Exam 2 - Spring Flashcards
(171 cards)
1
Q
spine is ___ shaped in utero and then what?
A
c-shared… then C and L become lordosis
2
Q
TP of C1 is located…
A
behind the mastoid process of the skull
3
Q
what has the largest cervical SP
A
C7 and then C2
4
Q
fx of c-spine (3)
A
- protection
- exit for spin-N from cerv and brachial plexus
- mobility and support of head in environ
5
Q
what is the keystone of the body
A
neck
6
Q
what is major conduit of body?
A
c-spine b/w head and rest of body
7
Q
superficial cervical fascia
A
b/w dermis and deep layer
N, bv, lymph
8
Q
deep cerv fascia
A
3 layers: investing, pretracheal, prevert
supports viscera
9
Q
posterior cerv M
A
nuchal line –> sacrum
- LBP can cause motion restriction to upper cervical region
sig mod of M at c2
- lots of oblique M txverse atlas and axis to occiput
10
Q
cerv M act as…
A
“auto balancing system”
- keep head lvl during mvmt
- high concentration of proprio
- N reflexes to suboccitpal M
11
Q
anterior cerv M
A
T3 –> occiput: mandible to hyoid, sternum, clavicle
- “strap M”
12
Q
SCM
A
sup anterior M
imp for BALANCE
- high concentration of proprioceptors
fx:
- SB and R head in opposite direction
- bilateral flexor of c-spine
congenital torticollis
13
Q
trapezius
A
superficial posterior M
- primary connection b/w head, neck, UE
nuchal line –> distal 1/3 of clavical and scapula
- elevates and retracts scapula
- extend, laterally flex, contralateral rotate head
14
Q
levator scapulae
A
upper 4 c-vert –> medial border of scapula
fx: elev scapula
* lifting arm distributes forces to head
referred pain from acute herniated disc at mid c-spine lvl
15
Q
scalene M
A
lateral stabilizers
- anterior and middle attached to rib 1
- posterior attaches to rib 2
- origin @ tubercles on C-TP
fx:
- flex c-spine
- breathing assist
16
Q
restriction of OA or AA can cause restriction in what N?
A
vagus
17
Q
A
18
Q
cerv vasc
A
SC
- can be impinged by hypertonic scalene muscles or elevated 1st rib
carotid (anterior to c-vert)
- can listen for bruits
vert
- comes off SC
19
Q
Vertebral Artery parth
A
C6 to TP of atlas –> Turns 90 degrees posteriorly –> Turns 90 degrees medially around the posterior edge atlas –> Turns to pass anteriorly and superiorly into the cranium where right and left vertebral a. form the basilar artery of the brain
20
Q
what combo of mvmts on the c-spine causes the MOST structural challenge on vasc flow to brain?
A
extension, SB, rotation on SAME SIDE
- dixxiness
21
Q
VERY impt to not put head into _____ during HVLA
A
extension
22
Q
bony structure of c-vert
A
7 vert
vert foramina LARGEST at C1 and tapers down to C7 BUT vert become progressively LARGER
allow for sig mobility w/o restricting cord
23
Q
Orientation of
Zygopophyseal (Facet) Joints
A
45 deg horizonal, face superior and posterior
b/w hori and coronal plane
STEEPER caudally (towards tail)
limits flex and extension
24
Q
zygophyseal joints get more ________ more inferiorly
A
angle becomes flatter, more horizontal
25
Articular Pillars
lateral masses that lie b/w superior and inferior facets
* posterior to c TPs
26
cerv TP characteristics
short and stubby
have txvrse foramen for vert A
each TP cradles a c-N which passes POSTEIROR to position of vert A
27
Joints of Lushka
C3-C7: synovial
* formed by uncinate process and superior adj vert
* create stab of heavy head and smaller neck
* **babies do not have b/c they do not need to support head wt @ birth**
****fx:
* main stab upright position of head
* guides flex/ext
* LIMIT LATERAL FLEXION
* support disc
28
Degeneration of joints of Lushka can cause
"side slip" --\> cerv N root stenoisis and impingement
29
The relative disc thickness is greatest in the
c-spine: 2/5! disk height: c-vert height
More flexion and extension is possible when the disc is thick and the AP diameter is relatively small.
