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Questions and Answers
What does the performance index measure in muscular evaluation?
What does the performance index measure in muscular evaluation?
Which of the following is considered an objective feature of clinical cervical instability?
Which of the following is considered an objective feature of clinical cervical instability?
Which symptom is most likely associated with fatigue in relation to cervical stability?
Which symptom is most likely associated with fatigue in relation to cervical stability?
What is indicated by symptoms that decrease with external support in cervical instability?
What is indicated by symptoms that decrease with external support in cervical instability?
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In assessing cervical instability, which finding would suggest a need for clinical intervention?
In assessing cervical instability, which finding would suggest a need for clinical intervention?
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What is primarily indicated by the presence of aberrant motions during active movement of the spine?
What is primarily indicated by the presence of aberrant motions during active movement of the spine?
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Which factor is NOT associated with the degeneration or mechanical injury of spinal stabilization components?
Which factor is NOT associated with the degeneration or mechanical injury of spinal stabilization components?
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What does clinical spinal instability result from?
What does clinical spinal instability result from?
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Which test specifically assesses the integrity of the Transverse Ligament?
Which test specifically assesses the integrity of the Transverse Ligament?
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What symptom may suggest mechanical injury of stabilizing components in the spine?
What symptom may suggest mechanical injury of stabilizing components in the spine?
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Which of the following is associated with the elastic zone of spinal motion?
Which of the following is associated with the elastic zone of spinal motion?
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What is the role of the cervical musculature in maintaining spinal stability?
What is the role of the cervical musculature in maintaining spinal stability?
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What term describes sudden accelerations or decelerations occurring outside the intended plane of spinal movement?
What term describes sudden accelerations or decelerations occurring outside the intended plane of spinal movement?
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What is a distinctive feature of the transverse processes of the upper six cervical vertebrae?
What is a distinctive feature of the transverse processes of the upper six cervical vertebrae?
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In the cervical spine, which joint allows the greatest amount of rotation?
In the cervical spine, which joint allows the greatest amount of rotation?
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What type of movement is coupled with lateral bending in the cervical spine?
What type of movement is coupled with lateral bending in the cervical spine?
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How does the orientation of the C1-C2 facet joints differ from those of the middle and lower cervical spine?
How does the orientation of the C1-C2 facet joints differ from those of the middle and lower cervical spine?
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During cervical lateral flexion, how do the occipital condyles move?
During cervical lateral flexion, how do the occipital condyles move?
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Which anatomical structures limit the movements of the spinal segments in the cervical spine?
Which anatomical structures limit the movements of the spinal segments in the cervical spine?
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What is the typical physical structure of the spinous process in the cervical vertebrae?
What is the typical physical structure of the spinous process in the cervical vertebrae?
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Which of the following is true for the superior surface of the cervical vertebra body?
Which of the following is true for the superior surface of the cervical vertebra body?
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Which ligament of the upper cervical spine is primarily responsible for stabilizing the cervical spine during rotation?
Which ligament of the upper cervical spine is primarily responsible for stabilizing the cervical spine during rotation?
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What serious consequence could result from joint configuration at the atlanto-occipital joints during excessive lateral flexion?
What serious consequence could result from joint configuration at the atlanto-occipital joints during excessive lateral flexion?
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Which of the following conditions could lead to increased risk of upper cervical ligament damage?
Which of the following conditions could lead to increased risk of upper cervical ligament damage?
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The maximum occlusion of the vertebral artery is more likely to occur during which movement?
The maximum occlusion of the vertebral artery is more likely to occur during which movement?
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What symptom is commonly associated with a reduction of blood flow to the cerebellum and brain stem due to vertebral artery occlusion?
What symptom is commonly associated with a reduction of blood flow to the cerebellum and brain stem due to vertebral artery occlusion?
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Before performing mechanical treatment on the cervical spine, what is a critical assessment step?
Before performing mechanical treatment on the cervical spine, what is a critical assessment step?
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What is a potential outcome of performing cervical spine manipulation in a patient with compromised vertebral arteries?
What is a potential outcome of performing cervical spine manipulation in a patient with compromised vertebral arteries?
