Week 2 - Mid to Lower Cervical Spine Flashcards
(141 cards)
1
Q
What fraction of the population experiences neck pain?
A
2/3rds
2
Q
What percent of individuals with neck pain will have chronic pain?
A
10%
3
Q
Does the frequency of neck pain increase or decrease with age?
A
increases
4
Q
Which gender and age has the highest incidence rate of neck pain?
A
Female and middle age
5
Q
As physical therapists working in outpatient centers approximately what percentage of patient are will be related to neck pain?
A
25%
6
Q
Which region of the spine is the most mobile?
A
Cervical
7
Q
What is the primary function of the cervical spine?
A
To accommodate for a wide range of motion required by the head.
8
Q
How many cervical vertebrae are there?
A
7 bony vertebrae
9
Q
Is the normal curvature of the spine kyphotic or lordotic?
A
lordotic
10
Q
What is the typical angulation of the cervical region?
A
angulation of lordosis typically ranging from 30-35 degrees
11
Q
Which cervical vertebrae are considered typical?
A
C3-C6
12
Q
Are typical cervical vertebrae bodies square or rectangular in shape?
A
rectuangular
13
Q
Are typical cervical vertebrae bodies wider in the medial to lateral aspects or anterior to posterior
A
wider in the medial to lateral aspects than anterior to posterior.
14
Q
Are the typical cervical vertebrae bodies flat or curved?
A
bodies are curved almost saddle shapped
15
Q
Are the typical cervical vertebral canal triangular or rectangular in shape? small or large? why?
A
more triangular in shape and is large to accomodate the increased thickness of the spinal cord that is associated with the cervical and brachial plexus.
16
Q
What is the saddle shape of the bodies of the cervical vertebrae due to?
A
Uncinate processes
17
Q
What are Uncinate processes?
A
A raised lateral hook on the superior lateral aspect of the bodies of cervical vertebrae C3-C7.
18
Q
What is a uncovertebral joint (u joint)?
A
a “psuedo joint” of articulation between the uncinate process and adjacent part of the vertebrae above
19
Q
What is the purpose of the u joint?
A
has a contribution in range of motion as the control lateral flexion and permit sagittal movement of flexion and extension.
20
Q
What is the clinical significance of the u joint?
A
degeneration may occur, intervertebral disc blends with so increase in compressive forces may develop bone spurs impinging nerve roots rendering neurological symptoms (muscle weakness, impaired sensation, and numbness and tingling in hands)
21
Q
What is another name for articular processes?
A
facets
22
Q
How many facets does each vertebrae have?
A
With the exception of C1, each vertebrae has a pair of superior and inferior facets.
23
Q
What is another name for facet joints?
A
apophyseal joints
24
Q
What type of joint is a facet joint?
A
flat plane synovial joint
25
What lines facet joints?
articular cartilaged
26
What encloses facet joints?
synovial lines capsule
27
Is the facet joint capsule innervated?
yes
28
What forms the facet joint?
the superior and inferior articular processes of the adjacent vertebrae
29
How would you describe the orientation of the facet joint?
oblique
30
What are the facet joints responsible for?
guiding intervertebral motion.
31
C2 Facet Orientation:
1. Superior facet articulates with ___.
2. Degree orientation of facet?
3. Favor what type of movment
1. Superior facet articulates with INFERIOR FACET OF C1.
2. 20 degree inclination to the horizontal plane.
3. Favor axial rotation.
32
C3-C7 Facet Orientation: Degree orientation of facet?
45 degree inclination to the horizontal and frontal planes.
33
What primarily influences the range of motion throughout the spine?
facet orientation
34
The mid-lower cervical spine permits movement in what planes? What does this support?
All 3: sagittal, horizontal, and frontal. Supports primary role of cervical spine supporting the required movement of the head.
35
Collectively the mid-lower cervical spine renders between what degree of flexion?
35-40 degrees
36
Collectively the mid-lower cervical spine renders between what degree of extension?
55-60 degrees
37
Collectively the mid-lower cervical spine renders between what degree of rotation and lateral flexion?
30-35 degrees
38
Across the entire craniocervical spine, what is the the total degree of flexion?
45-50 degrees
39
Across the entire craniocervical spine, what is the the total degree of extension?
75-80 degrees
40
Across the entire craniocervical spine, what is the the total degree of unilateral rotation?
