Cervical Spine Anatomy and Injuries
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Questions and Answers

A patient with a history of lumbar disc herniation is likely to develop which of the following conditions?

  • Increased cervical lordotic curve due to muscular weakness
  • Spondylosis (osteoarthritis of the spine) and potential neural element compression (correct)
  • Torticollis due to bilateral sternomastoid muscle spasm
  • Hypertrophy of muscles in the non-dominant extremity

    • What observation during a cervical spine inspection would indicate a possible nerve root impingement?

  • Normal cervical spine curvature
  • Increased lordotic curve
  • Rotation of head from unilateral spasm of sternomastoid muscle
  • Lessened lordotic curve (correct)

    • A patient presents with their head laterally flexed. What is the MOST likely cause of this posture?

  • Bilateral hypertrophy of neck muscles
  • Normal cervical spine alignment
  • Forward head posture
  • Unilateral spasm of neck muscles (correct)

    • Why is understanding the structural changes to the spine critical for preventing recurrence or worsening of spinal conditions?

    <p>To identify predisposing factors like scar tissue that may increase vulnerability to injury (A)</p> Signup and view all the answers

    When observing a patient's soft tissue symmetry during a cervical spine inspection, what should the examiner be looking for?

    <p>Bilaterally comparable muscle mass, tone, and contour accounting for dominance. (A)</p> Signup and view all the answers

    Following a neck contusion, what is the MOST critical initial assessment to determine the severity and guide immediate management?

    <p>Evaluating voice quality and swallowing ability. (C)</p> Signup and view all the answers

    An athlete who sustained a neck contusion reports pain with swallowing, though has full and pain-free ROM. What is the MOST appropriate next step?

    <p>Refer the athlete to a physician for further evaluation. (C)</p> Signup and view all the answers

    When can an athlete with a neck contusion return to play?

    <p>When they have regained full, pain-free range of motion and strength, and have physician approval. (A)</p> Signup and view all the answers

    What mechanism of injury (MOI) is MOST commonly associated with neck contusions in sports?

    <p>&quot;Clothes lining&quot; or a similar impact. (B)</p> Signup and view all the answers

    A patient reports dizziness, confusion, and nystagmus following a whiplash injury. Which of the following conditions should be suspected?

    <p>Vertebral artery impingement (C)</p> Signup and view all the answers

    What is the primary characteristic differentiating cervical facet joint syndrome from a cervical disc herniation or nerve impingement?

    <p>Achy, intermittent pain relieved by positional changes (D)</p> Signup and view all the answers

    Ecchymosis around the anterior throat area following trauma suggests what type of injury mechanism?

    <p>Tension or excessive pulling on soft tissues. (C)</p> Signup and view all the answers

    An athlete has sustained a neck injury during a football game. Which of the following signs and symptoms would necessitate immediate immobilization and transport to the nearest emergency department?

    <p>Abnormal neurological signs and specific tenderness (D)</p> Signup and view all the answers

    A patient presents with restricted active, resisted, and passive range of motion (AROM/RROM/PROM) in the cervical spine, accompanied by localized pain. Palpation reveals tenderness between the transverse processes of the vertebrae. What is the most likely diagnosis?

    <p>Cervical facet joint syndrome (A)</p> Signup and view all the answers

    Which of the following is a key criterion for an athlete's return to play following a cervical injury?

    <p>Full, pain-free range of motion and strength, with physician approval (B)</p> Signup and view all the answers

    Which of the following is a primary function of the odontoid process (dens) of the axis (C2) in relation to the atlas (C1)?

    <p>To act as a fulcrum, facilitating head rotation and load transfer. (C)</p> Signup and view all the answers

    How does the anterior longitudinal ligament (ALL) contribute to the stability and function of the cervical spine?

    <p>By running anteriorly along the vertebral bodies, limiting extension and reinforcing the anterior discs. (D)</p> Signup and view all the answers

    What is the functional significance of the unique structural design of the atlas (C1) in supporting the skull?

    <p>Its lateral masses (pillars) are designed to evenly distribute the weight of the skull, providing stability. (A)</p> Signup and view all the answers

    In the context of cervical spine trauma, such as a whiplash injury, what structures are most likely to be affected, leading to pain and dysfunction?

    <p>The ligamentous structures and intervertebral discs, due to sudden hyperextension and hyperflexion. (B)</p> Signup and view all the answers

    How do 'typical' cervical vertebrae (C3-C7) differ structurally from the atlas (C1) and axis (C2)?

    <p>Typical cervical vertebrae have distinct features such as a lamina, pedicles, spinous process, and body, which are less defined in the atlas and axis. (D)</p> Signup and view all the answers

    A patient reports localized neck pain following a car accident. What is the MOST likely underlying cause?

    <p>Muscular strain or ligamentous sprain (A)</p> Signup and view all the answers

    Which of the following BEST describes pain of a mechanical nature in the cervical spine?