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Which position is most effective at provoking arm symptoms during Spurling's test?
Which position is most effective at provoking arm symptoms during Spurling's test?
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What is a common characteristic of symptoms associated with cervical radiculopathy?
What is a common characteristic of symptoms associated with cervical radiculopathy?
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What effect does side flexion towards the painful side have on symptoms in cervical radiculopathy?
What effect does side flexion towards the painful side have on symptoms in cervical radiculopathy?
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Which intervention is considered effective for treating cervical radiculopathy symptoms?
Which intervention is considered effective for treating cervical radiculopathy symptoms?
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What is a defining feature of clinical instability in the spine?
What is a defining feature of clinical instability in the spine?
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What could be a consequence of secondary musculoskeletal problems associated with cervical radiculopathy?
What could be a consequence of secondary musculoskeletal problems associated with cervical radiculopathy?
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Which technique is used to measure the neck rotation range of motion?
Which technique is used to measure the neck rotation range of motion?
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What may cause the symptoms of cervical radiculopathy to worsen during neck movement?
What may cause the symptoms of cervical radiculopathy to worsen during neck movement?
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What is a positive indicator when assessing the patient's response during the initial therapy position for C1?
What is a positive indicator when assessing the patient's response during the initial therapy position for C1?
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Which of the following tests is performed first and aims to reduce symptoms?
Which of the following tests is performed first and aims to reduce symptoms?
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During the Deep Neck Flexor Endurance Test, what indicates the test's termination?
During the Deep Neck Flexor Endurance Test, what indicates the test's termination?
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What distinguishes patients with neck pain due to clinical instability during neck flexor muscle assessments?
What distinguishes patients with neck pain due to clinical instability during neck flexor muscle assessments?
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In the Neck Flexor Muscle Endurance Test, at what angle should the patient lift their head above the plinth?
In the Neck Flexor Muscle Endurance Test, at what angle should the patient lift their head above the plinth?
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Which of the following symptoms is NOT indicative of a positive test during the initial therapy position for C1?
Which of the following symptoms is NOT indicative of a positive test during the initial therapy position for C1?
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What is measured to assess the activation of deep cervical flexors in the craniocervical flexion test?
What is measured to assess the activation of deep cervical flexors in the craniocervical flexion test?
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What is the normative endurance value for women during the Deep Neck Flexor Endurance Test?
What is the normative endurance value for women during the Deep Neck Flexor Endurance Test?
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Study Notes
Cervical Spine Disorders
- Objectives: Students should be able to memorize clinical anatomy and biomechanics, identify red flags of the cervical spine, and understand classification and treatment of cervical disorders.
Cervical Vertebrae Characteristics
- Transverse processes in the upper six cervical vertebrae contain a foramen (foramen transversarium).
- Typical transverse processes also have anterior and posterior tubercles for muscle attachment.
- The superior surface of the cervical vertebral bodies projects upward at the sides, while the inferior surface is correspondingly beveled.
- The spinous processes are short and bifid, except for the seventh spinous process (vertebra prominens).
Joints of the Cervical Spine
- Craniovertebral Joints: Include atlanto-occipital (occipital condyles and atlas) and atlanto-axial joints (atlas and axis). Occiput-C1 joints are formed by convex-shaped occipital condyles and the concave-shaped superior articular surfaces of the atlas.
- Zygapophyseal Joints (Facet Joints): Located between the articular processes of adjacent vertebrae. The middle and lower cervical facet joints are in the sagittal plane, inclined upward and forward at approximately 45°. The C1-C2 facet joints are oriented more horizontally to allow for greater mobility.
- Uncovertebral Joints: Unique to the cervical spine (C3-C7). They're formed by the uncinate processes articulating with the level above.
- Intervertebral Joints: These joints connect the vertebral bodies.
Ligaments
- Anterior Longitudinal Ligament (ALL): Runs along the anterior aspect of the vertebral bodies.
- Posterior Longitudinal Ligament (PLL): Located along the posterior aspect of the vertebral bodies.
- Ligamentum Flavum: Connects lamina of adjacent vertebrae.
- Interspinous Ligament: Connects spinous processes.
