Neck 2

Question 1

Circle of Willis

x2 subclavian arteries….
x2 vertebral arteries…
x1 basilar artery (at base of medulla oblongata, the main supply to brain stem

Due to the structure of the atlas (C1) the vertebral artery is susceptible to rotational injury as it goes outward to go through the transverse foramina & then kinks back up to enter the skull

Answer 1

Circle of Willis continued…..

Aortic arch…….
brachiocephalic trunk…..
common carotid……& subclavian…….
internal carotid (supplies the brain)

Question 2

List 4 of the cardinal signs & symptoms of upper cervical instability

Answer 2

1 - Drop attacks - overt loss of balance in relation to head movements
2 - Facial lip paraesthesia - reproduced by active or passive neck movements
3 - bilateral or quadrilateral limb paraesthesia - constant or reproduced by head movement
4 - Nystygmus - produced by active or passive neck movements, nausea may also be present

Question 3

List tests of active & passive assessment for cervical ligament injury

Answer 3

Atlanto-occipital joint isolation - nod
(tests alar lig. - dens of axis to occiput)
C1-C2 rotation with the neck flexed (atlanto-axial ligs)
C2-C3 rotation with protraction & retraction
Upper cervical extension, & rotation & lateral flexion to the same side (C0-C3)

(LOOKING FOR EMPTY END FEEL/INCREASE IN ROM
REPRODUCTION OF SYMPTOMS OF INSTABILITY, PRODUCTION OF LATERAL NYSTYGMUS & NAUSEA)

Question 4

List 5 main ligaments of the neck

Answer 4

Anterior longitudinal lig
(base of skull to sacrum)
Posterior longitudinal lig
(from base of skull to sacrum)
Supraspinous lig - tip of Sp to next
Interspinous lig - attaches to lig. flavum that runs deep into spinal column
Ligamentum flavum (strongest lig) - base of skull to pelvis, in front of & between the lamina, protects spinal cord & nerves, runs in front of facet joint capsules

Question 5

Symptoms of Vertebral Basilar insufficiency

5 Ds and ANTOF

Answer 5

Dizziness
Drop Attacks
Diploplia
Dysarthria
Dysphagia
Ataxia of gait
Nausea with possible vomiting
Tinnitus
Occipital HAs
Facial Paraesthesia

Question 6

Name 2 intrinsic factors that expose the VBI to injury

Answer 6

atheroma (an accumulation of degenerative material in the inner layer of artery walls.
thrombosis

Question 7

Name 4 extrinsic factors that expose the VBI to injury

Answer 7

osteophytes
vertebral artery passing through longus colli or ant. scalene
anatomic anomaly - presence of a bony ring instead of OA membrane as the VA passes over arch of C1
vertebral artery passing beneath bands of fascia causing constriction on rotation

Question 8

Whiplash - What happens?

Answer 8

lower C segments are forced to extend beyond normal ROM & rotate about an abnormally high axis - causes anterior surfaces to separate & lower facet joints to collide

neck is compressed from rising torso

single most common source of neck injury from whiplash is lower zygapophyseal joint

Question 9

Internal Carotid Artery disease

Answer 9

Early presentation - mid-upper cervical pain, pain around ear, head pain
ptosis
lower cranial nerve dysfunction (8-12)
acute onset of pain described as “unlike any other”

Late presentation - transient retinal dysfunction
Transient ischemic attack

Question 10

Vertebrobasilar artery disease

Answer 10

Early presentation - mid-upper cervical pain
occipital pain
acute onset of pain described as “unlike any other”

Late presentation - hindbrain transient ischemic attack
5 D’s & ANTOF, limb weakness, memory probs, cranial nerve dysfunction; Hindbrain stroke -eg.Wallenberg’s syndrome, locked in syndrome

Question 11

Upper Cervical Instability

Answer 11

Early presentation - neck & head pain
feeling of instability
hyperactive cervical muscles
constant support needed for head
worsening symptoms

Late presentation - bilateral foot & hand dysthaesia
feeling of lump in throat
metallic taste in mouth (cranial nerve 8)
arm & leg weakness
lack of co-ordination bilaterally