MSK UQ Unit 1 COMBO set

What is the vertebrobasilar artery system?

A vascular system formed by the vertebral arteries that supply the spinal cord, brainstem, cerebellum, and posterior cerebral hemispheres.

Where do the vertebral arteries originate?

They usually arise as branches of the subclavian arteries, but may also arise from the aortic arch or common carotid artery.

How many parts is each vertebral artery divided into?

Four parts

What is the first part of the vertebral artery (V1)?

The portion that arises from the subclavian artery and ascends to enter the transverse foramen.

What muscles does the first part of the vertebral artery run between?

Between the longus colli and anterior scalene muscles.

At what cervical level does the vertebral artery usually enter the transverse foramen?

Typically at C6, but it may enter as high as C4.

Why is compression common in the first part of the vertebral artery?

Due to congenital factors, muscular compression, or age-related changes.

What is the second part of the vertebral artery (V2) also called?

The transverse portion of the vertebral artery.

Where does the second part of the vertebral artery travel?

Through the transverse foramina from its entry point (usually C6) up to C2.

What anatomical structures place the second part of the vertebral artery at risk for compression?

The uncinate processes of the vertebral bodies, especially with osteophytes or joint subluxation.

What is the third part of the vertebral artery (V3)?

The suboccipital portion, extending from the artery’s exit at C2 to entry into the spinal canal.

How does the vertebral artery travel in the third part?

It runs upward and laterally to enter the transverse foramen of C1, then exits C1 and travels posteriorly, medially, and superiorly to the foramen magnum.

Why is the third part of the vertebral artery clinically significant?

It is subjected to the greatest mechanical stress and is a common site of compression.

What types of pathology can affect the third part of the vertebral artery?

Blunt trauma, osteophytes, and atherosclerosis.

Between which cervical levels is the vertebral artery most vulnerable to compression and stretching?

Between C1 and C2.

How much cervical rotation occurs at C1–C2?

Approximately 50% of total cervical rotation.

During which motion is the vertebral artery most vulnerable to stretch?

During contralateral cervical rotation.

What happens in the fourth part of the vertebral artery (V3)?

Both vertebral arteries enter the cranial cavity and unite to form the basilar artery.

Where do the vertebral arteries meet to form the basilar artery?

Within the arachnoid space at the level of the foramen magnum.

What are the arthrokinematics of AO flexion?

Anterior roll with posterior slide.

What are the arthrokinematics of AO extension?

Posterior roll with anterior slide.

What are the arthrokinematics of AO right lateral flexion?

Right roll with left slide.

What are the arthrokinematics of AO left lateral flexion?

Left roll with right slide.

What primarily occurs at the atlanto-axial joint?

Rotation

What is the axis of rotation for AA rotation?

The dens of C2.

What structures twist around the dens during AA rotation?

The atlas and the transverse ligament.

What happens to the vertebral arteries during AA rotation?

They are stretched.

What are the arthrokinematics of C2–C7 flexion?

Facet joints slide anteriorly and superiorly

What are the arthrokinematics of C2–C7 extension?

Facet joints slide posteriorly and inferiorly.

What occurs on the ipsilateral side during right lateral flexion at C2–C7?

Facets slide inferiorly and posteriorly.

What occurs on the contralateral side during right lateral flexion at C2–C7?

Facets slide superiorly and anteriorly.

What occurs on the ipsilateral side during right rotation at C2–C7?

Facets slide inferiorly and posteriorly.

What occurs on the contralateral side during right rotation at C2–C7?

Facets slide superiorly and anteriorly.

What movements create an opening pattern in the cervical spine?

Flexion, contralateral side-bending, and contralateral rotation.

What movements create a closing pattern in the cervical spine?

Extension, ipsilateral side-bending, and ipsilateral rotation.

What does CPG stand for in neck pain management?

Clinical Practice Guideline

How common is neck pain worldwide?

Very common and increasing worldwide

What is the lifetime incidence of neck pain?

Approximately 22–77%

How does neck pain rank in workers’ compensation costs?

Second only to low back pain

What percentage of outpatient PT visits involve neck pain?

Approximately 25%

Is neck pain recurrence common?

Yes, recurrence and chronicity rates are high

Which sex has a higher risk of neck pain?

Female

How does prior neck pain affect future risk?

History of neck pain increases risk of recurrence

What age-related factor increases neck pain risk?

Older age

What job-related factors increase neck pain risk?

High job demands and low social/work support

Which lifestyle factor increases neck pain risk?

Smoking history

How is low back pain related to neck pain risk?

History of low back pain increases risk

When does the most rapid recovery from neck pain usually occur?

Within the first 6–12 weeks

What happens to recovery after 12 months?

Little to no further recovery is expected

How does chronic neck pain typically behave over time?

Symptoms may be stable, fluctuating, or recurrent

Symptoms may be stable, fluctuating, or recurrent

High pain intensity

Which self-reported measure predicts worse prognosis in neck pain?

High self-reported disability

How does pain catastrophizing affect neck pain prognosis?

Higher catastrophizing is associated with worse outcomes

Which psychological factor in the acute phase predicts poor prognosis?

