MS1: Affectations of Cervical Spine Flashcards
what are the superficial muscles of the neck
traps
SCM
levator scapulae
rhomboids
ant, middle and post scalene
what are the deeper muscles of the neck
splenius capitis
semispinalis capitis
longissimus capitis
what are the deepest muscles of the neck
splenius cervicis
semispinalis cervicis
longissimus cervicis
what are the upper cervical ligaments
apical > alar > transverse > cruciate > membrane tectoria
describe torticollis
SCM affected, CN 11 or spinal accessory nerve
tilt head towards affected side and rotation of chin to unaffected
describe congenital torticollis and the cause
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
SSx of congenital torticollis
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
treatment of congenital torticollis
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
describe acquire torticollis
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
treatment of acquired torticollis
treat primary cause
PT
traction; braces
cervical orhosis
what is spontaneous atlantoaxial subluxation
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
risk factors and SSx of SAS
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
treatment of SAS
non-surgical:
- recumbent pos usually reduces displacement
- cast/brace for 6 wks
surgical
- atlantoaxial arthrodesis - esp if cord compression
describe degenerative disk disease
traumatic lesions of disc
- inflamed joint
- bone spurs
- thinned disc
most common symptom is pain
what is the pathology of DDD
spurring of cervical spine; common C4-C5 and C5-C6; has greatest motion
disc protrusion or sublaxation > most common C6-C7
SSx of DDD
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
DDD bet C5-C6
paresthesia of thumb, index and radial forearm
weak biceps, brachioradialis and ECRL and ECRB
LOM elbow flex and wrist extend
DDD bet C6-C7
paresthesia of middle finger
weak triceps, wrist flexors and finger flexors
LOM elbow ext and wrist/finger flex
DDD bet C4-C5
paresthesis of lat deltoid and biceps
weak deltoid and biceps
LOM abd and elbow flex
diagnosis and DD of DDD
diagnosis
- cervical xray > spurs
- MRI
DD
- spinal cord tumor
- myelopathy from cervical spondylosis
- infection
- TOS
management of DDD
nonop
- PT: heat, traction, bed rest
- cervical collar
- postular exercises
surgical
- formainotomy
- laminectomy
- disk excision
- arthrodesis
what is thoracic outlet syndrome
group of disorders assoc w pressure of nerves and vessels in thoracic outlet
- cervical rib
- scaleneus syndrome
- costoclavicular syndrome
what is the interscalene triangle
proximal space
borders:
- ant: anterior scalene
- post: middle scalene
- inf: 1st rib
contents
- brachial plexus trunks
- subclavian artery
what is the costoclavicular space
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
retropectoralis minor space
distal space; subcoracoid
borders
sup - coracoid
ant - pec minor
post - ribs 2-4
contents
- brachial plexus cords
- axillary artery and vein
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
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
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
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
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
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
what is acute cervical syndrome
whiplash assoc w MVA > injury to muscles of neck
DD for SCS > if no neurologic = ACS
SSx for ACS
neck pain
occipital headache
LOM of neck all planes
pain on ligaments
absent neurologic deficits
treatment for ACS
nonop
- rest
- cervical brace
- muscle relaxant and pain reliever
- PT
surgica;
- once stable and if symptomatic
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
