Cervical I

Question 1

Neck pain epidemiology

Answer 1

. More females than males
. Lifetime prevalence: 70%
. Incidence peaks 20-40 y/o
. Incidence higher in patients w/ multiple medical problems, high job stress, and occupational factors

Question 2

Neck pain complaint causes

Answer 2

. Poor posture 
. Repetitive use and strain 
. Degenerative spine/disc 
. Trauma 
. Rheumatic conditions 
. Head and neck infections 
. Psychological stress 
. Respiratory problems 
. Compensatory

Question 3

Atlas

Answer 3

. No vertebral body
. Rotates around dens of C2
. Heavy lat. mass palpable just inf./post to mastoid processes
. Small post. Tubercle instead of spinous process

Question 4

Axis

Answer 4

. Dens (odontoid process)

. Larger palpable, bifid spinous process

Question 5

What contributes to stability of cervical spine

Answer 5

. Unique uncinate (uncovertebral) joints of Luschka on lat. vertebral body

Question 6

Uncinate joints

Answer 6

. Allow fl/extension but limit segmental sidebending
. Potentially reduce disc herniation
. Shearing stresses can cause degenerative spurs as early as teen yrs

Question 7

Degenerative arthritis in uncinate and facet joints are causes of what?

Answer 7

.cervical nerve root compression

Question 8

Z joints of cervical spine

Answer 8

. 45 degree angle toward the eye

Question 9

Cervical transverse processes

Answer 9

. Ant. Part is modified rib
. Post. Part is true transverse process
. Ant. And post. Parts are fused but maintain a foramen for vertebral a. Starting at C6

Question 10

Vertebral aa.

Answer 10

. Provide circulation to post. Brain

. Extension and sidebending/rotation of c spine can put vertebral aa. At risk for occlusion in some patients

Question 11

Lateral masses/articular pillars of c spine

Answer 11

. Facet joints form bony column on lat. aspect of cervical column (lat. mass)
. Key landmark
. Palpable masses are not transverse processes

Question 12

Cervical landmarks for palpation

Answer 12

. Occiput
. Lat. mass of atlas 
. Spinous process of axis 
. Hyoid bone
. Thyroid
. Cricoid
. Vertebra prominens, large spinous process

Question 13

Neuro testing C5, 6, 7

Answer 13

. C5: motor: deltoid, biceps, bicep reflex, lat. arm dermatome
. C6: motor: bicep, wrist extensors, extensor reflex, lat. forearm dermatome
. C7: motor: tricep, wrist flexors, finger extensors, flexor reflex, middle finger dermatome

Question 14

Neuro testing C8 and T1

Answer 14

. C8: motor: interossei, finger flexors, no reflex, 4-5 fingers and forearm dermatome
. T1: motor: interossei, no reflex, med. elbow dermatome

Question 15

Fascia of neck

Answer 15

. Superficial, intermediate, deep
. Follows tube w/in tube structure
. Continues into mediastinum to blend into pericardium and great vessels
. Superficial fascia splits to invest the t rap and SCM mm.
. Superficial lymph penetrates investing fascia to gain access to deep lymph

Question 16

Cervical lymphatic

Answer 16

. Divided into superficial and deep chains

. Stretching neck mm. And fascia helps lymph drain

Question 17

Paravertebral mm.

Answer 17

. Longus colli (C1-T3)
. Longus capitus (occiput to C3-6)
. Traps: primary connection btw head, neck, and upper extremity

Question 18

Ant. Neck mm.

Answer 18

. Strap mm. Attach to sternum to hyoid and hyoid to skull
. Scalenes and deep paravertebrals stabilize head and neck
. Provide proprioceptive feedback

Question 19

Sternocleidomastoid m.

Answer 19

. Divides neck into ant. And post. Triangles
. Attaches to clavicle and sternum
. Innervated by CN XI
. Unilaterally sidebends beck to ipsilateral side, rotates away
. Bilaterally: flexor of neck, extender at OA joints
. Elevates amnubrium and med. ends of clavicle to assist in pump-handle motion in deep respiration

Question 20

Congenital torticollis

Answer 20

. Infants present w/ neck sidebent and rotated in opposite directions

Question 21

;evaporated scapula

Answer 21

. From transverse processes of C1-4
. Insert: upper med. scapula
. Elevates scapula and rotates med.

Question 22

Suboccipital mm.

Answer 22

. Stabilize head and act as proprioceptive sensors

. Irritability leads to headache that penetrates deep in skull

Question 23

Post. Spinal mm.

Answer 23

. Semispinalis, cervicis, and longissimus

. Can cause extension dysfunctions

Question 24

Ant. Spinal mm.

Answer 24

. Longus colli/rectus capitus

. Can cause flexion dysfunctions

Question 25

Deep layer post. Mm.

Answer 25

``` . Multifidae and rotators cervicis . Receive segmental innervation . Palpation of tart is best indication of segmental somatic dysfunction . Short mm. . Essential mm. Of proprioception ```

Question 26

Accessory mm. Of respiration

Answer 26

. SCM | . Scalenes

Question 27

Scalene mm.

Answer 27

. Connect cervical transverse processes to ribs 1 and 2 . Bilaterally flex neck . Unilaterally sidebend neck ipsilaterally, rotate away . Brachial plexus and subclavian a. Lie btw not. And middle scalene mm. . Scalene dysfunction can cause dysfunction of cervical spine and affect neurovascular components of upper extremity

Question 28

Thoracic outlet syndrome

Answer 28

. Neurovascular compression btw ant. And middle scalenes, clavicle and 1st rib OR bite pec minor and upper ribs . Result of trauma, repetitive movements, tumors, pregnancy, or cervical rib . N. Compression causes pain, weakness, . Arterial compression causes pallor and coldness in arm . Venous compression causes swelling and pain in arm

Question 29

Adson’s maneuver

Answer 29

. Tests for subclavian a. Compression . Compression: loss of radial pulse w/. Ipsilateral sidebending of neck, abducting and externally rotating arm, extending neck and holding breath . Test position tenses ant. And middle scalenes to narrow interscalene space . Pos test: radial pulse obliterated and symptoms reproduced

Question 30

Standing exam for neck pain

Answer 30

. Standing structural for posture, symmetry, relationship of head to weight, amt of lordosis

Question 31

Seated exam for neck pain

Answer 31

. AROM/PROM for cervical and thoracic regions, . Neurovascular exam . Exam of thoracic spine and ribs

Question 32

Active ROm of neck

Answer 32

``` . Flexion: 90 degrees . Extension 70 . Sidebending 35-45 . Rotation 90 . 50% of rotation occurs at atlantoaxial joint ```

Question 33

Wallenberg test

Answer 33

. Tests for vertebral insufficiency . Cervical spine is extended and then gently rotated side to side . If nystagmus develops or patient is nauseous or dizzy then cervical articulatory techniques contraindicated

Question 34

OA in c spine

Answer 34

. Hypertrophic changes of z joints and vertebral bodies . Treat w./ specific mobilization of restricted areas . Strengthen cervical musculature and facilitate stability

Question 35

RA and down’s in c spine

Answer 35

. Ligamentous laxity of C2 causing C1 and C2 instability | . Contraindication of thirst techniques