Podcast
Questions and Answers
What should be monitored during the vertebral artery testing procedure?
What should be monitored during the vertebral artery testing procedure?
Which of the following is NOT considered a contraindication to traction or manipulation of the neck?
Which of the following is NOT considered a contraindication to traction or manipulation of the neck?
Which condition is a red flag that warrants referral for further investigation?
Which condition is a red flag that warrants referral for further investigation?
In the context of cervical spine evaluation, what does the presence of hyperreflexia indicate?
In the context of cervical spine evaluation, what does the presence of hyperreflexia indicate?
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What is a common reaction that should cause caution but is not a contraindication during vertebral artery testing?
What is a common reaction that should cause caution but is not a contraindication during vertebral artery testing?
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After diagnostic triage, neck pain can be classified as which of the following?
After diagnostic triage, neck pain can be classified as which of the following?
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What is a sign that indicates potential cervical myelopathy from the provided criteria?
What is a sign that indicates potential cervical myelopathy from the provided criteria?
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Which of the following symptoms might indicate vertebral artery insufficiency?
Which of the following symptoms might indicate vertebral artery insufficiency?
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What type of classification focuses on the signs and symptoms that match interventions for specific subgroups?
What type of classification focuses on the signs and symptoms that match interventions for specific subgroups?
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Which condition is classified as 'neck pain with mobility deficits'?
Which condition is classified as 'neck pain with mobility deficits'?
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What model shifts focus from structural dysfunction to symptom response during movement?
What model shifts focus from structural dysfunction to symptom response during movement?
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What is the primary role of the transverse ligament of the atlas?
What is the primary role of the transverse ligament of the atlas?
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Which of the following is NOT one of the four current classification categories for neck pain according to the 2008 updates?
Which of the following is NOT one of the four current classification categories for neck pain according to the 2008 updates?
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What is the central concept behind the treatment-based classification system?
What is the central concept behind the treatment-based classification system?
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Which ligament is primarily responsible for the stabilization of the upper cervical spine?
Which ligament is primarily responsible for the stabilization of the upper cervical spine?
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What should be considered before any mechanical treatment involving the cervical spine?
What should be considered before any mechanical treatment involving the cervical spine?
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Which grouping corresponds with 'neck pain with radiating pain'?
Which grouping corresponds with 'neck pain with radiating pain'?
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What is a potential risk when manipulating the upper cervical spine?
What is a potential risk when manipulating the upper cervical spine?
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Which classification model primarily categorizes based on the specific goals of treatment?
Which classification model primarily categorizes based on the specific goals of treatment?
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What are some symptoms resulting from occlusion of the vertebral artery?
What are some symptoms resulting from occlusion of the vertebral artery?
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What term best describes neck pain associated with headaches?
What term best describes neck pain associated with headaches?
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In which circumstance is maximum occlusion of the vertebral artery likely to occur?
In which circumstance is maximum occlusion of the vertebral artery likely to occur?
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What consequence may arise from an interruption of normal blood supply to the brain via the vertebral artery?
What consequence may arise from an interruption of normal blood supply to the brain via the vertebral artery?
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What unique structural feature is associated with the apical ligament of the atlas?
What unique structural feature is associated with the apical ligament of the atlas?
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Which zone of spinal motion is characterized by minimal passive resistance?
Which zone of spinal motion is characterized by minimal passive resistance?
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What position of the neck performed in Spurling's test is most effective at provoking arm symptoms?
What position of the neck performed in Spurling's test is most effective at provoking arm symptoms?
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What condition is primarily caused by degeneration and mechanical injury of spinal stabilization components?
What condition is primarily caused by degeneration and mechanical injury of spinal stabilization components?
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What symptom is NOT typically associated with cervical radiculopathy?
What symptom is NOT typically associated with cervical radiculopathy?
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Which symptom is NOT commonly associated with clinical spinal instability?
Which symptom is NOT commonly associated with clinical spinal instability?
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Which test measures the integrity of the transverse ligament?
Which test measures the integrity of the transverse ligament?
