Cervical Spine MSK I Voice over ppt. MD-spring 2012

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Cervical Spine: 

Cervical Spine

Differences Between Cervical & Lumbar Spine: 

Differences Between Cervical & Lumbar Spine Nerve roots exit ABOVE the level for which they are named Disc dysfunction and stenosis will affect the SAME nerve root Angle of facets is 45 ° in cervical spine

Cervical Vertebra: 

Cervical Vertebra

Atlas (C1): 

Atlas (C1)

Axis (C2): 

Axis (C2)

Subcranial Mechanics: 

Subcranial Mechanics FB – atlas slides forward BB – atlas slides back SB right – atlas slides right SB left – atlas slides left Rotation occurs between A/A

Mid Cervical Mechanics: 

Mid Cervical Mechanics FB – upslide facets BB – downslide facets SB right – upslide left, downslide right Rotation right – upslide left, downslide right Myofasical tightness

Midcervical/Upper Thoracic: 

Midcervical /Upper Thoracic Using CROM FB – 55 ° ± 9 ° SB – 45° ± 5-6° Rotation – 70-75° CROM is valid and reliable

Posture Related Neck Ache: 

Posture Related Neck Ache Pain – neck, upper trap, interscapular , suboccipital No anasthesia or parasthesia Gradual onset No significant history of trauma

Posture Related Neck Ache: 

Posture Related Neck Ache Forward Head and shoulders Limited cervical AROM Tight upper trap, levator , suboccipt , pecs Weak middle and lower trap Tenderness/increased tone Poor postural awareness/ergonomics No neurological signs

Sprain/Strain/Synovitis: 

Sprain/Strain/Synovitis Awkward movement or overstretch Pain worsens over 2-3 days Pain centered in upper trap/levator to interscapular and/or subcranial region

Sprain/Strain/Synovitis: 

Sprain/Strain/Synovitis Forward head posture Limited AROM SB and rotation in one direction Upper trap and levator tight involved side Tenderness/increased tone Paraspinals, suboccipitals , upper trap/levator, interscapular muscles

Painful Entrapment: 

Painful Entrapment Sudden painful catch While turning head or returning from eccentric movement Noticed in AM when waking up due to incorrect posture unilateral

Painful Entrapment: 

Painful Entrapment Postural Shift of neck away from painful side, muscle guarding AROM limited SB, rotation to involved side and BB (due to downslide) Swollen facet capsule Pain and muscle guarding paraspinals and levator No neurological signs

Multifidus Isometric: 

Multifidus Isometric

Cervical Radiculopathy: 

Cervical Radiculopathy Due to lateral foraminal stenosis or disc herniation “higher incidence… due to spondolytic changes than cervical disc herniation ” Lateral interbody articulation/ uncinate process/joint of von lushka

Joint of Von Lushka: 

Joint of Von Lushka

Cervical Radiculopathy: 

Cervical Radiculopathy 4 th /5 th decade – females > males C6 and C7 most commonly involved Gradual onset of pain – neck, upper trap and spread into UE Difficulty falling asleep due to pain and parasthesias in UE Increased pain with “look up” or SB

Cervical Radiculopathy: 

Cervical Radiculopathy Forward head and shoulders Limited SB and BB with pain into UE Neurological signs in dermatome/ myotome Distraction decrease pain Compression increases pain Tenderness on side of involvement

Test cluster most predictive: 

Test cluster most predictive ULTTA Median Nerve Shoulder abd , elbow ext, supin , wrist ext, finger ext Cervical rotation < 60 Distraction test Spurling test Form of compression

Dermatomes: 

Dermatomes C4 – upper trap C5 - lateral delt C6 – thumb C7 – middle finger C8 – ulnar border of the hand/pinky T1 – medial forearm T2 – medial arm

Myotomes & Reflexes: 

Myotomes & Reflexes C4 – upper trap C5/6 – biceps C6- wrist extensors C7 – triceps, wrist flexors C8 – thumb extensors T1 – intrinsics (finger add/ abd ) Reflexes C5/6 – biceps C6 – brachioradialis C7 - triceps