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OPP Lect 18

QuestionAnswer
Functions of cervical vertebrae 1.Stabilize and support head. 2.Permit motion of head and neck. 3.Protect the vertebral artery, spinal roots, and spinal cord.
Neck pain is seen more in men or women? WOMEN
2 major age ranges for neck pain? 1.20-40: MVA. 2.30-60: Osteoarthritis.
Is neck pain the leading musculoskeletal complaint? NO, 2nd to low back pain. **2/3 of people get neck pain. 2nd in ER to lacerations.
Is neck pain usually chronic? YES, usually arises from an acute event and then persists for more than 12 months. **Only 1/3 experience complete resolution of symptoms.
Unique anatomy of the cervical spine 1.Uncinate processes (C3-C7): add support and prevent herniation. 2.Bifid spinous processes (C2-C6). 3.Foramen Transversarium (C1-7): contains vertebral artery. 4.Lordotic curve (also seen in lumbar).
What is contained within the Foramen Transversarium (transverse foramen)? Vertebral Artery.
Main functions of cervical muscles 1.Stabilize. 2.Movement: unilaterally (rotate), bilaterally (flex/extend).
Where do C1-7 spinal nerve roots exit the C-spine? ABOVE their respective cervical vertebrae.
Where does spinal nerve root C8 exit? BELOW C7. **All other spinal nerve roots exit below.
Do Fryette's laws apply to the neck? NO
Primary motion of O-A segment (Head-C1) Flexion & Extension. **"Yes" joint
Primary motion of A-A segment (C1-2) Rotation. 50% of cervical rotation occurs here. **"No" joint
rotation and side-bending at the O-A segment occur in the ________ direction? OPPOSITE
rotation and side-bending in the Typical cervicals (C2-7) occur in the ________ direction? SAME
Where does most of cervical SIDEBENDING occur? Lower cervicals. (mainly C2-7)
Typical cervical facet motion: Extension Both CLOSED
Typical cervical facet motion: Flexion Both OPEN
Which facet is open if patient is rotated and sidebent to the left in the cervical spine? RIGHT. **Left is locked closed.
which facet is open if patient is rotated and sidebent to the right in the cervical spine? LEFT. **Right is locked closed.
When examing the neck, how should the head and eyes move? TOGETHER, consitently throughout the exam.
Dorsokyphosis is associated with: 1.Advanced Age. 2.Depression. 3.Postural abnormality.
Sluggish movement is associated with: 1.Fibromyalgia. 2.Osteoarthritis (OA). 3.Cervical strain. **Protecting from further pain, body will move slowly).
Torticolis is associated with: 1.Acute muscle spasm. 2.Herniated disc (HNP)
Examining Active range of motion of the neck Have patient seated, always asses ACTIVE ROM first in order to see what they can do. **Prevents you from creating a new injury. 1.Rotation: >80. 2.sidebending: >45. 3.Flexion: >50. 4.Extension: >60.
How should passive ROM of the neck compare to active ROM? it should be equal to or greater. If not they are protecting against pain. **have patient seated.
What is the most sensitive indicator to pathology intrinsic to neck? (what motion becomes restricted first)? ROTATION. (look into X-ray if it is less than 80 deg). **Sidebending is also a good indicator.
What would an ABRUPT end feel indicate? A non-anatomic barrier causing restriction. **End feel is the end of a ROM as the anatomic barrier is reached.
What should you do when rotation ROM is less than 80 degrees? 1.Neurological exam. 2.X-ray.
Where is the most common location of OA in the cervical spine? C5-6. Could be tender or enlarged.
What is the most commonly irritated neck muscle? Upper Trapezius b/c it is connected to all 7 vertebrae and distal acromion.
What does the Spurling Maneuver test for? Radiculopathy. NOT sensitivity. will cause tingling in hands and arms. **Tap on top of sidebent & extended head.
What is the most common cuase of radiculopathy? (positive spurling test) OA. it can cause 50% reduction of foramen.
Neuro exam: Motor nerves and muscle group 1.C5:deltoid 2.C6:wrist extensors. 3.C7:wrist flexors. 4.C8:finger flexors. 5.T1:interossei muscles.
Neuro exam: Refelxes 1.Biceps: C5. 2.Brachioradialis: C6. 3.Triceps: C7
What happens to the vertebral artery during cervical rotation? 90% occluded on contralateral side. **Worsens with EXTENSION. Be careful using force.
VAD Vertebral Artery Disection. Very rare but dangerous. Avoid rotation thrust in EXTENSION **Can cause incoordination visual disturbance, paralysis, death.
Can there be radiculopathy with a NEGATIVE Spurlings test? YES, it is rarely positive. **Look for: 1.loss of full ROM (esp rotation), 2.Abnormal upper extremity, 3.Paracervical tenderness. **Vertical traction will provide relief.
When would you want to order further testing on a cervical spine injury? 1.Radiculopathy. 2.Fever. 3.Acute pain with tenderness. 4.No tightness or spasms.
What special tests would you order with a cervical spine injury? 1.X-Ray (radiculopathy & trauma). 2.Labs (Fever & acute pain w/ tenderness). 3.MRI (Radiculopathy & rapidly dev neuro deficit). 4.Bone Scan (injury + normal X-ray & localized vertebral body tenderness)
Screening tests Prior to treatment of C-spine somatic dysfunction 1.Vertebral Artery Challenge Test. 2.Cervical Compression Test. 3.Beighton Hypermobility screen. 4.DTRs or UE strength test.
Positive Vertebral Artery challenge test If neurological symptoms occur after 10 seconds of rotation to one side while supine.
Positive Cervical compression test Exacerbation of arm pain, numbness, or tingling when push on head inferiorly while patient is seated. **Cervical neuritis
Positive Beighton Hypermobility Screen If 4/5 joints on non-dominant side or pos. 1.Dorsiflexion of index finger > 90 deg. 2.Apposition of thumb to forearm. 3.>10 deg elbow hyperext. 4.>10 deg knee hyperext. 5.hands flat on the floor with knees extended.
Created by: WeeG