Conditions of the Cervical Spine

C1 Myotome

Chin tuck ; Resist superiorly

C2 Myotome

Protrusion ; Resist posteriorly (on chin and forehead)

Rotation ; Resist cheek (BOTH SIDES - resist in neutral)

C3 Myotome

Lateral Flexion ; Resist cheek (BOTH SIDES - resist in neutral)

C4 Myotome

Shoulder shrug ; Resist inferiorly on shoulders

C5 Myotome

Shoulder ABD ; Resist inferiorly above elbows

C6 Myotome

Elbow flexion ; Try to extend elbow

Wrist extension ; Try to fold wrist

****The ‘idk’ shrug*****

C7 Myotome

Elbow Extension ; Try to bend elbow

Wrist flexion ; Try to extend wrist

****Volleyball ready stance*****

C8 Myotome

Finger flexion ; Try to uncurl fingers

Thumb extension ; Try to bend thumb

****Monkey hand*****

Cervicogenic Headache

Head pain from soft tissue disorders in the cervical spine

• C1-C3 dysfunctions of facet joints = primary cause

• Pain :

  • Localized : Neck/occipital region

  • Radiates : Forehead/temple, ears, eyes

• Causes : trauma, posture, Women 4x : Men 1x

• Symptoms : Consistent unilateral pain that starts in neck & spreads

• Special Tests :

1. Cervical Flexion-Rotation Test

2. Craniocervical Flexion Test

3. Deep Neck Flexor Endurance Test

Cervical Flexion-Rotation Test

Position : Supine w/ AROM full neck flexion

Test : Rotate pt’s head bilaterally and compare sides

Positive : >10 difference OR pain

Testing For : Cervicogenic Headache

Craniocervical Flexion Test

COME BACK TO

Deep Neck Flexor Endurance Test

Position : Supine

Test : AROM tuck chin + lift head & hold

Positive : Less than average time

• Females : 29-32 seconds

• Males : 35-40 seconds

Testing For : Cervicogenic Headache

Whiplash

Injury to neck from rapid movement causing trauma to cervical soft tissue/bones

• 0-4 Grades:

0. No pain & no signs

1. Pain but no signs
   - Small muscle lesions not significant enough to cause spasms

2. Musculoskeletal signs (causing limited ROM, spasms, swelling, tenderness)
   - Sprained ligaments & muscles tears

3. Musculoskeletal & neurological signs (issues with reflexes, decreased usage dermatomes & myotomes)
   - Usually have pressure on or irritation of nerves

4. Fracture or dislocation

• Pain :

  • Localized : Neck &/or headaches

• Causes : trauma

• Symptoms : Depending on grades, could also have blurred vision, spinal instability, ears ring, fatigue

Facet Joint DJD

(Frequently due to DDD {disc degenerative disease}) - Disc deteriorates & facets have to bear more weight → DJD

• Pain :

  • Localized : Neck to scapular region

• Causes : aging & obesity

• Symptoms : Pain that worsens with extension (could lead to cervicogenic headache) = limited extension ROM

  

Spinal Stenosis DJD

Narrowing of the canal squeezes spinal cord (Normal spacing of canal and cord is 2.5mm on sides & 1mm front/back)

• Pain : Bilateral arm pain

• Causes : bony overgrowth from OA or aging, calcification of ligaments of the spinal canal, scoliosis, disc herniations

• Symptoms : Bilateral arm pain, fatigue, numbness/tingling, weakness, abnormal reflexes/sensory loss

  • Cervical Myelopathy : Disruption of nerves impulses through neck & affects LE strength, gait, and bowel/bladder

Foraminal Stenosis

OA or DJD in neural foramen with osteophytes overgrowing in foramen & constricting spinal nerve → causing radiculopathy (“pinched nerve”)

• Pain :

  • Centralization : When distal pain moves closer to spine (GOOD!!!)

  • Peripheralization : When distal pain moves further down arm (BAD!!!)

• Causes : Aging OR accelerated hyper- or hypo-mobility

• Symptoms : Neck & UE pain, numbness/tingling, weakness, loss of reflexes

  • !! Usually decrease in pain with neck flexion & shoulder ABD (placing arm overhead)!!

• Special Tests :

1. Spurling’s Compression Test

2. Cervical Distraction Test

3. Upper Limb Tension Test (ULTT)

Herniated Disc

• Pain :

  • Localized :

  • Radiates :

• Causes :

• Symptoms :

• Special Tests :

Spurling’s Compression Test

Cervical Distraction Test

Upper Limb Tension Test (ULTT)