Cervical Spine Disorders in Physical Therapy

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Questions and Answers

What is the primary function of the nuchal ligament in humans?

To prevent overflexion of the neck (correct)

To facilitate rotation of the atlas

To provide stability to the thoracic spine

To connect the spinous processes to the axials

Which ligament is primarily responsible for encircling the dens?

Tectorial ligament

Alar ligament

Transverse ligament of the atlas (correct)

Cruciform ligament

At what vertebral level does the posterior longitudinal ligament end?

C2 (correct)

What structure reinforces the transverse ligament of the atlas?

Cruciform ligament Signup and view all the answers

Which ligament tightens when the head is flexed?

Tectorial ligament Signup and view all the answers

What is the primary role of the apical ligament?

To become taut during head traction Signup and view all the answers

Which of the following ligaments serves to prevent overflexion of the neck?

Nuchal ligament Signup and view all the answers

Which portion of the cruciform ligament has its origin on C2?

Vertical portion Signup and view all the answers

What is the most common cause of cervical radiculopathy?

Foraminal encroachment of the spinal nerve Signup and view all the answers

Which of the following symptoms is commonly associated with cervical radiculopathy?

Pain in the neck and one arm Signup and view all the answers

Which of the following exams is NOT part of the findings for diagnosing cervical radiculopathy?

Positive straight leg raise test Signup and view all the answers

Which precaution is NOT typically included in the management of cervical radiculopathy?

Increased cervical flexion activities Signup and view all the answers

What condition can cause inflammation or impingement in cervical radiculopathy?

Spondylitic spurs Signup and view all the answers

What is a significant risk when considering mechanical treatment for the cervical spine?

Unverified integrity of upper cervical ligaments Signup and view all the answers

Which muscle group primarily supports the cervical lordosis in an upright posture?

Longus colli Signup and view all the answers

What may lead to damage of the ligaments in the upper cervical spine?

Congenital absence Signup and view all the answers

Which combination of movements is associated with maximum occlusion of the vertebral arteries?

Extension and rotation Signup and view all the answers

What type of tests are used to assess ligamentous instability in the cervical spine?

Ligament stress tests Signup and view all the answers

Which of the following muscles is classified as a capital flexor?

Longus capitus Signup and view all the answers

What is suggested by the redundancy in the vertebral arteries?

Facilitated full atlas rotation Signup and view all the answers

Which muscle group is responsible for the deep anterior support of the cervical spine?

Longus colli and rectus capitus anterior Signup and view all the answers

During cervical lateral flexion, what occurs at the C1-C2 and occiput-C1 segments?

Relative rotation occurs to the opposite side. Signup and view all the answers

In the cervical spine, which motion is coupled with lateral flexion from C2-T1?

Rotation toward the same side Signup and view all the answers

Which of the following is a common sign of cervical myelopathy?

Muscle wasting of hand intrinsic muscles Signup and view all the answers

What condition is indicated by a temperature greater than 37°C and fatigue?

Inflammatory or systemic disease Signup and view all the answers

Which of the following factors is associated with neoplastic conditions in the cervical spine?

History of cancer Signup and view all the answers

What type of injury is typically associated with acute pain and whiplash?

Acceleration-deceleration injury Signup and view all the answers

Which symptom does vertebral artery insufficiency NOT typically include?

Muscle weakness Signup and view all the answers

What is a key feature observed in patients suffering from acute neck pain and associated disorders?

Muscle imbalance between superficial and deep neck muscles Signup and view all the answers

What distinguishes the vertebrae of the lower cervical spine from those of the thoracic and lumbar spine?

They possess clearly defined vertebral bodies and spinous processes. Signup and view all the answers

What is the primary function of the uncovertebral joints in the cervical spine?

Facilitate mobility of the lower cervical spine. Signup and view all the answers

Which characteristic of the articular facet joints in the lower cervical spine aids in weight-bearing and motion guidance?

They are inclined forward at approximately 45°. Signup and view all the answers

What unique feature does the atlas possess that distinguishes it from other vertebrae?

It is a wide, thin ring of bone without a spinous process. Signup and view all the answers

How are the superior articular facet surfaces of the atlas characterized?

They are oval and concave. Signup and view all the answers

What is the alignment of the joint surfaces of the superior articular facet of C2, and how does this relate to its function?

Aligned horizontally; allows rotation. Signup and view all the answers

What describes the atlanto-occipital joint?

It features a convex-on-concave articulation. Signup and view all the answers

What term is used to refer to the diarthrodial articulations between the uncinate process and the adjacent body?

Uncovertebral joints. Signup and view all the answers

Which factors are associated with poor outcomes 6 months after whiplash injury?

Moderate posttraumatic stress symptoms and impaired vasoconstriction Signup and view all the answers

What is a recommended management strategy for whiplash-associated disorders?

Gentle active range of motion within patient tolerance Signup and view all the answers

What is a characteristic symptom of clinical instability of the cervical spine?

Intolerance to prolonged static postures Signup and view all the answers

What finding is indicative of altered neuromotor control strategy in patients with neck pain?

Delayed deep neck flexor activation Signup and view all the answers

Which of the following is NOT a criterion for clinical instability?

Chronic neck pain without acute episodes Signup and view all the answers

What is the measurement goal during the Craniocervical Flexion Test (CCFT)?

Holding pressure steady for 10 seconds at 26 mm Hg Signup and view all the answers

Which statement about posttraumatic stress symptoms is accurate in relation to whiplash injuries?

