The Cervical Spine Flashcards
Patients with neck pain make up what percentage of all patients seen in outpatient practice?
25%
During which decade of life is neck pain most prevalent?
50s
Which biological sex experiences neck pain more frequently?
women
What structure travels through the cervical transverse foraminae?
vertebral artery
Describe the vascular course of the vertebral artery
aortic arch -> subclavian -> vertebral -> basilar artery
How does the structure of C1 differ from other cervical vertebrae?
no vertebral body & no spinous process
What are the attachments of the alar ligaments?
dens -> occipital condyles of the cranium
What are the attachments of the transverse ligament?
horizontally at C1 (covers the dens)
What are the relevant ligaments of the upper cervical spine?
alar ligaments & cruciform ligament (transverse ligament & longitudinal bands)
What are the functions of the alar and cruciform ligaments?
they keep the dens in close approximation to the C1 articulation & away from the spinal canal during motion
What are the attachments of the longitudinal bands of the upper cervical cruciform ligament?
medially from transverse ligament -> superiorly to occiput -> inferiorly to C2
What are the relevant joints of the lower cervical spine?
facet (zygapophyseal) joints, articulation of vertebral bodies, uncovertebral joints
What is the ligamentum nuchae (nuchal ligament)?
broad expansive ligament that extends from the spinous process of C7 to the external occipital protuberance
What are 2 functions of the ligamentum nuchae?
increases the depth of the cervical spinous processes, allowing for muscular attachment & helps limit cervical flexion
List 4 relevant muscles of the posterior upper cervical spine.
- rectus capitis posterior major
- rectus capitis posterior minor
- obliquus capitis inferior
- obliquus capitis superior
Age < 50 years old, pain less than 12 weeks, symptoms isolated to the neck, and restricted cervical ROM are common to which Neck Pain Category?
Neck Pain with Mobility Deficits
What is the most common onset of symptoms for Neck Pain with Mobility Deficits?
recent unguarded/awkward movement or position & there can be associated (referred) upper extremity pain
List 3 competing serious diagnoses that should be ruled out before classifying a patient with Neck Pain with Mobility deficits?
- cervical fracture
- upper cervical instability / hypermobility
- vertebrobasilar/arterial insufficiency
What are 3 items to ask about during the subjective to screen for upper cervical instability or fracture?
- fall from height?
- MVA?
- Long-term exposure to corticosteroids? (RA, lupus, pulmonary conditions)
List 3 reasons that patients may have long-term exposure to corticosteroids
systemic problems:
- rheumatoid arthritis
- systemic lupus erythematosus
- pulmonary conditions
What are 3 clinical tests to assess for upper cervical ligamentous insufficiency?
- Sharp-Pursor test
- Alar ligament integrity test
- Central P-A segmental mobility
Which ligament is tested during the Sharp-Pursor test?
transverse portion of cruciform ligament of C1-2
List the 4 categories of neck pain as described by the International Classification of Functioning, Disability, and Health.
- Neck Pain with Mobility Deficits
- Neck Pain with Headaches
- Neck Pain with Movement Coordination Impairments
- Neck Pain with Radiating Pain
Which ICF Classification for neck pain is described below:
- age < 50
- acute pain
- restricted cervical ROM
- pain isolated to neck
Neck Pain with Mobility Deficits
Which ICF Classification for neck pain is described below:
- unilateral
- neck/suboccipital pain
- ipsilateral provocation of head/suboccipital symptoms during manual assessment
- restricted ROM
- restricted segmental mobility
- Cranial Nerve Flexion test (+)
Neck Pain with Headaches
Which ICF Classification for neck pain is described below:
- longstanding pain (over 3 months)
- Cranial Nerve Flexion test (+)
- Deep Neck Flexor test (+)
- weakness of neck and upper quarter muscles
- ergonomic inefficiencies with repetitive activities
Neck Pain with Movement Coordination Impairments
Which ICF Classification for neck pain is described below:
- Spurling’s (+)
- ULTT (+)
- Manual Traction (+)
- cervical rotation less than 60° toward involved side
- success with reducing upper extremity symptoms with initial interventions
Neck Pain with Radiating Pain
The following are the most effective treatments for which ICF neck pain category:
- cervical mobilization / manipulation
- thoracic mobilization/manipulation
- stretching exercise
- coordination, strengthening, & endurance exercise
Neck Pain with Mobility Deficits
The following are the most effective treatments for which ICF neck pain category:
- upper and/or lower cervical spine mobilization/manipulation
- stretching exercise
- coordination, strengthening, & endurance exercises
Neck Pain with Headache
The following are the most effective treatments for which ICF neck pain category:
- coordination, strengthening, & endurance exercise
- patient education & counseling
- stretching exercise
Neck Pain with Movement Coordination Impairments
The following are the most effective treatments for which ICF neck pain category:
- upper quarter & nerve mobilization procedures
- cervical traction
- thoracic mobilization/manipulation
Neck Pain with Radiating Pain
List 4 of the most effective treatments for neck pain with mobility deficits.
