Musculoskeletal Physiotherapy 2: Cervical Spine Lecture Flashcards

A set of 100 vocabulary flashcards covering clinical anatomy, vascular conditions, neurological disorders, and mechanical neck pain of the cervical spine.

Atlas ($C1$)

The first cervical vertebra which lacks a vertebral body and a true spinous process, primarily facilitating flexion and extension at the atlanto-occipital joint.

Axis ($C2$)

The second cervical vertebra characterized by a small vertebral body with a superior projection called the Dens (Odontoid process).

$C8$ Nerve Root

The cervical spinal nerve that exits the vertebral column below the seventh cervical vertebra.

Brachial Plexus

A network of nerves formed by the anterior rami of $C5-T1$ providing nerve supply to the upper limb.

Red Flags: VBI symptoms

A cluster of warning signs for vascular issues consisting of the 5 D's and 3 N's.

5 D's of VBI

A clinical mnemonic representing Dizziness, Diplopia, Dysarthria, Dysphagia, and Drop attacks.

3 N's of VBI

A clinical mnemonic representing Nausea, Numbness (perioral), and Nystagmus.

Craniovertebral Instability (AAI)

Excessive movement at the $C1-C2$ vertebrae resulting from bony or ligamentous abnormalities.

Odontoid Fracture Type I

A rare and potentially unstable fracture involving the upper part of the odontoid peg.

Odontoid Fracture Type II

An unstable fracture occurring at the base of the odontoid with a high risk of non-union.

Odontoid Fracture Type III

A fracture through the odontoid extending into the lateral masses of $C2$, typically having the best prognosis for healing.

Hangman's Fracture

The colloquial name for a fracture involving both pedicles or the pars interarticularis of the axis ($C2$).

Jefferson Fracture

A burst fracture of the Atlas ($C1$) often resulting from traumatic axial compression.

AO Spine Classification: Type A

A category of lower cervical fractures characterized by compression injuries like impaction or burst fractures.

AO Spine Classification: Type B

A category of lower cervical fractures involving distraction injuries, such as posterior ligamentous injury or hyperextension.

AO Spine Classification: Type C

A category of lower cervical fractures characterized by rotation and translation injuries, such as facet dislocations.

Sharp Purser Test

A clinical test for instability performed by stabilizing $C2$ and applying posterior cranial pressure.

Alar Ligament Test

A clinical test for ligamentous stability performed by stabilizing $C2$ and performing side flexion or rotation.

Cervical Arterial Dissection (CAD)

A tear in the vertebral artery wall (or internal carotid) that may result in a stroke.

Vertebrobasilar Insufficiency (VBI)

A condition characterized by decreased blood flow to the posterior portion of the brain, often provoked by neck positions.

CAD Age Risk Factor

A vascular condition more commonly identified in younger populations under $55$ years of age.

VBI Age Risk Factor

A vascular condition typically observed in older patients over $65$ years of age.

Horner’s Syndrome

An unfamiliar neurological symptom that can be a presenting feature of cervical arterial dissection.

Sustained End Range Rotation (ERRT)

A VBI screening test held for $10$ seconds to monitor for symptom reproduction or nystagmus.

Test Latency in VBI Screening

The required $10$ second wait period in a neutral position between testing the left and right sides during ERRT.

Circle of Willis

The arterial ring at the base of the brain supplied by the vertebral and carotid arteries.

Basilar Artery

The vessel formed by the junction of the two vertebral arteries that provide blood to the brain's posterior portion.

Pincer-like Deformities

Deformities seen in cervical myelopathy resulting from disc/osteophyte complex compression of the spinal cord.

Myelomalacia

A softening or lack of fluid signal on MRI indicating spinal cord compression.

Disc Prolapse Peak Incidence

A condition most common in the $3^{rd}$ to $5^{th}$ decade of life, specifically between $51-60$ years of age.

Cervical Radiculopathy

Compression of a nerve root as it exits the vertebral column, resulting in neurological loss like weakness or reflex changes.

Cluster of Wainner

A group of findings including positive Spurling's, axial distraction, ULTT1, and rotation $< 60$ degrees used to diagnose radiculopathy.

Spurling's Test

A provocative test used to identify cervical radiculopathy by compressing the nerve root.

Axial Distraction Test

A test used to diagnose radiculopathy where pulling on the head potentially relieves nerve root symptoms.

ULTT1

Upper Limb Tension Test 1, used to assess nerve root sensitivity and irritability.

Stinger and Burner Syndrome

A transient brachial plexopathy or traction injury common in contact sports like rugby or NFL.

Cervical Myelopathy

Injury to the spinal cord due to severe compression, often presenting with bilateral neurological symptoms.

Whiplash Associated Disorders (WAD)

A range of clinical manifestations resulting from an acceleration-deceleration mechanism of energy transfer to the neck.