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Which intervention is considered effective for managing symptoms of cervical radiculopathy?
Which intervention is considered effective for managing symptoms of cervical radiculopathy?
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What type of motion is categorized as aberrant motion during active movement?
What type of motion is categorized as aberrant motion during active movement?
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What is NOT a common consequence of cervical radiculopathy due to decreased cervical spine range of motion?
What is NOT a common consequence of cervical radiculopathy due to decreased cervical spine range of motion?
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What best describes clinical instability of the spine?
What best describes clinical instability of the spine?
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Which of the following factors does NOT contribute to degeneration or mechanical injury of stabilizing components?
Which of the following factors does NOT contribute to degeneration or mechanical injury of stabilizing components?
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What is typically observed as a physical symptom of clinical instability in the cervical region?
What is typically observed as a physical symptom of clinical instability in the cervical region?
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Which method is NOT used to assess neck rotation range of motion?
Which method is NOT used to assess neck rotation range of motion?
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Which exercise is recommended for improving symptoms related to cervical radiculopathy?
Which exercise is recommended for improving symptoms related to cervical radiculopathy?
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What does the Transverse Ligament Stress Test assess?
What does the Transverse Ligament Stress Test assess?
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What effect do movements such as side flexion and rotation have on cervical radiculopathy symptoms?
What effect do movements such as side flexion and rotation have on cervical radiculopathy symptoms?
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Which characteristic is unique to the seventh cervical vertebra?
Which characteristic is unique to the seventh cervical vertebra?
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What is the primary function of the forward inclination of the articular facet joints in the cervical spine?
What is the primary function of the forward inclination of the articular facet joints in the cervical spine?
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During cervical lateral flexion at the upper cervical spine, what type of relative rotation occurs?
During cervical lateral flexion at the upper cervical spine, what type of relative rotation occurs?
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Which anatomical feature is responsible for the coupling of motions in the cervical spine?
Which anatomical feature is responsible for the coupling of motions in the cervical spine?
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What type of joint is specifically formed by the occipital condyles and the atlas?
What type of joint is specifically formed by the occipital condyles and the atlas?
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Which of the following motions is not physiologically coupled in the cervical spine?
Which of the following motions is not physiologically coupled in the cervical spine?
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In what orientation are the articular facet joints of the C1-C2 segment compared to the middle and lower cervical spine joints?
In what orientation are the articular facet joints of the C1-C2 segment compared to the middle and lower cervical spine joints?
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What anatomical structure primarily limits the movements of each spinal segment in the cervical spine?
What anatomical structure primarily limits the movements of each spinal segment in the cervical spine?
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Study Notes
Cervical Spine Disorders
- Objectives: Students should be able to memorize related clinical anatomy and biomechanics, identify red flags of the cervical spine, and recognize/understand classification and treatment of cervical disorders.
Cervical Vertebrae Special Characteristics
- The transverse processes of the upper six cervical vertebrae contain a foramen (foramen transversarium).
- Anterior and posterior tubercles on the transverse processes provide muscle attachment points.
- The body's superior surface projects upward at the sides.
- The body's inferior surface is correspondingly beveled.
- The spinous process is short and bifid, except for the seventh spinous process.
Joints of the Cervical Spine
- Craniovertebral Joints: Include atlanto-occipital and atlanto-axial joints.
- Zygapophyseal Joints (Facet Joints): Facet joints with a 45-degree inclination.
- Joints of the vertebral bodies (intervertebral Joints): Include uncovertebral Joints
- Uncovertebral Joints: Unique to the cervical spine (C3-C7).
Uncovertebral Joint
- These joints are formed by uncinate processes.
- Unique to the cervical spine, these joints articulate with the level above.
- The zygapophyseal joints (facet joints) are comprised of the superior articular process of one vertebrate and the inferior articular process of an adjacent vertebrate
Facet Joints Orientation
- The articular facet joints of the middle and lower cervical spine (C2-C7 to T1) are in the sagittal plane and incline upward and forward at approximately 45 degrees.