    <p>Pain that varies in intensity based on cervical spine positioning (A)</p> Signup and view all the answers

    A patient with a history of cervical disc issues reports radiating pain down their arm. What condition should be suspected FIRST?

    <p>Cervical nerve root and/or brachial plexus injury (D)</p> Signup and view all the answers

    A patient reports a gradual onset of neck pain without a specific injury. What is the MOST likely cause?

    <p>Overuse injuries or postural abnormalities (A)</p> Signup and view all the answers

    A patient is experiencing consistent neck pain that does not change with different cervical spine positions. What is the MOST probable cause of this consistency?

    <p>Inflammation (D)</p> Signup and view all the answers

    Why is it crucial to re-evaluate a patient’s current symptoms even if they have a prior history of cervical spine injury with similar symptoms?

    <p>To account for potential new or residual problems (D)</p> Signup and view all the answers

    A patient presents with pain between their shoulder blades but denies any neck or shoulder injury. Which condition should be considered as a possible cause?

    <p>Angina pectoris (B)</p> Signup and view all the answers

    Following a whiplash injury, a patient reports that certain neck movements consistently provoke their pain, while others alleviate it. What does this pattern MOST likely indicate?

    <p>Mechanical nature of the pain (A)</p> Signup and view all the answers

    A patient reports experiencing sudden, intense neck pain immediately after lifting a heavy object. What is the MOST likely mechanism of injury?

    <p>Specific traumatic event (D)</p> Signup and view all the answers

    What is the PRIMARY purpose of asking a patient about the onset of their neck pain?

    <p>To differentiate acute versus chronic conditions (A)</p> Signup and view all the answers

    Which of the following is the MOST accurate description of the anatomical location of the hyoid bone?

    <p>At the level of the C3 vertebrae, moving with swallowing. (D)</p> Signup and view all the answers

    During an examination, which of the following structures would be MOST appropriate to palpate to assess the primary pulse point in the cervical region?

    <p>Carotid artery (C)</p> Signup and view all the answers

    When palpating the posterior aspect of the skull, which structure is being assessed and what characteristic is MOST important to note?

    <p>Occiput; identifying muscular attachments. (D)</p> Signup and view all the answers

    A patient reports pain during both active and passive range of motion during cervical spine examination. Based on this information, which of the following conditions is MOST likely?

    <p>Ligament sprain, where both active and passive ROM can elicit pain (D)</p> Signup and view all the answers

    During active range of motion testing of the cervical spine, a patient is asked to touch their chin to their chest. Which movement is being assessed?

    <p>Flexion (B)</p> Signup and view all the answers

    When performing passive range of motion testing of cervical extension, what is the typical end feel and anatomical limitation?

    <p>Hard end feel due to the occiput contacting the cervical spinous processes (C)</p> Signup and view all the answers

    During resisted range of motion testing of cervical lateral flexion, where should the resistance be applied?

    <p>Temporal and parietal regions (C)</p> Signup and view all the answers

    Which of the following statements BEST describes the use of end feels in ligamentous/capsular testing of the cervical spine?

    <p>End feels associated with passive ROM essentially serve as endpoints for joint capsule and ligamentous stress tests. (A)</p> Signup and view all the answers

    A patient presents with numbness in the lateral forearm and thumb. Which dermatome is MOST likely affected?

    <p>C6 (D)</p> Signup and view all the answers

    When assessing myotomes of the cervical spine, which movement is associated with the C7 nerve root?

    <p>Elbow extension or wrist flexion (C)</p> Signup and view all the answers

    Which of the following is MOST likely to cause a 'stinger' or 'burner' injury?

    <p>Compression or distraction of the brachial plexus. (D)</p> Signup and view all the answers

    During a brachial plexus traction test, a patient experiences radiating pain on the same side as the shoulder being depressed during lateral flexion of the cervical spine. What does this MOST likely indicate?

    <p>A traction injury (D)</p> Signup and view all the answers

    In the vertebral artery test, the clinician extends, laterally flexes, and rotates the patient's neck. A positive test would MOST likely be indicated by what?

    <p>Dizziness, confusion, or nystagmus (A)</p> Signup and view all the answers

    While performing the Babinski test, the clinician strokes a blunt instrument along the plantar aspect of the foot. What constitutes a positive result?

    <p>Dorsiflexion of the great toe and splaying of the other toes (A)</p> Signup and view all the answers

    A clinician applies a downward force on a patient's head while they are seated. The patient reports pain radiating down their arm. What provocative test is being performed and what does a positive sign indicate?

    <p>Cervical Compression Test; indicates nerve root compression. (A)</p> Signup and view all the answers

    Flashcards

    Cervical Spine

    The upper region of the spine comprising vertebrae C1-C7, allows for neck movement.

