UW Health Sports Medicine Upper Spine Treatment and Examination

UW Health Sports Medicine: Upper Spine Treatment and Examination Notes

About Me

  • Alex Olver, PT, DPT
  • Sports Physical Therapy Resident at UW Health Sports Medicine

Learning Objectives

  • Understand the anatomical/physiological structures of the cervical and thoracic spine.
  • Perform screening examination for cervical and upper thoracic spine involvement.
  • Use manual techniques and therapeutic exercise to address impairments found in the examination.

Case #1: Scenario Overview

  • Context: Attending junior varsity (JV) football practice for a player's neck/upper back injury.
  • Observation: Player lying on back, with coaches surrounding him.
  • Essential Actions:
    • Assess the situation and injuries.
    • Ask pertinent questions for evaluation:
      • What symptoms are present?
      • Mechanism of injury?
      • Any numbness or tingling?

Spine Anatomy

  • Overview of Vertebral Structures:
    • Cervical (7)
    • Thoracic (12)
    • Lumbar (5)
    • Sacrum (S, fused)
    • Coccyx (4, fused)
  • Key Structures:
    • Spinous Process
    • Lamina
    • Superior Articular Processes
    • Pedicles
    • Transverse Processes

Cervical Spine Anatomy

  • Cervical Vertebrae Overview:
    • 7 cervical vertebrae: C1 (Atlas) and C2 (Axis).
  • Detailed Structures of C1 and C2:
    • Atlas (C1):
      • Superior view displays anterior arch and transverse foramen.
    • Axis (C2):
      • Dens (odontoid process), bifid spinous process, vertebral foramen.

Cervical Facet Orientation

  • Orientation: Cervical facet joints oriented 45 degrees to horizontal, with superior facets facing posteriorly and superiorly.
  • Significance: Important for understanding motion mechanics and potential issues arising from misalignment or injury.

Arthrokinematics of the Cervical Spine

  • Flexion:

    • Mechanism: Decompression occurs with roll of the occipital bone over the atlas, with assistance from ligaments.
    • Movement: Flexion of head and neck involves rocking motion around the C1-C2 joints.

  • Extension:

    • Mechanism: Atlanto-occipital joints allow for extension, with posterior capsular structures tightening.
    • Movement: Involves anterior sliding of the atlas.

  • Rotational Movements:

    • Axial rotation primarily between C1 and C2; critical for assessing injury and treatment.

Ligamentous Structures of the Cervical Spine

  • Important Ligaments:
    • Anterior Longitudinal Ligament
    • Posterior Longitudinal Ligament
    • Ligamentum Flavum
    • Transverse Ligament of Atlas
    • Alar Ligaments
    • Nuchal Ligament

Cervical Musculature

  • Primary muscles involved:
    • Rectus Capitis Posterior Minor & Major
    • Oblique Capitis Superior & Inferior
    • Longissimus Capitis
    • Scalene Muscles
    • Sternocleidomastoid
    • Levator Scapulae

Upper Crossed Syndrome

  • Muscle Imbalances:
    • Tightness in Upper Traps & Levator Scapula versus Weakness in Deep Neck Flexors.
    • Weakness in Lower Traps & Serratus Anterior versus Tightness in Pectoralis.

Cervical Kinematics

  • Contribution of Cervical Segments:
    • C0-C1 (mainly nodding), C1-C2 (dominant for rotation), and C2-C7 (contributes flexion, extension, side-bending).
  • Further evidence suggests neck movement may affect thoracic movement down to T6.

Neuroanatomy of Cervical Spine

  • Brachial Plexus:
    • Contributions: Roots C5-T1; significant in assessing upper extremity function.
    • Key Nerves:
      • Musculocutaneous
      • Median
      • Ulnar
      • Radial
      • Axillary

Brachial Plexus Injury

  • Types:
    • Erb’s Palsy (Upper Brachial Plexus Injury):
      • Resulting from traction and increased angle between neck and shoulder affecting C5-C6.
    • Klumpke’s Palsy (Lower Brachial Plexus Injury):
      • Resulting from excessive pull of the limb affecting C8-T1.

Stingers

  • Mechanism: Head and neck are rotated away from a depressed shoulder, leading to traction on the brachial plexus.
  • Symptoms resemble pain/numbness through the arm, often temporary.

Dermatomes and Myotomes

  • Schematic marking of dermatomes for C2-T2 denoting sensory distribution areas.
  • Myotomes associated with specific spinal levels correlating to muscle actions and reflexes (e.g., C5 for elbow flexion).

Cranial Nerves Overview

  • CN I through CN XII:
    • Functions including smell, vision, eye movement, facial expressions, balance, and more.
    • Importance of testing methods for each nerve to assess functionality.

Muscle Referral Patterns

  • Trigger points in cervical and upper torso affecting referred pain in areas such as the head/neck and shoulders.