C-Spine and TMJ

Question 1

The Cervical Spine is broken into:

Answer 1

Upper Cervical:
C0-C1 (atlanto occipital joint)
C1-C2 (atlanto axial joint)

Lower Cervical:
C2-C3 to C7-T1

Question 2

How much does the upper C spine contribute to the motion of the neck

Answer 2

50%

Question 3

What is the primary movement of C0-C1?

Answer 3

C0-C1 Atlanto Occipital Joint performing flexion and extension (30% total)

Question 4

What is the primary movement of C1-C2?

Answer 4

C1-C2 Atlanto-Axial Joint performing rotation (45% each side)

Question 5

What are the deep ligaments of the c spine?

Answer 5

Transverse Ligament of Atlas
Alar Ligaments (holds Dens)

Question 6

What type of motion happens in the lower c spine?

Answer 6

Primarily Type II
rotation and side-bending happen on the same side

Question 7

Actions of upper trap

Answer 7

Extension
SB
Contra Rotation

Question 8

Action of Levator Scapula

Answer 8

Extension
SB
Ipsi Rotation (to C spine, not scapula)

Question 9

Action of Scalenes

Answer 9

SB
Contra Rotation

Question 10

Action of SCM

Answer 10

Bilateral Flexion of the Neck with extension of Upper C Spine
Unilateral SB
Contra Rotation

Question 11

Action Sub-Occipital Group

Answer 11

Extend the Occiput on the cervical spine

Question 12

Muscles of Deep Cervical Flexors

Answer 12

Longus Colli, Longus Capitus

Question 13

What is TMJ

Answer 13

Articulation between condyle of the mandible and the temporal bone
(disc attached to lateral pterygoid)

Question 14

Muscles and Motion of Opening/Closing TMJ

Answer 14

Opening: Lateral Pterygoid
Closing: Temporalis, Masseter, Medial Pterygoid

Question 15

Muscles and Motion of Lateral Deviation TMJ

Answer 15

Ipsilateral temporalis and masseter
Contralateral Pterygoids

Question 16

Muscles and Motion of Protrusion/Retrusion of TMJ

Answer 16

Protrusion: pterygoids (jaw forward)
Retrusion: Posterior fibers of temporalis and anterior fibers of the neck

Question 17

Resting Position of the mouth

Answer 17

mandible slightly retracted and teeth slightly apart

Question 18

Acute Phase of Cervical Sprains and Strains

Answer 18

Protecting healing tissue, decrease inflammation and pain, minimize loss of ability
Modalities: E Stim, Cold Pack, Non-Thermal US, Laser
Manual: STM
Therex: AROM in pain-free ROM
PT Education: Posture Ed, Activity Modifications

Question 19

Types of Cervical Collars

Answer 19

Soft
Tynor Hard Collar
Miami J Collar

Question 20

Sub Acute Phase of Cervical Sprains and Strains

Answer 20

decrease inflammation and pain
regaining mobility
Modalities: CP/HP E Stim, US, Laser, Intermittent Traction
Manual: STM, gentle manual cervical traction
Therex: AROM, light stretching, postural exercise, gentle ISO strengthening in pain free position
Education: Posture Ed, HEP

Question 21

Chronic Phase of Cervical Sprains and Strains

Answer 21

restore full mobility, posture re-ed, regaining full strength, training postural muscle endurance
Modalities: HP/CP
Manual: STM to restore full mobility, sub occipital release, manual cervical traction, manual stretching, joint mob
Therex: stretching spinal stabilization, upper extremity strengthening, ISO exercises for cervical strength, re-ed of deep cervical flexor
Education: HEP, slow return to pre-injury activity

Question 22

What is cervical Spondylosis?

Answer 22

chronic degenerative condition that involves either
Disc (DDD), Joints (DJD), or BOTH
(theres no space)

Question 23

What tissues can cervical spondylosis possibly have an impact?

Answer 23

Neural tissues in spinal canal or intervetebral foreamen

Question 24

What are the symptoms of Cervical Spondylosis?

Answer 24

Stiffness
Pain
Loss of Mobility
Crepitus
Radiculopathy
Myelopathy leading to weakness

Question 25

What is the chronic long term adaptations of cervical spondylosis?

Answer 25

Connective Tissue shortening Chronic Muscle Tightness Joint OA Capsular Tightness restricting segmental mobility

Question 26

What can you use to decrease pressure on joint/disc/connective tissue by decreasing tightness of c spine?

Answer 26

STM Traction Stretching

Question 27

What is Cervical Disc Disease

Answer 27

a result of wear and tear or trauma

Question 28

What should treatment be focused on for radiculopathy?

Answer 28

decreasing neural compression and patient education to avoid movements that close on the IV foreamen *because of nerve damage treatment should not go for extended periods without signs and symptoms improving (May require surgery)

Question 29

Thoracic Outlet Syndrome

Answer 29

Condition where there is compression of the artery, nerve, or vein in the thoracic outlet A result of trauma, overuse, or mechanical dysfunction

Question 30

What are common areas of compression in thoracic outlet syndrome?

Answer 30

Scalenes Between the clavicle and 1st Rib Under Pec Minor

Question 31

What is the goal when treating TOS?

Answer 31

decrease tightness in the anterior lateral cervical musculature and the axilla, and ensure there are normal mechanics for the upper quarter

Question 32

What is Cervical Facet Joint Dysfunction

Answer 32

"crick in the neck" (somatic or segmental) Overfacilitation of the nervous system at a particular cervical segment which leads to local muscle guarding and impaired mobility

Question 33

What is an acute episode of Cervical Facet Joint Dysfunction

Answer 33

sleeping wrong, moving too quickly, trauma

Question 34

Cervical Posture Dysfunction

Answer 34

Chronic adaptations (long periods) of poor posture on in response to previous trauma that was not rehabilitated properly Requires restoration of proper length to tight structures and strengthening to inhibited muscle groups

Question 35

What is the typical presentation of Cervical Posture Dysfunction

Answer 35

tight sub-occipital muscles, SCM, scalenes, pectoral muscles, hypertonic levator scap and/or upper trap Weakness in deep neck flexors and interscap muscles

Question 36

What is TMJ dysfunction?

Answer 36

Develops due to muscle imbalance from grinding, chewing on one side, chewing gum, sleeping position, or compensation for cervical spine dysfunction

Question 37

What are signs and symptoms of TMJ dysfunction?

Answer 37

pain (usually one sided) worse with opening popping, limited ability to open mouth, difficulty chewing