Ortho-Exam 1- Cervical Spine

Front 1

what is the first landmark that is palpable in the cervical spine

Back 1

the spinous process of C2

Front 2

what is unique about the spinous processes of the cervical spine

Back 2

C3-7 are bifid and C7 is the most prominent

Front 3

what direction do the sp of the spinous processes face

Back 3

horizontal in upper cervical area and become more angles as you go down into the thoracic spine

Front 4

what is the direction of the facets?

Back 4

oriented at 45 degree angle "gutter like"

Superior: face up and back
inferior: face down and forward

Front 5

what is the function of the uncovertebral joint

Back 5

support the disc and guide motion

Front 6

describe the path of the spinal nerve as it exits the cord

Back 6

motor and sensory roots course close to the uncovertebral joint and the facet joint

Front 7

where do the cervical nerve roots exit the spinal cord in relation to the vertebra

Back 7

cervical nerve roots exit above the vertebra of the same number

Front 8

what is the direction of the cervical nerve root exiting the sc, what does this tell us

Back 8

directly horizontal so for example C4 can only be impinged by C3-C4 disc

Front 9

what are the two possible effects of the structures bordering the spinal canal

Back 9

1) protect the spinal cord
2) may also cause impingement of the spinal cord

Front 10

what are hte anterior structures bordering the spinal canal

Back 10

posterior portion of the vertebral body and the disc and PLL

Front 11

what ar ehte lateral structures bordering the spinal canal

Back 11

pedicls and capsule of facet joints

Front 12

what are the posterior structures bordering the spinal canal

Back 12

lamina and ligamentum flavum

Front 13

what are the anterior structures bordering the foraminal opening

Back 13

posterolateral margin of the vertebral body and the disc

Front 14

what are the posterior structures bordering the foraminal opening

Back 14

inferior and superior articular processes

Front 15

what are the superior/inferior structures bordering the foraminal opening

Back 15

pedicles

Front 16

what is the arthrology of the occiput on the atlas

Back 16

Convex occiput on Concave atlas with NO INTERVERTEBRAL DISC

Front 17

where does C1 nerve root exit

Back 17

between the occiput and the atlas

Front 18

the OA joint is also called the "what" joint

Back 18

"YES" joint

Front 19

in flexion what happens to the occiput

Back 19

forward tilt and backward glide increaseing the distance between the occiput and the posterior arch of C1

Front 20

in extension what happens to the occiput

Back 20

backward tilt and forward glide decreaseing the distance between the occiput and the posterior arch of C1

Front 21

there is 2x more ____ than _____ at the OA

Back 21

2x more extension than flexion

Front 22

what is the normal distance between occiput and spinous process of C1

Back 22

3-5 mm

Front 23

If there is a fx in the dens, what would be demonstrated in th emotion of the cervical spine

Back 23

C2 will show no rotatino, but the dens will move

Front 24

explain the role of the alar ligament

Back 24

when you sidebend to the right, the occipital condyles move to the left causing tension in the alar ligament (on the left) which will cause ipsilateral rotation of the axis (C2 sp moving in the opposite direction of the sidebending)

Front 25

where does the alar ligament lie

Back 25

from the posterolateral surface of the odontoid process to the occiput

Front 26

the OA has how much motion of
flexion
extension
sidebending
rotation

Back 26

Flexion: 5 degrees
Extension: 10 degrees
Sidebending: 3-5 degrees each side
Rotation: <2 degrees each side

Front 27

the atlant axial joint is the "what joint"

Back 27

"NO joint"

Front 28

what are the surfaces of the AA joint

Back 28

convex atlas on convex axis

Front 29

where does more than half of the cervical rotation come from

Back 29

AA joint

Front 30

in which joint of the cervical spine is there a true synovial joint

Back 30

between the atlas and the odontoid process

Front 31

explain the motions that occur at C2-T4 during flexion

Back 31

Vbody tilts forward, superior facets move forward and up, nucleus, intervertebral foramen increases, increased volume of the spinal canal

Front 32

explain the motions tha toccur at C2-T4 during flexion

Back 32

Vbody tilts backward, superior facets move down and back, nucleus pushed anteriorly, sc bunches up, intervertebral foraminal space reduced