- Supraspinous Ligament: Runs along the tips of the spinous processes.
- Transverse Ligament: Attaches to the anterior ring of the atlas, encloses the dens.
- Alar Ligaments: Wing-like structures originating from the dens's lateral borders, inserting on the occiput. The configuration enables considerable lateral flexion (which can damage the medulla oblongata).
- Apical Ligament: Originates from the tip of the dens, inserts on the occiput. Becomes taut with head traction.
Vertebral Artery
- Maximum occlusion of the vertebral artery occurs with a combination of extension and rotation.
- Occlusion of the vertebral artery can cause dizziness, nystagmus, slurring of speech, and loss of consciousness, if there is an interruption of the normal blood supply to the brain stem and cerebellum.
- Before traction or manipulation techniques on the upper cervical spine, vertebral arteries should be cautiously tested in each direction.
Red Flags
- Sensory Disturbances: Age >50, sensory disturbances of hands and muscle wasting of intrinsic hand muscles
- Neurological Symptoms: Drop attacks, blood pressure >160/95 mmHg, muscle weakness or unsteady gait, hyperreflexia, bowel and bladder disturbances
- Pain & Other: Severe limitation during neck AROM in all directions, unexplained loss of weight, constant pain that's unresponsive to rest, night pain, temperature > 37°C
- Trauma: Post-trauma, Down syndrome, occipital headache/numbness
- Inflammation: Rheumatoid arthritis, systemic inflammatory diseases
- Tumors: History of cancer.
Classification of Cervical Spine Conditions
- Neurological/Non-specific (mechanical): Classified based on symptoms/signs.
- Clinical Condition: Classified based on the affected condition (e.g., cervicogenic headache).
- Pathoanatomical: Classified based on structure dysfunction (e.g., facet joint, intervertebral disc, myofascial).
- Response to Movement (centralisation): Based on how movement changes symptoms.
Treatment Based Classification of Cervical Conditions
1- Cervical hypomobility (neck pain with mobility deficits). 2- Cervical radiculopathy (neck pain radiating along a nerve root). 3- Cervical instability (neck pain with impaired movement coordination). 4- Acute pain (including whiplash) (neck pain with movement coordination impairments (WAD)). 5- Cervicogenic headache (neck pain with headache).
Examination Findings & Proposed Interventions (for Cervical Hypomobility)
- Examination Findings: Restricted AROM (active range of motion) and PROM (passive range of motion), restricted PIVM (passive intervertebral motion), absence of UE (upper extremity) radicular symptoms, sudden or gradual onset of symptoms, Deficient in cervicosacuplothoracic strength and motor control (subacute and chronic patients).
- Proposed Interventions (e.g., Cervical Hypomobility): AROM exercises, muscle energy techniques, cervical and thoracic mobilization interventions.
Clinical Instability
- Clinical instability is the inability of the spine to maintain its displacement pattern under physiological loads.
- This may result in damage to the spinal cord or nerve roots, and pain.
- Increased size of the neutral zone and reduction in passive resistance to motion in the elastic zone are believed to be contributing factors.
- Contributing factors to clinical instability include poor posture, repeated trauma, acute trauma, and weakness of the cervical musculature.
Clinical Examination Tests
- Sharp-Purser test: Used to assess the integrity of the atlanto-axial joint, specifically the transverse ligament.
- Transverse ligament stress test: Tests for hypermobility of the atlantoaxial joint.
- Neck flexor muscle endurance test: Assesses deep neck flexor endurance.
- Craniocervical flexion test: Assesses the activation (and endurance) of the deep cervical flexors and identifies compensation strategies.
Clinical Presentation of Cervical Radiculopathy
- Typical symptoms include neck pain, radiating arm pain, paraesthesia.
- Symptoms are generally amplified with side flexing, extending, or rotating the neck, because these movements reduce the space for nerve root egress.
- The patient might have muscle weakness in the affected area, reflex impairment, headaches or scapular pain.
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Description
Test your knowledge on cervical spine disorders, including clinical anatomy, biomechanics, and treatment classifications. This quiz will challenge you to identify red flags and understand the characteristics of cervical vertebrae and their joints.