WAD Grade 0

Whiplash classification for patients with no neck complaints and no physical signs.

WAD Grade 1

Whiplash classification for patients with neck complaints of pain, stiffness, or tenderness only, with no physical signs.

WAD Grade 2

Whiplash classification for neck complaints and musculoskeletal signs such as decreased ROM and point tenderness.

WAD Grade 3

Whiplash classification for neck complaints and neurological signs including decreased reflexes or weakness.

WAD Grade 4

Whiplash classification for neck complaints with evidence of fracture or dislocation.

Low Load Isometrics

A recommended exercise treatment for the management of Whiplash Associated Disorders.

Thoracic Spine Manipulation

A manual therapy technique that may be effective for acute WAD, whereas cervical manipulation lacks evidence for efficacy.

Symptom Severity Prognosis (WAD)

Significant predictors of persistent pain include a VAS score $> 5/10$ or NDI $> 15/50$.

Impact of Events Scale (IES)

A tool used $3-6$ weeks post-injury to screen for posttraumatic stress; a score $> 25$ warrants a psychology referral.

Acute Wry Neck

Sudden onset of sharp neck pain with protective deformity and movement limitation.

Zygapophyseal Wry Neck

A type of wry neck common in children and young adults involving sudden movement and locking of the facet joints.

Discogenic Wry Neck

A type of wry neck common in middle-aged adults, often occurring after waking from sleep with a gradual onset.

Atlantoaxial Rotatory Fixation (AARS)

A fixed rotatory subluxation of $C1$ on $C2$, more common in younger children.

Spondylosis

Degeneration of the spine associated with aging, including disc breakdown and osteophyte formation.

Osteophyte

Bony outgrowths associated with spinal degeneration and spondylosis.

Spinal Stenosis

Narrowing of the spinal canal which can lead to myelopathy.

Foramen Stenosis

Narrowing of the intervertebral foramen which can lead to radiculopathy.

Ligamentum Nuchae

A large ligament in the posterior neck that helps support the cervical spine.

Alar Ligaments

Ligaments that connect the dens to the occipital condyles; damage can increase rotation by up to $30\%$.

Transverse Ligament of Atlas

A strong ligament that holds the dens against the anterior arch of the atlas.

Vertebral Artery Trauma Presentation

A condition where $46\%$ of patients report neck pain and $67\%$ report occipital headaches with abrupt onset.

Myelomalacia Signal

The lack of fluid signal on an MRI which indicates compression or softening of the spinal cord.

Paraesthesia ($P+N$)

A sensation of pins and needles, often a symptom of nerve root compression.

Myotome

A group of muscles supplied by a single spinal nerve root, used to test for neurological weakness.

Dermatome

An area of skin supplied by a single spinal nerve root, used to test for sensory loss.

Hyperreflexia

Overactive or overresponsive reflexes, a sign of upper motor neuron lesions or cord compromise.

Hyporeflexia

Diminished reflexes, often a sign of lower motor neuron injury or radiculopathy.

Spasticity

Increased muscle tone or stiffness, often associated with spinal cord injury or myelopathy.

Atherosclerosis

A potential cause of VBI involving the build-up of plaque in the vertebral arteries.

PPIVMs

Passive Physiological Intervertebral Movements used to assess cervical mobility.

PAIVMs

Passive Accessory Intervertebral Movements used to assess joint glides in the cervical spine.

Cervical Arterial Dissection Referral

Suspected cases require immediate ambulance referral to the Emergency Department.

Drop Attacks

A VBI symptom involving a sudden collapse without loss of consciousness.

Diplopia

A VBI symptom characterized by double vision.

Dysarthria

A VBI symptom characterized by difficulty in speech or talking.

Dysphagia

A VBI symptom characterized by difficulty in swallowing.

Nystagmus

Involuntary, rhythmic eye movement that can be provoked during VBI testing.

Perioral Numbness

Numbness around the mouth and nose, a clinical indicator of vascular insufficiency.

Dizziness Differentiator

If rotation provokes symptoms, trunk rotation with a still head is used to differentiate the vestibular system from VBI.

Occipital Headache

A type of headache often associated with upper cervical spine dysfunction or vascular trauma.

Neck Disability Index (NDI)

An outcome measure used to assess the impact of neck pain on daily activities, particularly in WAD patients.

Post-traumatic Stress (PTS)

Psychological symptoms following injury; a score $> 25$ on the IES suggests the need for specialist referral.

Surgical Progression in Myelopathy

Surgical intervention is generally intended to halt disease progression rather than significantly improve symptoms.

Stinger Syndrome Duration

Symptoms typically resolve in $24$ hours, but mild weakness can last up to $6$ weeks.

Cervical Support during Sleep

Advice frequently given for the management of both zygapophyseal and discogenic wry neck.