30
c motion
* Flexion: 80°-90°
* Extension: 70°
* Sidebending: 20-45°
Rotation: 70-90
31
Disc Motion in Flexion and Extension
On flexion, disc shifts more posteriorly
On extension, disc shifts more anteriorly
32
CERVICAL DIVISIONS
Upper Cervical Division
* Occiput, Atlas, Axis
* As a unit provide \>50% of rotation, flexion/extension
Lower Cervical Division
* C3-C7 vertebral segments
* SB and rotates in SAME direction
33
flex/ext mostly controlled by
OA
34
rotation mostly controlled by
AA
35
SB controlled mostly by
C3-C7
36
gross cerv motion is guided by...
facet joint orientation
M
ligaments
37
coupled motions of c-spine
OA: SB and R in **opp** directions
AA: **only** R
C3-C7: SB and R in **same** direction
* due to facet joints
38
Extension places facets more ____ therefore _____ is easier
vert
SB
39
Flexion moves the facet plane _____ facilitating \_\_\_\_\_\_
horizontal
rotation
40
typical c vert:
atypical c vert:
c3-c6
c1 (no body), c2, c7
41
Typical Cervical Vertebrae (6)
v-formaen is large and triangular
TP has foramina for vert A and V
BIFID SP
superior facets face superior/posterior
inferior facets face inferior/posterior
rectangular body
42
C1 (5)
**no body --\> RING-LIKE**
no TRUE SP
articulation for dens
NO IV DISC
very palpable TPs
43
c2 (4)
dens (odontoid process) = superior axis of rotation
NO disc above
SP palpable
superior facets are CONVEX
44
c7
prominent SP, SELDOM BIFID!
* appears like thor vert
NO vert-A
45
AA jt motion
ONLY R via odontoid process
* txverse ligament allows SLIGHT flex
NO SB (lateral flex)
46
OA joint
"single" joint that is actually 2 sep joints
* anterior: b/w dens and anterior arch: synovial
* posterior: b/w dens and strong txverse lig of atlas
* **pivot about which AA joint rotates**
convex condyles of occiput --\> concase superior facets of atlas
LIMITED motion due to lig attachements
forms R and L "ellipsoid", congruent synovial joints
superior facets of atla face: BUM - back, up, medial
47
OA ligaments
ALL, PLL
anterior and posterior OA membrance
tectorial membrane:
* base of skull --\> PLL in c-area
48
OA motion...
what is it limited by?
"makes smallest yes motion with head"
flex: lim by skull contact with dens
ext: lim by tectorial membrane
49
what can destab cerv lig?
RA
steriods
down syndrome
50
OA motiong
limited by M and lig
primary = flex/ext
* flex --\> posterior slide of occiput
* ext --\> anterior slide of occiput
SB and R are **opposite!**
* due to lateral OA lig
* rotation is linked to translatory SLIDE
51
Biomechanically, Occiput acts like
sphere
* major motion = flex/ext
* minor motion = SB, R
52
in motion testing (SB test) of C3-C7, translation to the R produces SB to the...
L
53
do fryettes principles apply to c-spine?
NO! - No group curves or neutral mechanics!
54
epidemiology of neck pain
9-102
peaks b/w 20-40 y/o due to MVA
peaks b/w 30-49 in gen pop
neck pain high in females than males
55
what is the most common complain of pts seen by pcp?
neck pain
56
what is the most common cause of neck pain
mech neck disorder
57
neck pain is the ____ most common reason that pts seen manual med tx
neck pain
LBP is first
58
Most neck pain as a result
cervical paraspinal spasm or other musculoskeletal factors
* decr ROM
* pain WORSE with mvmt, BETTER with rest
* lack of organic/systemic pathos
59
non-trauma neck pain can be caused by...
soft tissue disorders:
* poor posture
* repetitive activity @ work
* sports
emotion/mental state
60
what is a stronger association? neck pain due to mental stress or due to repetitive occupational activities?
