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Questions and Answers
What are potential symptoms of injuries in the cervicoencephalic region (C0-C2)?
What are potential symptoms of injuries in the cervicoencephalic region (C0-C2)?
What is the primary motion of the atlanto-axial joint (C1-C2)?
What is the primary motion of the atlanto-axial joint (C1-C2)?
Where does the vertebral artery typically enter the cervical spine?
Where does the vertebral artery typically enter the cervical spine?
What is a common mechanism of injury for the vertebral artery?
What is a common mechanism of injury for the vertebral artery?
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Which cervical spine region is most associated with referred pain to the upper extremities?
Which cervical spine region is most associated with referred pain to the upper extremities?
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What is the main supporting ligament of the atlanto-axial joint?
What is the main supporting ligament of the atlanto-axial joint?
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What is the characteristic curvature of the cervical spine?
What is the characteristic curvature of the cervical spine?
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Which symptoms might indicate cervicobrachial pathology?
Which symptoms might indicate cervicobrachial pathology?
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What is the incorrect statement regarding the Joints of Luschka?
What is the incorrect statement regarding the Joints of Luschka?
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Which description accurately characterizes cervical radiculopathy?
Which description accurately characterizes cervical radiculopathy?
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What is a common cause of Torticollis?
What is a common cause of Torticollis?
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Which grade of Whiplash Associated Disorder indicates no physical signs?
Which grade of Whiplash Associated Disorder indicates no physical signs?
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How does the upper cervical spine behave during flexion?
How does the upper cervical spine behave during flexion?
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Which condition is often characterized by unilateral muscle weakness and altered sensation?
Which condition is often characterized by unilateral muscle weakness and altered sensation?
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What is NOT a common symptom of disc herniation in the cervical spine?
What is NOT a common symptom of disc herniation in the cervical spine?
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What is the primary risk factor for spondylosis?
What is the primary risk factor for spondylosis?
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Which type of torticollis is typically congenital and may result from trauma during birth?
Which type of torticollis is typically congenital and may result from trauma during birth?
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What is a common trigger for spasmodic torticollis?
What is a common trigger for spasmodic torticollis?
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Study Notes
Cervical Spine Overview
- Course title: Spinal Treatment FT 300/PT 600
- Institution: Vancouver College of Massage Therapy
- Learning outcomes: review cervical anatomy and biomechanics, perform assessments of the cervical spine, and review common pathologies of the cervical spine.
- Reading assignment: Magee Chapter 3 (Cervical) - page 148
Cervical Spine Anatomy
- Stability is sacrificed for mobility
- Vulnerable to injury due to heavy head and stable thoracic spine
- Normal lordotic curvature: ~30-35°
- Cervical lordosis
- Thoracic kyphosis
- Lumbar lordosis
- Sacrococcygeal kyphosis
Spinal Landmarks
- C2-first palpable spinous process (SP) below occipital bone
- C7/T1-most prominent SP at the base of the neck
- C7 will usually slide anterior from a palpating finger with cervical extension
- T4- level with the root of the spine of scapula or apex of axillary fold
- T7-T8-level with the inferior angle of scapula
- Thoracic TP palpation Rule of 3s
- T1-T3 TPs: at level of corresponding SP
- T4-T6 TPs: ~½ segment above SP
- T7-T9 TPs: at ~level of SP of vertebra above
- T10-T12 have SP's that project from a position similar to T9 & rapidly regress until T12 is like T1
- T12 - level with the head of the 12th rib
- L4 - level with the superior border of the iliac crest
- PSIS & S2 - level with most inferior portion of PSIS
- Sacral Apex - level with upper greater trochanter and have patient rotate hip to locate trochanter
Cervical Spine Divisions
- Cervicoencephalic (CO-C2): Injuries potentially involve brain, brainstem, spinal cord. Symptoms: headache, fatigue, vertigo, poor concentration, hypertonia of sympathetic nervous system, and irritability. Principle motion: flexion-extension. Atlanto-occipital joint (CO-C1) and Atlanto-axial joint (C1-C2). Most mobile articulation, principle motion: rotation. Main supporting ligament: transverse ligament of atlas.
- Cervicobrachial (C3-C7): Pain usually referred to upper extremity. Symptoms: headaches, restricted ROM, paresthesia, altered myotomes/dermatomes, radicular signs.
Ligaments
- Alar ligament: originates from lateral border of dens
- Transverse ligament: belongs to atlas and holds dens in place
- Cruciform ligament: two projections from transverse ligament
Vertebral Artery
- Passes through transverse processes of cervical vertebrae
- Usually starts C6 but enters as high as C4
- Supplies 20% of blood supply along with internal carotid (80%)
- Lies close to facet joints and vertebral body
- Compression by osteophyte formation, facet injury
- Stressed by rotation, extension, and traction
- Most common mechanism of injury (non-penetrating): neck extension with or without side flexion or rotation
- Symptoms may be delayed: Vertigo, drop attacks, nausea, tinnitus, visual disturbances.