    Atlas (C1)

    The first cervical vertebra that supports the head and connects to the skull.

    Axis (C2)

    The second cervical vertebra characterized by the odontoid process, allowing rotation of the head.

    Anterior Longitudinal Ligament

    A ligament that runs in front of the cervical bodies, reinforces anterior discs and limits extension.

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    Odontoid Process

    The peg-like projection on the Axis (C2) that acts as a fulcrum for head rotation.

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    Herniated Disc

    A condition where the inner core of a spinal disc protrudes, narrowing joint spaces.

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    Lordotic Curve

    The natural inward curve of the cervical spine; normally has a lordotic shape.

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    Poor Posture Indicators

    Signs such as increased lordotic curve indicating muscular weakness or imbalance.

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    Torticollis

    A condition causing the neck to twist, often due to muscle spasm.

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    Soft Tissue Symmetry

    Assessment of muscle mass and tone bilaterally to detect abnormalities.

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    Return to Play Criteria

    Full pain-free range of motion (ROM) and strength, along with physician approval.

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    Vertebral Artery Impingement

    A condition where the vertebral artery is compromised, leading to dizziness, confusion, and nystagmus.

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    Cervical Disk Injury

    Includes nerve impingement, causing abnormal neurological signs and peripheral pain or paresthesia.

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    Cervical Facet Joint Syndrome

    Localized pain due to locked facet joints, often from abnormal positions or repetitive movements.

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    Symptoms of Cervical Facet Joint Syndrome

    Includes intermittent pain, limited mobility, and relief through positional changes; often involves inflammation.

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    Peripheral Pain

    Pain or paresthesia not likely in normal neurological findings unless chronic.

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    Criteria for Return to Play

    Player must have full pain-free range of motion and strength, plus physician approval.

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    Neck Contusion

    Bruising of neck tissues, often caused by extreme pulling or compression.

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    MOI

    Mechanism of Injury; specific cause leads to neck injuries like contusions.

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    Voice Box Injury Symptoms

    Include loss of voice, raspy voice, pain when swallowing, may require physician attention.

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    Integrity of Spinal Cord

    The state of health and functionality of the spinal cord and nerve roots.

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    Location of Pain

    The specific area where pain is felt, indicating potential injury type.

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    Radiating Pain

    Pain that extends along a neural pathway, suggesting nerve issues.

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    Acute Onset

    Sudden pain realization often due to a specific event or injury.

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    Chronic Pain

    Persistent pain that develops gradually, often from overuse.

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    Consistency of Pain

    How pain intensity and location change or stay the same.

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    Inflammatory Pain

    Pain resulting from inflammation, typically relentless.

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    Mechanical Pain

    Pain that varies with movement and cervical positioning.

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    Prior Injury Evaluation

    Assessing a patient's past injuries for current symptoms.

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    Neural Pathway

    The routes through which nerves transmit pain signals.

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    Non-dominant extremity

    An extremity that shows signs of strain/spasm or atrophy, indicating possible neurological injury.

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    Palpation

    A physical examination technique used to assess muscle and joint dysfunction through manual examination.

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    Active Range of Motion

    Movement of a joint performed by the patient without assistance, assessing joint function.

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    Passive Range of Motion

    Movement of a joint performed by an examiner without patient assistance, assessing joint limits.

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    Resisted Range of Motion

    Tests strength by applying resistance while the patient attempts movements.

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    Neurological Testing

    Assessment of neurological function including dermatomes, reflexes, and myotomes.

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    Brachial Plexus Evaluation

    Assessment focusing on upper limb sensory and motor functions mapped to cervical nerve roots.

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    Spurling Test

    A specialized test assessing cervical spine nerve compression by applying pressure while extending and rotating the neck.

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    Babinski Test

    A reflex test assessing nerve function by stroking the foot; abnormal response indicates neurological damage.

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    Cervical Compression Test

    A test for identifying cervical spine issues by applying downward pressure on the head.

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    Brachial Plexus Injury

    An injury characterized by burning/stinging sensations in the neck and upper arm due to stretched or compressed nerves.

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    Cervical Distraction Test

    A test where traction is applied to the head to determine if pain is alleviated or worsened, indicating nerve root issues.

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    Cervical Spine Injuries

    Injuries to the neck caused by acute trauma or chronic conditions like poor posture and repetitive stress.

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    Myotomes

    Muscle groups innervated by specific spinal nerves, assessed during neurological testing.

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    Dermatomes

    Areas of skin sensation innervated by specific spinal nerves, used to evaluate nerve function.

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    Study Notes

    Cervical Spine Overview

    • The cervical spine can experience degenerative changes, such as arthritis.
    • Pathology can affect discs and nerve roots.
    • Trauma, including whiplash and direct impacts, can cause indirect or direct damage.

