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COMP ORTHO > Cervical > Flashcards

Cervical Flashcards

(81 cards)

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1
Q

Cervical biomechanics - mechanical function of C spine

A

Structural support for torso
flexibility of motion for activity
protect spinal cord

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2
Q

Cervical biomechanics - Mechanical stability - active vs pasive

A

active - mm (they produce force)

passive - vertebrae, ligaments, disc, facets

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3
Q

Cervical biomechanics - disturbances

A 
Biological factors (obese, age, weakness, pregnancy) 
Fatigue injuries, surgeries
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4
Q

Anatomy - pillars

A

Triangular column of support - 3 pillars

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5
Q

Anatomy - ant pillar

A

made up of vertebral bodies - starts between C2/3

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6
Q

Anatomy - post pillar

A

made up of bilateral facets, starts at C1

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7
Q

Anatomy - weight distribution at pillar

A

Starts with 50-50 weight distribution between pillars and then becomes NWB as you get lower
Middle C spine has more weight on the facets

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8
Q

Anatomy - where is injury more likely

A

upper cervical

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9
Q

Anatomy - occipital condyles articulate with

A

sup facet of atlas (C1)

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10
Q

Anatomy - occipital condyles - shape

A

oval - convex

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11
Q

Anatomy - typical vertebrae

A

C3-C7

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12
Q

Anatomy - atypical vertebrae

A

C1 (atlas)

C2 (axis)

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13
Q

Anatomy - bodies of C vertebrae are

A

tilted forward, facets are opposite

uncinate processes are higher on lateral edge to prevent sup vert from moving forward or back

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14
Q

Anatomy - membrane tectoria

A

wide sheet of collagen fibers in dense CT, covers AA lig complex

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15
Q

Anatomy - apical ligament

A

odontoid process to ant rim of foramen magnum

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16
Q

Anatomy - alar ligament

A

dens to lateral foramen magnum

control contralateral rot and side to side motion

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17
Q

Anatomy - transverse ligament

A

occipital tubercles to lateral mass of C1

limits translation of C1 on dens

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18
Q

Anatomy - cruciform ligament

A

limits flex and ext

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19
Q

Cervical IVD - made of

A

annulus and nucleus

NO NP

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20
Q

Cervical IVD - thicker where

A

anteriorly (creates lordosis)

