MS1: Affectations of Cervical Spine

Question 1

what are the superficial muscles of the neck

Answer 1

traps
SCM
levator scapulae
rhomboids
ant, middle and post scalene

Question 2

what are the deeper muscles of the neck

Answer 2

splenius capitis
semispinalis capitis
longissimus capitis

Question 3

what are the deepest muscles of the neck

Answer 3

splenius cervicis
semispinalis cervicis
longissimus cervicis

Question 4

what are the upper cervical ligaments

Answer 4

apical > alar > transverse > cruciate > membrane tectoria

Question 5

describe torticollis

Answer 5

SCM affected, CN 11 or spinal accessory nerve

tilt head towards affected side and rotation of chin to unaffected

Question 6

describe congenital torticollis and the cause

Answer 6

present at birth; bones are normal but gradually develops

causes:
- unknown
- abnormal head pos in utero
- prenatal injury
- fibroma of prenatal origin of muscle
- rupture of SCM during delivery; hematoma or scar formation

Question 7

SSx of congenital torticollis

Answer 7

non tender, cylindrical enlargement of SCM 2 wks after birth > spontaneous regression 3-6 mo.

more common in girls
noted when child sits

flatenning and shortening on tilted side
facial asymmetry starts @ 3 mo.

raised shoulder on affected side
rot and lat flexion are LOM; normal flex/ext
cervico dorsal scolio
eyestrain from ocular imbalance

Question 8

treatment of congenital torticollis

Answer 8

non-surgical
- passive stretching to overcorrected pos
- pos head at sleep
- active stretch of SCM

surgical
- mod to severe
- open resection of 1cm; lengthen SCM

Question 9

describe acquire torticollis

Answer 9

w pain and stifness

causes
- acute trauma and inflammation: atlantoaxial rotatory sublaxation, inflamed SCM, lymphadenitis
- chronic infection: osteomyelitis, tumor
- arthritic: RA, osteoA, ankylosing spondylitis
- scarring
- paralytic
- hysterical > inability to control neck muscles
- spasmodic - CNS lesion > involuntary rhytmic contract of neck muscles

Question 10

treatment of acquired torticollis

Answer 10

treat primary cause
PT
traction; braces
cervical orhosis

Question 11

what is spontaneous atlantoaxial subluxation

Answer 11

anterior displacement of atlas on axis of gradual onset

laxity of transverse part of cruciate ligaments
- local inflammation from throat or RA
- small odontoid; developmenta failures
- congenital hypoplasia

Question 12

risk factors and SSx of SAS

Answer 12

risk factors
- down’s syndrome
- morquio’s syndrome
- bone dysplasia
- osteogenesis inferfecta

SSx:
- neck stiffnes or pain in UE w/ or w/o troticollis
- hyperactive reflexes > cord compression

Question 13

treatment of SAS

Answer 13

non-surgical:
- recumbent pos usually reduces displacement
- cast/brace for 6 wks

surgical
- atlantoaxial arthrodesis - esp if cord compression

Question 14

describe degenerative disk disease

Answer 14

traumatic lesions of disc
- inflamed joint
- bone spurs
- thinned disc

most common symptom is pain

Question 15

what is the pathology of DDD

Answer 15

spurring of cervical spine; common C4-C5 and C5-C6; has greatest motion

disc protrusion or sublaxation > most common C6-C7

Question 16

SSx of DDD

Answer 16

pain on neck radiate to arm; inc w coughing or sneezing
paresthesis of dermatome affected
occipital headache and bluring of visio; vertigo
weakness of UE
LOM of neck, tenderness over cervical spine, nuerologic changes in UE

Question 17

DDD bet C5-C6

Answer 17

paresthesia of thumb, index and radial forearm
weak biceps, brachioradialis and ECRL and ECRB
LOM elbow flex and wrist extend

Question 18

DDD bet C6-C7

Answer 18

paresthesia of middle finger
weak triceps, wrist flexors and finger flexors
LOM elbow ext and wrist/finger flex

