Upper Cervical Spine Flashcards
The OA joint includes
CO-C1
The AA jt contains..
Atlantis C1 & Axis C2
Transverse ligament restrains..
Primary restraint for posterior –> ant translation at the AA jt
Alar ligament is the primary means of …
-what does the alar ligament attach?
the ROTARY STABILITY of the CV unit (AA jt)
-attaches the skull to C2 vertebra (VIA THE DENS) and functions to check side to side movements of the head
Primary motion at OA jt is ..
flex/ext
Occipital condyles glide — with extension
anteriorly (downhill)
what’s the primary motion at the AA joint?
ROTATION
IF a patient has less than 45 deg of head rotation, what would you suspect?
possible restriction at C1/C2 (AA jt)
how do you test CN 8?
hear watch ticking?
balance test
To test CN III..
look at upward, downward and medial gaze
To test CN V, look at ..
corneal reflex, face sensation & clench teeth
what are the 4 Cervical spine clearing tests? (NOT pure VBI testing)
- Sharp-Purser Test (sublux of C1 on C2)
- Transverse Ligament Test (A-P translation of AA jt)
- Alar Ligament Test (rotation)
- Vertebral Artery Test
What is a positive test of Sharp-Purser?
IF the patient’s sx are RELIEVED by pushing back on the forehead (means that C1 is subluxing on C2)
IF the alar ligament is too lax, during the alar ligament test..
C2 does not move as soon as the head is sidebent (the alar lig rotates C2 with the skull VIA the dens)
The transverse ligament test (+) sx =
lump in throat lip paresthesias nausea vomiting sever HA/ms spasm dizziness INDICATES transverse ligament NOT resisting the ant shear of C1 on C2 (AA jt)
what exam is HIGHLY indicated as a test for cervicogenic HA?
Cervical flexion-rotation test of the AA jt (PIVM)
IF you perform a PAIVM of the OA joint into EXT & SB L, what are you testing?
the L OA joint
when performing a POST CONDYLAR GLIDE PAIVM of the OA jt and you want to assess the L OA..
rotate 30 deg to L
add post glide
assess end feel
IF your patient presents with decr flex, decr R rotation & decr L SBing
R restriction b/c SBing to OPPOSITE SIDE when in passive flexion
POSITIONAL DX is an ERS
Spinal stenosis is..
narrowing of spinal canal, IV foramina OR radicular canals
–space b/t SC & vertebral elements is compromised
When measuring the ratio of A-P to transverse diameter of the SC, you are measuring —-
-a ratio of — indicates substantial SC flattening
measuring the CORD FLATTENING & severity of stenosis
–a ratio of < 0.4 indicates substantial SC flattening (neuro impairment & myelopathy)
IF a patient has ipsilateral motor deficits with contralateral sensory deficits, they most likely have what kind of spinal stenosis..
Brown-Sequard syndrome
“cervicogenic headache” is actually a subgroup of HA patients with..
concomitant head AND neck pain
What % of tension-type HA is of ms origin?
90%
What do you do if a pt presents with a HA assoc w HIGH FEVER, STIFF NECK or RASH
RED FLAG do not treat
when examining for cervicogenic HAs, what does your exam include?
- ms length?
- ms strength & actvation?
AROM
-ms Length: tightness of SCM, UTrap, Lev scap, scalenes, suboccipitals, pec major & minor
-ms strength & activation: weak deep neck flexors, active neck flexion test, CCF - deep neck flexor performance
VBI testing
What cervicogenic HA exam should you perform of the manual assessment?
assess AA jt rotation
also AA flexion & rotation – AA rotation to side of HA about HALF of the opposite side!!!
what myofascial trigger points are often present in pts w cervicogenic HAs?
SCM
IF a pt has neurological signs s/p WAD, what is their classification?
Grade III
If a patient has WAD with signs of musculoskeletal dysfunction, what grade are they?
Grade II
What is the CUT OFF TIME for increased risk of chronicity s/p WAD?
complaints of pain after 45 days increases the risk of chronicity
What ms generates the greatest contraction during a rear end impact?
SCM generated up to 179% of MAX voluntary contraction
in a LATERAL IMPACT accident, what ms is activated the most?
-awareness of impending impact does what?
the splenius capitis contralateral to impact
-decr ms response
What sort of stress tests are used s/p WAD eval
Upper Cervical Ligament Stress Tests
- Alar ligament
- Transverse ligament
- Sharp-Purser
- Vertebral Artery Test
what interventions are more effective - active or passive?
ACTIVE (exercise, normal activities, mobilization/manipulation)
should patients use cervical collars?
NO EVIDENCE TO SUPPORT IT - prolonged sx & poor outcome
what ms should be trained s/p WAD?
deep cervical flexors
cervical extensors
rotation & lateral flexion
** LINK b/t ms fatigue & impaired postural control **
