Neck and C spine Flashcards by Sarah Gillen

Cervical nerve root exits ______ the numbered vertebra

Above

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What are the atypical cervical vertebrae

C1 = atlas — lacks a vertebral body and rotates around the dens of C2

C2 = axis — body extends superiorly to form dens

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Is the C2-C3 articulation considered typical?

Yes

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From C2-C7, the upper cervical facets align in a plane pointing toward the _____

The lower cervical facets point to the opposite _______

Eye; ASIS

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For C3-C7, the lateral aspects of the bodies have superior projections (uncinated processes) articulating with superadjacent vertebrae, what is the function of this articulation?

Helps support lateral sides of cervical intervertebral discs and protect from herniation

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_______ joint = synovial joint between articular processes

Facet (zygopophyseal)

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______ joint = vertebral bodies separated by fibrocartilaginous disc

Intervertebral

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The 2 primary motions at the OA joint are ______ and ______, with minor motions being ____ and ______

The Occiput rotates and sidebends to the _______ sides

Flexion; extension; SB; rotation

Opposite

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Primary motion at AA joint

Rotation

[atlas rotates around dens of C2]

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How does sidebending relate to rotation in typical cervical vertebrae from C2-C7?

R and SB typically occur in same direction (type II mechanics)

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What are some things to look for in your observation of the neck?

Trauma, scars, masses, goiter

Carrying angle

Increased or decreased lordosis

Distended external jugular vein (elevate head of bed 30 deg)

Tracheal deviation

Masses in the neck, mediastinal mass, atelectasis, large pneumothorax

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What landmarks are associated with the neck and C spine exam?

Occiput
Mandible
Clavicle
Manubrium
SCM m.
Trapezius m.
Hyoid bone
Thyroid cartilage
Cricoid cartilage
Trachea
Spinous processes
Vertebral prominens (C7)
Interspinous ligament
Transverse processes
Facets
Articular pillars
Anterior and posterior triangles

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What are the 3 borders of the anterior triangle?

Mandible
SCM
Midline

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What are the 3 borders of the posterior triangle?

SCM
Trapezius
Clavicle

[omohyoid crosses lower portion]

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What lymph nodes are associated with a typical neck exam?

Superficial and posterior cervical chain
Occipital
Pre/post auricular
Submandibular
Submental
Tonsillar
Supraclavicular

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LNs are normally small, round or ovoid, and smooth. On exam you should note their size, shape, mobility, consistency, and tenderness. Increased size = lymphadenopathy. Generalized LAD is seen in what conditions?

HIV/AIDS
Infectious mono
Lymphoma
Leukemia
Sarcoidosis

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______ = infectious cervical lymphadenitis

Scrofula

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The ____ of the stethoscope can be used over the carotid arteries to assess for thrills and bruits

Bell

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Assessing the ___________ assesses for the right atrial pressure as the right internal jugular vein is in direct line with the SVC

Jugular venous pressure

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How do you assess jugular venous pressure?

Place pillow under pt head to relax SCM

Raise head of exam table to 30 deg and turn head slightly away of side you’re examining

ID the IJV using tangential lighting and table adjustments to identify the oscillation point/meniscus of IJV pulsations

ID the highest point of pulsation; extend an object horizontally from the apex. Place ruler vertical from sternal angle to create a right angle with the horizontal object

Distance in cm above sternal angle (right atrium) is JVP

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What is a normal JVP?

Less than 3-4 cm above the sternal angle

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Low JVPs are best seen in near ______ position — this would be a _______ patient

Supine; hypovolemic

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High JVPs are best seen in ______ position — this would be a _______ patient

Upright seated; hypervolemic

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The trachea should be midline in the neck. Use spaces between _____ and _____ as landmarks.

Thyroid; SCMs

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Lateral displacement of the trache can occur in what condition?

Tension pneumothorax

The ______ of the thyroid overlies the 2nd-4th tracheal rings. Have the patient _____ the neck slightly to relax SCMs

Isthmus; flex

While examining the thyroid, once the neck is flexed, you place fingers of both hands on pt’s neck so that index fingers lie just below the ______cartilage. Have the pt swallow so that the thyroid rises up under finger pads. Observe for ____ and _____

Cricoid; contour; symmetry

While exampining the thyroid, displace the ______ to the right and left to palpate each individual lobe. The anterior surface of a lateral lobe is approximately the size of the distal phalanx of the ______ and feels somewhat _____

Trachea; thumb; rubbery

If the thyroid is noted to be enlarged on palpation, what is your next step in the exam?

Listen over lateral lobes to detect bruit - which may be heard in hyperthyroidism

A simple, non-nondular, or possibly multinodular thyroid enlargement may indicate what condition?

Goiter

A soft non-rubbery thyroid would indicate what condition?

Grave’s disease

A firm, non-rubbery thyroid may indicate what condition?

Hashimoto’s thyroiditis or mlaignancy

A tender thyroid may indicate what condition?