Facet Joints
- Superior facets: face upward, backward, and medially
- Inferior facets: face downward, forward, and laterally
- Facilitates FLX/EXT, but prevents simple rotation or side flexion without both occurring together (coupled movement)
- Greatest FLX/EXT of facet joints: C5-C6 (C4-C5 & C6-C7)
- Degeneration more likely to be seen at these levels.
- SPs at level of facet joints of same vertebrae
- First palpable SP is C2
- Resting position: midway between flexion and extension
- Close packed position: full extension
- Capsular pattern: side flexion and rotation equally limited extension
Joints of Luschka
- Pseudojoints
- Between C3-C7 and develop with age
- Uncinate process above & uncus below
- Made as intervetebral discs degenerate
- Limits side flexion
Cervical Nerve Roots
- Named for the vertebrae below it
History
- Spondylosis is often seen in people 25 years of age or older
- Present in 60% of those older than 45 years and 85% of those older than 65 years of age
- Symptoms of osteoarthritis don’t usually appear until a person is 60 years+
Pain
- Bone pain occurs immediately
- Muscle/lig pain immediate (e.g., tear) or delayed (e.g., MVA)
- Symptoms do not refer into arm for C4 nerve root injury or above
- Cervical radiculopathy (injury to nerve roots in spine) presents with unilateral muscle weakness (myotome), sensory alteration (dermatome)
- Disc herniation causes severe neck pain that may radiate into shoulder, scapula/arm, limit ROM, increase pain during coughing, sneezing, jarring, or straining
Observation
- (No specific details provided)
Upper Crossed Syndrome
- Involves Tight upper trapezius and levator scapulae and Weak deep neck flexors, rhomboids, serratus anterior and lower trapezius and Tight pectoralis
Movement
- (No specific details provided)
Protraction & Retraction
- (No specific details provided)
Upper vs Lower Cervical Spine
- During FLEXION, Upper cervical spine (CO-C2) nods
- Lower cervical spine (C2-C7) flexes
- Absence of one movement during flexion indicates restriction.
Neurological
- (No specific details provided)
Myotomes
- Neck flexion: C1 to C2
- Neck side flexion: C3 and cranial nerve XI
- Shoulder elevation: C4 and cranial nerve XI
- Shoulder abduction/shoulder lateral rotation: C5
- Elbow flexion and/or wrist extension: C6
- Elbow extension and/or wrist flexion: C7
- Thumb extension and/or ulnar deviation: C8
- Abduction and/or adduction of hand intrinsics: T1
Referral
- (No specific details provided)
Facet Joint - Referred Pain
- (No specific details provided)
Pathologies
- (No specific details provided)
Common Dysfunctions
- Whiplash
- Cervical Facet Irritation
- Brachial Plexus Injuries (Burners & Stingers)
- Torticollis
Whiplash Associated Disorder
- Acceleration-deceleration injury to the head and neck
- MVA or contact sports
- Quebec Task Force (QTF) division:
- Grade 0: no neck pain, stiffness, or physical signs
- Grade 1: neck complaints of pain, stiffness, or tenderness
- Grade 2: neck complaints and physical signs of decreased ROM
- Grade 3: neck complaints and neurological signs
Brachial Plexus Injuries (Burners & Stingers)
- Blow to part of the brachial plexus or from stretching or compression of the brachial plexus
- Can be associated with MVA
Torticollis ("Wry Neck")
- Abnormal positioning of the head and neck relative to the body
- Typically head/neck side flexed to affected side; face turned away
- Involvement of levator scapula places head in extension
- Involvement of SCM places head in flexion
Acute Acquired Torticollis
- Painful unilateral shortening or spasm of neck muscles, resulting in abnormal head position
- May result from activation of latent trigger points (e.g., being left in a short position, breeze chilling a muscle), subluxation of C1 on C2 (trauma related), facet joint irritation, infection, or disc-related pain.
Pseudotorticollis
- Type of acute acquired torticollis
- Painful limitation of all neck movement due to idiopathic global muscle spasm
- Person cannot move the head in any direction without pain
- Head is held in neutral
- No obvious onset of trauma
Congenital Torticollis
- Contracture of one SCM resulting in abnormal head position
- Present from infancy
- Corrected by stretching or surgically
- May result from trauma in birth process causing inflammation and later fibrosis of SCM, malposition of fetus in utero, or torsion of fetus's cranial bones.
- Causes are idiopathic and not clearly understood.
Spasmodic Torticollis
- Localized dystonia resulting in involuntary spasm of cervical muscles and an abnormal head position.
- Uncontrollable rhythmic spasm of neck muscles that often worsen during stress.
- May result from idiopathic causes, linked to depression and stress, CNS lesions, malformation of atlanto-occipital articulation, postural dysfunction (scoliosis), or trauma.
Special Tests
- Spurling's (Foraminal Compression Test)
- Distraction Test
- Valsalva
- Shoulder Abduction Test (Bakody's)
- Lateral Flexion Alar Ligament Stress Test
- Transverse Ligament
Treatment Techniques
- (No specific details provided)
Joint Play Movements
- Anterior Glide (pg 249)
- Lateral Glide (pg 255)
- Vertebral Lateral Translations (pg 22-23)
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