3- Craniovertebral

Question 1

What is the function of the upper cervical spine? Lower cervical spine?

Answer 1

UCS positions the head on the neck

LCS positions in the head in space

Question 2

What is the expected ROM for cervical rotation?

Answer 2

80-90 degrees

Question 3

What is the expected ROM for cervical sidebending?

Answer 3

45 degrees

Question 4

What is the expected ROM for cervical flexion?

Answer 4

40 degrees

Question 5

What is the expected ROM for cervical extension?

Answer 5

70-80 degrees

Question 6

How is cervical ROM affected as we age?

Answer 6

Decreases 4-5 degrees over every 10 year period

Question 7

Where do the alar ligaments attach?

Answer 7

to a pair of anterior tubercles on the foramen magnum

Question 8

Where are the brain-stem-spinal cord junction housed?

Answer 8

Posterior of the foramen magnum

Question 9

Which cervical vertebrae are typical?

Answer 9

C3-6

Question 10

How are C3-6 oriented superiorly? Inferiorly?

Answer 10

Superiorly: concave transversely, convex A-P

Inferiorly: Convex transversely, concave A-P

Question 11

Where do the transverse processes of C3-6 face?

Answer 11

Lateral, anterior, Inferior

Question 12

What houses the vertebral artery C3-6?

Answer 12

Transverse foramen

Question 13

Which directions for the superior and inferior facets face C3-6?

Answer 13

Superior: posterior and cranial

Inferior: anterior and caudal

Question 14

What is different about C7?

Answer 14

Transitional vertebra that connects the mobile C-spine to the stable T-spine. It has a long spinous process with a single tuberacle at the end

Question 15

What is different about cervical discs?

Answer 15

They have less soft nuclear material because they bear less weight

Question 16

Where does the alar ligament run? What does it do?

Answer 16

• dorsolateral dens to medial occipital condyles
• limits rotation and SB of the occiput on the axis

Question 17

The UCS is responsible for approximately _____% of the motion throughout the entire C-spine

Answer 17

50%

Question 18

SB and rotation are couple to the ______ side in O-A joint, UCS

Answer 18

Opposite

Question 19

SB and rotation are couple to the ______ side in the LCS

Answer 19

Same

Question 20

During right sidebending, the right occiput moves _____. The left?

Answer 20

R= medial, inferior,anterior

L= LPS

Question 21

Which directions to the superior articular facets of C1 face?

Answer 21

superior and medial

Question 22

How many degrees of freedom does the O-A joint have?

Answer 22

2 (flex/ext, SB)

Question 23

What is special about C2-3?

Answer 23

It is a transitional vertebra. The superior articulat facets behave like UCS. The inferior articular facets behave like LCS

Question 24

How are the superior articular facets of C2-C7 oriented?

Answer 24

slightly convex, face cranial and posterior

Question 25

How are the inferior articular facets oriented?

Answer 25

Slightly concave, face caudal and anterior

Question 26

What is the facet orientation in the LCS?

Answer 26

approximately 45 degrees to horizontal

Question 27

What are some indicators of neoplastic conditions?

Answer 27

- Age \>50 yrs - Previous history of cancer - Unexplained weight loss - Constant pain - Night pain - Unexplained capsular patterns

Question 28

What temperature can be an indicator of inflammatory or systemic disease?

Answer 28

\>100 F

Question 29

What BP can be an indicator of inflammatory or systemic disease?

Answer 29

\> 160/95 mmHg

Question 30

What resting pulse can be an indicator of inflammatory or systemic disease?

Answer 30

\>100

Question 31

What resting respiration can be an indicator of inflammatory or systemic disease?

Answer 31

\>25 bpm

Question 32

What else can be an indictor of systemic or inflammatory disease?

Answer 32

Fatigue

Question 33

What are some high risk factors that indicate X-Ray?

Answer 33

\> 65 y.o. Dangerous MOI Limb paresthesias

Question 34

What are some low risk factors that may indicate X-Ray?

Answer 34

Rear-end MVA Delayed onset neck pain Absence of midline tenderness

Question 35

What is the neck step in indication for Xray?

Answer 35

Check if the patient is able to rotate 45 degrees to both sides

Question 36

What are some indicators of cervical cord compression?

Answer 36

- Bilateral or quadrilateral limb paresthesias with cervical motion - Hyper-reflexia - Clonus - + Babinski's or + Hoffman's

Question 37

What are some indicators of cervical myelopathy

Answer 37

B or Q limb paresthesias and/or weaknesses + Hoffman's and/or + Babinski's Hyperreflexia Sensory disturbance of the hands Muscle wasting of the hand intrinsics Unsteady gait Bowel and bladder disturbances

Question 38

How is cervical myelopathy graded?

Answer 38

1-5 based on gait disturbances 1= normal gait, mild

Question 39

How long must you wait after a whiplash injury to test vertebral artery?

Answer 39

4-6 weeks

Question 40

What are some outcome predictors for whiplash?

Answer 40

Post-traumatic stress High NDI score Cold hyperalgesia Age

Question 41

What are the most commonly involved root levels of cervical radiculopathy?

Answer 41

C6 and 7

Question 42

When is peak incidence for cervical radiculopathy?

Answer 42

4th and 5th decades

Question 43

What is a medical emergency?

Answer 43

Acute torticollis caused by a facet joint dislocation

Question 44

What should you ask regarding VBI?

Answer 44

Hx or neck trauma 5Ds And 3 Ns Hx or RA, HTN, Stroke Steroid use Increasing symptoms with specific movements

Question 45

What does the alar ligament test test?

Answer 45

Frontal plane stability (alar ligament integrity)

Question 46

What does the Transverse ligament test test for?

Answer 46

Saggital plane stability (transverse ligament integrity)

Question 47

What does the Jefferson Fracture Test test for?

Answer 47

Transverse plane stability

Question 48

What does the distraction test test for?

Answer 48

Longitudinal stability

Question 49

What does the Sharp-Purser Test test for?

Answer 49

integrity of the transverse ligament, UCS translational stability