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PTRS 845 Final > Lower Cervical Spine > Flashcards

Lower Cervical Spine Flashcards

1
Q

Describe the location of the lower cervical spine

A

From C3-C7

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2
Q

Describe the primary muscle dysfunction associated with neck pain

A
  • 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
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3
Q

Describe how you can test the endurance of neck musculature

A

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

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4
Q

Describe the balance of neck extensors to flexors and which fatigues more easily

A

We have more neck extensors than flexors

The flexors fatigue more easily and are compensated for with global muscles

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5
Q

Structure: serves as an attachment site for neck mm, can be elevated or have limited motion with musculature is tight

A

1st Rib

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6
Q

Describe what breathing pattern can affect the 1st rib

A

Mouth breathers

Breathing through your mouth requires use of neck mm which over time can affect the position and mobility of the 1st rib

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7
Q

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

A

U Joint

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8
Q

Structure: Saddle shaped, diarthrodial/synovial joint

A

Uncovertebral or “U” joint

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9
Q

Structure:

  • Extend from C3-T1
  • Formed between uncinate processes/surfaces
  • Develop in 1st 12 yrs of life
A

U Joint

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10
Q

Describe the 4 functions of the U Joint

A
  • Assist with segmental flexion/extension gliding and rotation
  • Restricts segmental SB
  • Thought to prevent posteriolateral disc herniation
  • May take pressure of vertebral artery
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11
Q

Describe Cyriax’s Examination Concept

A

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
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12
Q

Describe an easing factor that can help differentiate shld pain from neck pain

A

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

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13
Q

List the 4 common MOI for neck pain

A
  1. Whiplash/MVA
  2. Collisions
  3. Spondylosis
  4. Infection, tumor or disease processes (degenerative/arthritic)
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14
Q

Describe the activities that can lead to neck pain

A
  • Poor sleeping posture
  • Excessive computer use or desk work
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15
Q

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)
A

Subjective exam

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16
Q

Part of the Neck Exam:

  • Posture
  • ROM
  • Combined motion
  • Repeated/sustained motion
  • Neuro/segmental testing
  • Muscle/endurance testing
A

Objective exam

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17
Q

Term: Side bending and rotation to the same side as the pain

A

Closing Restriction

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18
Q

Term: Side bending and rotation to the opposite side of the pain

A

Opening Restriction

19
Q

Describe the position you would test a pt. with acute cervical pain

A

Potentially in sitting because laying down can aggravate sx

20
Q

Describe what the literature says about thoracic vs. cervical manipulations for neck pain

A

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

21
Q

Describe the pattern of referred pain of cervical discs as studied by Cloward

A
  1. Posterior disc pathology presents as DIFFUSE PAIN
  2. Anterior disc pathology presents as LOCALIZED PAIN
  3. Centralized disc pathology refers over the SPINES
  4. Lateral disc pathology refers to the VERTEBRAL BORDER of the SCAPULA
22
Q

Describe why (according to Cloward) posterior/lateral pain is diffuse while anterior/lateral pain is focal

A

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

23
Q

Describe the two types of cervical disc herniation

A

Soft: migration of nucleus

Hard: bulging of annulus

24
Q

List the two most common levels of cervical disc herniations

A

C6-7 (60%); C5-6 (30%)

25
Q

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
A

Cervical Disc Herniation

26
Q

Condition: Subjective

  • Agg: looking down or turning head
  • Limited ADLs
  • Altered speed of movement
  • Driving, sitting, work
A

Cervical Disc Herniation

27
Q

Cervical Disc Herniation: Pain at back of neck, head and face

A

Upper C-spin

28
Q

Cervical Disc Herniation: Pain at base of neck and top of shld

A

C4-5

29
Q

Cervical Disc Herniation: Pain at scapula, across the shld joint, posterior/lateral aspect of upper arm

A

C5-6 OR C6-7

30
Q

Cervical Disc Herniation: Objective

  • Abnormal posture
  • Limited flex/ext
  • Painful unilateral ROM (SB or Rot)
  • Central PA pain > unilateral
  • Spurling +
A

Cervical Disc Herniation

31
Q

Condition: Degenerative changes of the spine

A

Spondylosis

32
Q

Describe the Chnages to the Cervical Discs throughout Life

A

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)

33
Q

Condition:

  • Loss of disc height
  • Loss of normal lordosis
  • Lateral clefts at U-joints
  • Intersegmental hypermobility/instability
A

Cervical Disc Degeneration

34
Q

Condition: Subjective

  • Cloward sign
  • Diffuse uni/bilateral sx
  • Agg: sustained flex, quick motion, end ROM
  • Long hx of neck pain or MVA
A

Spondylosis

35
Q

Condition: Objective

  • Poor posture
  • limited and painful ROM
  • Painful central/unilateral PA
  • Sensory AND Motor Loss
  • Hyporeflexia
A

Spondylosis

36
Q

Condition:

  • MOI: Sudden neck movement
  • Synovial capsule impingement w/in facet
  • Localized pain +/- mm spasm
  • Acute torticollis
A

Acute Cervical Facet Syndrome

37
Q

Condition: Objective

  • Limited ROM +/- mm guarding
  • Limited B SB
  • PPIVM: segmentally limited
  • PAIVM: limited, painful
  • NO neuro sx
  • Palpable tenderness and mm spasm
A

Cerivcal Facet Syndrome

38
Q

Condition:

  • Occuring in older pt. w/degenerative changes
  • Occuring in younger pt. w/trauma
  • Inflammation due to viral or chemical
A

Cervical acute nerve root

39
Q

Condition: Subjective

  • Pain worse distally w/dermatomal pattern
  • Possible cloward sign
  • Pain can be constant
A

Cervical acute nerve root

40
Q

Condition: Objective

  • Uncomfortable posture
  • Corrected posture/deformity increases pain
  • ROM only available in 1-2 motions
  • Neuro +
A

Cervical acute nerve root

41
Q

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
A

Cervical chronic nerve root

42
Q

Condition: Objective

  • Altered posture
  • Neuro +/-
  • ROM limited by closing movements
  • Spurling +
  • Neurodyanmic testing +
A

Cervical chronic nerve root

43
Q

Condition:

  • > 55 yo
  • neck and arm pain
  • painful/restricted ROM
  • sensory/motor defects
  • intrinsic hand mm wasting/loss of hand dexterity
A

Cervical Stenosis

44
Q

Describe the levels of central cervical stenosis

A

Mild = < 13 mm

Severe = < 10 mm (equivalent to cord compression)

PTRS 845 Final (11 decks)

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