65-75 degrees
41
Across the entire craniocervical spine, what is the the total degree of unilateral flexion?
35-40 degrees
42
Flexion and Extension occurs about which plane in the C2-C7 spine?
Sagittal Plane
43
What angle plane does the flexion and extension motion follow in the C2-C7 spine?
oblique plane (recall the 45 degree inclination that exits between facet joints)
44
Describe the motion of the facets of the C2-C7 spine during flexion.
the INFERIOR articular facets of the superior vertebrae slide superiorly and anteriorly, relative to the superior articular facets of the inferior vertebrae.
45
During flexion, the sliding action between relatively flat articular surfaces of facets C2-C7 creates what? what purpose does this serve?
creates a "gapping" or opening between the two surfaces of joint separation. This allows for flexion.
46
What structures limit flexion of C2-C7 and are they located anterior or posterior? (4)
Posterior Structures:
1. Posterior Longitudinal Ligament
2. Ligamentum Nuchae
3. Interspinous Ligaments
4. Muscles
47
Describe the motion of the facets of the C2-C7 spine during extension.
the INFERIOR articular facet of the superior vertebrae slide inferiorly and posteriorly relative to the superior articular facets of the inferior vertebrae .
48
During extension, the sliding action between relatively flat articular surfaces of facets C2-C7 creates what?
Facets approximate or "close" down as the move closer to one another moving in the posterior direction.
49
What structures limit extension of C2-C7 and are they located anterior or posterior? (3)
```
Anterior Structures:
1. Anterior Longitudinal Ligament
2. Approximation of Apophyseal Joints
(close of facet joints)
3. Muscles
```
50
Describe the motion of the facets of the C2-C7 spine during lateral flexion.
```
Ipsilateral Side (sidebend):
inferior articular facets of the superior vertebrae slide inferiorly and a little posteriorly
```
Contralateral Side:
inferior articular facets slide superiorly and slightly anteriorly
51
During lateral flexion, the sliding action between the relatively flat articular surfaces of C2-C7 creates what?
```
Ipsilateral Side (sidebend):
facets downslide aka close down
```
Contralateral Side:
facets upslide aka slightly gaps/opens
52
Describe the motion of the facets of C2-C7 spine during axial rotation.
Ipsilateral Side of Rotation:
inferior facet of the superior vertebrae slides posteriorly and slightly inferior
Contralateral Side of Rotation:
inferior facet of the superior vertebrae slides anteriorly and slightly superior
53
When describing the movment of the facets during motion of the spine, what is used as the reference point?
the inferior facet of the superior vertebrae and its sliding movement on the superior facet of the superior vertebrae (bilaterally or unilaterally - ipsilateral/contralateral)
54
Is spinal coupling the same for the upper and mid-lower cervical spine?
No, opposite.
55
Describe the coupling pattern between lateral flexion and axial rotation in the upper cervical spine AA joint.
In the upper cervical spine AA joints lateral flexion and axial rotation coupling occurs to the opposite side or contralaterally
56
Describe the coupling pattern between lateral flexion and axial rotation in the mid-lower cervical spine C2-C7.
In the mid-lower cervical spine axial rotation and lateral flexion coupling pattern occurs to the same side or ipislaterally.
57
In the upper cervical spine AA joint, right lateral flexion occurs with a small amount of ___. Is this coupled contralteral or ipsilateral?
left axial rotation (contralaterally)
58
In the upper cervical spine AA joint, right axial rotation occurs with a small amount of ___. Is this coupled contralteral or ipsilateral?
left lateral flexion (contralaterraly)
59
In the mid-lower cervical spine C2-C7, right lateral flexion occurs with a small amount of ____. Is this coupled contralteral or ipsilateral?
right axial rotation (ipsilaterally)
60
In the mid-lower cervical spine C2-C7, right axial flexion occurs with a small amount of ____. Is this coupled contralteral or ipsilateral?
right lateral rotation (ipsilaterally)
61
Which of the cervical spine is a "transitional segment"?
C7
62
Where are the interbody joints located?
from between C2+C3 to L5+S1
63
What kind of joints are interbody?
Synarthrodial joints
64
T/F: the interbody joints are cartilaginous.
True
65
What kind of movement due the interbody joints permits?
Permit slight to no amount of movement
66
What is the facet orientation of the A-A joints? What motion does this permit?