- cervical mobilization/manipulation
- thoracic mobilization/manipulation
- stretching exercises
- coordination, strengthening, & endurance exercise
List 3 of the most effective treatments for neck pain with headaches.
- upper and/or lower cervical mobilization/manipulation
- stretching exercises
- coordination, strengthening, & endurance exercises
List 3 of the most effective treatments for neck pain with movement coordination impairments.
- coordination, strengthening, & endurance exercises
- patient education & counseling
- stretching exercise
List 3 of the most effective treatments for neck pain with radiating pain.
- upper quarter and nerve mobilization procedures
- cervical traction
- thoracic mobilization/manipulation
The C5 nerve root involvement can result in weakness of which muscle(s)?
Deltoid (test at 90° abduction)
The C6 nerve root involvement can result in weakness of which muscle(s)?
Biceps brachii & Extensor Carpi Radialis Longus/Brevis (test with wrist in extension and radial deviation)
The C7 nerve root involvement can result in weakness of which muscle(s)?
Triceps (test with arm overhead, elbow in slight flexion) & Flexor Carpi Radialis (test in wrist flexion and radial deviation)
The C8 nerve root involvement can result in weakness of which muscle(s)?
Abductor Pollicis Brevis
The T1 nerve root involvement can result in weakness of which muscle(s)?
First Dorsal Interossei (test by resisting finger abduction)
Which dermatomal area is associated with the C5 nerve root?
Lateral forearm
Which dermatomal area is associated with the C6 nerve root?
Distal thumb
Which dermatomal area is associated with the C7 nerve root?
Distal middle finger
Which dermatomal area is associated with the C8 nerve root?
Distal fifth finger
Which dermatomal area is associated with the T1 nerve root?
Medial forearm
Which reflex tests the C5 nerve root?
biceps brachii
Which reflex tests the C6 nerve root?
brachioradialis
Which reflex tests the C7 nerve root?
triceps
The biceps reflex tests which nerve root?
C5
The brachioradialis reflex tests which nerve root?
C6
The triceps reflex tests which nerve root?
C7
Which dermatomal area is supplied by the same nerve root associated with the biceps reflex?
lateral forearm (nerve root C5)
Which dermatomal area is supplied by the same nerve root associated with the brachioradialis reflex?
distal thumb (C6)
Which dermatomal area is supplied by the same nerve root associated with the triceps reflex?
distal middle finger (C7)
Which dermatomal area is supplied by the same nerve root associated with the abductor pollicis brevis?
distal fifth finger (C8)
Which dermatomal area is supplied by the same nerve root associated with the first dorsal interossei?
medial forearm (T1)
Name the reflex that is most closely associated with lateral forearm sensation
biceps brachii reflex (C5)
Name the reflex that shares a nerve root with distal thumb sensation
brachioradialis reflex (C6)
Name the reflex that “shares” a nerve root with distal middle finger sensation
triceps reflex (C7)
Injury or sensitivity of which nerve root is most closely associated with:
- deltoid weakness
- lateral forearm sensation change
- altered biceps reflex
C5 nerve root
Injury or sensitivity of which nerve root is most closely associated with:
- biceps / ECRL weakness
- distal thumb sensation change
- altered brachioradialis reflex
C6 nerve root
Injury or sensitivity of which nerve root is most closely associated with:
- triceps / FCR weakness
- distal middle finger sensation change
- altered triceps reflex
C7 nerve root
Injury or sensitivity of which nerve root is most closely associated with:
- thumb abduction (APB) weakness
- distal fifth finger sensation change
- reflexes intact
C8 nerve root
Injury or sensitivity of which nerve root is most closely associated with:
- finger abduction (1st DI) weakness
- medial forearm sensation change
- reflexes intact
T1 nerve root
Compare and contrast the nerve supply and reflex testing of the biceps brachii vs brachioradialis muscles.
Both are supplied by the C5 & C6 nerve roots. C5 is tested with the biceps reflex, while C6 is tested with biceps strength & the brachioradialis reflex
List 4 of the most common exam findings for Neck Pain with Mobility Deficits
- younger person (< 50)
- acute neck pain
- symptoms isolated to neck
- restricted cervical ROM
List 6 of the most common eval/exam findings for Neck Pain with Headaches.
- U/L headache associated with neck/suboccipital sx
- headaches are aggravated with neck movements / positions
- headaches produced/aggravated with provocation of ipsilateral cervical structures (myofascia/joints)
- restricted cervical ROM
- restricted cervical segmental mobility
- (+) Cranial Cervical Flexion test
List 6 of the most common eval/exam findings for Neck Pain with Movement Coordination Impairments.
- longstanding neck pain (3 months +)
- (+) Cranial Cervical Flexion test
- (+) Deep Neck Flexor test
- coordination, strength, & endurance deficits of neck and upper quarter muscles
- Flexibility deficits of upper quarter muscles
- ergonomic inefficiencies with performing repetitive activities