Upper Cervical Spine

Question 1

The OA joint includes

Answer 1

CO-C1

Question 2

The AA jt contains..

Answer 2

Atlantis C1 & Axis C2

Question 3

Transverse ligament restrains..

Answer 3

Primary restraint for posterior –> ant translation at the AA jt

Question 4

Alar ligament is the primary means of …

-what does the alar ligament attach?

Answer 4

the ROTARY STABILITY of the CV unit (AA jt)

-attaches the skull to C2 vertebra (VIA THE DENS) and functions to check side to side movements of the head

Question 5

Primary motion at OA jt is ..

Answer 5

flex/ext

Question 6

Occipital condyles glide — with extension

Answer 6

anteriorly (downhill)

Question 7

what’s the primary motion at the AA joint?

Answer 7

ROTATION

Question 8

IF a patient has less than 45 deg of head rotation, what would you suspect?

Answer 8

possible restriction at C1/C2 (AA jt)

Question 9

how do you test CN 8?

Answer 9

hear watch ticking?

balance test

Question 10

To test CN III..

Answer 10

look at upward, downward and medial gaze

Question 11

To test CN V, look at ..

Answer 11

corneal reflex, face sensation & clench teeth

Question 12

what are the 4 Cervical spine clearing tests? (NOT pure VBI testing)

Answer 12

1. Sharp-Purser Test (sublux of C1 on C2)
2. Transverse Ligament Test (A-P translation of AA jt)
3. Alar Ligament Test (rotation)
4. Vertebral Artery Test

Question 13

What is a positive test of Sharp-Purser?

Answer 13

IF the patient’s sx are RELIEVED by pushing back on the forehead (means that C1 is subluxing on C2)

Question 14

IF the alar ligament is too lax, during the alar ligament test..

Answer 14

C2 does not move as soon as the head is sidebent (the alar lig rotates C2 with the skull VIA the dens)

Question 15

The transverse ligament test (+) sx =

Answer 15

lump in throat
lip paresthesias
nausea
vomiting
sever HA/ms spasm
dizziness 
INDICATES transverse ligament NOT resisting the ant shear of C1 on C2 (AA jt)

Question 16

what exam is HIGHLY indicated as a test for cervicogenic HA?

Answer 16

Cervical flexion-rotation test of the AA jt (PIVM)

Question 17

IF you perform a PAIVM of the OA joint into EXT & SB L, what are you testing?

Answer 17

the L OA joint

Question 18

when performing a POST CONDYLAR GLIDE PAIVM of the OA jt and you want to assess the L OA..

Answer 18

rotate 30 deg to L
add post glide
assess end feel

Question 19

IF your patient presents with decr flex, decr R rotation & decr L SBing

Answer 19

R restriction b/c SBing to OPPOSITE SIDE when in passive flexion
POSITIONAL DX is an ERS

Question 20

Spinal stenosis is..

Answer 20

narrowing of spinal canal, IV foramina OR radicular canals

–space b/t SC & vertebral elements is compromised

Question 21

When measuring the ratio of A-P to transverse diameter of the SC, you are measuring —-
-a ratio of — indicates substantial SC flattening

Answer 21

measuring the CORD FLATTENING & severity of stenosis

–a ratio of < 0.4 indicates substantial SC flattening (neuro impairment & myelopathy)

Question 22

IF a patient has ipsilateral motor deficits with contralateral sensory deficits, they most likely have what kind of spinal stenosis..

Answer 22

Brown-Sequard syndrome

Question 23

“cervicogenic headache” is actually a subgroup of HA patients with..

Answer 23

concomitant head AND neck pain

Question 24

What % of tension-type HA is of ms origin?

Answer 24

90%

Question 25

What do you do if a pt presents with a HA assoc w HIGH FEVER, STIFF NECK or RASH

Answer 25

RED FLAG do not treat

Question 26

when examining for cervicogenic HAs, what does your exam include? - ms length? - ms strength & actvation?

Answer 26

AROM -ms Length: tightness of SCM, UTrap, Lev scap, scalenes, suboccipitals, pec major & minor -ms strength & activation: weak deep neck flexors, active neck flexion test, CCF - deep neck flexor performance VBI testing

Question 27

What cervicogenic HA exam should you perform of the manual assessment?

Answer 27

assess AA jt rotation | also AA flexion & rotation -- AA rotation to side of HA about HALF of the opposite side!!!

Question 28

what myofascial trigger points are often present in pts w cervicogenic HAs?

Answer 28

SCM

Question 29

IF a pt has neurological signs s/p WAD, what is their classification?

Answer 29

Grade III

Question 30

If a patient has WAD with signs of musculoskeletal dysfunction, what grade are they?

Answer 30

Grade II

Question 31

What is the CUT OFF TIME for increased risk of chronicity s/p WAD?

Answer 31

complaints of pain after 45 days increases the risk of chronicity

Question 32

What ms generates the greatest contraction during a rear end impact?

Answer 32

SCM generated up to 179% of MAX voluntary contraction

Question 33

in a LATERAL IMPACT accident, what ms is activated the most? | -awareness of impending impact does what?

Answer 33

the splenius capitis contralateral to impact | -decr ms response

Question 34

What sort of stress tests are used s/p WAD eval

Answer 34

Upper Cervical Ligament Stress Tests - Alar ligament - Transverse ligament - Sharp-Purser - Vertebral Artery Test

Question 35

what interventions are more effective - active or passive?

Answer 35

ACTIVE (exercise, normal activities, mobilization/manipulation)

Question 36

should patients use cervical collars?

Answer 36

NO EVIDENCE TO SUPPORT IT - prolonged sx & poor outcome

Question 37

what ms should be trained s/p WAD?

Answer 37

deep cervical flexors cervical extensors rotation & lateral flexion ** LINK b/t ms fatigue & impaired postural control **