They can contribute to worse health outcomes after injury Signup and view all the answers

Which symptom suggests instability in the cervical spine?

Feeling of instability or shaking Signup and view all the answers

Study Notes

Physical Therapy for Cervical Spine Disorders

Objectives: Students should be able to memorize clinical anatomy and biomechanics of the cervical spine, identify red flags of cervical spine disorders, and understand the classification and treatment of cervical disorders.

Functional Anatomy

Cervical spine is divided into two groups based on structure and function.
Lower cervical vertebrae (C2-C7) have similar structure to thoracic and lumbar vertebrae with distinct vertebral bodies and spinous processes.
Transverse processes have foramina allowing passage for the vertebral artery.
From C3-T1, there are 10 saddle-shaped, diarthrodial articulations between the uncinate process and the adjacent body, known as uncovertebral joints (or joints of Luschka). These joints aid in mobility of the lower cervical spine.
Articular facet joints in lower cervical spine are in the sagittal plane, tilting forward by approximately 45 degrees. This allows the facet joints to support weight and guide the motion of the segment.

The Atlas

The atlas (C1) has a thin, wide ring shape with a well-developed transverse process, but no spinous process.
It has concave joint surfaces above and below, serving a disc-like function.
The atlanto-occipital joint is a convex-on-concave joint in the spine. Superior articular facet surfaces of the atlas are oval and concave.

The Axis

The axis (C2) has an inferior articular facet similar in form and function to lower cervical facets.
The superior articular facets of C2 align in the horizontal plane and allow for rotation.
The dens (odontoid process) of C2 acts as a pivot for the atlas.

Ligaments

Anterior and posterior longitudinal ligaments, ligamentum flavum are found throughout the cervical spine, functioning similarly to the thoracic and lumbar spine.
Interspinous and supraspinous ligaments blend with the nuchal ligament of the cervical spine.
Nuchal ligament originates from spinous processes of the cervical spine and inserts on the occiput.
It prevents overflexion of the neck.
Tectorial ligament is a thickening of the posterior longitudinal ligament, arising from C2, and inserting on the occiput. It becomes tight with flexion of the head.
Cruciform ligament lies deep to the tectorial ligament, having both vertical and transverse portions that originate on C2 and insert similarly to the tectorial ligament.
Transverse ligament of the atlas has origins and insertions on the posterior aspect of the anterior ring of the atlas, housing the dens. It is lined with synovial membrane and articular cartilage for lubrication during rotation.
Alar ligaments are wing-like structures originating from the lateral borders of the dens and inserting on the occiput. They are a major component of the stabilization system for the upper cervical spine.

Muscles

Muscles involved in the cervical spine are grouped into superficial posterior, deep posterior, superficial anterior, and deep anterior functional groups.
Proper flexibility and balance in these groups are needed for normal cervical spine function in upright posture.
Longus colli, semispinalis cervicis, and multifidus provide support and posture function.
Rectus capitus anterior, rectus capitus lateralis are capital flexors, while suboccipital extensors, semispinalis, and splenius capitis are capital extensors.

Vertebral Artery

Vertebral arteries pass upwards through the lateral foramina of cervical vertebrae.
A redundant portion allows for full rotation of the atlas in both directions, and the vertebral arteries enter the cranium at the foramen magnum and join to form the basilar artery.
Occlusion of vertebral artery can damage brainstem and cerebellum, causing dizziness, nystagmus, slurred speech, loss of consciousness.
Manipulation techniques on the upper cervical spine should be carefully evaluated due to potential vascular damage.

Testing Ligamentous Instability

Sharp-Purser test and Lateral flexion/alar ligament stress test assess potential ligamentous instability.

Cervical Red Flags

Sensory disturbance in hands, muscle wasting of hand intrinsic muscles, unsteady gait, hyperreflexia, bowel/bladder disturbances, multisegmental weakness/sensory changes, are possible signs of cervical myelopathy.

Neoplastic Conditions

Age greater than 50 years, history of cancer, unexplained weight loss, constant pain with no relief from bed rest, and night pain may indicate neoplastic conditions.

Upper Cervical Ligamentous Instability

Common symptoms include occipital headaches and numbness, and severe limitations during neck active range of motion (AROM).

Inflammatory or Systemic Disease

Symptoms include fever >37°C, blood pressure >160/95, resting pulse >100 bpm, resting respiration > 25 bpm, and fatigue.

Classification of Cervical Spine Disorders

Acute Pain and Whiplash Associated Disorders
Clinical Instability
Cervical Radiculopathy
Hypomobility
Cervicogenic Headache

Management

Relative rest, physical modalities, intermittent use of a cervical collar, gentle AROM, and activity modification are generally recommended treatments.
Specific treatments for each condition may also involve gentle manual therapy/exercise or avoidance of pain-inducing manual therapy or exercises.
For Clinical Instability, postural education, cervical stabilization exercise programs, and ergonomic corrections are important.
For Cervical Radiculopathy, traction and exercises are likely interventions along with thoracic spine manipulation.
For Hypomobility, AROM exercises, cervical and thoracic mobilization, and manipulation including isometric techniques are likely interventions.
Cervicogenic headache management may involve cervical and thoracic mobilization/manipulation, strengthening neck and postural muscles, and postural education.

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Description

This quiz focuses on cervical spine disorders and the essential clinical anatomy and biomechanics relevant to physical therapy. Students will learn to identify key features, red flags, and treatment approaches for cervical spine issues. Test your understanding of functional anatomy and the role of different cervical components in treatment.