Upper Cervical Spine Anatomy and Function

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Questions and Answers

What does an ADI greater than 3-4 mm indicate?

Injury to the alar ligament or transverse ligament (correct)

Stable ligaments around the dens

Normal spinal alignment

No risk of spinal cord injury

What is a positive result of the Prone Vertebral Artery Test?

Enhanced stability of the cervical vertebrae

Increased range of motion in the cervical spine

No symptoms present during the test

Dizziness or abnormal cranial nerve function (correct)

What does the Sharp-Purser Test specifically assess?

Cervical range of motion under axial load

Presence of whiplash symptoms

Stability of the transverse ligament only

Upper cervical spine instability (correct)

Which factor signifies a positive outcome in the Alar Ligament Stress Test?

Failure to feel ligamentous end-feel Signup and view all the answers

What is the primary purpose of assessing cranial nerve function during the Supine Vertebral Artery Test?

To identify dizziness or nausea Signup and view all the answers

In the context of cervical injuries, what could result from unstable ligaments?

Potential spinal cord impingement Signup and view all the answers

What condition is most likely assessed by the Transverse Ligament Stress Test?

Transverse ligament instability Signup and view all the answers

What is a common result when ligaments are found to be stable in patients?

Ability to engage in normal activities Signup and view all the answers

Which cranial nerves are screened during the Prone Vertebral Artery Test?

All cranial nerves from I to XII Signup and view all the answers

What joint is responsible for allowing flexion and extension in the upper cervical spine?

Atlanto-Occipital Joint Signup and view all the answers

How does lateral flexion couple with rotation in the upper cervical spine?

It is contralateral. Signup and view all the answers

Which action is NOT performed by the sub-occipital muscles?

Lateral Flexion Signup and view all the answers

What is a common cause of cervicogenic headaches?

Facet dysfunction in the upper cervical spine Signup and view all the answers

What technique is considered effective for treating upper cervical spine pain?

Manual therapy Signup and view all the answers

What should be screened before implementing manual therapy in the upper cervical spine?

Vertebral artery dysfunction Signup and view all the answers

What is the main function of the sub-occipital muscles?

Assist in head stabilization Signup and view all the answers

Which test is considered the gold standard for evaluating the upper cervical spine?

Plain radiograph Signup and view all the answers

Which statement accurately describes the coupling of lateral flexion and rotation in the lower cervical spine?

It is ipsilateral. Signup and view all the answers

What can cause forward head posture in patients?

Increased weight on the cervical spine Signup and view all the answers

What type of headache occurs due to greater occipital nerve entrapment?

Tension headache Signup and view all the answers

What should a therapist do to maximally open the right OA joint?

Flex the upper cervical spine, side bend left, and rotate right Signup and view all the answers

Which factor does NOT contribute to cervical radiculopathy?

Non-cervical injuries Signup and view all the answers

Study Notes

Upper Cervical Spine Anatomy

The upper cervical spine comprises the occiput, atlas (C1), and axis (C2).
Joints of the upper cervical spine include the occipitoatlantal (OA) and atlantoaxial (AA) joints.
The alar and transverse ligaments support the upper cervical spine, holding the dens in place. Injury to these ligaments can permit movement of the dens.
Biomechanically, the occipitoatlantal joint facilitates flexion, extension, and lateral flexion, but no rotation.
The atlantoaxial joint primarily permits rotation, accounting for 70% of total cervical rotation.
In the lower cervical spine, lateral flexion and rotation couple ipsilaterally.
To close a facet on one side, extend, side bend, and rotate the cervical spine towards that side. Conversely, to open a facet, flex, side bend, and rotate the spine away from that side.
In the upper cervical spine, lateral flexion and rotation couple contralaterally.

Upper Cervical Spine Musculature

The suboccipital muscles include the rectus capitis posterior major, rectus capitis posterior minor, oblique capitis inferior, and oblique capitis superior.
These form a triangular structure at the base of the skull on both sides.
The greater occipital nerve passes through this triangle.
Origin: Axis and Atlas. Insertion: Occipital Bone. Action: Extension, side-bending, and rotation of the upper cervical spine. These muscles are important for supporting the head during activity.
Fatigue in these muscles can lead to spasms and greater occipital nerve entrapment, causing cervicogenic headaches.
Forward head posture increases the weight load on the upper cervical spine, potentially leading to suboccipital muscle inflexibility and pain.

Signs and Symptoms of Upper Cervical Spine Dysfunction

Pain in the cervical spine (upper or lower, potentially both at once).
Cervicogenic headaches.
Limited range of motion (ROM) in the cervical spine, particularly at the OA and AA joints.
Neurological or cranial nerve symptoms in the upper cervical spine.
Lower cervical spine issues might manifest as cervical radiculopathy (pain radiating into upper extremities).

Tension and Mechanical Headaches

Tension headaches can result from extended forward head posture and suboccipital muscle spasm.
Symptoms often start in the occiput and radiate to the parietal, frontal, and temporal regions, potentially even behind the eyes.
Cervicogenic headaches and tension headaches frequently coexist.

Causes of Upper Cervical Spine Issues

Upper or lower cervical spine disc dysfunction (although discs are absent at OA & AA).
Upper or lower cervical spine facet dysfunction (a common cause).
Upper or lower cervical spine postural dysfunction (from poor posture over time).
Upper cervical spine instability (rare 0.1-0.6%).
Down Syndrome (increased risk, 10-20% occurrence, 1-2% symptomatic).
Rheumatoid Arthritis.
Cervical spine trauma (like whiplash).

Upper Cervical Spine Interventions

Manual therapy is effective for treating pain, headaches, and limited movement in the upper cervical spine and provides greater short-term pain relief than exercise alone.
Pre-manual therapy screening is necessary for upper cervical spine instability and vertebral artery dysfunction risk.
Therapeutic exercises are crucial for treating upper cervical spine instability and vertebral artery dysfunction.

Evaluation of the Upper Cervical Spine

Tests for vertebral artery assessment include the prone vertebral artery test and the supine vertebral artery test, along with the Sharp-Purser test, alar ligament test and transverse ligament stress test.
The gold standard for assessment is a plain radiograph (or MRI) to evaluate the atlas dens interval (ADI).
An ADI greater than 3-4 mm is considered abnormal, indicating possible alar ligament or transverse ligament injury; instability of the ligaments would permit movement of the dens causing injury to the spinal cord.
Cervical spine injuries are more likely in collision athletes due to axial load impact to the head and neck.

Specific Tests

Prone Vertebral Artery Test: Patient in prone, actively extending the upper cervical spine, monitored for dizziness or CN (cranial nerve) dysfunction or dizziness.
Supine Vertebral Artery Test: Similar to prone, but performed in supine position. Multiple stages progressing from minimal to full.
Sharp-Purser Test: Used to assess upper cervical instability. The patient is seated in slight flexion. This is helpful in patients with axial load type of injuries, whiplash, tension/cervicogenic headaches.
Alar Ligament Stress Test: The clinician passively side bends the upper cervical spine while stabilizing C2, looking for changes in the alar ligament.
Transverse Ligament Stress Test: Patient in supine, clinician attempts anterior movement of the occiput and C1 on C2, monitor for cranial nerve symptoms.

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Description

Explore the intricate anatomy of the upper cervical spine, including the occiput, atlas, and axis. This quiz covers joint functions, ligament support, and the biomechanics involved in movement. Test your knowledge on the unique attributes of the upper cervical spine and its musculature.