Cervical Spine Clinical A+K

Give examples of daily activities where you use cervical flexion.

Looking down to read a book or phone; fastening buttons/zips; writing at a desk.

When you tilt your head down, what movement occurs at the cervical spine?

Cervical flexion.

In what plane and axis does cervical flexion occur?

Sagittal plane; mediolateral axis.

In what plane and axis does cervical extension occur?

Sagittal plane; mediolateral axis.

In what plane and axis does cervical side flexion occur?

Frontal plane; anteroposterior axis.

In what plane and axis does cervical rotation occur?

Transverse plane; longitudinal/vertical axis.

What are the agonists for cervical flexion?

Longus colli; Longus capitis; Sternocleidomastoid.

What are the antagonists for cervical flexion?

Upper trapezius; Levator scapulae; Semispinalis capitis/cervicis; Erector spinae.

What are the agonists for cervical extension?

Semispinalis capitis/cervicis; Levator scapulae; Trapezius; Erector spinae.

What are the antagonists for cervical extension?

Longus colli; Longus capitis; Sternocleidomastoid.

What are the agonists for cervical side flexion?

Ipsilateral scalenes; Ipsilateral SCM; Ipsilateral levator scapulae; Ipsilateral trapezius.

What are the antagonists for cervical side flexion?

Contralateral scalenes; SCM; levator scapulae; trapezius.

What are the agonists for cervical rotation?

Sternocleidomastoid; Semispinalis; Splenius.

What are the antagonists for cervical rotation?

Opposing rotators (e.g., left rotation opposed by right rotation muscles).

What are the origins of trapezius?

Occipital protuberance; superior nuchal line; ligamentum nuchae; spinous processes C7–T12.

What are the insertions of trapezius?

Lateral 1/3 clavicle; acromion; spine of scapula.

What are the actions of trapezius?

Cervical extension; cervical side flexion; scapular elevation; upward rotation of scapula.

Describe the morphology of trapezius.

Flat triangular paired muscle; covers upper back, neck, shoulders; upper/middle/lower fibres.

What is the nerve supply of trapezius?

Motor: Spinal Accessory Nerve (CN XI); Sensory: C3–C4.

What are the origins of sternocleidomastoid?

Manubrium of sternum; medial clavicle.

What are the insertions of sternocleidomastoid?

Mastoid process; superior nuchal line.

What are the actions of sternocleidomastoid?

Contralateral rotation; ipsilateral flexion.

Describe the morphology of sternocleidomastoid.

Long bilateral neck muscle; two heads (sternal thick/tendinous; clavicular broad/fleshy).

What is the nerve supply of sternocleidomastoid?

Motor: Spinal Accessory Nerve (CN XI); Sensory: C2–C3.

What is the primary movement of the atlanto-occipital joint?

Flexion/extension (nodding).

What type of joint is the atlanto-occipital joint?

Synovial ellipsoid/condyloid; biaxial.

What is the primary movement of the atlanto-axial joint?

Rotation (~50° each side).

How many joints make up the atlanto-axial complex?

Three synovial joints.

What type of joints are cervical facet joints?

Synovial plane joints.

What type of joints are intervertebral joints (C2–C7)?

Symphysis joints with fibrocartilaginous discs.

Name two ligaments of the cervical spine.

Examples: ALL; PLL; Ligamentum flavum; Interspinous; Ligamentum nuchae; Alar; Apical; Transverse ligament.

What features should be inspected around the cervical spine?

Alignment; curves; symmetry; head posture; chin/nose alignment; muscle bulk; scapular position.

How do you measure cervical flexion?

Tape measure: chin to chest.

How do you measure cervical extension?

Tape measure: chin to chest; observe cervical curve.

How do you measure cervical side flexion?

Tape measure: ear to shoulder; compare sides.

How do you measure cervical rotation?

Visual or tape measure: chin to shoulder.

Name two muscles that perform cervical rotation.

Sternocleidomastoid; Splenius.

Name two muscles that perform cervical side flexion.

Scalenes; Levator scapulae.

What limits cervical flexion?

Posterior ligaments; posterior muscle tension; facet capsule stretch; chin–chest contact.

What limits cervical extension?

Anterior longitudinal ligament; anterior muscle tension; facet compression; mild spinous contact.

How do you identify C6 vs C7?

C6 disappears on extension; C7 remains prominent.

How do you perform a PA on C6/C7?

Locate spinous process in prone; apply gentle PA pressure with thumbs.

How do you locate C2?

First palpable spinous process below occiput.

How do you isometrically test cervical flexion?

Hand on forehead; patient pushes forward.

How do you isometrically test cervical extension?

Hand on back of head; patient pushes backward.

How do you isometrically test cervical side flexion?

Hand on side of head; patient pushes sideways.

How do you isometrically test cervical rotation?

Hand on side of forehead; patient attempts to rotate.

How do you activate and palpate trapezius?

Shoulder elevation for upper fibres; shoulder abduction with elbows at 90° to palpate all fibres.

How do you activate and palpate sternocleidomastoid?

Ipsilateral side flexion with contralateral rotation; palpate along side of neck.