Front 33

where does the transverse ligament lie

Back 33

forms a ring around the odontoid process with the anterior arch of the atlas

Front 34

where does the alar ligament lie

Back 34

occiput to the posterolateral surface of the odontoid process

Front 35

where do the cruciate lig. lie

Back 35

form cross to protect the spinal canal, posterior wall to the dens,

Front 36

where does the apical ligament lie

Back 36

from the tip of the odontoid process to the occiput, prevents distraction

Front 37

O and I of SCM

Back 37

mastoid process of the occiput to sternum and medial 1/3 of the clavicle

Front 38

what motion occurs with unilateral contraction of the SCM compared to bilateral contraction

Back 38

Unilateral: contralateral rotation, ipsilateral sidebending, extension of upper cervical spine

Bilateral: forward head position, extension of upper cervical spine and flexion of the lower cervical spine

Front 39

O and I of the scalenes

Back 39

from the transverse process of cervical vertebra 2-7 to the medial portion of the first and second ribs

Front 40

what motion occurs with unilateral contraction of the scalenes compared to bilateral contraction

Back 40

unilateral: ipsilateral sidebending, some (minimal) role in rotation

bilateral: forward head position, extension of upper cervical and flexion of lower cervical

Front 41

how would you best stretch the scalenes

Back 41

contralateral side bending and rotation (either contra or ipsi) while in slight flexion of upper cervical

Front 42

what role do the suboccipital muscles play

Back 42

responsible for upper cervical extension, sidebending, and rotation also fine tuning of htre head position

Front 43

O and I of the upper trap

Back 43

occiput to the lateral 1/3 of clavicle and acromion

Front 44

what motion occurs with unlateral contraction of the upper trap compared to bilateral contraction

Back 44

unilateral: ilsilateral SB, contralateral rotation, extension of the upper c spine

bilateral: forward head and upper cervical extension

Front 45

o and i of the levator scap

Back 45

tprocess of first 4 cervical vertebra to superior angle of the scap

Front 46

what motion occurs with unilateral contraction of the upper trap compared to bilateral contraction

Back 46

unilateral: ipsilateral sidebending and rotation of the c spine and upper cervical spine

Bilateral: forward head and upper cervical extension

Front 47

what si the combined actino of the post. cervical musculature

Back 47

to produce upper cervical extension

Front 48

why does a forward head posture occur

Back 48

to maintain a horizontal line of vision so the lower cspine flexes

Front 49

what nerve innervates the facet joints

Back 49

the medial branch of the posterior primary rami on its own level and the level below

Front 50

what innervates the intervertebral discs

Back 50

the recurrent nerve on its own leveel and trhe level above (c and T spine) or on its own level and the level below (L spine

Front 51

what is the alternative approach we take when treating the spine

Back 51

a problem-oriented approach vs. a diagnosis oriented approach

Front 52

what is the most common cause and source of neck pain

Back 52

muscle disorders

Front 53

what are the causes for muscle dysfunction

Back 53

1) trauma
2) postural/working habits
3) tension/stress
4) tightness/weakness
5) muscle imbalance

Front 54

what are common complaints with muscle dysfunction

Back 54

1) headaches
2) radiating (reffered pain)

Front 55

what are the general intervention approaches for muscle dysfunction

Back 55

1) stretching/improving ROM
2) strengthening
3) postural reeducation
4) relaxation
5) addressing poor work habits/conditions

Front 56

what is a trigger point

Back 56

area of hypersensitivity of a muscle when palpated, provokes local tenderness with referred pain to a distant region

Front 57

what are the possible reasons for trigger points

Back 57

1) acute, sustained and/or
repetitive tauma
2) chronic shortening
3) irritation of the related nerve root

Front 58

what are tender points

Back 58

area of tenderness without referred pain

Front 59

what ar the 3 types of muscle disorders

Back 59

1) muscle spasm, guarding
2) muscle strain
3) myositis

Front 60

what is muscle spasm

Back 60

increased tone in response to trauma, or a secondary response to an acute injury

Front 61

S and S of muscle spasm

Back 61

tenderness to muslce palpation, increased muscle tone

Front 62

what is the process that could cause muscle guarding over time to become chronic

Back 62

1) circulatory stasis
2) retention of metabolites
3) pain

Front 63

what is a muscle strain

Back 63

muscle injury (tear) usually due to trauma

Front 64

what are the S and S of a muscle strain

Back 64

hx of trauma or significant muscular effort, pain upon palpaition of injured muscle. Rest decreases pain. Activities/movements increase the pain. Stiffness after resting for a period of time.

