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Cervical Spine Flashcards

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1
Q

How many vertebrae in the Cervical Region?

A

7

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2
Q

What are the names of C1 and C2?

A

Atlas (C1), Axis (C2)

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3
Q

What structure does Vertebral Artery travel through?

A

Transverse Processes of Spine

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4
Q

What structures do nerve roots travel through?

A

Intervertebral foramen

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5
Q

What is the Craniovertebral Region made up of?

A

Cranium, C1 and C2

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6
Q

What are the names of the two major ligaments in our skull region?

A

Alar ligament and Transverse Atlantal Ligament

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7
Q

Where does Alar Ligament attach?

A

Arises from sides of odontoid process (dens) and it passes laterally to attach to occiput

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8
Q

What does the Alar ligament prevent?

A

Flexion and rotation

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9
Q

Roles of Transverse Atlantal Ligament

A

Keeps the dens in contact with the anterior arch of the atlas and keeps dens away from the spinal cord

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10
Q

What would happen with a Transverse Atlantal Ligament sprain?

A

Dens could migrate posteriorly within the central foramen and could impinge spinal cord

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11
Q

What are the 4 parts of the Vertebral Artery?

A
  1. Proximal
  2. Transverse
  3. Suboccipital
  4. Intracranial
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12
Q

What part of the vertebral artery is more susceptible to injury?

A

Laterally bending/ continuous bending. It has two 90 degree bends due to C1 being so much further so large ROM, already under stress from the weaving, rotation causes pinching

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13
Q

Where does proximal vertebral artery start and enter?

A

It runs off the origin of the artery (subclavian) and travels up entering at approximately C6

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14
Q

Where is the point of entry for the transverse vertebral artery?

A

Point of entry from C6 and runs to C2. This is the straight vertical part of the artery.

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15
Q

Where does the suboccipital vertebral artery run?

A

Runs from the transverse foramen of C2 to point of penetration in the foramen magnum to enter brian.

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16
Q

Where does the Intracranial vertebral artery run?

A

Penetration of dura mater at the level of the foramen magnum to the lower border of the pons.

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17
Q

Vertebrobasilar Insufficiency Internal Causes

A

Atherosclerosis and Thrombosis

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18
Q

What is thrombosis?

A

Thrombosis is a blood clot where we have occlusion of the artery

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19
Q

What is atherosclerosis?

A

Fatty deposit within the artery causing a slight blockage of blood flow; limits blood flow due to less surface area

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20
Q

What portions of the vertebral artery are more commonly affected by vertebrobasilar insufficiency internal cause?

A

Proximal and Transverse

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21
Q

Vertebrobasilar Insufficiency External Cause: Dissection.

A

Tearing of the artery

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22
Q

What does a vertebral artery dissection consist of?

A

Tearing of tunica intima which decreases lumen size and we get less blood flow and blood fills between the inner and outer layer of the artery instead. (can lead to blood clot)

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23
Q

What can happen with dissection and cervical instability?

A

instability can disrupt ligaments causing larger ROM that is unfavourable

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24
Q

What happens if the alar ligament is ruptured?

A

we get a 30% increase in rotation causing a dramatic strain on artery with increased rotation