mental stress
61
when pain stricks, focusing on _____ is key
emotion
62
Risk Factors For Neck Pain
1. depression
2. incr age
3. hx LBP, headache
4. physical work, job demans
5. lack of control over work (low job statisfaction), social support
6. obesity
7. smoking
8. unusual postures
63
osteoarth usually appears...
after 60
64
edema where can cause difficulty swallowing and thus neck pain
overstretched ALL and retroesophageal tissues
65
spurlings manuver
neck compression with SB
tests for cerv radiculitis:
* stenosis
* cer spondylosis
* osteophytes
* trophic facet joints
* herniated disc
66
distraction test
"lifts head up" to decrease/releieve pain of nerve root compression
67
wallenburg's test
test vert A insufficiency:
supine --\> SB (both sides) --\> rotate --\> wait 30 sec
postive = dizzy, nausea, lighthead
68
with erect posture, wt of head is....
in forward head position, head is approx ___ with which wt of head is...
10 lbs
3in in front of COG = 30 lbs
69
forward head position of depression
rounded back
fwd posture --\> INCR cerv lordosis
* approx posterior articulations
* narrows IV foramina
70
POSTURAL TRAINING TO REVERSE ANTERIOR POSITION OF THE HEAD AND EXESSIVE Cervical LORDOSIS.
distraction exercise with 5-10lbs sandbag on head and maint erect posture
proprioceptive concept of posture is learned with no effert
71
cerv spondylosis
long standing disc degen --\> narrow disc space --\> marginal new bone formation
joints of lushka --\> hypertrophy, calcification, OSTEOPHYTOSIS --\> DECR IV foramen
72
osteophytosis of joints of lushka encroach on...
spinal canal
IV foramen
degen changes of facet joints
---\> neuro deficits of cord and nerve root
73
vertebrobasilar ischemia
Encroachment of the osteophytes ON Cervical spondylosis) upon the vertebral arteries
can result in dizziness and vertigo
74
whiplash
hyperflex --\> hyperext injury usually due to MVC
may injure: ALL/PLL, interspinal lig, dura, articular capsule, and/or M
* IV disc may be patho deformed
* can laso have no tissue dmg
usu gets c-spined (head restraints)
75
irritation of cerv symp N may...
hypertonicity of cer v soft supporting tiss, esp deep nuchal M
* over-excit of beta receptors in injured neck --\> traumatic vertigo
76
restraction phase of whiplash
the upper torso is pushed forward by the seat back while the occupant’s head remains nearly stationary
forcing lower neck (C5-C7) into a pronounced extension while the upper part is in flexion.
phase ends when the maximum neck flexion and torso extension
77
whiplash injury occurs during what phase? due to?
retraction phase due to abnormal loading of soft-tissue
78
after retraction phase of whiplash, entire head/neck complex moves into...
overall ext --\> limted by contact with head restrait or reflex contracture of neck M
79
Injury to anterior spinal structures can result
•cervical instability in extension, axial rotation, and lateral bending .
80
hypoermobility of neck due to whiplash can result in....
early degen of IV disc or vert
segmental hypoermob --\> long-term instab
81
symptoms of whipllash
headache: greater superior occipital N (C1, C2 lvl)
pain b/w scapuale
paresthesia down arm (often temp) - scalenes (thoracic inlet like)
torticollis (contraction of SCM)
dysphagia: swell/edema in anterior cerv structure
dizzy/vertigo
82
referred pain zones of C1-C7
83
Dermatomal distributions of the Occipital Nerves
formed by roots of C2-C4
pain --\> occipital vertex or parietal areas of head
84
what lig may be injured during the retraction phase of whiplash
c5-c6 ALL
85
Anterior structures in the lower cervical spine may be susceptible to injury through
•excess distraction during the retraction phase of whiplash.
86
Cervical Spine Facet Referred Pain
C1-2 Posterior auricular in distribution of the greater occipital nerve.
C2-3, C3-4 Paraspinal and trapezial areas.
C4-5, C5-6 Trapezial areas.
C5-6, C6-7 Trapezial and periscapular areas.
87
Trigger Point and Referral Pain of SCM, trapezius, leator scapulae
88
Injury with Head Facing Forward Versus Effect of Head Rotated
more injury with rotation -\> shear in lateral rotatory torque motion
89
common Characteristics of Patients with Neck Pain after Automobile Accident
* Female.
