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Cervical Spine I Flashcards

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1
Q

Describe the vertebral artery anatomy

A

Arises from subclavian artery and passes upward on longus colli to enter C6 foramen up to C1 to 1st cervical nerve and veins piercing post OA membrane and then foramen magnum to join basilar artery

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2
Q

Percentages of vertebral vs carotid cerebral blood flow

A

Vertebral is 11% and carotid is 89%

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3
Q

Name the AO ligaments

A

Anterior and posterior Atlanto occipital membranes

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4
Q

Name the C2 with occiput ligaments

A

Tectorial membrane
Alar ligament
Apical ligament

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5
Q

Name the AA joint ligaments

A

Anterior and posterior atlantoaxial membrane
Transverse/cruciate ligament

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6
Q

Anterior Atlanto Occipital Membrane

Connects
Provides

A

Anterior foramen magnum to anterior arch C1

AP stability

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7
Q

What ligament is a continuation of the ALL ligament?

A

Anterior Atlanto Occipital membrane

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8
Q

Posterior Atlanto Occipital Membrane

Connects
Provides

A

Occiput to post ring of C1

Prevents anterior and vertical translation of C1/C2

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9
Q

Which ligament is analogous to posterior Atlanto occipital membrane in cervical spine?

A

Yellow ligament

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10
Q

Tectorial Membrane

Connects
Provides

A

C2 body to foramen magnum
Limits flx, ext, vertical translation

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11
Q

Alar Ligament

Connects
Provides

A

Dens obliquely to occipital condyles
Rotation
(L LIMITS C1 ROTATION OF HEAD TO R)

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12
Q

Which C2 with oxxiput ligament has no major significance?

A

Apical

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13
Q

Which cervical ligament is continuation of PLL

A

Tectorial membrane

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14
Q

Anterior Atlanto Axial Membrane

Connects

A

C1 to C2 anteriorly

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15
Q

Posterior Atlanto Axial Membrane

Connects

A

Post ring of atlas and axis

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16
Q

Which AA ligament is continuation/analogous to yellow lig?

A

Posterior Atlanto Axial membrane

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17
Q

When is true yellow ligament (lig flavum) present and why?

A

Not present until C2/C3 to allow UCS rotation. Compromises stability for mobility

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18
Q

Transverse ligament

Connects

A

Dens in tact with anterior arch C1

MOST IMPORTANT LIG IN UCS

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19
Q

Nuchal ligament

Connects
Function

A

Posterior occipit to C7
No major sig

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20
Q

ALL

Connects
Function

A

Entire length of spine
Little known

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21
Q

Name the suboccipital muscles

A

Recurs capitus post major/minor
Oblique capitus superior/inferior

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22
Q

The sub occipital muscles all produce what functions?

A

B/L extension and unilateral SB and rot of UCS

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23
Q

Rectus capitis posterior major connects?

A

C2 SP to inf nuchal line on occiput

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24
Q

Rectus capitis posterior minor connects?

