Neck and Spine Lecture Flashcards
3 types of joints
- Fibrous (immovable)
- Cartilaginous (minimal movement)
- Synovial (freely moveable)
Describe cartilaginous joints
- Minimal movement
- Cartilage b/w bony surfaces
- AC joint, symphysis pubis, vertebral bodies
Describe fibrous joints
- Immovable
- Skull sutures
Describe synovial joints
- Freely moveable
- Articular cartilage, synovial fluid/joint capsule, ligament
- Ball and socket (hip, shoulder)
- Hinge (fingers, elbow)
- Condylar (knee, TMJ)
TMJ - type of joint and description
- Synovial joint
- Busiest joint of the body (talking and chewing)
What is the busiest joint of the body?
TMJ (talking and chewing)
What is the TMJ formed by
- Fossa/articular tubercle of temporal bone
- Condyle of mandible
Inspection of TMJ:
- Redness, swelling, deformity
- Swelling may be just anterior to external auditory meatus
- Check for symmetry bilat
Palpation of TMJ:
- Fingers anterior to tragus
- Pt opens mouth
- Should have smooth ROM
- Snap or click w/o pain is ok
- Note swelling/tenderness
Primary supporting structure of the trunk?
Spine
Vertebral column consists of:
- 24 vertebrae (7 C, 12 T, 5 L)
- 1 fused sacrum and coccyx (vestigial tail)
- Offset by intervertebral discs
What are the spinal nerves protected by?
Intervertebral foramen
What is the spinal cord protected by?
Posterior vertebral arch
Where are the spinal joints slightly moveable?
Between the vertebral bodies and articular facets
Define intrinsic muscles
Originates in the limb or part in which it inserts
Define extrinsic muscles
Does NOT originate within the part or limb in which it inserts
Intrinsic muscles of the back
- Extend from cranium to pelvis
- Maintain posture and move vertebral column
- Divided into superficial, intermediate, deep
Extrinsic muscles of the back
- Connect upper extremities to the trunk
- V shaped muscles of upper and mid back
- Lat dorsi, trap, rhomboids, levator scapulae
Muscles involved in C-spine motion (flex, ext, rotation, lat bending)
- Flex: SCM, scalene, pre-vertebrals
- Extension: trap, splenius, small intrinsics
- Rotation: SCM, small intrinsics
- Lat bending: scalene, small intrinsics
SCM, scalene, pre-vertebrals control what C-spine movement?
Flexion
Trap, splenius, small intrinsics control what C-spine movement?
Extension
SCM and small intrinsics control what C-spine movement?
Rotation
Scalene and small intrinsics controls what C-spine movement?
Lateral bending
Inspection of spine from the side:
- Cervical lordosis
- Thoracic kyphosis
- Lumbar lordosis
What is a gibbous?
Exaggeration of the thoracic kyphosis (hunchback)
What is a Dowager’s hump? What causes it?
- Exaggeration of the thoracic kyphosis in post-menopausal women
- Caused by osteoporotic wedge fractures
Inspection of spine from behind:
- Alignment of shoulders and iliac crests
- Gluteal folds
- Look for scoliosis
Scoliosis of the C-spine is a form of:
Torticollis (or can arise form abnormal muscle spasm)
What will scoliosis of the C-spine cause?
Uneven shoulder height
Uneven shoulder height could be a sign of:
C-spine scoliosis
Palpation of the spine:
- Spinous processes (C7 most prominent, note any tenderness)
- SI joint
- Paravertebral muscles
- Sciatic notch
Tenderness at C1-C2 in patients with RA can indicate?
Impending high cervical subluxation
How to palpate sciatic nerve?
-In sciatic notch
-Pt lies on opposite side, hip flexed
-Just lateral to ischial tuberosity
(or standing w/hip and knee flexed)
Percussion of the spine:
Gentle thumping w/ulnar aspect of fist
Most motion in the spine is in the:
C-spine
ROM testing for C-spine:
- Flexion (chin to chest)
- Extension (look up)
- Rotation (look over shoulder)
- Lat bending (tilt head toward shoulder)
T and L spine ROM
- Flexion (pt bend over)
- Extension (place hand on small back and ask them to bend backwards)
- Rotation
- Lat bending
Patient w/cervical radiculopathy may have:
Neuro deficits in UE
Patient w/cervical myelopathy may have:
Neuro deficits in UE OR LE
Special tests for C-spine:
Distraction, compression, Valsalva, swallowing, Adson’s/Wright’s
What is distraction test and how to do it?
- Special test of C spine
- Place open palm of dominant hand under pts chin, other hand over occiput, gently lift head to distract spine
- Is pain relieved?
Mechanism of distraction test
C spine can sometimes relieve pain due to narrowing of neural foramen or by decreasing pressure on capsules around facet joint
What is the compression test?
- Special test of C spine
- Opposite of distraction test
- May provoke symptoms of cervical or radicular pain
- Press down on pts head and see if this provokes pain
What is the Valsalva test?
- Special test of C spine
- Hold breath and bear down, pain anywhere?
- Intra-abdominal pressure increases thereby increasing intrathecal pressure (CNS)
- Pain my be provoked in a dermatome
What is the swallowing test?
- Special test of C spine
- Pts w/anterior cervical disk herniation or bony osteophytes can have difficulty swallowing if disk/osteophyte is pressing against esophagus
When is Adson’s test performed?
Only in patients with positional shoulder pain
Adson’s vs. Wright’s test
- Adson’s turn head to same side
- Wright’s turn head to opposite side
Inspection of lumbar spine:
- Redness, cafe-au-lait spots, lipomas
- Evaluate posture, check for scoliosis
Lipomas in lumbar spine area may be a sign of:
Spina bifida
Palpation of lumbar spine
- Sit on stool behind pt
- Fingers over iliac crests, thumbs rest over L4-L5
- Palpate spinous processes moving up then back down
Lumbar spine special tests:
- SLR
- Crossed SLR
- Hoover test
What is the straight leg raise test designed to do?
Stretch sciatic nerve and reproduce back or leg pain
With HNP, pain during the SLR test occurs at what angle?
30-70 degrees
During SLR, sciatic nerve is stretched between what angles?
30-70 degrees
SLR technique
- Lift leg supporting heel and knee
- Note angle at which pt feels pain and location (back vs leg)
- Lower leg until pain resolves then dorsiflex foot
- If NO pain, then prob hamstring tightness
What is the crossed SLR test?
SLR on the uninvolved side
What is the Hoover test?
- To determine malingering
- Cup hands under each heel
- Tell pt to lift good leg first (try to feel downward pressure of “bad” leg)
- If they are actually weak, you should NOT feel this
