MSK I Cervical Powerpoint 2-MD Spring 2012

Category: Education

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Cervical Spine II:

Cervical Spine II

Subcranial Instability:

Subcranial Instability Causes: RA, ankylosing spondylitis , down’s syndrome, corticosteroids, post trauma Post Trauma Always get A/P radiograph with open mouth – odontoid view

Subcranial Instability:

Subcranial Instability Transverse lig . of atlas prevents excessive anterior translation Normal 3mm adults, 4mm children Compress medulla, spinal cord, vertebral arteries, superior sympathetic ganglion

Subcranial Instability :

Subcranial Instability Patient Symptoms Pain in upper neck radiating to occiput , temporal or frontal aggravated by jarring movements Difficulty returning head to neutral after looking down or forward Feeling that their head is “falling off”

Subcranial Instability:

Subcranial Instability Lower brain stem symptoms Vertebral artery signs Spinal cord symptoms Sympathetics Nasopharyngeal symptoms Refer DIRECTLY to Physician

Flattening of occipito-cervical curve:

Flattening of occipito-cervical curve

Acceleration/Deceleration Whiplash:

Acceleration/Deceleration Whiplash History of trauma – usually MVA Symptoms minor to severe, may be bilateral – but worse on one side Various anatomical structures involved May have autonomic symptoms Must have odontoid view radiograph before treatment

Acceleration/Deceleration Whiplash:

Acceleration/Deceleration Whiplash Pt. presentation Guarded posture Limited AROM with muscle guarding No neurological signs – check Babinski Abnormal Muscle tone Joint overstretch/ hypermobility Weak anterior neck musculature Tenderness and increased tone to palpation

Cervical Spine Stenosis & Myelopathy:

Cervical Spine Stenosis & Myelopathy Degenerative Disc Disease (DDD) – lose disc height Vertebra slide posteriorly – narrow central canal Degenerative Joint Disease (DJD) – osteophytes form at posterior aspect of vertebral bodies Compress anterior aspect of cord Mimic ALS, MS, Parkinson’s

Cervical Spine Stenosis & Myelopathy:

Cervical Spine Stenosis & Myelopathy Aching in neck and shoulders – occasional radiation into B UE B Parasthesias UE and LE B Weakness in UE and LE, problems with balance/coordination

Cervical Spine Stenosis & Myelopathy:

Cervical Spine Stenosis & Myelopathy Forward head with thoracic kyphosis Limited AROM Permanent or transient neurological signs + Babinski , clonus and general weakness of LE Muscle tightness

Headaches :

Headaches Musculoskeletal Origin: Pain begins in cervical, suboccipital or thoracic region and radiates to head Affected by change in position, movement or cervical provocation May have history of trauma


Headaches Forward head posture Poor postural awareness/ergonomics Upper trap/levator tightness Increased tone and tenderness No neurological signs

Medical/Congenital Conditions of Cervical and Thoracic Spine:

Medical/Congenital Conditions of Cervical and Thoracic Spine

Muscular Torticollis:

Muscular Torticollis Etiology unknown Minimal deformity at birth, firm swelling develops in SCOM Swelling resolves leaving contracture and deformity – SB to same side and rotate away Radiographs differentiate from boney torticollis Stretching performed daily for first year

Scheurmann’s Disease:

Scheurmann’s Disease Osteochondrosis of the spine Begins at puberty and progresses until growth complete, males > females Form of AVN affecting anterior epiphyseal plate Disc projections into vertebra – Schmorle’s Nodes Affects 3-4 levels – marked kyphosis

Fracture & Fracture/Dislocation:

Fracture & Fracture/Dislocation Due to fall on head/neck, diving, MVA Fracture treated with traction for reduction and immobilization Spare the spinal cord Fracture/dislocation involve spinal cord resulting in quadrapalegia Surgical fixation



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