A

C1 post tubercle to inferior nuchal line on occiput

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25
Oblique capitis superior connects
C1 TP to lateral inferior nuchal line
26
Obliques capitus inferior connects
C2 SP to C1 TP
27
Name the lower cervical flexors
SCM Longus Colli Hyoids Scalenes
28
Name the upper cervical flexors
Longus capitus Rectus capitis anterior and lateralis
29
Longus colli Connects Function
Anterior arch atlas to T3 vertebral body Deepest anterior cervical muscle, provides cervical flexion and important stabilization
30
Hyoids Connect Function
Hyoid bone to mandible and thorax Neck flexion and stability, open mouth
31
Scalenes Connects Function
Anterior: C3-C6 TPs to 1st rib Middle: C2-C7 TPs to 1st rib Posterior: C4-C6 TPs to 2nd rib Unilateral: IPS SB and Rotation B/L: inspiration
32
Name the cervical extensors
Splenius capitis Semispinalis capitis
33
Splenius capitis Connects Function
T1-T3 SPs and nuchal lig C5-C7 to superior nuchal line and mastoid Ipsilateral rotation
34
Semispinalis capitis Connects Function
C4-C6 TPs and C7-T1 SPs to lat EOP B/L extension U/L contralateral SB
35
Levator Connects Function
C1-C4 TP to superior angle scap Elevates and downwardly rotates scap
36
Platysma Connects Function
Most superficial anterior cervical muscle Wide mouth opening
37
Cricoid Connects Function
Vertebral artery entered transverse foramen of C6 here
38
Total C spine flexion/extension
Flx: 45-50 Ext: 75-80
39
Total C spine SB/Rot
SB: 35-40 Rot: 65-75
40
C0-C1 flx/ext
Flx: 5 Ext: 10
41
C0/C1SB and rot
SB: 5 Rot: 0
42
C1-C2 flex/ext
Flx: 5 Ext: 10
43
C1-C2 SB and rot AROM
SB: 0 Rotation: 35-40
44
C2-C7 flx/ext
Flx: 35-40 Ext: 55-60
45
C2-C7 rot/SB AROM
Rotation: 30-35 SB: 30-35
46
Upper vs lower cervical spine arthros
Upper: SB and rot opp Lower: SB and rot same
47
OA arthros flx/ext/SB
Flx: Convex occipital condyles glide posterior Ext: convex occipital condyles glide anterior SB to R: R C0 MIA, L C0 LPS with conjunct L rot
48
AA arthros flx, ext, rotation
Flx: vex C1 facets roll ant and glide post Ext: vex C1 facets roll post and glide ant R rot: C1 R facet glides post and C1 L facet glides anterior
49
Mid cervical spine arthros
Flx: glide up and forward Ext: glide down and back R SB: R down and back, L up and forward R ROT: R down and back, L up and forward
50
L UCS rotation and alar ligament
L UCS rotation will tighten the R alar ligament, moving R occipital condyle left, producing R SB
51
Canadian C Spine Rules Automatic radiograph
Automatic radiograph: Age>65 Fall over 1 meter or 5 stairs Axial load to head MVA > 100km/hr Bike collision Paresthesias in extremities
52
Canadian C spine Rules 2nd tier
If no to automatic radiographs section: Injury was rear end collision Delayed onset neck pain Absence of midline tenderness of c spine Ambulatory at any time Able to sit in ER
53
Canadian C spine rules last tier
Able to AROM rotate 45 each way If no: radiograph
54
Cervical Spine Stenosis - define - associated with
Narrowing of spinal canal, central or lateral Spondylosis
55
What is most common cause of cervical spinal disorders in those > 55 yrs old
Stenosis
56
Names the 3 kinds of cervical spine stenosis
Traumatic Congenital Degenerative
57
Degenerative cervical spine stenosis can be due to?
Osteophytes, lig flavum hypertrophy, DDD
58
Cervical spine flx opens canal by how much and ext closes canal by how much
Flx opens 31% Ext closes 26%
59
Best PT rec for short term relief for cervical spine stenosis
Acupuncture and cervical collar
60
Best PT rec for cervical spine stenosis
Traction Thoracic manipulation Flx based protocol
61
Traction guidelines for cervical spine stenosis
15-20m at 16-24# in 24 degrees cervical flexion
62
Cervical myelopathy - definition - classified by
Cervical cord compression Gait dysfunction
63
Cervical myelopathy sx
Unsteady gait + Hoffman’s / + babinksi B/L or Q/L parasthesias Hyper reflexia B/B issues Intrinsic muscle wasting of hands
64
Cervical myelopathy cluster
Gait deviations + Hoffman’s + inverted Supinator + babinski Age > 45 3/5 = +30.9 LR 1/5 = -.18 LR
65
Whiplash Do not test what Tx