Question 19

DDD bet C4-C5

Answer 19

paresthesis of lat deltoid and biceps
weak deltoid and biceps
LOM abd and elbow flex

Question 20

diagnosis and DD of DDD

Answer 20

diagnosis
- cervical xray > spurs
- MRI

DD
- spinal cord tumor
- myelopathy from cervical spondylosis
- infection
- TOS

Question 21

management of DDD

Answer 21

nonop
- PT: heat, traction, bed rest
- cervical collar
- postular exercises

surgical
- formainotomy
- laminectomy
- disk excision
- arthrodesis

Question 22

what is thoracic outlet syndrome

Answer 22

group of disorders assoc w pressure of nerves and vessels in thoracic outlet
- cervical rib
- scaleneus syndrome
- costoclavicular syndrome

Question 23

what is the interscalene triangle

Answer 23

proximal space

borders:
- ant: anterior scalene
- post: middle scalene
- inf: 1st rib

contents
- brachial plexus trunks
- subclavian artery

Question 24

what is the costoclavicular space

Answer 24

middle space

borders:
ant - clavicle and subclavius
post - 1st rib and scalenes
medial - costoclavicular ligament
lat - upper scapular border

contents
- brachial plexus div
- subclavian artery and vein

Question 25

retropectoralis minor space

Answer 25

distal space; subcoracoid

borders
sup - coracoid
ant - pec minor
post - ribs 2-4

contents
- brachial plexus cords
- axillary artery and vein

Question 26

what are the causes of TOS

Answer 26

cervical ribs
- congenital; extra rib on C7 or C6
- close approximation > impingement
- increase pulsation in neck > subclav artery

scalenus syndrome
- spasm causes compression of nerves and artery against first rib

Question 27

SSx of TSO

Answer 27

appears around 30 yo.
more common in women
feel of fulness in neck

firm rounded immovable tender mass 2-3 cm above middle of clavicle
+ pulsation from subclav artery

clawhand
paresthesisa
palor, cold, cyanosis
+ adsons > dec radial pulse

Question 28

treatment of TSO

Answer 28

non surgical
- rest
- injection of procaine to scalenius
- sling/brace > relieve strain on shoulder
- strengthen traps and levator scap

surgical
- myotomy of scalene ant
- remove portion of first rib/clavicle

Question 29

what is costoclavicular syndrome

Answer 29

compression in betw clavicle and rib 1

cause
- postural gradual sagging of shoulder girdle; middle life
- holding shoulder at attention
- tumors
- callus formation from fracture of clavicle

Question 30

diagnosis and treatment of costoclavicular syndrome

Answer 30

diagnosis
- no radial pulse when abd
- bruit is heard at infraclavicular area
- angiography

treatment
- strengthen traps and levator scap
- resection of rib 1 or clavicle

Question 31

what are the tests for TOS

Answer 31

adson’s
- extends neck and turn head to side
- no pulse on arm where turned = +

allen’s
- 90/90/90 shouler abd, ER and elbow flex; turn head away from examined UE; check pulse

costoclavicular test
- exaggerated attention; check pulse

Question 32

what is acute cervical syndrome

Answer 32

whiplash assoc w MVA > injury to muscles of neck
DD for SCS > if no neurologic = ACS

Question 33

SSx for ACS

Answer 33

neck pain
occipital headache
LOM of neck all planes
pain on ligaments
absent neurologic deficits

Question 34

treatment for ACS

Answer 34

nonop
- rest
- cervical brace
- muscle relaxant and pain reliever
- PT

surgica;
- once stable and if symptomatic

Question 35

what is klippel feil syndrome

Answer 35

congenital syntosis of cervical spine
fusion of all or just lower cervical vertebrae
laminal arches not developed

SSx
- short neck
- low posterior hairline
- flex/ext better than lateral flex
- head held in oblique pos

treatment
- none
- plastic surgery just to release webbing of neck; still short