Cervical Spine

posterior, anterior

atlanto occipital flexion arthrokinematics slide is _____ and extension arthrokinematics slide is _____

half, spin, transverse ligament, alar ligaments, vertebral arteries

atlanto axial axial rotation arthrokinematics account for _____ of rotation, _____ at pivot joint, held in place by _____, limited by _____ plus joint capsule/muscle tension, full rotation stretches _____

superior/anterior, opening, reduces

C2-C7 flexion arthrokinematics are _____ slide with facet _____, _____ contact pressure

inferior/posterior, closing, increases

C2-C7 extension arthrokinematics are _____ slide with facet _____, _____ contact pressure

posterior/inferior, closing, anterior/superior, opening

C2-C7 rotation and lateral flexion arthrokinematics are ipsilateral _____ slide (facet _____) and contralateral _____ slide (facet _____)

extension, flexion, opposite, protraction

retraction is lower spine _____ with upper spine _____, protraction is _____, more _____

longus coli, longus capitis, stability, neutral head posture

_____/_____ are called dynamic anterior longitudinal ligament, add _____ to cspine, important for _____

suboccipitals, muscle spindles

_____ have high density of _____ and help with precise control of atlantooccipital and atlantoaxial joints

neck, age, women

_____ pain is very common, increase with _____, more prevalent in _____

favorable, reoccurrence, chronicity

natural history of neck pain is _____, rates of _____/_____ are high

older, women, history, low back, job, smoking, support

risk factors for new episode of neck pain include _____ age, _____ sex, _____ of neck pain, history of _____ pain, high demand _____, _____ history, low social/work _____

>40, history, low back, cycling, strength, hands, worrisome, qol

risk factors for chronic neck pain include _____ age, _____ of neck pain, coexisting _____ pain, _____ as regular activity, loss of _____ in _____, _____ attitude, poor _____

favorable, variable, 6-12 weeks, slows, 12 months

resolution of neck pain symptoms is generally _____ but _____ by condition, most recovery occurs within _____ and then _____, no recovery after _____

acute trauma, injury start date, insidious

prognosis for neck pain is more clear cut for _____ due to clear _____, _____ onset is less predictable

intensity, self reported, catastrophizing, post traumatic stress, cold

acute trauma poor prognosis is linked to high pain _____, high _____ disability, high pain _____ scale, high _____ symptoms, and _____ hyperanalgesia

age, MSK, physical, psychological health, worker’s comp

insidious onset poor prognosis is linked to older _____, previous history of other _____ disorders, poor _____/_____, and _____ cases

numerous, serious, screen

_____ sources in cervical region that can cause neck pain, including more _____ conditions, must perform PT _____

age 65+, dangerous MOI, paresthesia in UE/LE, high velocity MVA, cannot sit comfortably, cannot walk independently, immediate neck pain, midline tenderness, rotate head 45 degrees, spinal boarding, imaging

canadian c-spine rules:

high risk factors (3)

low risk factors (5)

unable to _____

_____ and refer for _____

no midline tenderness, no evidence of intoxication, normal alertness, no neurological deficits, no painful distracting injuries, imaging

NEXUS rules (5) _____ indicated unless meet all

neck disability index, >30%

_____ is recommended outcome assessment tool for neck pain, score _____ linked to poor prognosis

ROM, joint mobility

examination should include cervical _____ and _____

mobility deficits, movement coordination impairments, headaches, radiating pain

four categories of neck pain for treatment classification

pain, ROM, end range, segmental, reproduced

neck pain with mobility deficits exam includes central/unilateral _____, limited cervical _____, pain at _____ ROM, restricted _____ mobility, pain _____ with restricted

manipulation, mobilization, ROM, stretching

neck pain with mobility deficits treatment, improve mobility, includes thoracic _____, cervical _____, cervical _____ and _____, cervical/scapular strength

trauma, headache, dizziness, concentrating, sensitivity, midrange, cervical cranial flexion, neck flexion endurance, sensorimotor

neck pain with movement coordination impairments exam includes MOI linked to _____/whiplash, _____ with _____/nausea, difficulty _____, light/sound _____, pain at _____ ROM, positive _____ and _____, _____ impairment