20 degree orientation to the horizontal plane allowing for rotation. (angle permits for more spin.
67
What are the components to each interbody joint? (3)
1. Intervertebral disc
2. Vertebral endplates
3. Adjacent vertebral bodies
68
What is the function of interbody joints?
Optimize function of the spine. (add to the integrity and optimal function of the spine.
69
What is the intervertebral disc made up of? (3)
1. Annulus Fibrosus
2. Nucleus Pulposus
3. Vertebral Endplate
70
What is unique about the Annulus Fibrosus to optimize its overall strength?
composed of concentric rings of fibrocartilage tissue (strength) with each layer of fibrocartilage oriented approximately 90 degrees differently to optimize its overall strength.
71
Normally where is the Annulus Fibrosus thickest? What supports it?
Normally is thicker on the anterior aspect and gets strong support from the anterior longitudinal ligament
72
What is different about the Annulus Fibrosus in the cervical spine? (3)
1. does not have complete concentric rings as it is almost crescent shape
2. posteriorly it is thinner
3. although it is supported by the posterior longitudinal ligament, it is not as strong and therefore makes it more prone to herniation
73
What is the center inner component of the intervertebral disc called?
Nucleus Pulposus
74
What is the Nucleus Pulposus consistency?
pulp-like gel
75
What are the two main purposes of the Nucleus Pulposus?
1. Shock Absorption
| 2. Distribution of Forces
76
How does the Nucleus Pulposus change from younger to older years?
Younger: made up of 70-90% water for shock absorption and dissipation of forces across the vertebrae.
Older: Reduction in water content therefore compressive loads on spine can be greater.
77
What is the main purpose of the intervertebral discs?
stabilizers
78
What are vertebral endplates?
cartilaginous caps made up of connective tissue that cover a majority of the superior and inferior surfaces of the vertebral bodies.
79
How do the Cartilaginous Caps change with age? (birth, childhood, adulthood)
Birth: very thick and account for 50% of the height of each intervertebral space
Childhood: serve as growth plates for the vertebrae
Adulthood: endplates become thinner and only occupy about 5% of the height of each intervertebral space
80
In the mid-lower cervical spine, the inferior facets of the superior vertebrae face ____ and ____, and the superior facets of the inferior vertebrae face _____ and ____.
In the mid-lower cervical spine, the inferior facets of the superior vertebrae face ANTERIORLY and INFERIORLY, and the superior facets of the inferior vertebrae face POSTERIORLY and SUPERIORLY.
81
"shingles on a roof" mimic the orientation of what facets?
C2-C7, 45 degree between the horizontal and frontal planes.
82
In what plane does Protration occur in? What motion is the head doing?
Sagittal Plane Motion, head translates forward.
83
Describe the motion of the Mid-Lower Cervical Spine and Upper Cervical Spine during Protraction.
Mid-Lower: FLEXES
| Upper: EXTENDENDS
84
What can extended periods of time of Protraction cause? (2)
1. Leads to a FORWARD HEAD POSTURES.
| 2. Stress/strain on joints and muscles
85
In what plane does Retraction occur in? What motion is the head doing?
Sagittal Plane Motion, head translates poteriorly.
86
Describe the motion of the Mid-Lower Cervical Spine and Upper Cervical Spine during Protraction.
Mid-Lower: EXTENDS
| Upper: FLEXES
87
Is Protraction or Retraction ROM greater?
Protraction ROM is greater than Retraction ROM.
88
Where in the cervical spine is rotation the greatest? Why?
the more cranial segments:
20 degree orientation to the horizontal plane of C1-C2 facet and transition to the 45 degree orientation to the horizontal and frontal plane allow for subsequent less rotation in lower cervical spine.
89
What position at the AO joint creates a POSTERIOR glide Occipital condyles?
Flexion
90
What position would you place the AO Joint in to create a MAXIMAL ANTERIOR glide of the Left Occipital condyle?
Extension
with
Right Rotation and coupled Left Lateral Flexion
91
What 2 positions would you place the AO joint in to test MAXIMAL POSTERIOR glide of the Left Occipital condyle?
Flexion
with
Left Rotation and coupled Right Lateral Flexion
92
What 2 positions would you place the AO joint in to test MAXIMAL ANTERIOR glide of the Right Occipital condyle?
