CSkills 1 - Cervical Spine

The craniocervical region is a combination of which three joints?

- Atlanto-occipital (OA)

- Atlanto-axial (AA)

- Intracervical apophyseal (facet) joints C2-C7

The superior articular facet of the atlas (C1) are what shape

Concave

What is the main movement of the OA joint?

Flexion/extension

What is the function of the OA joint?

Independent motion of the head

What type of joint is the OA joint?

Plane synovial

What is the capsular pattern of the OA joint?

Equal restriction of extension and lateral flexion > extension > flexion

What motions occur in the sagittal and frontal plane at the OA joint?

Nodding and side bending, respectively

What motion does NOT occur at the OA joint?

Rotation

What is the primary motion that occurs between C1 and C2?

Rotation

In regards to the atlas and axis, which vertebra is primarily in motion during rotation?

The atlas (C1)

The dens of C2 sticks between

The anterior arch of C1 and the transverse ligament of the atlas

If your patient has numbness and tingling in their arms when they look down, they likely have

A damaged or torn transverse ligament of the atlas

The job of the transverse ligament of the atlas

To prevent the atlas from sliding forward on the axis

The alar ligament attaches from the

Dens to the occipital condyles

What does the alar ligament limit?

Rotation of the cranium and atlas relative to the dens

During rotation, the _ alar ligament is more taut

Contralateral

How much craniocervical rotation occurs at the AA joint

50%

What is the facet joint motion at the AA joint if you were rotating to the right?

A forward slide of C1 on the left rise and a posterior slide of C1 on the right side

If you wanted to isolate the AA joint, how would you position your patient

Place them on their back and flex the cervical spine before testing rotation

How would you isolate the OA joint?

Place your patient on their back, side bend their head, and tuck their chin into the ipsilateral shoulder

The superior facet of C3-C7 faces what direction

Superior and posterior

The inferior facet of C3-C7 faces what direction

Inferior and anterior

In the cervical spine, at around what angle do the facet joints tilt?

45 degrees

The 45 degree tilt of the articular facets of C2-C7 allows for

Movement in all 3 planes of motion

The facet joint is made up of

The inferior articular facet of one vertebra and the superior articular facet of the vertebra beneath it

What is the resting position of the cervical spine

30-35 degrees of extension

All joints of the cervical spine interact together to produce

A significant amount of motion

How much flexion and extension comes from the OA and AA

20%, mainly the OA

How much flexion and extension of the cervical spine comes from C2-C7

80%

What is the arthrokinematics of the OA joint?

Convex head on concave atlas

What is the arthrokinematics at the AA joint

Tilting (can't do much with it)

If your patient had limitations in head extension, how would you mobilize?

Apple a posterior to anterior slide

What are the arthrokinematics of cervical spine extension at the facet joints

The inferior facets of the superior vertebrae slide inferior and posterior

What are the arthrokinematics of the cervical spine at the facet joint during flexion

The inferior facet of the superior vertebrae slide superior slide superior and anterior

C2-C7 work together to produce _ degrees of extension and _ degrees of flexion

50-60; 30-40

Maximum flexion/extension of the cervical spine comes from

Between C5 and C6

At C5/C6, there is greater

Disc degeneration and posterior protrusion

If you wanted to improve flexion of C2-C7, you would

Apply a superior and anterior slide

What is the total motion of axial rotation

60-70 degrees

What are the contributions to axial rotation

50% from AA joint and 50% from C2-C7

How much rotation occurs about the atlas twisting around the dens

35-40 degrees

At the facet joint during rotation, the motion of the ipsilateral side is akin to _ and the motion of the contralateral side is akin to _

Extension; flexion

A 45 year old male patient complains of pain and stiffness with rotation to the left, difficulty looking over his shoulder when driving, and has pain when looking up. The pain is sharp, deep, and only on the left side. What is a possible tissue source?

Left sided facet joint, since all the presenting motions cause compression of the joint

Lateral flexion and rotation of the cervical spine is

Coupled

Since rotation and lateral flexion is coupled at the cervical spine, if you rotated your head to the right

There will also be right sided lateral flexion

If side bending and rotation are coupled, how is it possible to maintain forward eyes

There is contralateral rotation at the AA joint OR there is contralateral side bending about the OA joint

If you asked your patient to side bend to the right and they also rotated, what might be causing this?

There might be stiffness about the AA joint that prevents contralateral rotation

Normal ROM of cervical spine flexion is

45-50 degrees

Normal ROM of cervical spine extension is

75-80 degrees

Normal ROM of cervical spine lateral flexion is

45 degrees

Normal ROM of cervical spine rotation is

60-70 degrees

What is closed pack position of the cervical spine

Neutral position

What is open pack position of the cervical spne

Slight flexion

What is the funciton of the suboccipital muscles

Allows for precise control of the AA and OA joint

What muscles would need to turn on to maintain forward eyes during left sided lateral flexion and why?

The right sided obliquus capitis inferior and rectus capitis posterior major to rotate the AA joint to the right

In regards to rotation that is caused by the scalenes

They usually only cause rotation back to neutral from a rotated position

What is the main function of the scalenes

They mainly contribute to proper breathing mechanics due to their rib attachments

If your patient was breathing through their scalene muscles, a possible side effect would be

Neck pain

Scalenus anticus syndrome is characterized by

Pain, numbness/tingling, weakness, coldness that is caused by a tight scalene that can compress the brachial plexus and subclavian artery

If your patient was reaching overhead, such as when changing a lightbulb or blowdrying their hair, and their arm went numb or cold, there is likely

Compression of the subclavian artery or a nerve from the brachial plexus

Bilaterally, the SCM causes

Neck flexion and upper cervical extension

Unilaterally, the SCM causes

Side bending and rotation

Lower cervical refers to anything that is below the

OA and AA joint

Acting alone, the SCM causes

Lower cervical flexion with upper cervical extension

The more that the SCM activates,

The more that the moment arm for the muscle changess

Referred pain of the SCM usually manifests in

On or behind the ears, well as just above the eyebrows, and in the subccipital region

The rectus capitus muscles cause motion at which joint ONLY

OA

Your deep neck flexors passively

Keep your cervical spine in a natural state of lordosis

The main function of the anterior longus muscles is to

Create stiffness in the spine

Posture of the head is balanced by the

Anterior scalene and SCM

At the head, the load shared by the anterior and posterior musculature

Is equally distributed

In forward head posture, the _ is prone to being tight due to overuse

Posterior musculature