Upper C-Spine

Question 1

Job of Transverse Ligament?

Answer 1

Restraint for posterior-anterior translation at the AA joint

Question 2

Job of Alar Ligament

Answer 2

Primary rotatory stability at AA joint- checks side to side movements of head

Question 3

Primary motion at OA joint is:

Answer 3

Flexion-Extension

Question 4

OA joint Flexion Arthrokinematics

Answer 4

Condyles move posteriorly- stresses posterior capsule

Question 5

OA joint Extension Arthrokinematics

Answer 5

condyles move anteriorly- stresses anterior capsule

Question 6

Primary motion at AA joint:

Answer 6

Rotation

Question 7

How much head rotation comes from AA joint?

Answer 7

50%

Question 8

Normal ROM of C1/C2?

Answer 8

45 degrees

Question 9

Subjective Red flags tell you not to do what?

Answer 9

Not to perform manual therapy techniques

Question 10

What are some subjective red flags:

Answer 10

1. H/O acute trauma
2. C/o Dizziness, drop attacks
3. c/o lump in throat, lip paresthesi, nausea or vomitting, severe HA
4. facial numbness
   change in bowel/bladder continence
5. Ataxia
6. extreme reluctance to move head
7. pt c/o difficulty lying down or lifting head from pillow

Question 11

Cervical exam red flags are?

Answer 11

1. BL or QL paresthesias or paresis (medical emergency)
2. diplopia
3. trapezius or SCM paresis
4. Hyperreflexia
5. Postitive Babinski, Hoffman’s, Clonus
6. Disdiadokokinesia
7. Dysphasia, dysarthria
8. Change in bowel/bladder continence

Question 12

Cervical Myelopathy Red Flags

Answer 12

1. sensory disturbance in hands
2. muscle wasting in intrinsics
3. unsteady gait
4. hoffman’s reflex
5. hyperreflexia
6. bowel or bladder dysfunction
7. multi-segmental motor weakness, sensory, or both

Question 13

VBI Red flags (5 D’s)

Answer 13

1. dizziness
2. drop attacks
3. diplopia
4. Dysarthria
5. Dysphagia

Question 14

VBI red flags (3N’s)

Answer 14

1. nausea
2. numbness
3. nystagmus

Question 15

Inflammatory or Systemic Disease red flags

Answer 15

Temp > 100 F
BP > 160/95
RR > 25 bpm
Pulse > 100 bpm
general fatigue

Question 16

Spinal Fractures Red Flags

Answer 16

major trauma without proper imaging

-severe limitation in AROM

Question 17

Upper CS ligament Instability Red Flags

Answer 17

Occipital headache and numbness

• severe limitation in all AROM
• signs of myelopathy

Question 18

Red Flags Neoplastic Conditions

Answer 18

> 50 yrs age

• Hx of CA
• unexplained weight loss
• constant pain and no relief with bed rest
• night pain

Question 19

Other VBI considerations

Answer 19

• CN testing
• Cardiovascular disease risk factors
• recent trauma
• severe ongoing HA/Migraine

Question 20

What are the cervical spine clearing test?

Answer 20

1. sharp-purser test
2. Alar Ligmanet
3. Transverse Ligament
4. Vertebral Artery Test

Question 21

What is the purpose of the sharp purser test?

Answer 21

test to determine subluxation of atlas (C1) on axis (C2)

Question 22

What is the purpose of the alar ligament test?

Answer 22

Test of immediacy, if alar ligament is intact, C2 will roate immediately to the opposite direction

Question 23

What is th epurpose ot he transverse ligament test?

Answer 23

anterior shear is resisted by the transverse ligament–> checking to make sure dens is in place

Question 24

What 2 tests can be done to assess AA Joint mobility?

Answer 24

1. AA segmental motion central and unilateral PA’s

2. AA cervical Flexion-Rotation test

Question 25

What 2 tests can be done to assess OA joint mobility?

Answer 25

1. OA SG with flexion/extension

2. OA posterior condylar glide technique with Rotation

Question 26

When testing OA joint in extension, which way do you SB?

Answer 26

Toward the side being tested

Question 27

When testing OA joint in flexion, which way do you SB?

Answer 27

away from side being tested