Cervical Spine Assessment

50% of cervical rotation comes from…

The A-A joint

30-40% of overall cervical motion comes from…

The O-A-A complex

What characteristic of the C2-3 joint makes its function more similar to the O-A-A complex than lower cervical segments?

It has near-horizontal Z-joint planes

Which two joints are the least mobile segments of the cervical spine?

O-C1 and C7-T1

Which joint is the most mobile segment of the cervical spine?

C1-2 (A-A joint)

What percentage of motion does each lower cervical segment contribute to overall cervical motion?

Less than 10%

What is the typical barrier to O-A flexion?

Posterior muscular tension

What is an alternative barrier to O-A flexion?

Ligamentous shortening

What is the final barrier to O-A flexion?

Ring of atlas abuts occiput

What is the effect of shortening of posterior O-A tissues?

Flexion loss

What limits O-A extension?

Compression of the suboccipital musculature

What is the ultimate barrier to O-A extension?

Ring of atlas abuts occiput

Is loss of flexion or extension ROM more common? Why?

Less likely to lose cervical extension due to significant amount of time spent in forward head posture

What is the coupling pattern of lateral flexion and rotation at the O-A joint?

Opposite

How much lateral flexion is available at the O-A joint?

Very little

What increases the capacity for O-A lateral flexion?

Partial rotation

What is the greatest constraint of lateral flexion and rotation at the O-A joint?

Bony congruency

Does levator scapula mobilize C1?

No

What do obliquus superior, rectus capitis posterior minor, rectus anterior, and rectus lateralis move?

Occiput

What motion does longus cervicis contribute to?

Flexion

What role do splenius capitis and SCM play on C1?

Act on cranium, indirectly moving the O-A complex on C2

Why is the biconvex nature of the A-A joint not visible on radiographs?

It is largely created by cartilage, not bone

What amount of A-A rotation can impact the contralateral vertebral artery?

Rotation greater than 30 degrees

What amount of A-A rotation can affect the ipsilateral vertebral artery?

Rotation greater than 45 degrees

Is the effect of A-A rotation on vertebral artery blood flow the same in all people?

No, it is highly variable

In the lower cervical segments, what amount of flexion/extension can be expected?

Approximately 12-20 degrees

In the lower cervical segments, what amount of lateral flexion can be expected?

Less than 10 degrees

In the lower cervical segments, what amount of rotation can be expected?

Less than 10 degrees

What are the implications of the compressive follower load in the cervical spine?

Most load bearing occurs through the body and discs anteriorly, thus the cervical spine experiences proportionally greater load through the Z joints and U joints than the thoracic and lumbar spine

Which type of structures provide greatest stability in neutral alignment?

Deep cervical musculature

Which type of structures provide greatest stability at end range?

Ligamentous structures

What are the limiters to cervical flexion?

Z joint capsules, PLL, ligamentum flavum, and interspinous ligaments

What are the limiters to cervical extension?

ALL, anulus fibrosis, impaction of spinous processes or laminae

What are the limiters to cervical lateral flexion?

Contralateral ligamentous structures and musculature, ipsilateral Z and U joint approximation

Where is the axis of rotation located for flexion/extension?

The anterior/superior portion of the inferior vertebra

What is the coupling pattern for the lower cervical spine?

Rotation, lateral flexion, and extension

What is the DOWN questionnaire?

Dropping things/clumsy hands, Off-balance/unsteady, Weakness in arm(s)/hand(s), Numbness/tingling in arm(s)/hand(s)

What are the most common early symptoms for degenerative cervical myelopathy?

Upper extremity symptoms/changes, fine motor function disturbances, gait disturbances

What cluster has been identified for C spine radiating pain?

Modified passive shoulder abduction test, Spurling’s arm pain test, and ≥2 of 4 ULTTs positive

Which subset of patients has an elevated risk for cervical instability?

Those with connective tissue disorders

What is Lhermitte’s sign?

A sudden electrical shock sensation down the back with neck movement, especially flexion

What is the rust sign?

When the patient spontaneously supports the head/neck, especially during transitional movements

What circumstances deem imaging inappropriate for non-acute atraumatic neck pain?

Prior surgery, known/suspected infection, malignancy, and chronic radiating pain

What symptoms are associated with neck pain with mobility deficits?

Unilateral neck pain, neck motion limitations, onset following unguarded/awkward movement/position, possible presence of UE referred pain

What impairments are associated with neck pain with mobility deficits?

Limited CROM, pain at ends of AROM/PROM, restricted segmental mobility, pain reproduced with provocation of involved segments

What symptoms are associated with neck pain with headache?

Non-continuous, unilateral neck pain with referred headache and headache precipitated/aggravated by neck movements/positions

What impairments are associated with neck pain with headache?

Headache reproduced with provocation of upper cervical segments, limited CROM, restricted upper cervical mobility, strength and endurance deficits in deep cervical flexors

What symptoms are associated with neck pain with movement coordination impairments?

Neck pain, referred upper extremity pain, other symptoms related to precipitating trauma/whiplash

What impairments are associated with neck pain with movement coordination impairments?

Strength, endurance, and coordination deficits in deep cervical flexors, neck pain in mid-range, worsening at end-range, neck and upper extremity pain reproduced with provocation of involved segments, segmental instability may be present

What symptoms are associated with neck pain with radiating pain?

Upper extremity paresthesias, numbness, and weakness

What impairments are associated with neck pain with radiating pain?

Pain reproduced with Spurling’s test or ULTTs, pain relived by cervical distraction, possible upper extremity sensory, strength, or reflex deficits associated with involved nerve