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PTRS 845 > Upper C-spine > Flashcards

Upper C-spine Flashcards

1
Q

What are important anatomical structures of the C1?

A

Anterior and posterior arches connected by lateral mass
Posterior aspect of anterior arch contains articular cartilage fro odontoid process
Lateral mass: superior concave and inferior convex articular facets

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2
Q

What are anatomical structures of C2?

A

Articulation of dens with C1

Articulation of C2 with C1 via superior and inferior facets

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3
Q

Where does rotation in upper C spine come from?

A

50% of rotation comes from AA joint because of: slopeness of facets, absence of discs, and biconvexity of AA joint

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4
Q

What are the ligaments of atlas to occiput?

A

ALL turns into AAO membrane

Lig flavum turns into PAO membrane

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5
Q

What are ligaments of axis to occiput?

A

PLL turns into tectorial membrane

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6
Q

What are ligaments of atlas to axis (AA joint)?

A

transverse ligament: passes behind dens, stabilizing dens against atlas, controls ant-post movement of AA joint

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7
Q

What happens if transverse ligament is injured?

A

dens will go back into the cord, and will have reproduction of cord symptoms
3mm motion is okay, 8-10 mm before you feel cord compression

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8
Q

What are ligaments of axis to occiput?

A

Alar ligament: resists flexion, contralateral SB, and contralateral rotation; tested in neutral, CV flex, and CV ext

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9
Q

What are the posterior muscles of the neck?

A

Rectus capitis posterior major
Rectus capitis posterior minor
Superior oblique
Inferior oblique

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10
Q

What is O,I, A of rectus capitis posterior major?

A

C2 SP to lateral aspect of nuchal line; bilaterally extends head, unilateral ipsilateral SB and rot

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11
Q

What is O, I, A of rectus capitis posterior minor?

A

C1 to medial aspect of nuchal line; extends head

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12
Q

What is O, I, A of superior oblique?

A

C1 TP to lateral aspect of nuchal line; bilaterally extends head, unilateral ipsilateral SB and contralateral rot

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13
Q

What is O, I, A of inferior oblique?

A

C2 SP to C1 TP; ipsilateral rotation

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14
Q

What are anterior neck muscles?

A

rectus capitis anterior
rectus capitis lateralis
longus capitis
longus colli

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15
Q

What is O, I, A of rectus capitis anterior?

A

lateral mass of C1 to base of the occiput; head flexion

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16
Q

What is O, I, A of rectus capitis lateralis?

A

C1 TP to jugular process; ipsilateral SB of head

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17
Q

What is O, I, A of longus capitis and longus colli?

A 
Segmental attachment, helps with anterior sagittal rotation that goes with flexion
Important for postural control
Eccentric control when extending head
Injured during MVA
longus colli: T3-C1
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18
Q

What nerves innervate the upper cervical muscles?

A

Dorsal and ventral rami of C1-C3 supplies all structures: muscles, OA AA and C2-3 Z joint, all ligaments, and vertebral arteries

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19
Q

What are biomechanics of upper C spine flexion?

A

OA: convex occipital condyles glide post on concave atlas
AA: C1 moves inferiorly on C2; C2 glides forward on C3

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20
Q

What are biomechanics of upper C spine extension>?

A

OA: convex occipital condyles glide anteriorly on concave atlas
AA: atlas moves superiorly; C2 moves backwards on C3

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21
Q

What are biomechanics of upper C spine rotation?

A

OA: ipsilateral condyle glides posteriorly
AA: ipsilateral moves posteriorly; contralateral facet moves anteriorly; atlas translates to opposite side

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22
Q

What are biomechanics of upper C spine side bend?

A

OA: ipsilateral condyle glides anteriorly

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23
Q

What are osteokinematics of OA and AA joint?

A

OA: primary flex/ext motion
AA: primary rotation motion

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24
Q

What are the coupled movements of the upper C spine?

A

SB and rot occurs in opposite direction

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25
Q

What happens with coupled motions during upper cervical R rot?

A

R rot and L SB of OA joint; R rot and R SB of joints of lower cervical spine

26
Q

What happens with coupled motions during upper cervical R SB?

A

R SB and L rot of OA joint; R SB and R rot of joints of lower cervical spine

27
Q

What are causes of vertebral artery injury?

A

MVA (extension injury)
Trauma (compression from osteophytic or disc, stretching, kinking)
Cervical instability and fractures
Manipulation or sudden neck movements

28
Q

What are signs and symptoms of vertebral artery problems?

A

5 Ds

can also have paresthesia/tingling on lip area or anywhere on their face

29
Q

What are effects of neck movement on VA?

A

rotation, rotation + ext, rot + ext + traction
These movements may occlude the contralateral VA; some evidence suggests ipsilateral VA occlusion if rotation continues beyond 30 degrees

30
Q

How do you assess VA for the safety of treatment?

A

listen carefully for signs and symptoms
screen for high risk people/history of vascular and arterial conditions
have patients perform active neck rotation while monitoring signs/symptoms
avoid treatments with combined extension and rotation

Takes 6 weeks to heal damaged VA

31
Q

What is pain patter for cervical pathologies?

A

UCS: base of neck, head and face
C4-5: base of neck and top of shoulder
C5-6, C6-7: scapula, across shoulder and post/lat aspect of upper arm

32
Q

What are parts of the UCS examination?

A

Observation, AROM (OP), scanning of joints, resisted testing, muscle imbalance, PPIVM, palpation, neuro exam (CN, CNS, segmental testing), special tests (compression/distraction, ligament testing)

33
Q

What are aspects of the CNS testing?