High acute post-traumatic stress

Which sensory finding is associated with poorer prognosis in neck pain?

Cold hyperalgesia

Which tool is used to measure pain intensity in patients with neck pain?

Numerical Pain Rating Scale (NPRS)

Which outcome measure assesses disability related to neck pain?

Neck Disability Index (NDI)

Which questionnaire assesses pain catastrophizing in neck pain patients?

Pain Catastrophizing Scale

Which outcome measure assesses psychological stress following a traumatic event?

Impact of Events Scale

Which serious medical conditions must be ruled out when screening patients with neck pain?

Infection, cancer, and cardiac pathology

Which vascular condition must be screened for in patients with neck pain?

Arterial insufficiency

Which ligamentous condition requires medical screening in neck pain patients?

Upper cervical ligamentous insufficiency

Which neurological finding requires referral in neck pain patients?

Cranial nerve dysfunction

When should fracture be considered in patients with neck pain?

Following trauma or presence of red flag findings

What does the Canadian C-Spine Rule (CCR) help determine in neck pain patients?

Need for cervical spine imaging after trauma

What is the purpose of the NEXUS criteria in neck pain evaluation?

Determining need for cervical spine imaging

What do the ACR Appropriateness Criteria guide?

Appropriate imaging selection for neck pain

In Neck Pain with Mobility Deficits, what is the primary physical impairment?

Motion limitation

In Neck Pain with Mobility Deficits, which ROM is routinely assessed?

Cervical active range of motion

What does the Cervical Flexion Rotation Test (CFRT) assess in Neck Pain with Mobility Deficits?

Upper cervical (AA) rotation

What does the Cervical Lateral Flexion Test (CFLT) assess in Neck Pain with Mobility Deficits?

First rib and cervicothoracic mobility

What is expected on neurological screening in Neck Pain with Mobility Deficits?

Negative neurological findings

In Neck Pain with Mobility Deficits, is distal upper extremity radiating pain present?

No, distal radiating pain excludes this category

Where is pain typically located in Neck Pain with Mobility Deficits?

Central or unilateral neck pain, possibly referring to shoulder girdle

Which patient population commonly fits Neck Pain with Mobility Deficits?

Older adults with non-traumatic onset

What manual therapy interventions are recommended in acute (<6 weeks) Neck Pain with Mobility Deficits?

Thoracic manipulation and cervical manipulation or mobilization

What exercises are recommended in acute (<6 weeks) Neck Pain with Mobility Deficits?

Cervical ROM exercises and scapulothoracic/upper extremity strengthening and stretching

What interventions are recommended during the subacute (6–12 weeks) phase of Neck Pain with Mobility Deficits?

Thoracic manipulation plus cervical manipulation or mobilization and endurance exercises

What exercise approach is recommended for chronic (>12 weeks) Neck Pain with Mobility Deficits?

Mixed exercise including neuromuscular control, strengthening, endurance, and aerobic conditioning

What adjunct treatments may be used for chronic (>12 weeks) Neck Pain with Mobility Deficits?

Dry needling, laser therapy, or intermittent traction

What is a cervicogenic headache?

A headache originating from cervical spine dysfunction due to convergence of cervical (C1–C3) afferents with trigeminal nerve afferents

Which cervical nerve roots are most associated with cervicogenic headache?

C1–C3

What neuroanatomical relationship contributes to cervicogenic headache?

Convergence of upper cervical nerve roots with trigeminal afferents in the dorsal gray column

Is cervicogenic headache typically unilateral or bilateral?

Usually unilateral

What neck-related factors typically provoke cervicogenic headache symptoms?

Neck movement or sustained postures

What body position often alleviates cervicogenic headache symptoms?

Lying down

What cervical ROM finding is common in cervicogenic headache?

Reduced cervical range of motion

What muscle impairment is often present in cervicogenic headache?

Reduced deep cervical flexor strength

What postural characteristic is commonly associated with cervicogenic headache?

Poor posture increasing stress on cervical musculature

What is cervical spondylosis?

A term describing degenerative changes of the cervical spine

What other terms are commonly used to describe cervical spondylosis?

Cervical arthritis, cervical disc disease, degenerative disc disease (DDD), arthrosis

At what age can cervical spondylosis begin?

As early as 30 years old

What percentage of people over age 60 show signs of cervical spondylosis?

More than 90%

Which cervical levels are most commonly affected by spondylosis?

C5–C6 and C6–C7

Should radiographic evidence of spondylosis always be considered symptomatic?

No, degenerative findings can be asymptomatic

How does cervical spondylosis typically begin?

Gradual onset of neck or arm symptoms

How do symptoms of cervical spondylosis usually progress?

Increase in frequency and severity over time

What time-of-day symptom is common with cervical spondylosis?

Morning stiffness that improves throughout the day

What serious conditions can cervical spondylosis sometimes present as?

Acute stiff neck, cervical myelopathy, or vertebrobasilar insufficiency (VBI)

What cervical plane of motion is most limited in spondylosis?

Sagittal plane (flexion/extension)