Extension
with
Left Rotation and coupled Right Lateral Flexion
93
A 45 year-old-male reports pain and difficulty moving his neck after a fall on the basketball court. He is a referee for Division 1 college basketball and notes he is having difficulty following the play of the game. He reports he is in excellent health.
Based on what you know about the craniocervical spine:
-What more do you need to know about his history?
Need more info about history:
- What happened?
- Describe fall?
- Did you loose consciousness (rule out upper cervical ligaments)?
- What are you having difficult with?
- What aggravates symptoms?
- What makes you feel better?
- What part of play is most difficult?
- Fill out outcome measures to see if he can't read or sit still or has pain with certain activities.
94
A 45 year-old-male reports pain and difficulty moving his neck after a fall on the basketball court. He is a referee for Division 1 college basketball and notes he is having difficulty following the play of the game. He reports he is in excellent health.
Based on what you know about the craniocervical spine:
-What would you include in your examination?
Look at active range of motion, ligament testing for stability control, then do passive range of motion. If positive for short pursar would check other ligaments depending on how positive.
95
What are the Posterior Cervical muscles? (5)
1. Multifidus
2. Semispinalis Cervicis
3. Semispinalis Capitis
4. Splenius Capitis
5. Uppper Trapezius
96
What are the Anterior Cervical muscles? (3)
1. Longus Capitis/Colli
2. Scalenes
3. Sternocleidomastoid
97
What is the function of Deep Cervical Muscles?
Local Stabilizers of Spine
98
Where do the Deep Cervical Muscles attach?
directly to vertebrae
99
What do the Deep Cervical Muscles control? (2)
1. Control Intersegmental Motion (stiffens)
| 2. Control the position of the Vertebrae
100
What is the Origin: Longus Capitis
anterior tubercles of Transverse Processes of C3-C6
101
What is the Insertion: Longus Capitis
inferior surfaces of Occiput
102
What is the Action: Longus Capitis
Unilaterally:
1. Flexion/Extension
2. Lateral Flexion Ipsilateral
Bilaterally:
3. Nodding
103
What is the Innervation: Longus Capitis
Ventral Rami C1-C4
104
What is the Origin: Longus Colli
Inferior Oblique Portion:
1. anterior surfaces of Bodies of C1-C3
Superior Oblique Portion:
2. anterior tubercles of Transverse Processes of C3-C5
Vertical Portion:
3. anterior Surface of C5-T3
105
What is the Insertion: Longus Colli
1. Tubercle of C1
2. anterior surface of C2-C4
3. anterior tubercles of Transverse Processes of C5-C6
106
What is the Action: Longus Colli
1. Nodding
| 2. Support of cervical Lordosis
107
What is the Innervation: Longus Colli
Ventral Rami C1-C8
108
What is the 2 functions of Longus Capitis and Longus Colli?
1. "Dynamic" anterior longitudinal ligament
2. Vertical Stability
*Key muscles in cervical rehabilitation*
109
What is the Purpose of a Cranial Cervical Flexor Test?
Assess strength of the deep cervical
110
What Equipment is used in a Cranial Cervical Flexor Test?
Stabilizer Unit
111
Describe the Cranial Cervical Flexor Test.
Ask patient to nod head on neck.
Avoid retraction and isolate movement to upper cervical spine.
Avoid activation of SCM.
Start at 20mm Hg
112
What is Normal for Cranial Cervical Flexor Test?
Able to generate 28-30mmHf (otherwise recruiting other muscles) of pressure for 10 sec without compensations.
113
What do patients with Neck Pain and CGH normally get for a Cranial Cervical Flexor Test?
114
What is the Intra and Inter tester ICC for the Cranial Cervical Flexor Test?
Intratester ICC = 0.98
Intertester ICC = 0.91
Good!
115
What is the purpose of the Deep Neck Flexor Muscle Test?
Endurance Test
| -Assesses strength of deep cervical neck flexors.
116
How long is a "Normal" Deep Neck Flexor Muscle Test?
>38 seconds
117
How long is a "Neck Pain" Deep Neck Flexor Muscle Test?
118
What is intra and inter tester reliability for the Neck Flexor Muscle Test?
Intratester Reliability: Moderate 0.82-.91
Intertester Reliability: Moderate 0.67-.78
119
What are the functions of more Superficial Cervical Musculature? (3)
- Global stabilizers of spine
- Larger Torque producing muscles
- Transfer and Balance external loads during movement.