A 
muscle tone: increased
spasticity
Clonus
DTR: hyper reflexive
Babinski: ext of great toe and abd of 2-5 toes
Hoffman: snapping tip of middle finger
34
Q

What are the general treatment guidelines for UCS?

A

Restore mobility
Posture
Movement impairment
Stability and coordination

35
Q

What must we keep in mind when treating headaches?

A

We must differentiate cervicogenic headache from other types

36
Q

What are the classifications of HA?

A

Vascular: pounding, associated with dizziness, visual disturbances, etc
Neurological: intense nerve type pain
Musculoskeletal: posture, position or activity related
Others

37
Q

What are the types of HA?

A

Migraine
Tension
Cervicogenic

38
Q

What are signs and symptoms of migraines and who gets them?

A

Prevalent in females
Episodic, lasts 4-72 hrs
Pulsating or throbbing, can be associated with neurological symptoms (aura, visual disturbance, altered concentration)
Can be aggravated by physical activity

39
Q

What is pain pattern for cervicogenic HA?

A

history of neck pain
unilateral HA; associated pain in neck, shoulder, arm
Variable pain, moderate intensity, non throbbing

40
Q

What are aggravating and easing factors for cervicogenic HA?

A

Agg: reproducible with neck mvmt, posture, position; changes with your treatment
Easing: use of modalities, medications change in position/posture, lying down

41
Q

what are signs and symptoms of cervicogenic HA?

A

Decreased neck movements

Patterns of HA (50% are occipital/suboccipital in MVA)

42
Q

What are causes of cervicogenic HA?

A

pressure on OA, AA, C2-3; hypo or hyper mobility; muscle shortening; DJF; trauma; tension in joint capusule

43
Q

What is PT intervention for HA?

A

postural correction: forward head posture can stress upper cervical structures and lead to HA
Restore glides and mobility; soft tissue work, traction
Ther ex/movement impairment

44
Q

What are causes, signs and symptoms of tension HA?

A 
Causes: stress or lack of sleep
Description: tightness anywhere on cranium or suboccipital region
Bilateral, trigeminal distribution
Women>Men
Agg/Ease: usually psychological
45
Q

What is treatment for tension HA?

A

light stretching, joint mobilization, suboccipital release, patient education, posture

46
Q

What injuries happen in MVA?

A

Whiplash: acceleration-deceleration injury to neck; injury to soft tissue
CC: neck pain/neck stiffness; neck pain and HA

47
Q

How is whiplash diagnosed?

A

patient history, examination, X-ray/imaging

48
Q

What are factors predicting impact and recovery for whiplash?

A

Direction of force: head on more detrimental
Velocity of impact
Curvature of CS
Symptoms present immediately or later post injury
# of accidents
Head position:

49
Q

After MVA what structures should be examined?

A 
Muscles: deep neck flexors
Discs
Joint/joint capsule
Ligaments
Nerves/NR
50
Q

What are location of symptoms for MVA?

A

sub-occipital, neck, shoulders, scapula, back, unilateral/bilateral frontal HA, retro-orbital pain, facial/throat pain, numbness/paresthesia in either UE, laryngeal disturbances

51
Q

In addition to the normal special questions what other questions must be asked for UCS?

A

Hearing or vision disturbances, dizziness, feeling of unsteadiness, depression or fatigue, irritability, insomnia, light-headed

Should related to VA, ligament integrity, CN, disc, and any other questions that might help rule out damage to intracranial structures

52
Q

What are special diagnostic tests used for UCS injuries?

A

CT, myelography, EMG in presence of neuro signs

X rays to rule out fracture (open mouth for dens)

53
Q

What are SE findings during acute stage of whiplash?

A

Pain is dominant complaint
Cautious/apprehensive with active movements of neck; shoulder or arm movement may be tolerated
May c/o dizziness with active movements

54
Q

What are OE findings during acute stage of whiplash?

A

AROM to tolerance
Neuro exam: cranial nerves, central, segmental
Ligament tests if tolerated
palpation deferred

55
Q

What are OE and findings for sub acute whiplash?

A

Active movement to end range (limited by stiffness and spasm)
OE: complete neuro, cervical spine stability testing, hypermobility/hypomobility with PPIVMs and PAIVMs as necessary
Address other areas as necessary

56
Q

What are OE findings for chronic whiplash?

A 
Symptoms may become intermittent
Limited active movements
Weak muscles
Postural changes
OE: palpation findings, neurodynamic tests, muscle activation, detailed biomechanical assessment
57
Q

What is intervention during acute stage of whiplash?

A

Goal: protect structures and mobility within tolerance
Cervical collars
Modalities: ice, etc
Patient education
ROM exercises (NWB): gentle ROM, isometrics
Walking program

58
Q

What is intervention for subacute/chronic whiplash?

A 
Goal: gain mobility and stability
Exercise (ROM/stabilization/isometrics)
Prevention
Postural re-education
Joint mobilization, as necessary
Soft tissue techniques
Muscle imbalance
59
Q

What are other traumatic injuries of the UCS?

A

A-O dislocation: 100% fatal, shear force of occiput on atlas
Fracture of posterior arch of atlas: result of vertical compression; results in massive sub occipital HA
A-A dislocation: rupture of transverse ligament, watch for cord compression signs

60
Q

What is a Jefferson fracture?

A

Fracture of anterior and posterior arches of C1
Break in 4 places
Usually from blow to back of head

61
Q

Dens fracture?

A

common in MVA

picked up on open mouth x-ray

62
Q

What is hangman’s fracture?

A

Fracture of pedicles of C2 with dislocation of the body of C2 on C3
Results in dens into brainstem
Not always fatal

PTRS 845 (9 decks)

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