff under the neck and inflate to 20 mmHg
With chin tuck cuff should increase 10 mmHg
100% endurance = 10 reps of 10 sec hold
Describe the balance of neck extensors to flexors and which fatigues more easily
We have more neck extensors than flexors
The flexors fatigue more easily and are compensated for with global muscles
Structure: serves as an attachment site for neck mm, can be elevated or have limited motion with musculature is tight
1st Rib
Describe what breathing pattern can affect the 1st rib
Mouth breathers
Breathing through your mouth requires use of neck mm which over time can affect the position and mobility of the 1st rib
Structure: Posterior lateral portion of the vertebral column that can be considered part of the intervertebral joint that is formed by the concavity of the inferior and convexity of the superior vertebral bodies
U Joint
Structure: Saddle shaped, diarthrodial/synovial joint
Uncovertebral or “U” joint
Structure:
- Extend from C3-T1
- Formed between uncinate processes/surfaces
- Develop in 1st 12 yrs of life
U Joint
Describe the 4 functions of the U Joint
- Assist with segmental flexion/extension gliding and rotation
- Restricts segmental SB
- Thought to prevent posteriolateral disc herniation
- May take pressure of vertebral artery
Describe Cyriax’s Examination Concept
Selective Tissue Tension Technique (STTT) - good for acute/subacute conditions NOT chronic condition
- If you can selectively stress each strcuture you can find the anatomical source of pain
Describe an easing factor that can help differentiate shld pain from neck pain
Pain that originates in the shld: pt. will hold arm close to body
Pain that originates in the neck: pt. will hold arm over head
List the 4 common MOI for neck pain
- Whiplash/MVA
- Collisions
- Spondylosis
- Infection, tumor or disease processes (degenerative/arthritic)
Describe the activities that can lead to neck pain
- Poor sleeping posture
- Excessive computer use or desk work
Part of the Neck Exam:
- Screen
- Look for central/peripheral neuro deficits
- Look for neurovascular compromise (vertebral artery)
- rule out fx or cervical myelopathy (cord compression)
Subjective exam
Part of the Neck Exam:
- Posture
- ROM
- Combined motion
- Repeated/sustained motion
- Neuro/segmental testing
- Muscle/endurance testing
Objective exam
Term: Side bending and rotation to the same side as the pain
Closing Restriction
Term: Side bending and rotation to the opposite side of the pain
Opening Restriction
Describe the position you would test a pt. with acute cervical pain
Potentially in sitting because laying down can aggravate sx
Describe what the literature says about thoracic vs. cervical manipulations for neck pain
Cervical manipulations can cause potential damage to the vertebral arterty, thus making them “higher” risk
The literature suggests that patients with mechanical neck pain benefit from thoracic manipulations
Describe the pattern of referred pain of cervical discs as studied by Cloward
- Posterior disc pathology presents as DIFFUSE PAIN
- Anterior disc pathology presents as LOCALIZED PAIN
- Centralized disc pathology refers over the SPINES
- Lateral disc pathology refers to the VERTEBRAL BORDER of the SCAPULA
Describe why (according to Cloward) posterior/lateral pain is diffuse while anterior/lateral pain is focal
Posterior disc issue: in this region there are more ligaments/structures thus injury to a disc can irriate more tissue types resulting in diffuse pain
Anterior disc issue: in this region there are less ligaments and structures thus an injury is very tissue specific and appears more focal
Describe the two types of cervical disc herniation
Soft: migration of nucleus
Hard: bulging of annulus
List the two most common levels of cervical disc herniations
C6-7 (60%); C5-6 (30%)
Condition: Subjective Exam
- Ache/stiffness
- Cloward signs
- Pin in upper neck, head, face, top of shoulder, scapula, posterior upper arm
- May or may not have distal sx
Cervical Disc Herniation
Condition: Subjective
- Agg: looking down or turning head
- Limited ADLs
- Altered speed of movement
- Driving, sitting, work
Cervical Disc Herniation
Cervical Disc Herniation: Pain at back of neck, head and face
Upper C-spin
Cervical Disc Herniation: Pain at base of neck and top of shld
C4-5
Cervical Disc Herniation: Pain at scapula, across the shld joint, posterior/lateral aspect of upper arm
C5-6 OR C6-7
Cervical Disc Herniation: Objective
- Abnormal posture
- Limited flex/ext
- Painful unilateral ROM (SB or Rot)
- Central PA pain > unilateral
- Spurling +
Cervical Disc Herniation
Condition: Degenerative changes of the spine
Spondylosis
Describe the Chnages to the Cervical Discs throughout Life
Child: small nucleus, 25% of disc
Teenager: Lateral cliffs form and begin to migrate to the middle with continued aging
Adult: No nucleus, completion of cliff migration results in disc being split in half
(cliff migration occurs due to large neck motion)
Condition:
- Loss of disc height
- Loss of normal lordosis
- Lateral clefts at U-joints
- Intersegmental hypermobility/instability
Cervical Disc Degeneration
Condition: Subjective
- Cloward sign
- Diffuse uni/bilateral sx
- Agg: sustained flex, quick motion, end ROM
- Long hx of neck pain or MVA
Spondylosis
Condition: Objective
- Poor posture
- limited and painful ROM
- Painful central/unilateral PA
- Sensory AND Motor Loss
- Hyporeflexia
Spondylosis
Condition:
- MOI: Sudden neck movement
- Synovial capsule impingement w/in facet
- Localized pain +/- mm spasm
- Acute torticollis
Acute Cervical Facet Syndrome
Condition: Objective
- Limited ROM +/- mm guarding
- Limited B SB
- PPIVM: segmentally limited
- PAIVM: limited, painful
- NO neuro sx
- Palpable tenderness and mm spasm
Cerivcal Facet Syndrome
Condition:
- Occuring in older pt. w/degenerative changes
- Occuring in younger pt. w/trauma
- Inflammation due to viral or chemical
Cervical acute nerve root
Condition: Subjective
- Pain worse distally w/dermatomal pattern
- Possible cloward sign
- Pain can be constant
Cervical acute nerve root
Condition: Objective
- Uncomfortable posture
- Corrected posture/deformity increases pain
- ROM only available in 1-2 motions
- Neuro +
Cervical acute nerve root
Condition: Subjective
- Dermatomal pattern, not necessarily distal
- “Patchy” distribution
- Usually intermittent
- Agg: sustained flexion or movement that narrow foramen
- Can be nagging
- able? to sleep at night
Cervical chronic nerve root
Condition: Objective
- Altered posture
- Neuro +/-
- ROM limited by closing movements
- Spurling +
- Neurodyanmic testing +
Cervical chronic nerve root
Condition:
- > 55 yo
- neck and arm pain
- painful/restricted ROM
- sensory/motor defects
- intrinsic hand mm wasting/loss of hand dexterity
Cervical Stenosis
Describe the levels of central cervical stenosis
Mild = < 13 mm
Severe = < 10 mm (equivalent to cord compression)