    Cervical Spine Anatomy (C1-C7)

    • The cervical spine consists of 7 vertebrae (C1-C7).
    • Includes specific structures like transverse processes, spinal canal, spinous processes, lamina, pedicles, and the body.
    • Features lateral neck muscles; splenius muscle, levator scapulae muscle, sternocleidomastoid muscle, scalene muscles (anterior, middle, posterior), thyrohyoid muscle, omohyoid muscle (superior and inferior), trapezius muscle, and deltoid muscle.
    • The Atlas (C1) and Axis (C2) are uniquely structured for skull support and movement. The dens of the axis is crucial for this function.

    Ligaments of the Cervical Spine

    • Anterior longitudinal ligament reinforces anterior discs and limits extension.
    • Posterior longitudinal ligament reinforces posterior discs and limits flexion.
    • Ligamentum nuchae (supraspinous ligament) limits flexion and is thicker in the cervical spine than in the thoracic or lumbar regions.
    • Interspinous and intertransverse ligaments limit flexion/rotation/lateral flexion supporting the spine.
    • Ligamentum flavum connects vertebrae, reinforcing articular facets, and limits flexion/rotation.

    Neurological Structures

    • Cervical nerves (C1-T1) form the Cervical Plexus.
    • The C4 nerve root forms the phrenic nerve and impacts breathing.
    • The Brachial Plexus stems from C5-T1 nerve roots, impacting the shoulder and arm.
    • Dermatomes (C1-T1) are sensory areas associated with each nerve root or spinal nerve.
    • Myotomes (C1-T1) describe muscular groups innervated by each nerve root or spinal nerve.
    • Reflex testing helps assess nerve function. Several reflex tests assess nerve root function, including C5, C6, and C7 testing.
    • This includes specific tests like Spurling's test, the brachial plexus traction test, and tests of upper motor neuron lesions.
    • These tests help diagnose and assess the integrity of the brachial plexus.

    Cervical Injuries

    • Cervical injuries are less common in athletics but account for over 90% of fatal injuries in certain contact sports like American Football.
    • Most cervical injuries are technique related and result from spearing or tackling/falling head first.
    • Common mechanisms of injury (MOIs) are axial loading, flexion, hyperextension, flexion-rotation, and lateral flexion.
    • The different MOIs result in similar outcomes, although severity differs.
    • Spinal injuries lead to serious damage such as spinal cord injuries.
    • Assessment of an injury and the emergency plan is crucial.
    • Assessment of spinal neurological integrity is paramount. This can be difficult, so always consider the worst-case scenario and contact specialists when assessing a suspected injury.

    Evaluation Techniques

    • HOPS (History, Observation, Palpation, Special Tests) is the primary method to diagnose cervical spine injuries.
    • The integrity of the spinal cord and nerve roots should be the first priority.
    • The history needs to encompass the characteristics, location, and mechanism of the injury. Pain consistency also must be evaluated appropriately.

    Cervical Spine Palpation

    • Anterior palpation involves evaluating structures like the hyoid bone, thyroid cartilage ("Adam's apple"), cricoid cartilage, sternomastoid muscles, scalenes, carotid artery, and lymph nodes.
    • Posterior and lateral palpation involves checking the occiput, transverse processes, spinous processes(C3-C7), and the trapezius muscles.

    Special Tests (Neurological)

    • Various special tests assess range of motion (ROM), including active, passive, and resisted movements.
    • Ligamentous/capsular testing assesses joint capsules.
    • Neurological testing evaluates nerve function, including brachial plexus evaluation, dermatomes, myotomes, and reflex tests (including the upper motor neuron lesions).
    • Spurling test helps identify spinal nerve root irritation.
    • Vertebral artery testing assesses blood flow to the cervical spine.

    Additional Injuries

    • Cervical strains and sprains exhibit a limited range of motion but no significant peripheral pain/paresthesia or abnormal neurological findings.
    • Contusions to the neck can lead to loss of voice, pain with swallowing, and tracheal injury.
    • Cervical root impingement, a common cause, can result from chronic muscular tension, spinal stenosis, or disc herniation.
    • Brachial plexus injuries (stingers/burners) commonly result in burning, achy pain, muscle weakness, and point tenderness.
    • Brachial plexus injuries can result from a forceful stretch or compression of nerve roots.
    • Chronic conditions may result from poor posture, muscle imbalances, and repetitive movement.
    • Vertebral artery impingement can also result from similar MOIs.
    • Signs of vertebral artery injuries include dizziness, confusion, and nystagmus.

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    Related Documents

    C-Spine Evaluation PDF

    Description

    Overview of the cervical spine, its anatomy (C1-C7), and potential injuries, including degenerative changes and trauma. Key structures include vertebrae, muscles, and ligaments such as the anterior and posterior longitudinal ligaments. Focus on the Atlas (C1) and Axis (C2) structures.

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