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67 Cards in this Set
- Front
- Back
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A typical cervical vertebra iscomposed of a body and neural arch |
The neural arch is composed of 2pedicles that from the sides and 2 lamina that meet in the midline to form theroof |
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Wherethe lamina meet is |
the spinous process extending posteriorly |
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Projectinglaterally from the junction of the pedicle and lamina |
is atransverse process on each side |
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2articularprocesses |
thesuperior and inferior project upward and downward and articulate with similarprocesses on adjacent vertebra to form the zygoapophyseal orfacet joints |
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The vertebra are separated fromeach other by intervertebraldiscs |
Each disc is composed of an inner(mainly gelatinous) nucleus pulposusand a mainly fibrous outer layer- the annulus fibrosis |
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The cervical intervertebraldiscs constitute approx |
Discs:¼ the length of the vertebral column |
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Discs: |
distribute stress over a wide area of thevertebra, Absorb shock,Allow mobility |
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•Thenucleus pulposus hasa high water content early in life, but with age tends to diminish - Withloss of water |
abnormalpressures begin to be exerted on the anulus, which may lead to herniationand/or disc degeneration - Pathologicchanges in adjacent structures (facet joint arthritis or osterophyteformation) may eventually develop as well- decreasing foraminalspaces |
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Eight pairs of nerve roots arise from thecervical spinal cord |
-Each nerve exits above the vertebra ofthe same number. -Each nerve, exit the first two pairs,leave the spinal column by passing through an intervertebralforamen. -In the cervical spine the foramen arequite small and almost entirely occupied by the nerve root.Anything that compromises this space,such as disc degeneration with spur formation could cause compression/ pressureon the nerve root- leading to motor/ sensory deficits |
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Narrowing of foramen may occur laterally in- medially in- |
-the intervertebral foramen -the spinal cord -The etiology may be primary (ie.Congenital), secondary to degenerative conditions, or a combination of the two. |
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CervicalAtypical Vertebra atlantoaxial joint- |
C1- the ATLAS, has no bodyIt’s body is attached to C2- theAXIS, and from the dens/ odontoidprocess -This allows for most of therotation in the cervical spine |
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C0-C1 |
10-15degrees flex/ex, 8 degrees SB, min. rotation |
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C1-C2 |
10degrees flex/ex, 45 degrees rot., little to no SB |
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C3-C7 |
64degrees flex, 24 degrees ext.,40 degrees SB and rot |
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T1-S1 |
80degrees flex,25 degrees ext.,45 degrees rot, 35 degrees SB |
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Inorder to perform ADL’s |
65-70degrees both of rotation and of flexion and extension are needed. |
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requires the greatest amount of cervical flexion and extension |
shoe tying at 66.7degrees |
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requires the greatest rotation |
driving a car in reverse (67.6) crossing the street (85 degrees |
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disc space level=2 #'s N. root compression=1# |
c3-c4 pressure on c4 |
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C3 - C4 level |
pressure on C4 myotome effected is diaphragm dermatome is medial to the deltoids DTR=n/a |
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C4-C5 level |
pressure on c5 myotome effected is Biceps (elbow flexors), deltoid (abd), ex. rotators dermatome is lateral upper arm DTR=bicipital reflex (brachioradialis) -thumb on biceps tendon, hit your thumb |
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C5-C6 level |
pressure on c6 myotome effected is Biceps (elbow flexors), wrist extensors dermatome is lateral forearm/thumbs DTR=brachioradialis (bicep) |
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c6-c7 level |
pressure on c7 myotome effected is triceps (elbow ext), wrist flexors, finger ext dermatome effected is middle finger DTR=tricep -square dancing, support arm on yours and hit superior to olecranon |
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c7-t1 level |
pressure on c8 myotome effected is finger flexors dermatome effected is medial arm DTR=interossei |
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C2 |
posterior head |
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c3 |
neck |
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dermatome T2 |
axillary region |
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t4 |
nipple line |
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t10 |
umbilical line |
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DTR |
+4 pathologically hyperreflexive (UMN, S/C or brain problem also clonus) +3 increased reflex (hyperreflexive) +2 normal +1 hyporeflexive 0: AReflexive |
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Fryette’s Lawsof Spinal Biomechanics |
In the cervical spine, SB and rot. occurto the same side |
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Whenthe thoracic and lumbar spines are in neutral |
SBand rot. occur to opposite sides |
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Whenthe thoracic and lumbar spines are in extreme flexion |
SBand rot. occur to the same side |
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Otherconsiderations in cervical anatomy |
hyoidbone, vertebral arteries and foraminal space |
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hard disc lesions |
older, spondylosis, DDD |
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soft disc lesions |
younger (30-50), accident or repetitive poor posture and mvmnt |
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CERVICAL DISC SYNDROMES- NUCLEARHERNIATION -Mostcommon in the younger patient |
A mass of nucleus pulposusbulges outward, usually posterolaterally atthe area of greatest weakness in the anulus fibrosis -With severe disc protrusion, compressionof the nerve root may occur, resulting in arm symptoms and radicular pain, and nerve root signs of decreased sensory or motor ability -Less severe herniation mayproduce only referred or axial spinepain, usually one-sided |
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HARD DISC LESION/ SPONDYLOSIS |
-More common cervical disc lesionresulting from chronic disc degeneration with subsequent narrowing of the discspace and ? Approximation of facet joints- decreasing foraminalspace- producing pressure on the nerve root -Inflammation and swelling may develop inconjunction with osteophyteformation along the disc edges due to the approximation of the vertebra- whichfurther contributes to the narrowing of the foramen and nerve root compression |
