Upper Cervical Spine Flashcards
Define the structures classified as USC
Occiput
Atlas (C1)
Axis (C2)
Describe the shape of the superior and inferior facets of C1
Superior = concave
Inferior = convex
List the 3 points of articulation b/t C1 and C2
Odontoid process
2 facet joints
Describe the shape of the inferior facet of C1 and the superior facets of C2
Both are convex
Only joint in body with 2 convex surfaces which along with the lack of a cervical disc decreases stability of the joint, stability mainly comes from ligaments
List the 3 features that allow the majority of rotation ROM to come from the USC
Biconvex joint surface
Downward slope of C2 facets
Lack of disc
Describe what the amount of cervical rotation can tell you about the pathology of the pain
In acute USC they have limited and painful rotation
In chronic USC they have functional rotation due to compensation of the rest of the spine
If rotation is not compromised = LCS
The following ligaments are renamed in the USC
- ALL
- Ligamentum flavum
- PLL
- Anterior atlo-occiput membrane
- Posterior alto-occiput membrane
- Tectorial membrane
List the AA ligaments
- Transverse: behind dens, stabilizing dens to atlas, control AP motion
- Alar: lateral dens, stabilizing dens to occiput, controls bilateral flex contralateral SB/Rot
List the 4 deep posterior neck mm
- Rectus captiis posterior major (extend, SB, rot)
- Rectus capitis posterior minor (extend, SB, rot)
- Superior oblique (ipsi SB, contral rot)
- Inferior oblique (ipsi rot)
List the 4 anterior neck mm
- Rectus capitis anterior (flexion)
- Rectus capitis lateralis (Ipsi SB)
- Longus capitis (posture control, eccentric ext control)
- Longus colli (posture control, eccentric ext control)
Longus mm = “deep flexors” (aid with sagittal anterior rot w/flex)
Describe the primary role of the small anterior neck mm
Important for proprioception of head position on neck
(large spindle to fiber density)
Describe the innervation of the neck mm, OA, AA, C2-3 Z jt, ligaments, vertebral arteries
Doran and ventral rami of C1-3
Describe the arthrokinematics of
OA flex
AA flex
OA: convex occipital condyle glide POST on concave atlas
AA: C1 moves inferiorly on C2; C2 glies forward on C3
Describe the arthrokinematics of
OA ext
AA ext
OA: convex occipital condyle glide ANT on concave atlas
AA: C1 moves superiorly on C2; C2 glides backward on C3
Describe the arthrokinematics of
OA rot
AA rot
OA: ipsi condyle glide posterior
AA: ipsi facet moves POST, contra facet moves ANT, C1 translates to OPPOSITE side
Describe the arthrokinematics of OA SB
Ipsi condyle glides ANT
Describe the osteokinematics of the OA and AA joints
OA: primarily flex/ext (yes jt)
AA: primarily rot (no jt)
Describe the coupling of the OA and AA joint
OA: OPPOSITE
AA: OPPOSITE
LIst the causes of injury to the VA
- MVA (ext)
- Trauma
- Cervical instab, fx
- Suddent neck movement, manip
List the 5 D’s for VA
- Drop attack
- Dizziness
- Dysphagia
- Dysarthria
- Diplopia
Also ask about lip/face parasthesia
Describe motions from least to most occulsion of the VA
Rotation > rot + ext > Rot + ext + traction
Describe the pattern of pain for
USC
C4-5
C5-7
USC: base of neck, head and face
C4-5: base of neck and top of shld
C5-7: scapula, across the shld jt, and post/lat aspect of upper arm
List some aggravating factors of the USC
sustained posture, rotation, TMJ issues
Describe the treatment guidlines for USC
Restore mobility > posture > movement impairment > stability and coordination
Describe the effect of forward head posture
Puts shear on LCS and the center of pressure moves anteriorly
Inhibits deep neck flexors (longus) – not longer in optimal position to function > leads to atrophy
Head tilts backext USC to keep eye level which increases pressure on posterior eliminates and DRG resulting in HA
Tightens ligamentus nuchae and other mm leading to adoptive changes
Describe the first exercises to address forward head posture?
Look at the thoracic spine:
Chest out moves neck back
Scap squeeze
Condition: head and face pain arising from the UCS
Cervicogenic headache
Condition: pounding headache associated with dizziness and visual distrubances
Vascular headache
List the 3 most common types of headach
- Migraine
- Tension (PT)
- Cervicogenic (PT)
Condition:
- Hx of neck or shld pain
- Unilateral, associated pain in neck, shld, arm
- Variable pain, moderate intensity, dependent on movement
- NOT throbbing
Cervicogenic HA
Condition:
Agg: neck movement, posture, position,
Ease: meds, modalities, change in posture, lying down, tx
Decreased ROM
Pattern: occipital/suboccipital
Cervicogenic HA
Condition: HA with redness under eyes
Cluster HA (vascular)
List the cases of cervicogenic HA
- Pressure on OA, AA, C2-3
- Hyper/hypo mobility
- Mm shortening
- DDD
- Trauma
Condition
- Tightness anywhere on the cranium or suboccipital region
- Bilat and trigeminal distribution
- W > M
Tension HA
List the causes of tension HA
Stress
Lack of sleep
List the CC following MVA/whiplash injuries
Neck pain
Neck stiffness
Neck pain + HA
Condition: acceleration-deceleration injury to the neck, injury to soft tissues
Whiplash injury
List the special Q’s specific for trauma/MVA
Hearing/vision disturbances
Dizziness
Feeling of unsteadiness
Depression/fatigue
Irritability
Insomnia
Condition:
Pain as dominant complaint
Apprehensive with AROM of neck
Shld/arm movement tolerated
Dizziness with active movement
Acute stage of MVA/whiplash
Condition:
AROM to end range limited by stiffness/spasm
Subacute stage of MVA/whiplash
Condition:
Sx intermittent
Limited active movements
weak mm
postural changes
Chronic stage of MVA/whiplash
Describe the goal of intervention in each stage following an MVA/whiplash injury
Acute: protect structures and mobility within tolerace
Subacute/Chronic: gain mobility and stability
Condition: rupture of transverse lig.; may result in cord compression
AA dislocation
Condition: vertical compression resulting in massive suboccipital HA
Fx of posterior arch of atlas (C1)
Condition: fx of anterior and posterior arch of C1
Jefferson fx
Condition:
Fx of C2 pedicles with disolcation of C2 on C3
Dens migrates into brainstem
Hangman’s Fx
