Cervical Spine Flashcards by Sean Sawer

Cervical spine roots

Above vertebrae

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Discs in our C spine?

No disk in the upper C spine

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Disc shape

Thin (for greater mobility)
Thicker anterior (for lordosis)

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Cervical radiculopathy- etiology

Disc herniation
Stenosis
Swelling/ inflammation

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Dynamic disc theory

Disc contents can move do to movements
Nucleus paplposis move posterio lateral (weakest part of the annulus)

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Cervical myelopathy

When the disc compresses onto the spinal cord

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Stenosis definition

Narrowing

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Stenosis causes

Osteophytes- lateral stenosis, degeneration of the spine (spodylosis)- lateral stenosis ,ligamentum flavum thickening (central stenosis)

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Neuro scan

Dermatome
Myotome
Reflexes
Special tests

Perform when you see any S & S, or want to rule out

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Dermatome procedure

1) get comfy
2) expose (not over clothing)
3) confirm understanding by testing sensation on another area
4) ask patient to close eyes
5) test entire Dermatome (proximal to distal)
6) bilateral
7) start light
8) if impaired test further with sharp blunt

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Dermatome Tricks

Star Trek sign (C5 radial- T1 ulnar)

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Cervical myotomes

Hold position and don’t let me move you (therapist should resis 5-8 sec)
Test bilaterally

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Cervical myotomes

C1,2- neck flexion S
C3- side flexion
4- shoulder elevation
5- shoulder abduction
6- elbow flexion, wrist extension
7- elbow extension, wrist flexion
8- thumb extension, ulnar deviation
T1- finger abduction/ adduction

Important to know alternatives as sometimes someone is limited abilities (comorbidities)

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Cervical reflexes

Deep tendon reflexes

If unable to get response- distract
- Jendrassik Maneuver( sit cross legged and try to pull apart)
- or count down from 99

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Cervical reflexes- areas

C5- deltoid
C6- biceps/ brachioradialis
C7- Triceps
C8- Pronator quadratics
T1- Abductor digit Minimi

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Reflex grades

0- no response
1- decreased response
2- normal response
3- exaggerated response
4- highteed

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UMN reflexes test - possible lesion of spinal cord, brain stem or brain

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Clonus
Babinski

Cervical special tests

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Cervical distraction test (positive- if symptoms reduced)
Spurling’s (reproduction of symptoms)

Upper limb tension test- procedure

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Supine
Test unaffected side first
Shoulder- forearm- wrist- fingers- ELBOW
Sensitize
Positive- reproduction of symptoms

Median nerve test (ULTT1)

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Shoulder depression, abduction (110 ULTT1, 40 ULTT1)
Supination forearm
Wrist extension
Finger thumb extension
Elbow extension

Radial nerve

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Shoulder depression abduction
Forearm pronation
Wrist flexion and ulnar deviation
Fingers and thumb flexion
Elbow extension

Ulnar (C8- T1 nerve roots)

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Depression abduction (10-90)
Forearm pronation
Wrist extension and radial deviation
Fingers and thumb ext
Elbow flexion

Stenosis intervention

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Open up intervertebral forman (flexion, traction, ipsilateral side flex and rotation)

Herniation interventions

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Retraction progressions

Ebb-Duchene paralysis

Brachial plexus injury (upper) Upper nerve root c5-6. waiters tip position Shoulder elbow paralysis Deltoid and radial surface and hand Shoulder dystopia during birth

Klumke’s Paralysis

C8, T1 lower brachial plexus. Forearm, hand, triceps paralysis Looks like an arm in a cast and a claw hand deformity From childbirth due to traction on an abducted arms as child being pulled out of birth

Facet Syndrome

Pain is worse with compression stress on the facet joint Pain in neck and/ or scapula region

Cervical facet arthrokinetmatics

Cervical facet joints are angle towards the eyes Side bending and rotation occur towards the same side Coupled mints into extension may be used to rule out facet joint involvement

Non-physiocological coupled movements (C spine)

Side flexion and rotation are performed i the opposite side

Vetebrobasilar insufficiency (VBI)- 5Ds 3Ns

Dizziness Diplopia Drop attacks Dysphagia (NOT dysphasia as that is a learning impairment) Dysarthria Nystagmus Nausea or vomiting Other neurological symptoms

Vertebral artery test (Cervical Quadrant test)

Patient supine position Take head into extension and side flexion and hold for 10-30 secs (eyes open ) If no symptoms, ipsilateral side flexion for another 10-30 secs Positive test- dizziness or nystagmus, indicates that the contalateral side is obstructed

Torticollis (congenital or acquired)

Unlateral shortening of the SCM muscle: ipsilateral side flexion and contra lateral rotation of the C-spine causing decreased AROM and PROM in the opposite side Rx: stretch the affected side SCM, strengthening exercises to improve balance between both sides

Congenital torticollis

Positional in uterus or trauma in childbirth Handling can help. Positional plagiocephaly- flat head syndrome when laying on one side and get flatter

Upper crossed syndrome

Chin poking (forward head) Tight- pec and upper trap and lev scap Weak- deep flexor and lower trap, rhomboids and serratus anterior May lead to alignment issues due to stress (ex. Facet joints and posterior discs)

Upper crossed- treatments

Postural correction Stretch tight Strengthen weak

Cervical instability

Excessive motion b/w two adjacent vertebrae Due to ligament damage, #, dislocation, joint damage, or weak muscles- from trauma, congenital malformations, long term corticosteroids, or secondary to other pathologies (ie. RA, or Down syndrome) If instability is suspected, no mobs or manipulations

S&S of cervical instability

Dizzy Lip or facial parenthesis Lump in throat Nausea/ vomiting Nystagmus Patient hesitant to move head or neck Pupil changes Severe headache Severe muscle spasm Soft end feel

Cervical spine tests

Antior shear or Sagittarius stress test Lateral flexion alar ligamanet stress test Lateral shear test Sharp-purser test Cervical flexion rotation test

Cervical spine muscular control

Inner unit muscles - attach segmentally and are tonic muscles that maintain posture - includes deep neck flexors, deep neck extensors, and suboccipital S - can often become weak and result in compensation from elsewhere

Special test for segmental stability

Craniocervical flexion test (increase pressure cuff) Hold for 10 secs Shoulder get at least 26 mmHg when starting at 20mmHg

How to improve segmental instability

Deep neck flexors training - aids in coordination and timing - analgesic effect

Cervical Spine Flashcards

(41 cards)