Cervical Spine

Question 1

‘Typical’ Cervical vertebrae

Answer 1

C3-C6

Question 2

Cranio-cervical region of spine

Answer 2

Occiput, C1 and C2

Question 3

Midcervical region of spine

Answer 3

C3-C6

Question 4

Cervico-Thoracic region of spine

Answer 4

C7-T2

“transition zone” - experiences more wear and tear

Question 5

Atlas

Answer 5

Role: Support the head
Anterior Arch:
- Tubercle for attachment of ant. longitudinal lig.
- Where dens of axis makes contact
Posterior Arch: Larger than anterior
Large transverse processess for ligaments that connect spine to cranium

Question 6

Articular Facets of Atlas (C1)

Answer 6

Both are concave

Question 7

Dens

Answer 7

Rigid vertical axis of rotation on axis (C2)

Makes contact with anterior arch of atlas

Question 8

Transverse ligament

Answer 8

Holds dens to anterior arch - attaches to lateral masses of atlas
Role: Horizontal stability of the atlanto-axial articulation

Question 9

Superior articular facets of C2

Answer 9

Convex

Question 10

Uncovertebral joints

Answer 10

Lip of bone on lateral side of vertebral bodies in C3-C6

AKA Joints of Luschka

Question 11

Atlanto-Occipital Joint

Answer 11

Primary Motion: Flexion/Extension
Minimal side bend
Rotational motion limited

Question 12

Atlanto-Axial Joint

Answer 12

Accounts for 50% of all cervical rotation (averages 40-45 degrees each direction)
Right rotation: Posterior-Inferior movement of right lateral mass with anterior-superior movement of left lateral mass (airplane analogy)

Question 13

Isolating AA Joint

Answer 13

Slowly take up full cervical flexion,

Maintain full flexion while gently rotating to either side

Question 14

Angle of cervical facet joints

Answer 14

45 degrees

Question 15

Nuchal Ligament

Answer 15

Limits cervical flexion

Continuation of the suprasinous ligaments

Question 16

Tectorial Membrane

Answer 16

Extension of the posterior longitudinal ligament
Attaches to the basilar portion of the occipital bone
Role: Generalized multidirectional stability

Question 17

Disruption of the Transverse Ligament

Answer 17

Often with trauma
Can occur with congenital conditions such as Down Syndrome or RA
Diagnostic image: Open Mouth films
- Look at distance between lateral mass of C1- want dens to be evenly spaced between the two.

Question 18

Test for Transverse Ligament

Answer 18

Modified Sharp Purser Test
- Pt sitting
- Slight cervical flexion
- **Assess resting symptoms
- C2 spinous process stabilized with a pincer grip
- Gently apply force at forehead (posterior, NOT into extension)
- Assess Symptoms
Positive Test: Decrease in symptoms with AP motion of the head OR excessive displacement with AP movement

Question 19

Alar Ligaments

Answer 19

Attach the apex of the dens to the medial sides of the occipital condyles
Resist excessive rotation of the head and atlas relative to the dens/C2 - C2 should move a bit with C1 during rotation

Question 20

Alar Ligament Test

Answer 20

• Patient in sitting
• Slight flexion to further engage the alar ligament
• Examiner stabilizes the C2 spinous process with pincher grip
• Initiate passive side flexion or rotation (just 5-10 degrees)
• Feel the movement of C2 during these movements
  Positive test: Failure to feel the movement of C2 (when rotation the head to the left, you should feel the right side of the spinous process pop up a bit)

Question 21

Why do the alar ligament and transverse ligament tests?

Answer 21

Easy, no equipment needed
Shows that you’ve assessed C-spine for documentation purposes

**BUT can cause more harm - assess symptoms, history, presentation first

Question 22

Vertebral Artery

Answer 22

Blood flow can be limited on one side with contralateral rotation

Question 23

Vertebrobasilar Artery Insufficiency test

Answer 23

**Need to do this before any C-spine manual therapy
Subjective history: Dizziness, diplopia, dysarthria, dysphagia, drop attacks, N/V, HA, Nystagmus

AKA VBI Test

Maitland:
Pt is seated - keep their eyes open
- Extension, 10 second hold
- Rotation, both directions, 10 second hold each way
- Extension+Rotation, both directions, 10 second hold each way

Question 24

Deep Short Neck Flexors

Answer 24

Rectus Capitus Anterior
Rectus Capitus Lateralis
-Attach from transverse processes/ anterolateral vertebral body of C1 to occipital bone

Question 25

Deep Long Neck Flexors

Answer 25

Longus Capitus

Longus Colli

Question 26

Superficial Neck Flexors

Answer 26

SCM
Scalenes
Hypertonic Tendencies
–> Potential vascular and neural compromise when scalenes are hypertonic because Brachial Plexus and Subclavian artery are running right here

(Scalenes also elevate ribs 1 and 2)

Question 27

How to use pelvis to facilitate head retraction (upper cervical flexion)

Answer 27

Anterior pelvic tilt? (in supine)

Question 28

Levator Scapulae

Answer 28

Area of frequent trigger points

Shoulder and cervical pain with decreased rotation

Question 29

Upper Trapezius

Answer 29

Area of frequent trigger points

Compressess C1-C2

Question 30

Posterior Intrinsic Extensors

Answer 30

Multifidus
Semispinalis Capitus
Semispinalis Cervicus
Rotatores
Splenus Capitus and Cervicus

Question 31

Suboccipitals

Answer 31

Rectus Capitus Posterior Major
Rectus Capitus Posterior Minor - More problems
- Spinous process to occiput
Obliquus Capitus Superior
- Transverse Process C1 to occiput
Obliquus Capitus Inferior
- Spinous Process C2 to Transverse Process C1

Question 32

Suboccipital Release

Answer 32

Maintain release with goal of contact with posterior rim of C1
Note any asymmetries

Question 33

What does the tendency for hypomobility at the cranio-cervical and cervico-thoracic regions contribute to?

Answer 33

Overuse of mid-cervical levels and common pathology of C5,6,7