Musculoskeletal Physiotherapy 2 Lecture Practice Flashcards

The cervical spine contains $7$ vertebrae and is the most mobile region of the spine.
Atlas (C1): Lacks a vertebral body and spinous process; supports the head via the atlanto-occipital joint ( $C0-C1$ ), primarily facilitating flexion and extension.
Axis (C2): Features the Dens (odontoid process) which articulates with the Atlas at the atlanto-axial joint ( $C1-C2$ ) for rotation.
Typical Vertebrae (C3-C7): Possess transverse foramina for the vertebral artery and bifid spinous processes.
Neurological Layout: The first $7$ cervical nerves exit above their corresponding vertebrae; the C8 nerve exits below the $7\text{th}$ cervical vertebra. The Brachial Plexus spans from C5 to T1.

Craniovertebral Instability (AAI): Excessive movement at $C1-C2$ resulting from trauma, degeneration, or congenital conditions like Down syndrome (10-20\text{ %} prevalence). Typical tests include the Sharp Purser Test and Alar Ligament Test.
Odontoid (Dens) Fractures: Classified by Anderson and D'Alonzo:
- Type I: Fracture of the upper peg (rare, potentially unstable).
- Type II: Fracture at the base (unstable, high risk of non-union).
- Type III: Fracture through the body and lateral masses of C2 (best prognosis).
Hangman's Fracture: A bilateral fracture of the pedicles or pars interarticularis of the Axis (C2).
Cervical Myelopathy: Spinal cord compression due to trauma or stenosis, presenting with bilateral neurological symptoms, ataxia, and bowel/bladder dysfunction. Myelomalacia (cord softening) is confirmed via MRI.
Stinger and Burner Syndrome: A transient brachial plexopathy common in contact sports, caused by traction or compression of the brachial plexus.

Cervical Arterial Dissection (CAD): A tear in the vertebral or internal carotid artery wall; it is a major cause of stroke in patients under $55$ years. Symptoms include sudden, unfamiliar, severe neck pain or headache.
Vertebrobasilar Insufficiency (VBI): Decreased blood flow to the posterior brain, often due to atherosclerosis or spondylosis. Screening uses the 5 D’s and 3 N’s:
- D's: Dizziness, Diplopia, Dysarthria, Dysphagia, Drop attacks.
- N's: Nausea, Numbness (perioral), Nystagmus.

Migraine: A primary headache often unilateral and frontotemporal. Manifests in four phases: Prodrome, Aura, Migraine (attack), and Postdrome.
Tension-Type Headache (TTH): The most common primary headache, characterized by bilateral "pressing" or "band-like" pain of mild-to-moderate intensity.
Cervicogenic Headache (CGH): A secondary headache caused by convergence in the Trigeminocervical Nucleus, where afferents from C1-C3 merge with the trigeminal nerve. It is typically unilateral and starts in the neck.
Cluster Headaches: Intense unilateral orbital or temporal pain lasting $15-180\text{ minutes}$ . Associated with autonomic signs like lacrimation, rhinorrhea, or ptosis.

Joint Anatomy: A specialized joint with a fibrocartilaginous disc and a vascular, innervated retrodiscal pad. Primary innervation is provided by the mandibular portion of the trigeminal nerve ( $V3$ ).
Disc Displacements:
- ADDwR (with reduction): Characterized by a joint click during opening; full range of motion (ROM) is often preserved.
- ADDwoR (without reduction): Known as a "closed lock," characterized by limited opening (<25-30\text{ mm}) and an absence of clicking.
Clinical Signs: Restricted ROM, joint noises, myalgia, and referred pain to the ear or temple. There is a strong neurophysiological link between the TMJ and the upper cervical spine.

Impingement-Related Shoulder Pain (IRSP): A clinical syndrome, not a pathology, involving encroachment of the rotator cuff or biceps tendons.
- External (Subacromial): Encroachment between the humeral head and the acromion; often causes a "painful arc" between $60-120^{\circ}$ .
- Internal: Encroachment between the humeral head and the glenoid rim, common in overhead athletes.
Rotator Cuff Related Shoulder Pain (RCRSP): The most common cause of shoulder pain (>60\text{ %}); management focuses on progressive loading of the Supraspinatus and other cuff muscles.
Shoulder Instability:
- TUBS: Traumatic Unidirectional Bankart Surgery.
- AMBRI: Atraumatic Multidirectional Bilateral Rehab Inferior.
Biceps/Labrum: Includes SLAP (Superior Labrum Anterior to Posterior) lesions, often caused by repetitive overhead activities or sudden traction. Tests include O'Brien’s, Speed's, and Biceps Load II.

Biomechanics: Stability is enhanced by the rib cage, which provides $3\text{ times}$ more load-bearing capacity than the vertebrae alone. Posture and ROM vary by region: T1-T4 (stiffest), T5-T10 (common site for rib dysfunction), and T11-L1 (mobile junction).
Red Flags: The thoracic spine is a common site for primary neoplasms and secondary metastases (e.g., from breast cancer).
Scheuermann’s Disease: Juvenile osteochondrosis leading to structural hyperkyphosis (>40^{\circ}), wedge-shaped vertebrae (>5^{\circ} in $3$ adjacent segments), and Schmorl’s nodes.
Scoliosis: Can be Structural (idiopathic or congenital) or Non-structural (compensatory due to leg length discrepancy). Bracing is indicated for idiopathic curves between $20-40^{\circ}$ .
Ankylosing Spondylitis (AS): An inflammatory condition linked to the HLA-B27 gene, characterized by "bamboo spine" and morning stiffness lasting >1\text{ hour}.