1f - Upper Cervical Spine Flashcards by Jenn Cantilli

what is the structure of C1 and how does this lend to its functions

no real body
giant superior facets
- articulate w occiput
inferior facets flatter but on angle
- orientation allows for rotation

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describe the orientation of C2

dens sits ant against C1
SC is posterior

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what is the function of the transverse ligament

hold position of C2 forward so that C1 can spin around it

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what is a characteristic of the transverse ligament which lends to its primary function

fibers have very low coefficient of friction to allow for a lot of movement as C1 spins around dens

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what is the result if the transverse ligament is injured

can’t stop C2 from moving posteriorly against SC

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what are 3 major risk factors that can lead to transverse/alar ligament damage/insufficiency

trauma (MVA, trauma, fall)
RA
connective tissue disorder

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what is the function of the alar ligament

comes off the head of dens to attach it to occiput

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how does the alar ligament’s function influence movement at upper cervical spine

occiput and C2 will have correlation w each other
- see some rotation when SB occiput (getting movement at C2)

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in SBing the occiput to the R, the R rotation at C2 is the result of what 2 things:

tension of alar ligament
geometry of facet joints

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describe the movements happening at the occiput condyles, C1, and C2 during SB R

occiput condyles roll right and glide L on C1 (vex on cave)

alar lig becomes taut and induces R rotation of C2

C1 is shaped like a wedge b/w occiput and C2 + the position of dens + strong transverse ligament = C1 can’t SB & is still

C2 is rotating R under C1 (which is still), C1 rotates L relative to C2

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path of vertebral artery and where is it at greatest risk for an injury

travels thru transverse foramen

at C1, there is a hook shape where you can get cervical arterial dissections and need to be careful of any manipulation at this level

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what is a (+) alar ligament test

no IMMEDIATE contralateral mvmt of C2 spinous process

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what is a (+) modified sharp purser test and what is the indication

dec in myelopathic sx

good specificity, worth taking time to stabilize w hard collar and send to ER

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describe the anatomy of what is happening during a (+) modified sharp purser test and why it would mean a dec in sx

when flex forward, occiput falls of edge of cliff and dens moves to posterior portion of arch
- presses SC against dens, resulting in sx down arms, legs, unstable head

when ext head, get a clunk as dens clunks against arch and relocates
- relief in sx

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what is the anterior shear transverse ligament safety test

pt supine and PT presses C1 anteriorly hold 10-15sec

(+) reproduction of myelopathic sx (not pain)

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what is an alternate method for an anterior shear transverse ligament safety test if pt is already having myelopathic sx lying in supine

in supine, PT presses ant on C2
nose should elevate immediately

(+) some dec in sx as taking pressure off

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what is the purpose of a lateral shear test

assess integrity of dens and osseous portion of C1 and its alar ligamentous attachment

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what is procedure of a lateral shear test

stabilize occiput and C1
laterally shear C2

pain isn’t necessarily (+)

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what is an important consideration when doing a cervical safety test

use in conjunction w clinical hx
- trauma, RA, down syndrome, connective tissue disorder

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what is indicated if clinical tests and tests implicate upper cervical instability

immediate referral to MD for further assessment w c-collar
- want orthopedic surgeon to make the decision ab treatment

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what are vertebral artery insufficiency sx similar to

myelopathic sx seen w SC

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what are clinical s/sx of vertebral artery insufficiency

5Ds
- dizziness
- diplopia
- dysarthria
- dysphagia
- drop attacks

Ataxia of gait

3Ns
- nausea
- nystagmus
- numbness of face

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what is a consideration of the ataxia of gait s/sx of vertebral artery insufficiency

might not show up immediately in gait
- might see it as do balance tests

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what is the procedure of vertebral artery screening and why

sustained rotation
- puts pressure on hooked part of vertebral artery

don’t let them close eyes and keep them talking so see if vision/speech changes

extension w rotation to be more provocative

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what do the results of vertebral artery screening indicate

if (-), not enough to r/o vertebral insufficiency good (+) test result validity

25yo F exercise physiologist w PMH of lyme dz and neck/back pain and went to chiropractor for 1st time. Onset of dizziness/lightheadedness 1wk ago secondary to chiropractic C and T manip. No immediate sx, but develop the next day. XR, EKG, and CBC all neg in ED. Virtual appt w PCP suggested PT. What cervical safety tests should be performed? a. alar lig in supine & sitting b. transverse lig test c. lateral shear test d. sustained rotation e. all of the above

all of the above - 5Ds, emphasis on sustained rotation

25yo F exercise physiologist w PMH of lyme dz and neck/back pain and went to chiropractor for 1st time. Onset of dizziness/lightheadedness 1wk ago secondary to chiropractic C and T manip. No immediate sx, but develop the next day. XR, EKG, and CBC all neg in ED. Virtual appt w PCP suggested PT. cerv ext reproduce sx L rotation reproduce, worsen in prolonged (-) alar, transverse, lateral shear keeping in mind that avery has been to ER and spoken to PCP, is she currently safe to treat?