ROM, posture, strengthening, mobilization

neck pain with movement coordination impairments treatment, improve proprioception, includes cervical _____, _____ training, cervical _____, cervical _____, and modalities

pain, headache, ROM, cervical flexion rotation

neck pain with headaches exam includes unilateral _____ with _____, aggravated by cervical _____, positive _____

SNAGS

neck pain with headaches treatment includes cervical mobilization, _____, scapulothoracic strength, neuro reed, manual therapy with therex

radiating, UE, paresthesia, weakness, wainner’s cluster

neck pain with radiating pain exam includes neck pain with _____ pain into _____, dermatomal _____, myotome _____, and positive _____

intermittent traction

neck pain with radiating pain treatment includes therex with manual, cervical/thoracic mobilization, and _____

contraindications, serious, risk factors, neurovascular

history helps to identify probability of _____ to treatment, existence of _____ pathology, and presence of _____ that increase risk for potential _____ pathology

gait, UMN, upper cervical instability

red flags include _____ disturbances, _____ signs, and behavior of _____

dizziness, drop attacks, diplopia, dysarthria, dysphagia, ataxia, anxiety, nausea, numbness, nystagmus

5 Ds And 3 Ns

upper cervical ligamentous instability, vertebrobasilar insufficiency, prior

cervical spine screening includes _____ and _____, done _____ to passive ROM or manual

alar, transverse, trauma, connective tissue, rheumatoid, down

upper cervical ligamentous instability include _____ and _____ ligaments, risk factors are history of _____, _____ disorders, _____ arthritis, _____ syndrome

trauma, connective tissue, vascular, smoker, tension, cholesterol

vertebrobasilar insufficiency risk factors include history of _____, _____ disorders, _____ anomaly, current/past _____, hyper_____, high _____

modified sharp purser, alar ligament stress

upper cervical instability special tests (2)

extension rotation

vertebrobasilar insufficiency special test _____

compression, nerve root, pain, sensory, motor, reflex

cervical radiculopathy is _____ of cervical _____, clinical manifestations can be broad including _____ or _____/_____/_____ deficits, variety of pathologies that cause

50-54, men, lumbar radiculopathy

cervical radiculopathy is most common in _____ age, _____ sex, and often preceded by _____

age, smoking, obesity, degenerative

risk factors for cervical radiculopathy include increased _____, history of _____, _____, and _____ thoracic/lumbar conditions

disc herniation, spondylosis

main causes of cervical radiculopathy include cervical _____ or _____

nucleus pulposus, strain, trauma, impingement

cervical disc herniation is injury where _____ is pushed through, due to excessive _____ or _____ to spine, results in _____ causing nerve damage

lower

cervical disc herniation is most common in _____ c-spine

ischemia, proinflammatory, sensitization, pain

nerve impingement causes mechanically _____ and chemically triggers _____ cascade and results in increased _____/_____

degenerative, age, majority, disc height, narrowing, impingement, pressure, bone spurs

spondylosis causes _____ changes to disc that occur with _____, _____ of cases, breakdown of disc causes decreased _____, causes _____ of IV foramen resulting in nerve _____, places increased _____ on joints and vertebra resulting in _____

unilateral, radiates, ipsilateral UE, paresthesia, weakness, diminished

cervical radiculopathy presents with _____ neck pain that _____ into _____, dermatomes may have _____, myotomes may have _____, reflexes may be _____

bakody sign, cluster of wainner

cervical radiculopathy special tests (2)

active ROM cervical rotation, spurling’s, cervical distraction, upper limb tension test 1

cluster of wainner tests (4)

60

positive active ROM cervical rotation is less than _____ degrees

disc height, osteophytes, soft tissue, bony, nerve

radiographs show _____ and presence of _____, MRI shows _____, CT scan views _____ details, EMG shows _____ entrapment

immobilization, not, mobilization, therex, traction, medications, injections

cervical radiculopathy conservative treatment includes _____ to limit inflammation but _____ supported by literature, physical therapy including cervical _____ and _____, small benefit of _____, _____ (NSAIDs, corticosteroids), and _____ (corticosteroids, lidocaine)

full resolution, 4-6 months, surgery

most causes of cervical radiculopathy have _____ in _____, if no improvement in 6 months may opt for _____