- The facets of C1-C2 are more horizontally oriented.
Motions Available
- Spinal movements (flexion, extension, translation, axial rotation, and lateral bending) frequently occur simultaneously.
- Coupling of motions depends on regional anatomical variations.
- In the cervical and upper thoracic spine, side bending is coupled with axial rotation in the same direction.
- The occiput-C1 joints involve convex-shaped occipital condyles and concave superior articular surfaces.
Ligaments of the Upper Cervical Spine
- Transverse Ligament: Originates and inserts on the interior surface of the anterior ring of the atlas; encloses the dens; provides lubrication as the atlas rotates.
- Alar Ligament: Winglike structure originating on the lateral borders of the dens and inserting on the occiput; a key portion of the stabilization system.
- Apical Ligament: Originates on the tip of the dens, inserts on the occiput; taut during head traction.
Important Considerations
- Upper cervical ligaments can be damaged in high-velocity accidents, weakened by inflammation (e.g., rheumatoid arthritis), or congenitally absent.
- The integrity of the upper cervical ligaments should be assessed before any mechanical treatment.
- Common tests include the Sharp-Purser test, lateral flexion alar ligament stress test, and transverse ligament stress test.
- Vertebral arteries should be tested prior to neck traction or manipulation. Signs of compromise include dizziness, nystagmus, speech slurring, blurring of vision, and unconsciousness.
Red Flags
- Red flags are features that indicate potential serious pathology. They should prompt referral for further investigation.
- Age, cancer history, weight loss, constant pain (especially with no relief), and night pain.
Classification Types
- Neurological/Non-Specific: Neck pain categorized as having neurological involvement or be considered non-specific (mechanical).
- Clinical Condition: Based on signs and symptoms.
- Pathoanatomical: Based on the malfunctioning structure (facet joint, intervertebral disc, myofascial).
Response to Movement (Centralisation)
- Symptom response based on how movement changes the symptoms, focusing on 'centralization'.
- Use this in categorizing patients.
- Facilitates planning of conservative treatment for acute spinal pain syndromes.
Treatment-Based Classification
- 1. Cervical Hypomobility: Neck pain with mobility deficits.
- 2. Cervical Radiculopathy: Neck pain with radiating pain (radicular).
- 3. Clinical Instability: Neck pain with movement coordination impairments.
- 4. Acute Pain (Including Whiplash): Neck pain with movement coordination impairments (WAD).
- 5. Cervicogenic Headaches: Neck pain with headache.
Cervical Hypomobility
- Examination finding includes restricted AROM, PROM, and PIVM testing for the cervical/upper thoracic regions.
- No upper extremity (UE) radicular symptoms.
- Sudden or gradual onset.
- Deficient or motor control/strength.
- Subacute or chronic status.
Cervical Radiculopathy
- A spinal nerve root disorder, often due to foraminal encroachment due to degenerative changes, bony spurs and/or herniated disc.
- Symptoms typically include unilateral pain.
- Bilateral can occur with severe bony spurs.
- Peripheral pain, weakness, pins and needle sensations can indicate the affected nerve root. This can be assessed by dermatomal and myotomal maps.
Clinical Instability
- Inability of the spine to maintain its displacement pattern under physiological loads.
- May lead to nerve root damage, irritation and pain.
- Increased neutral zone and reduction in passive resistance to motion created in the elastic zone.
- Causes include poor posture, repetitive trauma, and muscle weakness.
Physical Examination Tests
- Sharp-Purser test: Assesses the integrity of the atlanto-axial joint, particularly the transverse ligament.
- Transverse Ligament Stress Test: Tests for hypermobility of the atlantoaxial articulation by positioning the patient and applying controlled pressure.
- Neck Flexor Muscle Endurance Test: Assesses the endurance of deep neck flexors.
- Craniocervical flexion test (CCFT): Assesses strength and endurance.
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Description
This quiz covers the clinical anatomy and biomechanics of cervical spine disorders. Students will learn to identify key characteristics of cervical vertebrae, recognize red flags, and understand the classification and treatment of related disorders.