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Cervicalspondylosisoccurs primarily in |
olderage group |
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Thelevels at which cervical spondylosis mosttypically occur at |
C5/C6>C6/C7>C3/C5>C7/T1 Thesechanges affect 70% of the population by age 70. |
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CERVICAL SPONDYLOSIS WITH MYELOPATHY -Rarely, large posterior osteophytesalong with degenerative narrowing of the bony canal may cause pressure on thespinal cord and produce mixed symptoms of: |
UE nerve root pain, signs and symptoms(LMN) and LE weakness, increased reflexes, (+) Babinski,gait difficulty (UMN) -IN many of these cases the LE symptomsare more disabling than the neck symptoms |
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Severaloverlapping syndromes in the cervical spine can be produced by disc disease |
1)axial or referred spine pain 2) radicular armsymptoms from nerve root compression and rarely 3)cord compression symptoms •90%of disc lesions in the cervical spine occur at the C5 and C6 levels, thosebeing the most mobile segments |
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CERVICAL SPRAIN/ WHIPLASH hyperextension injury: |
scm longissimus colli all 1st sympathetic ganglion -anterior to T1 |
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Whiplashoccurs of a hyperextension force that develops in rear-end automobilecollisions |
-Trauma is a result of the inertial forcesapplied to the head -Painis generated by structures such as: the SCM, longissimus colli muscles, intervertebraldisc, facet capsule and ant.Longitudinal ligament |
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pos structures |
cervical ext, PLL |
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Hemorrhageand edema may be present in the prevertebral areawhere the sympathetic nerve chains arelocated and are occasionally stretched, producing unusual symptoms such as |
nausea,tinnitus, blurred vision,anddizziness -•Chronicpain that continues for weeks, months is not uncommon |
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Whiplash-Initial Signs and Symptoms |
•Thereare usually few symptoms immediately post injury •A fewhours later, patient may begin to notice stiffness in the neck, followed bypain and inability to move the neck normally. •Painradiates from neck to occiput-along path of greater occipital lobe nerve •Discomfort/painmay also be present in the interscapular areaas well as the ant. chest wall |
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Examdemonstrates |
tendernessto palpation in the ant. And pos. neck musculature, decreased ROM,Painfulextension and mild torticollis may be present. |
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CONGENITAL MUSCULAR TORTICOLLIS |
Deformity noted at birth (congenital),much more common after breech deliveries -Results from a unilateral contracture ofthe SCM •Causeis unknown, but fibrosis of the muscle occurs •*A“tumor” of dense fibrous tissue is often found in the muscle shortly afterbirth •Themass gradually subsides over weeks and leaves a shortened and contracted SCM mucle |
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Congenital muscular torticollisis often associated with other congenital disorders |
such as hip dysplasia and clubfoot |
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Milddeformities |
gentlestretching exercises repeated several times daily |
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Thecrib should be placed, holding, and feeding should be done so that the child must |
-turntoward the corrected position **Mostcases improve within 6 months and the mass usually resolves |
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Most common modes of SCI: |
MVA”s-45%, Falls-20%, Sports injuries 15%- of these diving injuries are the most common. |
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Redflags to alert practioner tosubtle spine injury include |
Facial trauma, calcaneal fracture,hypotension, and localized tenderness and spasm. -Significant injury is also more likely inpatients with osteopenia orneuromuscular disease |
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BURNER or STINGER |
*Traction or compression nerve injury toa cervical nerve root or brachial plexus trunk.Often involves the C5 or C6 nerve root,or upper trunk of brachial plexus, with burning, numbness, tingling, orweakness in the distribution of the nerve root or trunk |
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horners syndrome 1st sympathetic ganglion |
ptosis: droopy eyelid miosis: abnormally contracting pupil enophthalmos: sunken eyeball anihidrosis: no sweating |
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THORACICOUTLET SYNDROME (TOS) |
Dueto compression of the neurovascular structures (nerve, artery, vein)between theneck and axilla |
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neuraland/or vascular signs and symptoms may be noted including but not limited toneural: |
sensoryand motor chnages, andvascular- pain, decreased pulse, (artery), swelling (vein) |
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CervicalRib |
tx: surgery |
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scalenius anticus |
adson's halsteads's tx: stretch scalenes, mob 1st rib |
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constoclavicular 1strib/clavicle |
costoclavicular/military brace test tx: stop using heavy backpack if possible |
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hyperabduction syndrome pec minor/coracoid process |
hyperabduction wrights test tx: stretch pec minor and major |
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tx for all |
address posture in all adl's esp fwd head and increase kyphosis, stretch tigh muscles and strengthen weak muscles |
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ERB- DUCHENNE BIRTH PALSY -born in lateral flex (cervical) |
-Damage to the upper roots (C5 and C6)leads to paralysis of the deltoids, biceps, ext. rotators, supinators ofthe forearm -In which the arm is held adducted, int.rotated, and forearm pronation. Wrist and finger function is usuallynormal |
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KLUMPKE”S BIRTH PALSY (child on lowerright) -The lower cervical and first thoracicnerve roots are involved (C8 and T1) (sensory loss here) -born with are over head |
The finger and wrist flexors andintrinsic muscles are denervatedand a claw hand deformity often results |
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Treatmentand Prognosis of Birth Palsy |
•Preventcontractures from developing, so that muscles who have return of function willhave available range.- via gentle ROM(as soon as tenderness disappears approx.2 weeks) and splinting •Reconstructivesurgery is often beneficial for alte deformities. Muscle transfers and osteotomies areused to restore motor function and correct malposition. |
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Overall prognosis for Erb’s palsy |
is relatively good compared with Klumpke’s and whole arm paralysis- more than 50-60% of upper arm paralysis show fair to good recovery of arm function- usually within 3 to 6 months •Full return of function is expected if recovery occurs within first month ; however, about one in ten patients only will have complete return of normal use of the arm. |