* Age 20- 40 years old.
* Head restraint height below the head center of gravity.
* Lightweight car.
90
CERVCAL RADICULAPATHY
“diskogenic syndrome”
Intervertebral disk herniation --\> nerve root entrapment
* acute injury
* facet synovitis
* preexisting degen changes aggravated by acute injury
* annular bulge from torque injury
91
Stiffness and an aching pain in cervical region often refers
to occipital region
* hold and brace neck: anulus and PLL and then N impingement
* ischemia
* limited ROM
* imflammed capsules
* neuro symp (tingly, numbness)
92
C6 root results pain to....
disthere digit paresthesia?
M weak?
radial forearm
thumb paresthesia
bicep, bracioradialis, wrist extensors
93
C8 root results pain to....
disthere digit paresthesia?
M weak?
ulnar forearm
right and little finger paresthesia
intrinsic hand weak
94
C7 root results pain to....
disthere digit paresthesia?
M weak?
dorsal forearm
index and middle finger paresthesia
tricep weak
95
C5 root results pain to....
disthere digit paresthesia?
M weak?
arm but stops at elbow
no paresthesia
shoulder weak
96
what kinds of colors of food will have antiox?
red, yellow, purple
97
what should be used for sub-acute/chronic neck pain?
spinal manipulation b/c it is more effective thant M relaxants
98
Isometric Muscular Contraction Exercises
start in a few days (contraindicated to begin early)
active resistive done solely by pt
ice and heat afterwards
99
Contra indicators to Manipulation of the Cervical Spine
* Aneurysm
* Bone tumor
* Carotid or vertebrobasilar disease
* Infection
* Ligamentous rupture or instability
* Metastatic carcinoma
* Osteopenia
* Anticoagulation therapy
* Previous surgery involving neck joints
* Rheumatoid arthritis of the cervical spine
* Unstable odontoid peg
100
nuchal headache is due to...
traps
greater occipital N
101
cerv lymph nodes
* Superficial Occipitial Lymph Node (#10)
* Jugulo-Digastric Lymph Node (#10)
102
Motor strength testing grade
* 5-Normal strength
* 4‐Active movement against gravity and some resistance
* 3‐Active Movement against gravity
* 2‐Active Movement of body part with gravity eliminated
* 1‐Barely detectable flicker or trace of contraction
* 0‐No movement
103
•Deep tendon Reflexes grading
0 Absent
1+ or + Diminished
2+ or ++ "Normal"
3+ or +++ Hyperactive without clonus
4+ or ++++ Hyperactive with clonus
104
C5 Motor and Sensory
105
C6 Motor and Sensory
106
C7 Motor and Sensory
107
C8 Motor and Sensory
108
T1 Motor and Sensory
109
why are we concerned about T1?
Cervical Sympathetic ganglion
•Tumor
* Pancoast tumor
* Horner’s Syndrome: Miosis, Ptosis, anhydrosis
110
Pancoast Tumor
tumor at apex of lung
symp:
* pain in post shoulder, ax, cerv spin, often down arm
* horners due to distruption of superior cerv gang
111
Valsalva Test
"bear down" to increased intrathecal P
112
swallowing test
tests atnerior cerv osteophytes, swelling --\> pain
113
adson's test
test thoracic outlet
114
brudzinski's sign
meningeal irritation
115
the shoulder girdle consists of what bones?
clavicle
scapula
humerus
116
joints of shoulder girdle
GH: ball and socket
SC: saddle
AC: plane biaxial/planer
\*\*\*SC and AC have reciprocal motion
* anterior/post
* elev/depression
* rotational
117
clavicle acts as...
strut for UE: allow max freedom of motion and txmit forces for UC to axial spine
ONLY boney attachment of arm to axial spine
118
pseudojoints of shoulder
Suprahumeral joint or Coracoacromial arch limits the abduction of the shoulder.
Scapulothoracic:
* indirectly attaches scapula to the thoracic wall via muscles
* helps the GH joint stability by keeping it aligned during movement.
