Upper Cervical Spine

Question 1

Define the structures classified as USC

Answer 1

Occiput

Atlas (C1)

Axis (C2)

Question 2

Describe the shape of the superior and inferior facets of C1

Answer 2

Superior = concave

Inferior = convex

Question 3

List the 3 points of articulation b/t C1 and C2

Answer 3

Odontoid process

2 facet joints

Question 4

Describe the shape of the inferior facet of C1 and the superior facets of C2

Answer 4

Both are convex

Only joint in body with 2 convex surfaces which along with the lack of a cervical disc decreases stability of the joint, stability mainly comes from ligaments

Question 5

List the 3 features that allow the majority of rotation ROM to come from the USC

Answer 5

Biconvex joint surface

Downward slope of C2 facets

Lack of disc

Question 6

Describe what the amount of cervical rotation can tell you about the pathology of the pain

Answer 6

In acute USC they have limited and painful rotation

In chronic USC they have functional rotation due to compensation of the rest of the spine

If rotation is not compromised = LCS

Question 7

The following ligaments are renamed in the USC

1. ALL
2. Ligamentum flavum
3. PLL

Answer 7

1. Anterior atlo-occiput membrane
2. Posterior alto-occiput membrane
3. Tectorial membrane

Question 8

List the AA ligaments

Answer 8

1. Transverse: behind dens, stabilizing dens to atlas, control AP motion
2. Alar: lateral dens, stabilizing dens to occiput, controls bilateral flex contralateral SB/Rot

Question 9

List the 4 deep posterior neck mm

Answer 9

1. Rectus captiis posterior major (extend, SB, rot)
2. Rectus capitis posterior minor (extend, SB, rot)
3. Superior oblique (ipsi SB, contral rot)
4. Inferior oblique (ipsi rot)

Question 10

List the 4 anterior neck mm

Answer 10

1. Rectus capitis anterior (flexion)
2. Rectus capitis lateralis (Ipsi SB)
3. Longus capitis (posture control, eccentric ext control)
4. Longus colli (posture control, eccentric ext control)

Longus mm = “deep flexors” (aid with sagittal anterior rot w/flex)

Question 11

Describe the primary role of the small anterior neck mm

Answer 11

Important for proprioception of head position on neck

(large spindle to fiber density)

Question 12

Describe the innervation of the neck mm, OA, AA, C2-3 Z jt, ligaments, vertebral arteries

Answer 12

Doran and ventral rami of C1-3

Question 13

Describe the arthrokinematics of

OA flex

AA flex

Answer 13

OA: convex occipital condyle glide POST on concave atlas

AA: C1 moves inferiorly on C2; C2 glies forward on C3

Question 14

Describe the arthrokinematics of

OA ext

AA ext

Answer 14

OA: convex occipital condyle glide ANT on concave atlas

AA: C1 moves superiorly on C2; C2 glides backward on C3

Question 15

Describe the arthrokinematics of

OA rot

AA rot

Answer 15

OA: ipsi condyle glide posterior

AA: ipsi facet moves POST, contra facet moves ANT, C1 translates to OPPOSITE side

Question 16

Describe the arthrokinematics of OA SB

Answer 16

Ipsi condyle glides ANT

Question 17

Describe the osteokinematics of the OA and AA joints

Answer 17

OA: primarily flex/ext (yes jt)

AA: primarily rot (no jt)