Thyroiditis

Muscles involved in C-spine flexion

SCM Scalenes Paravertebral muscles

Normal ROM of neck flexion

45-90

Muscles involved in C-spine extension

Splenius capitus Splenius cervicis Intrinsic spinal mm

Normal ROM of neck extension

70-90

Muscles involved in C-spine rotation

SCM | Intrinsic spinal mm

Normal ROM of neck rotation

70-90

Muscles involved in C-spine sidebending

Scalenes | Intrinsic spinal mm

Normal ROM for neck sidebending

20-45

______ ______ = nerve entrapment by musculoskeletal or myofascial tissue that produces paresthesias in the area of the distribution of the nerve and creates sensory dysfunction/pain and may also decrease muscle strength

Central neuropathy

What are 2 common sites for central neuropathy to occur

Intervertebral foramen Thoracic outlet

Describe test — positive finding? — what does it indicate? Compression test

With head an neck in neutral position, add axial loading force caudally looking for upper extremity pain, paresthesias, or numbness + test = reproduction of symptoms (pain/paresthesia in distribution of nerve root) Indicates central neuropathy

Describe test — positive finding? — what does it indicate? Spurling’s

Tests nerve root compression/irritation. Tested with an axial force in neutral, then extension, then SB/rotation toward. Test of high specificity + test = reproduction of symptoms (pain/paresthesia in distribution of nerve root) Indicates central neuropathy

Describe test — positive finding? — what does it indicate? Neck distraction test

Doc places one hand under pt chin and places the other hand around the occiput, slowly distracting the head + test = alleviation of symptoms Indicates = central neuropathy

Describe test — positive finding? — what does it indicate? Valsalva test

Pt holds breath and bears down, which increase intrathecal pressure + test = increased symptoms (pain/paresthesia in distribution of nerve root) Indicates = space occupying lesion in cervical canal

What are the boundaries of the thoracic outlet

1st ribs 1st thoracic vertebra Manubrium

The thoracic outlet is best thought of as what 3 zones?

Scalene triangle Costoclavicular space Retropectoralis minor

What structures pass through the thoracic outlet?

Brachial plexus Subclavian v Subclavian a Thoracic duct (L)

What is the difference between the thoracic duct and the right lymphatic duct?

Thoracic duct drains majority of body Right lymphatic duct drains body’s right upper quadrant

Describe test — positive finding? — what does it indicate? Roos or EAST test

Abduct shoulder to 90 and externally rotate with elbow flexed to 90. Physician instructs patient to open and close fist for up to 3 mins + test = reproduction of symptoms (pain/paresthesias) Indicates = thoracic outlet syndrome, specifically compression of subclavian a

Describe test — positive finding? — what does it indicate? Adson test

Locate radial pulse on affected arm. Physician abducts, extends, and externally rotates the shoulder while palpating the radial pulse. First, pt’s head is extended and rotated toward affected side; then, pt’s head is rotated away from affected side + test = loss or changes in pulse; reproduction of symptoms (pain/paresthesias) Indicates = thoracic outlet syndrome, specifically compression of subclavian a. between scalenes (when looking away from affected side) or 1st cervical rib (when looking toward affected side)

Describe test — positive finding? — what does it indicate? Wright’s hyperabduction test

Physician locates and monitors the radial pulse on the affected side. Abduct the patient’s arm above his/her head with some extension + test = loss or change in pulse; reproduction or symptoms (pain/paresthesias) Indicates = thoracic outlet syndrome, specifically neurovascular entrapment by pectoralis minor m

Describe test — positive finding? — what does it indicate? Costoclavicular test (aka military/halstead)

Physician locates and monitors the radial pulse on affected side. With the elbow extended and supinated, extend the shoulder and apply caudal pressure on the shoulder + test = loss or change in pulse; reproduction of symptoms (pain/paresthesia) Indicates = thoracic outlet syndrome, specifically neurovascular entrapment between 1st rib and clavicle

What 4 special tests are used to detect central neuropathy?

Compression test Spurling’s maneuver Neck distraction Valsalva test

What are the 4 special tests used to detect and differentiate thoracic outlet syndrome?

Roos (EAST) test Adson test Wright’s hyperabduction test Costoclavicular test (military/halstead)

What are the 3 exam findings/special tests are used to detect subarachnoid irritation?

Nuchal rigidity on exam Brudzinski’s sign Kernig sign

Describe test — positive finding? — what does it indicate? Nuchal rigidity

Patient supine. Place hands behind pt head, flex neck forward until chin touches chest + test = marked neck stiffness/resistance to flexion Indicates = inflammation in subarachnoid space (e.g., meningitis or subarachnoid hemorrhage)

What PE finding is present in 57-92% of cases of acute bacterial meningitis, and 21-86% of subarachnoid hemorrhage?

Nuchal rigidity

Describe test — positive finding? — what does it indicate? Brudzinski’s sign

Patient supine. Place hands behind patient’s head, flex neck forward until chin touches chest + test = flexion in both hips and knees Indicates = inflammation in subarachnoid space (e.g., meningitis or subarachnoid hemorrhage)

T/F: for both brudzinski’s sign and kernig sign, the sensitivity is low and specificity data is limited

True

Describe test — positive finding? — what does it indicate? Kernig sign

Place patient supine and flex hip and knee to 90. Attempt to passively extend the leg at the knee + test = increased resistance to extension and pain behind knee, +/- back pain radiating to posterior thigh (sources vary) Indicates = meningeal/dural irritation

Cervical spinal cord injuries can occur in any sport, but particularly in what 3 sports?

Football Hockey Lacrosse

What type of injury accounts for over half of c-spine injuries?

Axial load — force transmitted to bone and disc

Cervical spinal cord injuries may occur when the neck is flexed to _______ degrees, because the lordosis is lost and protective soft tissues are no longer protective

Fracture of C1 due to axial compression

Jefferson fracture

Fracture due to flexion and compression injury

Wedge fracture

C2 odontoid fractures typically occur at the junction of _____ and ______, often requiring surgery

Process; body

C2 bilateral arch fracture due to hyperextension injury

Hangman’s fracture

Spinous process fractures may occur with ________ or ________ force from muscle contraction

Hyperextension; avulsion

At what vertebral level(s) would you see a Clay Shoveler’s fracture?

C6 or C7

Flexion and compression injury may lead to anterior-inferior _____ fragment

Teardrop [this is a teardrop fracture]

Comminuted fracture that can result in severe spinal cord injury

Burst fracture

Flexion injury leading to facet dislocation without fracture

Anterior subluxation