Can be either flexion or ext based, ext worse Vertebral artery for first 4-6 weeks Cervical collar 3 weeks or until capsular pattern reduces
66
Median recovery time for whiplash
31 days
67
Whiplash prognostic factors for full recovery
<35 yrs old NDI < 32%
68
Whiplash prognostic factors for ongoing pain
Age > 35 NDI > 40% Hyperalgesia sx and cold intolerance
69
Percentage of patients who do well in PT for whiplash
40% do well 40% mod well 20% no improvement
70
Cervical radiculopathy Common nerve and age
C6/C7 40-50
71
Cluster to identify cervical radic
+ULTT < 60 degrees towards painful side + spurlings + distraction 2/4 21% 3/4 65% 4/4 90%
72
PT tx for cervical radic
Mixed but usually involves Cervical side glides Cervical traction Thoracic manipulation Deep neck flx strengthening
73
Disc lesions in C spine Sx
Limited flx, scapular/arm pain Traction helps, posterolateral prolapse rare in C spine
74
Acute Torticollis causes
Disc derangement Facet it dislocation SCM spasms Facet impingement c2/c3
75
Tx for acute toeticollis from disc derangement and facet impingement
Disc derangement: traction with ext Impingement: mobs
76
4 categories for differential diagnoses
1. Movement 2. Neuro 3. Compression/distraction 4. Segmental tests/stress
77
When is it good to use sustained postures for testing?
When AROM, PROM, resistance not producing sx
78
Shoulder abduction test
Patient sitting or standing, have patient put arm on top of their head + test is reduction in sx for C5/C6 compression
79
Dizziness test
Seated, PROM to head rotation, then head stable and rotate trunk. If sx with both then possible vertebral A If sx only with head rotation, possible inner ear
80
Cervical reflexes
C5: biceps C6: brachioradialis C7: triceps
81
Cervical cutaneous innervation
C1: vertex of head C2: post auricular C3: lateral neck C4: upper trap C5: lateral arm/deltoid C6: post thumb C7: post mid finger C8: post pinky finger T1: medial forearm T2: axilla
82
Cervical myotomes
C1: head flx - Rectus capitis ant and lat C2: head ext - Rectus capitis post C3: neck SB: scaleni C4: shld elevate: UT and levator C5: shld abd: deltoid, Supra C6: elbow flx, wrist ext: biceps, ECRL/B C7: elbow ext, wrist flx: triceps, FCR C8: thumb ext: EPL/EPB T1: finger add/abd: interrosseous
83
C5/C6/C7/C8/T1 root syndrome pain referrals
C5 - scap, arm down to radial wrist/hand no fingers C6 - to index finger and thumb C7 - index/mid/ring finger, back of arm C8 - 4th/5th fingers T- - no scap or finger pain, medial arm and forearm
84
C8 diff diagnosis
TOS PANCOST TUMOR
85
Craniovertebral scan What order to screen
Test UCS first and then vertebral artery
86
Cervical cord compression/myelopathy cardinal sx
B/L or Q/L parasthesias Hyper reflexia below lesion level (@ or above lesion level will be hypo) + clonus, babinski, Hoffman’s, inverted supinator Arm/leg weak B/L lack coordination
87
Shimizu reflex or scapulohumeral reflex
Apply caudal direction force to tip of spine of scap and acromion + is elevation of scap or abd humerus + UMN above C3
88
Most common C spine adverse event
Craniovertebral artery dissection (57%)
89
SAEs under 50 age usually due to
Trauma
90
Risk factors for arterial dysfunction
Diabetes Hypertension High cholesterol Corticosteroid use Migraines Trauma Cardiac disease Vascular disease Blood clotting disorders Anticoagulants Smoker Recent infection Immediately post partum Absence of mechanical source for sx
91
Early presentation sx for vascular adverse event
Mid upper cervical pain Pain around ear/jaw Frontotemporoparietal head pain Occipital headache Pain “unlike any other” (main finding)
92
Besides HVLA, what else do you want to stay away from for vascular compromise?
Any end range techniques
93
Cranial nerve scan
1: olfactory: smell 2/3: optic/occulomotor: pen light on pupil to constrict 3/4/6: occulomotor, torchlear, abducens: follow H pattern 5: trigrminal: clench teeth for massater palpation 7: facial: smile, puff cheeks, raise eyebrows 8: acoustic: can follow commands 9/10: glossooharyngeal/vagus: stick out tongue and say ah tongue midline 11: spinal acc, resist shld shrug and rot head 12: hypoglossal: tongue stick out and side to side

Cervical Spine I (1 decks)

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