Untitled Quiz

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)