cervical spine review

atlanto-occipital joint motions

flexion and extension

arthrokinematics of atlanto-occipital joint flexion

anterior roll, posterior slide

atlanto-axial joint motions

rotation

arthrokinematics of atlanto-axial rotation

spin

ligaments associated with atlanto-axial joint

transverse, alar

transverse lig holds _____ around _____

atlas, dens

alar ligaments limit _____

rotation

both vertebral arteries are stretched in ______

full rotation

motions at C2-C7

flexion, extension, rotation, lateral flexion

arthrokinematics of C2-C7 flexion

superior and anterior slide

arthrokinematics of C2-C7

• ipsilateral rotation = ____

• contralateral rotation = ______

posterior and inferior slide, superior and anterior slide

arthrokinematics of C2-C7

• ipsilateral - lateral flexion = ____

• contralateral - lateral flexion = ______

posterior and inferior slide, superior and anterior slide

combined motions of the cervical spine

protraction and retraction

retraction = upper cervical ______, lower cervical _____

flexion, extension

protraction = upper cervical ______, lower cervical _____

extension, flexion

deep neck stabilizers

longus capitis and coli

longus capitis and coli

• _____ cervical region

• important for _____ posture

• “dynamic ______ ligament”

flexion, neutral head, anterior longitudinal

sub-occipitals have lots of _____

proprioceptors

risk factors for new episode of neck pain

• _____ age

• female

• PMHx of _____/____ pain

• high demand _____

• _____

• low _____ support

older, neck, back, job, smoker, social

risk factors for chronic neck pain

• older than ______

• PMHx ____ pain

• coexisting _____ pain

• regular _____

• decreased strength in _____

• _____

• poor ____

40, neck, back, cycling, hands, anxiety, QOL

neck pain MOI = ____, typically _____, can be _____/_____

variable, insidious, traumatic, nontraumatic

types of neck pain (4) = neck pain with ….

mobility deficits, headaches, radiculopathy, movement/coordination impairments

DDx

• multiple ______

• must perform _____ screen even if appears _____ related

sources, PT, MSK

Canadian C-Spine rules (if any are yes, refer for imaging)

*traumatic accident and:

• high risk factors: ______, ______, ______

• low risk factors: ______, ______, ______, ______, ______

• unable to rotate head _____ degrees to the R and L

age 65+, dangerous MOI, paresthesia in UE/LE

high velocity MVA, cant sit comfortably, cant walk independently, immediate neck pain, midline tenderness

45

NEXUS rules (if any are true = refer for imaging)

• _____ tenderness

• evidence of _____

• poor levels of ______

• _____ deficits

• pain is _____

midline, intoxication, alertness, neurological, distracting

neck pain with mobility deficits - CPR presentation

• ____/_____ pain

• limited cervical _____

• pain at _____

• decreased segmental ____

• pain with ____ of restricted segments

central, unilateral, ROM, end range, mobility, palpation

neck pain with mobility deficits - CPR treatment

• cervical and thoracic _____ (PAIVM)

• ____, flexibility

• _____/_____ strength

mob, ROM, cervical, scapular

neck pain with radiating pain - CPR presentation

• _____ paresthesia

• _____ weakness

• positive ______

dermatomal, myotomal, wanniers cluster

neck pain with radiating pain - CPR treatment

• ____ and _____

• cervical and thoracic ___ (PAIVM)

• intermittent _____

manual, ther ex, mobs, traction

common outcome measure for neck pain

neck disability index

prognosis

• most recovery in first _____ weeks, then slows

• no recovery after _____

6-12, 12mo

poor prognosis = insidious onset + (one of the following)

• _____ age

• PMHx ____ disorders

• decreased _____/____ health

• ____ comp

old, MSK, physical, mental, workers

passive accessory motions =

CPA, UPA, transverse glide

5 Ds And 3 Ns =

dizziness, drop attack, diplopia, dysarthria, dysphasia

anxiety, ataxia

nausea, numbness, nystagmus

alar and transverse ligament instability risk factors

• history of ____

• _____ disorders

• ____ arthritis

• _____

trauma, connective tissue, rheumatoid, down syndrome

special test for transverse lig

modified sharp-purser test

special test for alar ligaments

alar ligament stress test

risk factors for vertebrobasilar insufficiency

• history of _____

• _____ disorders

• ____

• _____

• high ____

• vascular _____

trauma, connective tissue, smoking, hypertension, cholesterol, anomaly

special tests for vertebrobasilar insufficiency

extension rotation test