Question 18

Describe the coupling of the OA and AA joint

Answer 18

OA: OPPOSITE

AA: OPPOSITE

Question 19

LIst the causes of injury to the VA

Answer 19

1. MVA (ext)
2. Trauma
3. Cervical instab, fx
4. Suddent neck movement, manip

Question 20

List the 5 D’s for VA

Answer 20

1. Drop attack
2. Dizziness
3. Dysphagia
4. Dysarthria
5. Diplopia

Also ask about lip/face parasthesia

Question 21

Describe motions from least to most occulsion of the VA

Answer 21

Rotation > rot + ext > Rot + ext + traction

Question 22

Describe the pattern of pain for

USC

C4-5

C5-7

Answer 22

USC: base of neck, head and face

C4-5: base of neck and top of shld

C5-7: scapula, across the shld jt, and post/lat aspect of upper arm

Question 23

List some aggravating factors of the USC

Answer 23

sustained posture, rotation, TMJ issues

Question 24

Describe the treatment guidlines for USC

Answer 24

Restore mobility > posture > movement impairment > stability and coordination

Question 25

Describe the effect of forward head posture

Answer 25

Puts shear on LCS and the center of pressure moves anteriorly Inhibits deep neck flexors (longus) -- not longer in optimal position to function \> leads to atrophy Head tilts backext USC to keep eye level which increases pressure on posterior eliminates and DRG resulting in HA Tightens ligamentus nuchae and other mm leading to adoptive changes

Question 26

Describe the first exercises to address forward head posture?

Answer 26

Look at the thoracic spine: Chest out moves neck back Scap squeeze

Question 27

Condition: head and face pain arising from the UCS

Answer 27

Cervicogenic headache

Question 28

Condition: pounding headache associated with dizziness and visual distrubances

Answer 28

Vascular headache

Question 29

List the 3 most common types of headach

Answer 29

1. Migraine 2. Tension (PT) 3. Cervicogenic (PT)

Question 30

Condition: - Hx of neck or shld pain - Unilateral, associated pain in neck, shld, arm - Variable pain, moderate intensity, dependent on movement - NOT throbbing

Answer 30

Cervicogenic HA

Question 31

Condition: Agg: neck movement, posture, position, Ease: meds, modalities, change in posture, lying down, tx Decreased ROM Pattern: occipital/suboccipital

Answer 31

Cervicogenic HA

Question 32

Condition: HA with redness under eyes

Answer 32

Cluster HA (vascular)

Question 33

List the cases of cervicogenic HA

Answer 33

- Pressure on OA, AA, C2-3 - Hyper/hypo mobility - Mm shortening - DDD - Trauma

Question 34

Condition - Tightness anywhere on the cranium or suboccipital region - Bilat and trigeminal distribution - W \> M

Answer 34

Tension HA

Question 35

List the causes of tension HA

Answer 35

Stress Lack of sleep

Question 36

List the CC following MVA/whiplash injuries

Answer 36

Neck pain Neck stiffness Neck pain + HA

Question 37

Condition: acceleration-deceleration injury to the neck, injury to soft tissues

Answer 37

Whiplash injury

Question 38

List the special Q's specific for trauma/MVA

Answer 38

Hearing/vision disturbances Dizziness Feeling of unsteadiness Depression/fatigue Irritability Insomnia

Question 39

Condition: Pain as dominant complaint Apprehensive with AROM of neck Shld/arm movement tolerated Dizziness with active movement

Answer 39

Acute stage of MVA/whiplash

Question 40

Condition: AROM to end range limited by stiffness/spasm

Answer 40

Subacute stage of MVA/whiplash

Question 41

Condition: Sx intermittent Limited active movements weak mm postural changes

Answer 41

Chronic stage of MVA/whiplash

Question 42

Describe the goal of intervention in each stage following an MVA/whiplash injury

Answer 42

Acute: protect structures and mobility within tolerace Subacute/Chronic: gain mobility and stability

Question 43

Condition: rupture of transverse lig.; may result in cord compression

Answer 43

AA dislocation

Question 44

Condition: vertical compression resulting in massive suboccipital HA

Answer 44

Fx of posterior arch of atlas (C1)

Question 45

Condition: fx of anterior and posterior arch of C1

Answer 45

Jefferson fx

Question 46

Condition: Fx of C2 pedicles with disolcation of C2 on C3 Dens migrates into brainstem

Answer 46

Hangman's Fx