120
Name *guy at computer learning over computer picture* Dysfunction?
Forward Head Posture
121
What effect does Forward Head Posture have on: TMJ
Posterior rotation of condyle and might sit further posterior in mandibular fossa. You don't want condyle to sit in the upper mandibular fossa because that's where it is thin, what it more anteiror on articular eminence.
Muscles will of TMJ will tense up from this position (test with open/closing, protruding/retracting, lateral deviate with normal and forward head posture)
122
What effect does Forward Head Posture have on: Upper Cervical Spine
Extended which won't allow for rotation
123
What effect does Forward Head Posture have on: Mid-Lower Cervical Spine
Flexed which won't allow for rotation
124
What is happening to the muscles involved in TMJ, Upper Cervical Spine, and Mid-Lower Cervical Spine with Forward Head Posture?
Ideal Posture: Posterior global muscles are lined up as they should be where inserting, SCM is posterior to clavicle.
Excessive Forward Head Posture: Extensors of the spine will be really activated and SCM will move anterior.
125
What is the median pressure achieved in individuals without and with neck pain using the Cranial Cervical Flexion Test?
Median pressure achieved= 28 mmHG (without neck pain)
Median pressure achieved= 24 mmHG (with neck pain)
126
What are the long term effects on posture of Excessive Forward Head Posture?
- Can result in "re-posturing" of the cervical spine which overtime passes a great deal of stress on the joints and muscles in the craniocervical region.
- Muscle position changes and have increased stress.
127
What are the effects on aging with the cervical spine?
-Recurrent loads over time change morphology.
Degenerative changes noted in bone marrow and the vertebral endplates, intervertebral discs resulting in decrease disc height with resultant osteophytic changes in the vertebrae, increased calcification of the ligaments in particular the posterior Longitudinal ligament, narrowing of the spinal canal
128
What are parts of the spine are effected with again? (2)
1. Vertebral Bone Changes
| 2. Vertebral Disc Changes
129
What are the effects on aging in the vertebral bones? What is the result?
Reduction in trabeculae, challenges system to withstand loads
130
What are the effects on aging in the vertebral discs? (2)
Loss of proteoglycans = reduction in water content
2. Loss of elastin
(loose height and elasticity as age)
131
What can form in the cervical spine with aging?
Osteophytes (bone spures) - where uncovertebral joints come in
132
What can effect the aging of the cervical spine?
Long term effects from disease for example osteoarthritis.
133
How is the age of your cervical spine determined? (6)
Created a standardized scale for cervical spine changes found in MRI related possibly to biological aging investigated:
1. Intervertebral discs
2. Ligaments
3. Spinal canal
4. Spinal alignment (slippage)
5. Vertebral body
6. Presence/absence stenosis
134
how the spatial orientation of the facet surfaces contributes to predominant motions (plane): Atlanto-occipital
- Convex occipital bones and C1 concave lateral masses
| - Favors flexion and extension (sagittal plane)
135
how the spatial orientation of the facet surfaces contributes to predominant motions (plane): Atlanto-axial
- 20 degrees near horizontal plane
| - Favors axial (horizontal plane) rotation
136
how the spatial orientation of the facet surfaces contributes to predominant motions (plane): Intercervical Segments
-45 degrees between horizontal and frontal planes
- Favors the combination of axial rotation and lateral flexion
- C4-C6 flexion/extension is greatest in this region of the spine
137
How do you calculate CROM?
Top of Head ROM - T1 ROM
138
What couple be an issue with the cervical spine if flexion is limited and/or painful?
Inferior facet joints of the superior V. unable to slide superior and anterior on the segment below
139
What could be an issue with the cervical spine if left lateral flexion is limited and/or painful?
- Reduced sliding/gliding (translation) in left side bending
- reduced closing (downsliding) on the Left side
- reduced gapping (upsliding on the contralteral side
140
What could be an issue with the cervical spine if rotation is limited and/or painful?
upper cervical and/or intercervical segements
AA Joint: sliding of inferior facets of C1 across the superior articular facts of C2
Mid-Lower Cervical Spine:
-Ipsilateral Side: reduced inferior and posterior glide
and/or
-Contralateral Side: reduced superior/anterior glide
141
What are characteristics of normal motions?
QQW
- smooth regardless of speed (quality)
- range is full for body type and age (quantity)
- pain free (willingness to move)
- passive is greater than active range
