MS1: Affectations of Cervical Spine Flashcards

1
Q

what are the superficial muscles of the neck

A

traps
SCM
levator scapulae
rhomboids
ant, middle and post scalene

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2
Q

what are the deeper muscles of the neck

A

splenius capitis
semispinalis capitis
longissimus capitis

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3
Q

what are the deepest muscles of the neck

A

splenius cervicis
semispinalis cervicis
longissimus cervicis

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4
Q

what are the upper cervical ligaments

A

apical > alar > transverse > cruciate > membrane tectoria

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5
Q

describe torticollis

A

SCM affected, CN 11 or spinal accessory nerve

tilt head towards affected side and rotation of chin to unaffected

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6
Q

describe congenital torticollis and the cause

A

present at birth; bones are normal but gradually develops

causes:
- unknown
- abnormal head pos in utero
- prenatal injury
- fibroma of prenatal origin of muscle
- rupture of SCM during delivery; hematoma or scar formation

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7
Q

SSx of congenital torticollis

A

non tender, cylindrical enlargement of SCM 2 wks after birth > spontaneous regression 3-6 mo.

more common in girls
noted when child sits

flatenning and shortening on tilted side
facial asymmetry starts @ 3 mo.

raised shoulder on affected side
rot and lat flexion are LOM; normal flex/ext
cervico dorsal scolio
eyestrain from ocular imbalance

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8
Q

treatment of congenital torticollis

A

non-surgical
- passive stretching to overcorrected pos
- pos head at sleep
- active stretch of SCM

surgical
- mod to severe
- open resection of 1cm; lengthen SCM

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9
Q

describe acquire torticollis

A

w pain and stifness

causes
- acute trauma and inflammation: atlantoaxial rotatory sublaxation, inflamed SCM, lymphadenitis
- chronic infection: osteomyelitis, tumor
- arthritic: RA, osteoA, ankylosing spondylitis
- scarring
- paralytic
- hysterical > inability to control neck muscles
- spasmodic - CNS lesion > involuntary rhytmic contract of neck muscles

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10
Q

treatment of acquired torticollis

A

treat primary cause
PT
traction; braces
cervical orhosis

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11
Q

what is spontaneous atlantoaxial subluxation

A

anterior displacement of atlas on axis of gradual onset

laxity of transverse part of cruciate ligaments
- local inflammation from throat or RA
- small odontoid; developmenta failures
- congenital hypoplasia

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12
Q

risk factors and SSx of SAS

A

risk factors
- down’s syndrome
- morquio’s syndrome
- bone dysplasia
- osteogenesis inferfecta

SSx:
- neck stiffnes or pain in UE w/ or w/o troticollis
- hyperactive reflexes > cord compression

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13
Q

treatment of SAS

A

non-surgical:
- recumbent pos usually reduces displacement
- cast/brace for 6 wks

surgical
- atlantoaxial arthrodesis - esp if cord compression

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14
Q

describe degenerative disk disease

A

traumatic lesions of disc
- inflamed joint
- bone spurs
- thinned disc

most common symptom is pain

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15
Q

what is the pathology of DDD

A

spurring of cervical spine; common C4-C5 and C5-C6; has greatest motion

disc protrusion or sublaxation > most common C6-C7

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16
Q

SSx of DDD

A

pain on neck radiate to arm; inc w coughing or sneezing
paresthesis of dermatome affected
occipital headache and bluring of visio; vertigo
weakness of UE
LOM of neck, tenderness over cervical spine, nuerologic changes in UE

17
Q

DDD bet C5-C6

A

paresthesia of thumb, index and radial forearm
weak biceps, brachioradialis and ECRL and ECRB
LOM elbow flex and wrist extend

18
Q

DDD bet C6-C7

A

paresthesia of middle finger
weak triceps, wrist flexors and finger flexors
LOM elbow ext and wrist/finger flex

19
Q

DDD bet C4-C5

A

paresthesis of lat deltoid and biceps
weak deltoid and biceps
LOM abd and elbow flex

20
Q

diagnosis and DD of DDD

A

diagnosis
- cervical xray > spurs
- MRI

DD
- spinal cord tumor
- myelopathy from cervical spondylosis
- infection
- TOS

21
Q

management of DDD

A

nonop
- PT: heat, traction, bed rest
- cervical collar
- postular exercises

surgical
- formainotomy
- laminectomy
- disk excision
- arthrodesis

22
Q

what is thoracic outlet syndrome

A

group of disorders assoc w pressure of nerves and vessels in thoracic outlet
- cervical rib
- scaleneus syndrome
- costoclavicular syndrome

23
Q

what is the interscalene triangle

A

proximal space

borders:
- ant: anterior scalene
- post: middle scalene
- inf: 1st rib

contents
- brachial plexus trunks
- subclavian artery

24
Q

what is the costoclavicular space

A

middle space

borders:
ant - clavicle and subclavius
post - 1st rib and scalenes
medial - costoclavicular ligament
lat - upper scapular border

contents
- brachial plexus div
- subclavian artery and vein

25
retropectoralis minor space
distal space; subcoracoid borders sup - coracoid ant - pec minor post - ribs 2-4 contents - brachial plexus cords - axillary artery and vein
26
what are the causes of TOS
cervical ribs - congenital; extra rib on C7 or C6 - close approximation > impingement - increase pulsation in neck > subclav artery scalenus syndrome - spasm causes compression of nerves and artery against first rib
27
SSx of TSO
appears around 30 yo. more common in women feel of fulness in neck firm rounded immovable tender mass 2-3 cm above middle of clavicle + pulsation from subclav artery clawhand paresthesisa palor, cold, cyanosis + adsons > dec radial pulse
28
treatment of TSO
non surgical - rest - injection of procaine to scalenius - sling/brace > relieve strain on shoulder - strengthen traps and levator scap surgical - myotomy of scalene ant - remove portion of first rib/clavicle
29
what is costoclavicular syndrome
compression in betw clavicle and rib 1 cause - postural gradual sagging of shoulder girdle; middle life - holding shoulder at attention - tumors - callus formation from fracture of clavicle
30
diagnosis and treatment of costoclavicular syndrome
diagnosis - no radial pulse when abd - bruit is heard at infraclavicular area - angiography treatment - strengthen traps and levator scap - resection of rib 1 or clavicle
31
what are the tests for TOS
adson's - extends neck and turn head to side - no pulse on arm where turned = + allen's - 90/90/90 shouler abd, ER and elbow flex; turn head away from examined UE; check pulse costoclavicular test - exaggerated attention; check pulse
32
what is acute cervical syndrome
whiplash assoc w MVA > injury to muscles of neck DD for SCS > if no neurologic = ACS
33
SSx for ACS
neck pain occipital headache LOM of neck all planes pain on ligaments absent neurologic deficits
34
treatment for ACS
nonop - rest - cervical brace - muscle relaxant and pain reliever - PT surgica; - once stable and if symptomatic
35
what is klippel feil syndrome
congenital syntosis of cervical spine fusion of all or just lower cervical vertebrae laminal arches not developed SSx - short neck - low posterior hairline - flex/ext better than lateral flex - head held in oblique pos treatment - none - plastic surgery just to release webbing of neck; still short