anterior, discectomy, foraminotomy, bone spacers, disc height

anterior cervical decompression and fusion has _____ approach, decompression includes _____ and _____, fusion uses _____ to restore _____

bending/twisting/lifting

main ACDF post op contraindication is no _____

prosthetic, motion, stress, surgery, adjacent

cervical disc arthroplasty uses _____ spacers instead of bone to restore disc height, maintains joint _____ which reduces _____ on adjacent levels, decreases need to perform _____ on _____ levels

posterior, widen, laminectomy, facetectomy, motion, spacer, decompression, anterior

posterior cervical foraminotomy uses _____ approach, _____ foramen by performing partial _____ and medial _____, preserves spine _____ and reduces need for _____ but has incomplete _____ and may still have _____ degeneration

compression, spinal cord, cervical spondylosis, PLL/ligamentum flavum degeneration

cervical myelopathy is _____ of _____ in cervical region, several causes most common is development from _____ then _____ or tumor/trauma

disc height, microinstability, osteophyte, diameter

cervical spondylosis causes decreased _____ and _____ (from _____ formation) resulting in decreased _____

extension, hyperextension, narrows, impingement, thicken, crowds

PLL/ligamentum flavum limit spinal _____, degeneration of ligamentous restraints causes _____, _____ canal and allows spinal cord _____, can also _____ which _____ the canal space

unilateral, radiating, arm, bilateral, tingling, numbness, extension, manipulating, gait, bowel/bladder, abnormal, weak, spastic, hyperreflexive, positive

cervical myelopathy causes _____ neck pain _____ into _____, symptoms may be _____, _____/_____ in UE/LE, symptoms worsen with _____, difficulty _____ small objects, _____ abnormalities, changes in _____, _____ dermatomes, myotomes are _____/_____, and reflexes are _____, _____ babinski/hoffman

lhermitte’s sign

cervical myelopathy special test _____

immobilization, soft collar, physical therapy, stabilization, effectiveness

cervical myelopathy conservative treatment is _____ (_____ to limit hyperextension), _____ focusing on _____ exercises, low _____

hypermobile, contraindicated

cervical myelopathy patients are _____ so several interventions are _____ (manual, therex, modalities)

decompression, fusion

surgical management of cervical myelopathy includes _____ (discectomy and foraminotomy) and _____ (bone spacers)

synovial, inferior, superior, below, stability

cervical facet joints are _____ joints that connect articular facets, _____ articular process articulates with _____ articular process _____, form pillars for _____ of vertebral column

inflammation, degeneration, trauma

cervical facet syndrome is _____ of facet joints, due to _____ or _____

weakness, force, overloaded, inflammation, degenerative, OA, osteophyte

degenerative facet syndrome is caused by _____ resulting in increased _____ on facet joints which become _____ and _____ occurs, lead to _____ changes to joint including _____ or _____ formation

axial, pain, radiates, suboccipital, shoulder, midback, ROM, end range

cervical facet syndrome presents with _____ neck _____ that _____ into _____ region/posterior _____/_____ region, and limited/painful _____ at _____

referral pattern

cervical facet syndrome and radiculopathy have different _____

facet joint degeneration, asymptomatic, facet block

_____ is common finding on radiograph but is often _____ making diagnosis difficult, may use _____ to relieve pain and find source

motion, mobilizations, ROM, stretching, traction

cervical facet syndrome with mobility issue is treated by restoring _____ through _____, _____, _____, and cervical _____

overload, surrounding muscles, isometrics, dynamic strengthening, postural

cervical facet syndrome with stability issue is treated by reducing _____ (on _____) by _____, progressive and _____, and _____ training

folds, synovial membrane, joint, facets, noncongruent, lubricate

synovial folds are _____ in _____ that project into _____, located throughout cervical spine _____, fill _____ spaces and _____ articular surfaces

quick, catch, inflammation

_____ movement of the neck can _____ one of the synovial folds within the joint, results in joint _____

localized, pain, constant, spasm, ROM, heat

synovial fold impingement presents with _____ neck _____ that is _____, muscle _____, restricted _____, often loosens with _____

free, modalities, mobilizations

synovial fold impingement treatment goal is _____ synovial fold through _____ (hot pack/electrotherapy) and _____