119
joint capsule of shoulder
thickening = primary stability to the glenohumeral joint
outer layer = fibrous - support/str
inner = synovial - reduce friction
120
the shoulder has the ____ ROM of any joint
greater
most venerability
121
when hyaline cartilage breaks down, it is called...
arthritis
122
GH joint
ball cmpt 3-4x larger than socket cmpt
glenoid labrum (fibrocartilage) = angled lip of GH joint to compensate for jt shallowness --\> incr depth of socket by ~50%
123
shoulder bursa fx to...
reduce friction b/w structures
124
M of GH joint and shoulder
flex: anterior deltoid
ext: lat dorsi, t. major, posterior deltoid
abd: middle deltoid
add: pac major, lat dorsi
ext-R: infraspinatus, t. minor
int-rot: subscapularis
125
Normal Range of Motion
Shoulder
Abduction 180°
* There is a 2:1 ratio between the glenohumral joint and the scapulothoracic joint.
* Pure abduction of the glenohumeral is 90°, After 120° external rotation is incorporated into the motion.
* Adduction 45° — must be done in front of body so some flexion
* Flexion 180°
* Extension 45-60°
* Internal rotation 55°
* External rotation 40-45°
126
For every \_\_\_degrees of abduction at the glenohumeral joint, there is ___ degrees occur at the GH and ____ degree occurs at the scapulothoracic joint
3, 2, 1
127
what happens then at 120 degrees?
surg neck of humerus is stopped by suprahumeral joint --\> then needs to rotate out of way
128
Codman Maneuver
* Standing anatomical position
* Abduct arm 180°
* Return arm to side of body in sagittal plane
* Note the difference in the direction of the palm
129
Apley Scratch Test
130
Apprehension Test
tests shoulder dislocation
131
Yergason Test
tests bicep tendonitis/bursitis or tear of txverse lig
1. felx elbow to 90
2. grasp elbow and wrist
3. ER and pull down on elbow while pt resists
132
Drop Arm Test
test rotator cuff tears
133
Cross Arm Test
tests AC joint disorder
134
Testing for Bicipital Tendonitis
feel in bicepital groove while pt rotates forearm
135
cardiac pain can refer to...
neck, shouler, ax, arm
cardiac plexus --\> T1-4 --\> L shoulder pain (infraclav and ulnar)
136
aortic arch refers pain to
right neck
137
gallballder refers pain to
tip of R shoulder and posterior scapula
138
duodenal inflammation refers pain to the
L shoulder
139
diaphragm refers pain to the
neck, shoulder, supraclav, trap, superior angle of scapula
same as shared N roots: C3-5
140
stomach refers pain to
b/w scapula @ lvl of T5-9
141
pancoasts tumor refers pain to
shoulder --\> horder syndrom
142
headache is defined as...
pain in head located above/around eyes/ears @ front/back of head or upper neck
143
crucial pain sensitive headache locations
suboccipital
upper cerb
scalp
144
greater occipital N refers pain to
head
145
is the brain sensitive to pain?
almost totally insenstive!
146
sudden onset headaches mean
subarachnoid hemorrhage
blood
mass lesion
147
worsening headache indicates
mass lesions
subdural hematoma
med overuse
148
headaches with systemic illness means.
meningitis/encephalitis
lyme disease
arthritis
149
lyme disease is due to
menigoencephalitis
150
Common Causes of Head Pain
1. bv dilation/constriction
2. M in neck/head
3. M in eye
4. sinus swollen
5. tooth infection
6. N
7. joints in jaw/neck with overuse or dmg
151
A 28 year old female medical student complains of frequent headaches. They feel like a band of pain around her head and the pain radiates into the upper neck on both sides. She’s had them since high school, but they seem to be more frequent and painful since she’s been studying for the boards and since she recently broke up with her boyfriend. There is no nausea or vomiting associated with them.