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25
Vertebral Artery Dissection- what motions would be dangerous in this case?
Flexion and extension of neck, need to avoid aggressive rotation when treating C1, C2 injury
26
Subjective Assessment for Vertebral Artery Dissection
- dizziness, virtual disturbances, paraesthesia, motor disturbance, deafness, swallowing, tinnitus,
27
What would you observe if someone had vertebral artery dissection?
- slurred speech, ataxic gait
28
What ligaments would you assess for Craniovertebral Stability?
Alar ligament, Transverse Ligament | --> test if they are stretched
29
Vertebral Artery Testing?
test by rotation, rotation and extension, (not done in clinics anymore)
30
Neck Region Red Flag Screening: Vertebrobasilar Insufficiency
5D's and 3N's - dizziness, - diplopia (double vision) - dysphagia (trouble swallowing) - dysarthria (trouble speaking) - drop attacks (fainting spells) - nausea - numbness (mostly around mouth) - nystagmus (uncontrolled eye movements)
31
12 cranial nerves:
``` I: Olfactory II: Optic III: Oculomotor IV: Trochlear V: Trigeminal (V1, V2, V3) VI: Abducens VII: Facial VIII: Vestibulocochlear (auditory) IX: Glossopharyngeal X: Vagus XI: spinal accessory nerve XII: Hypoglossal ```
32
Cranial Nerve I: Olfactory; sensory, motor or both? testing?
Sensory: smell Test: close a nostril and ask if they can smell something; alcohol, coffee grinds, etc
33
Cranial Nerve II: Optic; sensory, motor or both? testing?
Sensory: vision Test: eye test/exam, see how far they can see, peripheral vision, examine expansive visual field
34
Cranial Nerve III: Oculomotor
Motor: movements of the eyes, pupil dilation Test: superior, inferior, medial, superolateral, pupillary reaction to light
35
Cranial Nerve IV: Trochlear; sensory, motor or both? testing?
Motor: controls eye movement of ONE eye muscle- superior oblique Test: inferomedial; look towards nose
36
Cranial Nerve V: Trigeminal VI; sensory, motor or both?
Both | V1- opthalmic; sensation to the forehead
37
Cranial Nerve V: Trigeminal V2; sensory, motor or both?
Both V2: maxillary Sensation to upper lip
38
Cranial Nerve V: Trigeminal V3; sensory, motor or both?
Both V3: mandibular Sensory to chin
39
Motor controls for Trigeminal Nerve and how to test Trigeminal Nerve
Motor: muscles of mastication Test: the sensation of the face, clench jaw
40
Cranial Nerve VI: Abducens; sensory, motor or both? testing?
Motor: Controls eye movement with ONE muscle- lateral rectus Test: lateral (abduct)
41
Cranial Nerve VII: Facial; sensory, motor or both?
Both Sensory: tongue, anterior 2/3 of tongue Motor: fascial muscles Test: fascial expressions
42
Cranial Nerve VIII: Vestibulocochlear; sensory, motor or both?
Sensory Auditory (hearing), vestibular system (equilibrium) Test: hearing of each ear, can they hear fingers rub together with eyes closed?
43
Cranial Nerve IX: Glossopharyngeal; sensory, motor or both?
Both Sensory: taste with posterior 1/3 of tongue Motor: swallowing Test: uvula elevation, gag reflexes, swallowing, can you feel larynx move?
44
Cranial Nerve X: Vagus; sensory, motor or both?
Both: Sensory: visceral sensation (lungs, GI tract) Motor: pharynx, larynx, soft palate, heart (RHR), involuntary muscles of the digestive tract Test: uvula elevation, gag reflex, swallowing,
45
Cranial Nerve XII: Spinal Accessory Nerve; sensory, motor or both?
Motor - trapezius and sternocleidomastoid Test: scapular elevation
46
Cranial Nerve XII: Hypoglossal; sensory, motor or both?
Motor - muscles of the tongue (intrinsic and extrinsic) Test: tongue protrusion; if injured, tongue will lean towards affected side
47
What Nerves Control Eye Muscle Movement?
Abducens- lateral rectus Trochlear- superior oblique Oculomotor- inferior oblique, superior rectus, medial rectus and inferior rectus
48
What is Bells Palsy?
idiopathic onset of facial pain- temporary facial paralysis or weakness on one side of the face - dysfunction of nerve VII - fascial nerve - due to swelling and inflammation of VII 85% of cases recover in 3 weeks
49
What does a neuro exam look at?
myotomes, dermatomes, reflexes
50
What are Dermatomes?
A localized area of skin that has sensation primarily via one single nerve root - can provide good approximation for cord levels but some overlap occurs - dermatome pattern begins with C2 dermatome. - pins and needles or impaired sensation of back of the neck would cause suspicion of C2 being impinged
51
Dermatome Testing
- use reference point (like cheek) - touch cheek and ask them to remember how it feels and then do the same touch on dermatome areas and ask what they feel in regards to reference touch - test each dermatome using different stimuli on both left and right side
52
C2 Dermatome- body level
mastoid process
53
C3 Dermatome- body level
supraclavicular fossa
54
C4 Dermatome- body level
Acromioclavicular Joint