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21
Q

Cervical facet joints - capsule is

A

thick! except post is thin

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22
Q

Cervical facet joints - capsule in neutral is

A

very lax - creates a lot of ROM

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23
Q

Cervical facet joints - at end range capsules are

A

taut - act as stabilizing ligaments

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24
Q

Cervical facet joints - orientation throughout C spine

A

Changes from sup/post/medial at C3 to lateral at C5/6

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25
Ant long lig
attaches to skull and vertebral body | loose att to discs
26
Post long lig
attaches to disc and body
27
Lig nuchae
continuation of supraspinous lig connects SP resists flex
28
lig flava
between laminar part of vertebrae | resists flex
29
Kinematics - flex ROM
40! (goni) | 35-70
30
Kinematics - ext ROM
50! (goni) | 50-77
31
Kinematics - LF
22 (goni) | 38-53
32
Kinematics - Rot
50 (goni) | 66-93 with 50% occuring at AA
33
Kinematics - first motion occurs where
OA!
34
Kinematics of OA with flex
Flex - Condyles glide post on atlas
35
Kinematics of OA with ext
condyles glide ant on atlas
36
Kinematics of OA with LF and rot
LIMITED! | Primary is 'yes'
37
Kinmatics of AA - what motion occurs here first
rot! NO limited in all other motion
38
Kinematics of typical - how many DOF
6 | entire c spine moves as unit guided by facets
39
kinematics of typical - during flexion
upper vertebrae glides ant and sup
40
kinematics of typical - during extension
upper vertebrae glides post and inf
41
kinematics of typical - lateral flex is coupled with
ipsilateral rotation
42
Ligament strain pattern - if flexion strain
lig nuchae, lig flavum, post long lig
43
Ligament strain pattern - if ext strain
ant long lig, ant OA membrane
44
SCM action
isolate motion at OA to extend head | flex C region, ipsilateral LF, contralateral rot
45
Ant scalene mm action
flex LF toward and rotate away (same as SCM)
46
Mid scalene mm action
flex and LF toward
47
Post scalene mm action
flexion | LF toward and rot toward
48
Neutral zone is where
head is moved passively without resistance where compression and tissue loads are at a min (10 LF, flex, ext, and 30 rot)
49
Whiplash - most dangerous if
structures are stretched apart in horizontal setting - soft tissue will be injured first but if all other structures fail, will eventually go down into spinal cord
50
VBI - s/s
5 Ds, 3 Ns Dizzy, diplopia, dysphagia, dysarthria, drop attack Nystagmus, nauseous, numbness
51
VBI - compromising position
contralateral rot, end range ext, extreme motions
52
VBI - gold standard to diagnose
doppler US
53
Cranio-vertebral ligament injuries - MOI
trauma
54
Cranio-vertebral ligament injuries - S/s
same as VBI (5 Ds, 3Ns) | also might have mouth/lip pareesthesias and feeling of lump in throat if dens involved
55
Cervical myelopathy is what
UMN lesion (to SC)
56
Cervical myelopathy s/s
UMN signs - spasticity, hyerreflexia, visual/balance disturbance, ataxia, b/b changes, paresthesias
57
Facet movement - typical - close packed in
full extension
58
Facet movement - typical - coupled motion
LF and Rot in SAME Ipsilateral facet closes with L Ipsilateral facet opens with rot
59
Facet - OA coupled motion
LF and rot in OPP direction
60
Cervical sponylosis (DDD) - capsular pattern - OA
extension and LF B | contralateral LF unilaterally
61
Cervical spondylosis (DDD) - capsular pattern - Typical
extension then rot and LF B, contralateral flex and rot unilaterally
62
IV disc is stressed with
rotation | will have pain with rotation if IVD are injured
63
IVD herniation s/s - agg and rel
agg - with sustained postures, compression, repeated flex | rel - activity, traction
64
rim lesion is what
horizontal tear of AF | usually from hyperextension or whiplash
65
Pain with compression and distraction - think
rim lesion as a possibility
66
What will show tear of AF for diagnosis of rim lesion
MRI
67
Cervical nerve roots are numbered for
the vertebrae below it
68
IV foramen does what with flex and ext
widens with flex | narrows with ext
69
Cervical radiculopathy - exam will show
pos neurodynamic testing cervical rot less than 60 to painful side relief with distraction pain with Spurlings test
70
Post functional load testing
prone in neutral, hold 15 sec without fatigue
71
Ant functional load testing
supine in neutral for ____ ?
72
Deep neck flexor strengthening with pressure biofeedback
20 mmHg, increase 6-10 mmHg | hold for 10 sec with no substitutions
73
Hoffman's sign
UMN | flick distal phalanx of middle finger and if thumb moves is positive
74
Spurlings
flex, ext, LF
75
Upper trap length
Flex LF away Rot towards
76
Levator length
Flex LF away Rot away
77
Scalene - ant, middle, post
``` ant = LF toward, rotate away middle = LF toward, neutral rotation post = LF toward, rotate toward ``` All flex too
78
Spurling
Compression with varying motion | Spurling when you add LF and extension
79
Transverse ligament special test
``` Sharp Puser Stabilize forehead and C2 Glide head and C1 post (relocation test) May hear clunk, see excessive mvmnt, or pt will have dec in lip numbness POS = MED EMERGENCY ```
80
Alar ligament special test
Stabilize C2 | LF and rot head to assess mobility of C2
81
Tectorial membrane special test
Stabilize C2 apply traction Reassess with flex/ext Pos if reproduce sx or if distraction of more than 1-2mm

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