Front 65

what is important about using a cervical collar

Back 65

you should avoid using the cervical collar continuously for several days/weeks wihtout patient doing ROM--- UNLESS fx damage is suspected

Front 66

what is the process by which to remove a cervical collar

Back 66

progressively starting with 15 min. 2-3x/day

Front 67

what is myositis

Back 67

inflammation of the muscle due to chronic microtrauma or repetive stress

Front 68

what are the S and S of myositis

Back 68

tenderness with palpation. rest decreases the pain. activities movmeents increase the pain. stifness after rest. feeling of loosening up with light activities. pain not as localized to a specific muscle compatred with muscle strain

Front 69

what is the most important aspect of intervention for myositis

Back 69

to identify and corrrect the cause of repetitive trauma

Front 70

what are the 3 types of joiunt dysfunction

Back 70

1) facet joint sprain
2) joint inflammation
3) facet impingement (joint locking)

Front 71

what is a facet joint sprain

Back 71

sprain of capsule of the post. joint and surrounding ligaments from sudden movement/trauma

Front 72

what is the only muscle that does both Side bending and rotation to the ipsilateral side

Back 72

levator scapulae

Front 73

your patient is "stuck" with neck in L sidebending, rotated to the right and extension of upper cervical vertebrae, what muscles are/couldbe involved

Back 73

L scm, L scalenes. L sub occip muscles, L upper trap

COULD NOT be any of these to the R nor could it be R or L levator scap!

Front 74

what are the S and S of facet joint sprain

Back 74

hx of mod=severe trauma. rest relieves the pain. Pin with movement, espiecally at the end of range. no marked restrictoin of movement. Pain to palpation of joint structrures

Front 75

what is joint inflammation

Back 75

irritatino of the posterior articulra structures

Front 76

what are the causes for joint inflammation

Back 76

chronic loading of the joint, secondary to poor posture and/or poor working havit

Front 77

what are the S and S of joint inflammation

Back 77

movement increases pain (especially loading to the post. joints), likely slight/moderate restriction of motion. tenderness with palpation of joitn structure. pain my astill be present at rest but will be reduced. typically better in the AM

Front 78

what is facet impingement

Back 78

sudden locking of the posteir joint due to the capsule of the post. joint getting impinged between the articular facets caused by sudden movements, with backward bending, sidebending and/or rotation

Front 79

what is the most common discogenic problem

Back 79

degeneration (spondy) NOT disc prolapse!

Front 80

when do you not do joint mobs for joint dysfunction

Back 80

with a facet jopint sprain! they need time to heal

Front 81

when are joint mobs effective for joint dysfunction

Back 81

joint inflammation and facet impingement

Front 82

what is spondylosis

Back 82

degeneratoin of the intervertebral disc and related articular structures

Front 83

where isthe most common site for a spondy

Back 83

C5/C6 and C6/C7

Front 84

what are the causes of a spondy

Back 84

repetitive trauma and postural stress (shear forces from hypermobile, lack of nutrition from hypomobile)

Front 85

what is the process of degeneration

Back 85

1) decreased dis height
2) develop osteophyte along uncovertebral process from increased WB and pull on capsule
3) hypermobility
4) outward bulging places stress on ALL and PLL
5) ALL and PLL produce traction spurs on epiphyseal rim
6) traction on longitudinal ligament --> increased mobility of the segment
6) osteophytes on posterior facets and thickening of subchondral bone from increased WB
7) narrowing of intervertebral foramen from the osteophytes--- nerve root irriation

Front 86

what are the key S and S for disc degeneration

Back 86

1) hx of joint pain and/or stiffness
2) positive signs on radiographs
3) local and referred pain from nerve root irritation
4) crepitus with movement
5) if irritation present, palpation or stress on the spinal segment will cause pain

Front 87

what movements do you want to avoid with dis degerneration

Back 87

cervical spine extension

Front 88

degenerative process may cause partial occlusion of the vertebral canal due to

Back 88

1) retrolisthesis of the vertebra
2) osteophytes of the vertebral rim posteroirly
3) posterior bulding of PLL
4) anterior bulding of ligamentum flavum

Front 89

why are cervical disc herniations not as common in cervical as in the lumbar

Back 89

1) pll covers entire post. aspect of disc
2) less weight to support
3) after 30, uncovertebral joints are weight bearing
4) nucleus is centrally located within the disc
5) uncovertebral joints provide lateral restraint