no - in ER just did XR and EKG but those wouldn't tell you anything wouldn't have been looking for this before and might have missed it

what are common locations for pain in UCS paths

base of skull unilateral ear/jaw/TMJ pain HA/ram's horn pattern

what is commonly injured if the UCS is

TMJ

what are common MOI for UCS path

often insidious, long standing slept funny MVA (WAD)

what are MAPS to the pt's pain

Movements Activities Positions Situations

what are 5 common MAPS for UCS path

computer work sleeping looking a phone turning head driving

what should be observed during a UCS eval

position of head on neck reposition in neutral as needed

how should you examine UCS ROM in an eval

cardinal planes (bias upper vs lower Cspine) pre- flex upper w nose nod, assess lower c spine pre- flex lower to assess C1/C2 - FRT in supine regionalization

what is a (+) FRT and what does this indicate

(+) ROM dec by 10deg + - normal ROM is 44deg indicate cervicogenic headache w C1/C2 restriction

what is FRT assessing

passive full cervical flex then rotation - how much C1 rotates on C2 (should be ~1/2 of cervical rotation from this segment)

what ms have a large influence on how the upper cspine moves

upper trap levator scap SCMS superficial ms are prime movers

what are the 4 main deep neck flexors

rectus capitis lateralis rectus capitis anterior longus capitis longus colli

what are the functions of deep neck flexors

maintain stability and position endurance ms not prime movers

norm for CCFT

24-28mmHg

what compensation do you look for during the neck flexor endurance test

see engaged SCM - extends UCS and flexes lower cspine - upper cervical flexors fight this

function of rectus capitus posterior major and minor

head ext and ipsilateral rotation

functions of obliquus capitus superior

head ext and side bending

functions of obliquus capitus inferior

ipsilateral head on neck rotation

what was noted in a muscle control assessment for pts w neck pain

inc activation of superficial neck extensors (ie upper traps, levator scap) and delayed activity in deep neck extensors (ie semispinalis cervicis, multifidi)

what was noted in motor control of pts w post-concussional HAs

overactive superficial ms, acting tonically

what was noted in motor control in WAD

dec deep cervical ms tonic hold - poor patterning, dec kinesthesia, and proprioception

what is a compensation for scapular winging

use upper trap which creates upper cervical extension

what is the significance of extra upper trap activity

impacts c spine bc of attachments

what are (+) findings of scapular dyskinesis

winging loss/lack of control when lifting loss/lack of control when lowering scapular asymmetry

what are the 4 main UCS dx

neck pain w mobility deficits wry neck (acute facet lock) / torticollis cervicogenic HA concussion

what does wry neck deformity describe

posture

what are other terms for wry neck deformity

acute facet joint lock acquired torticollis

what will the pt complain of if they have a wry neck deformity

neck pain/stiffness w loss of ROM - often accompanies by spasm of surrounding ms (UT or SCM)

what are the 4 types of acquired torticollis

traumatic micro induced sudden onset/acute muscular post viral

traumatic micro induced acquired torticollis: common pt pop, sx, treatment and resolution

young hypermobile females motor control deficit several episodes quickly resolve restore ROM, address MC

sudden onset/acute acquired torticollis: MOI, treatment and resolution

facet or disc dysfunction that created inflammatory response facet: restore ROM, address MC disc: no manip, soft collar 2-3 days self resolve 1-2 weeks, PT speeds up process

muscular acquired torticollis: MOI, treatment

spasm SCM and stuck is SCM ms action: lat flex and contralateral rotation STM, ms lengthening, functional adapt, ROM

post viral acquired torticollis: pt pop/MOI, treatment

spontaneous onset in child or adolescent after URI causing temp insufficiency of UCS ligaments manual therapy contraindicated

what are wry neck deformities that should be referred and what are examples

if no ms involvement, concern for CNS/PNS signs spasmodic torticollis drug induced hysterical

what is spasmodic torticollis

neurological conditions w or w/o a tick, can be transient

what might cause drug induced torticollis

antipsychotics

what is hysterical torticollis

psychological no objective signs

what are 8 research informed UCS interventions

1. modify function at work, ergonomics 2. change ROM disturbances 3. address motor control deficit (feed forward mech) 4. sensory motor function 5. change pain processing 6. psychosocial distress 7. sensory motor processing 8. multimodal approach

what are the 3 main ways to change ROM disturbances in UCS

joint mob traction ms length

how can you address motor control deficits in UCS

change patterning

how can you intervene on sensory motor function in UCS (3)

joint position sense balance response endurance and strength deficits

what intervention is the "low hanging fruit" for UCS

ergonomics

what is the ideal sitting posture and why

hip above knee to get slight lumbar ext and then put thoracic and cervical spines in neutral if you flex lumbar spine, flexes thoracic and ext cspine

why is thoracic spine an important thing to address when addressing cervical spine

if thoracic segments not moving well, inc work thru cspine

typical initial prescription and the progression for joint mobs in UCS

initial: 5-10 reps, 3-5 hold, grade 2-4 progression: 10-15reps, 3-10hold, grade 4

what are 6 things that the joint mob prescription depends on

pt tolerance in moment pt tolerance after treatment chronicity of mobility deficits hx w manual therapy grade of mobility deficits pt psychosocial factors/beliefs

what does a feed forward mechanism have to do with motor control interventions

anticipatory/automatic ms that brace for movement w pain and loss of activity, motor planning has been altered and changed - start by doing them in isolation and then function

what are 3 components to interventions to change motor control patterns/progressions

1. patterning in isolation then co-contraction 2. endurance strength and function 3. retrain normal movement patterns (ROM)

as a rule, for pts who sx are more irritated, what type of exercises are good to strengthen DNE or DNF

isometric

what should be integrated w sensory motor function

strength and endurance training

if you at retraining sensory motor function, what feedback to do you give for joint position sense

external cue for cervical position

what type of intervention is used to treat sensory motor function

cervical kineasthetic treatment

what is a common piece of equipment used when improving motor control

laser on head

what is it important to educate the patient on

to change pain processing and psychosocial distress - address fear avoidance - desensitize movement *importance of aerobic exercise

1f - Upper Cervical Spine Flashcards

(80 cards)