tension headache
* increased myofascial pain sensitivity due to sens of N in supraspinal region & second order N in spinal dorsal horn/trigeminal nuc
* decreased antinoci/inability of body to stop painful stim
152
types of tension headaches
1.Emotional
* Stress and anxiety
* Depression
* Anger/unresolved conflicts
2.Postural
* Occupational
* Postural imbalance
* Abnormal spinal curves
* Poor posture
3.Muscle hypertonicity or fatigue
* Maintenance of a frown- frontalis muscle affected
* Bruxism- temporalis and masseter affected
* General fatigue- decreased support of head
153
what is the most common location that causes tension headache
OA
154
•A 34 year woman presents complaining of frequent episodes of severe head pain. She knows one is coming because she often sees wavy lines or blind spots just before it starts. The pain is throbbing, on one side, and is often so bad that she vomits. She has to lie down in a dark room until it goes away which can be hours or the whole day. Sleeping helps. She thinks that they are associated with her period and maybe some foods or wine.
migraine: nociceptors are vasc but pulsations perceived painful when sens occurs
155
pathophys of migraine
disorders neuro control of craniocerebral circ: cephalic and intracranial cerebral A
migraine is triggers when inflam response reaches pain-sensitive
vasoconstric --\> vasodil of sympath bv @ base of brain and meninges
**suscep can be inherited**
156
Multi-Mechanistic Action of Migraine
inflam involving PG and neuropeptides --\> vasodil --\> (+) nocic surr brain --\> pain sig --\> 1st sensation of pain
periph sens from activation of nocic --\> incr stim of N in trigeminal N --\> central sensitization
157
Migraine
Osteopathic Treatment: during attack
–Evaluate SD of head, neck and shoulders (as well as whole body)
–Gentle indirect treatment so **not** to stimulate vagus
–Counterstrain to cervical especially suboccipital and inion
–Avoid HVLA –Lymphatic drainage
–Sympathetic reflexes at T1-T4 related to bv of the head
158
Migraine
Osteopathic Treatment: b/w attacks
–Patient is more tolerant of manipulation
* **Cranial OMT better in between attacks**
–Treat SD that are present in the head, cervical and upper thoracic spine (and whole body)
159
•A 26 year old man presents with severe, intermittent headaches that he has had for years. These headaches are characterized by an intense burning pain on one side of his head, accompanied by tearing in his eye and a runny nose. When they strike, the attacks typically occur several times a day and usually last anywhere from 15 minutes to 3 hours. He states he feels better walking around. He can be headache free for months at a time, but the attacks always return lasting for weeks or months with increased frequency in the fall and spring. He has seen several healthcare providers, including headache specialists, with little or no improvement.
Cluster Headaches
160
cluster headaches
pain around 1 eye
drooping of lid
tearing, congestion
involves CN V
* neurogenic inflam of vasc plexus of cav sinus/tributaries/autonomic N
* affects sphenopalatine ganglion (pterygopalatine) and cervical sympathetic ganglion
161
proposed mechanisms of cluster headaches (5)
1. hemodynamic: vaso change 2ndary to primary neuro discharge
2. CN V: substance P carry impulses to max and ophal div --\> sphenopalatine gang
3. ANS
4. circadian rhythm: hypoT controls circadiam rhy since they occur at same time every day
5. serotonin
162
OMT Treatment Considerations
Cluster Headaches
T1-4 SNS
upper ribs
severe pain behind eye responds well to tx SD @ C1/2
163
•A 45 year man complains of pain and pressure around his face, forehead, and upper teeth that he’s had for 3 weeks. He’s had a cold that just won’t go away and has congestion, a post-nasal drip, and complains of feeling tired. He says that when he presses on his checks and forehead it feels sore.
sinus headache
164
sinuses are formed by...
4 bones:
* frontal: drained by gravity
* sphenoid
* ethmoid
* maxillary
* \*\*\*other cav drained by ciliated cells that move mucus to nasal passages
165
•Goblet cell secretions are thinned by ___ and thickened with _____ stimulation
PNS
SNS
166
Osteopathic Manipulative Medicine
Sinusitis
tx
* SNS of upper thorax
* PNS of OA and upper cerv
* sphenopalatine gang to decr thick mucus
"milk", P, lymph drainage to face
CS tender points of neck
ME
suboccipital myofasical to cerv spine
167
Cervical Spine Referral
Greater Occipital Nerve
168
trigger pts of SCM and upper trap
169
Trigger Points
Suboccipital Muscles
side of head and face
170
dowager hump
171
cafe au lait indiccate
neurofibromatosis