55
C5 Dermatome- body level
Radial side of Antecubital Fossa
56
C6 Dermatome- body level
Thumb (dorsal side)
57
C7 Dermatome- body level
Middle Finger (dorsal side)
58
C8 Dermatome- body level
Little finger (dorsal side)
59
T1 Dermatome- body level
Medial Epicondyle
60
What is a myotome?
A muscle or group of muscles supplied by a single nerve root
61
Myotome: muscle weakness
Fatigued right away when force is applied and you can break force right away
62
Myotome: fatiguable weakness
can hold muscle contraction for a prolonged period, however, when you repeat it it becomes weaker each time you do it. - a positive myotome will fatigue with repeated reps
63
C2 myotome: action
neck flexion
64
C3 myotome: action
neck side-bend
65
C4 myotome: action
shoulder shrug
66
C5 myotome: action
shoulder abduction
67
C6 myotome: action
elbow flexion, wrist extension
68
C7 myotome: action
elbow extension, wrist flexion
69
C8 myotome: action
thumb extension
70
T1 myotome: action
finger splay
71
What is a deep tendon reflex? (DTR)
a brisk tap to a partially stretched muscle tendon near its point of insertion - elicits a DTR
72
Reflexes depend on:
- intact afferent nerve fibres (sensory) - intact efferent nerve fibres (motor) - normal functioning synapses in the spine - normal functioning neuromuscular junctions on the tapped muscle - normal muscle functioning (contraction)
73
Reflex Tips:
- ensure the patient is fully relaxed | - distract patient if they cannot relax fully themselves
74
Jendrassik Maneuvers
- Upper extremity reflexes: clench teeth, squeeze thighs, cross feet - Lower extremity reflexes: lock fingers together and pull one against the other - increases drive of reflex
75
C5 Nerve: reflex target
biceps
76
C6 Nerve: reflex target
brachioradialis
77
C7 Nerve: reflex target
triceps
78
Grade 0 DTR:
absent, (arereflexia)
79
Grade 1 DTR
diminished reflexes (hyporeflexia), reflex but not as dramatic as you hope
80
Grade 2 DTR
Normal
81
Grade 3 DTR
Exaggerated reflex (hyper-reflexive) without clonus
82
Grade 4 DTR
Hyperactive with clonus (rhythmic oscillations between flexion and extension)
83
C5: reflex, sensory, motor
- Abduction of the shoulder, sensation is anterior medial bicep, and we have bicep reflex
84
C6: reflex, sensory, motor
- Free throw position - bicep flexion, wrist extension, - sensory is over thumb on the dorsal aspect - decreased brachioradialis reflex
85
C7: reflex, sensory, motor
- impingement at neck, - fatigable weakness with elbow extension (triceps) and wrist flexion - sensation down the backside of the middle finger - impaired tricep reflex
86
C8: sensory, reflex, motor
- thumb extension - numbness in the pinky - associated reflex
87
T1: sensory, reflex, motor
- finger splay | - an impaired sensation of inside of bicep (no reflex)
88
Intervertebral Foramen
- Between every pair of vertebrae are two apertures (openings), the intervertebral foramina - The foramen allows for the passage of the spinal nerve root, dorsal root ganglion, the spinal artery of the segmental artery, communicating veins - Increase in the volume with flexion (flexion opens and makes room) - Decrease in the volume with extension
89
What can cause decreased space in Intervertebral Foramen
- disc hernia, or osteophyte formation, inflammation, or spinal tumour (can all cause impingement on nerve)
90
Cervical Radiculopathy
- impingement of cervical spinal nerve or nerve root - commonly worse with extension, ipsilateral side-bending/rotation - unilateral neuropathic pain - dermatome and/or myotome reflex deficits where the nerve is compressed - may be relieved with the head flexed forward or looking towards oppposite side
91
C6 Radiculopathy
- fatigable weakness with elbow flexion (bicep) or wrist extension - sensation in lateral arm - reflex 1/4: hypo-reflexive brachioradialis - aggravated with neck extension, ipsilateral side flexion/rotation, - easing; neck flexion - motor deficit in myotomes - most ocmmonly affected ; levada curve - segment is already in the most amount of extension
92
Etiology
narrowing (stenosis) of IVF (decreased disc height) - IVF dis herniation - infection - inflammatory exudate - physical injury or trauma - spinal tumours
93
Treatment for Cervical Radiculopathy: Education
- posture - medication; NSAIDs, neuropathic - avoidance of aggravating positions (extension, ipsilateral rotation, side-flexion) - encourage alleviating postiions (flexion, contralateral rotation)
94
Treatment for Cervical Radiculopathy: Manual Therapy
- global and local cervical spine traction - segmental SAL mobilizations - Soft tissue techniques (i.e., massage, stretching) of the mechanical interface of C6
95
Treatment for Cervical Radiculopathy: Exercise
- neurodynamic flossing (median, radial) | - encourage nerve to wiggle itself free

Injuries (6 decks)

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