C0-C1 & C1-C2
What levels of the c-spine contain no intervertebral disks?
8
How many pairs of nerve roots are found in the c-spine?
rami
_____ - carry sensory & motor information
rami
Roots come together & divide into 2 ______.
C1-C4
Cervical plexus nerve roots @ what levels?
-Occipital
-Supraclavicular
-Shoulder
-Upper thoracic regions
Cervical plexus innervates (4)
C5-C8
Brachial plexus nerve roots @ what levels?
--C4-T2 (may also contribute)
- part of shoulder
- arm
- hand
Brachial plexus inervates (3)
- history of spinal pathology
- recurrent brachial plexus trauma
- chest/breast pain
- headaches or other head pain
- eye examination
- psychosocial factors
Past medical history questions (6)
- location of pain
- MOI & onset
> acute
> insidious
- Consistency of pain
- Postural influences
- Other symptoms
Present condition history question (5)
myelopathy
______________ - disease affects spinal cord
dysphasia
_______________ - speech impairment caused by brain lesion
dysarthria
________________ - speech impairment caused by dysfunction of the muscles and joints associated w/ speech
C7
A patient w/ pathology at the ___ nerve root may complain of sensory issues on the dorsal hand between the thumb and index finger.
spasm of cervical muscles
Cervical curvatures: Lordotic curve
--flattening = ____________
forward head posture
Cervical curvatures: Lordotic curve
--increased curve = ___________
posturing to decrease nerve root pressure
Cervical curvatures: Lordotic curve
--lateral bending = _____________
- postural changes
- muscle spasm
- weakness
Forward head posture accompanied by excessive flexion of the cervical spine causes (3):
AC joint, deltoid, & clavicle should be level
--Dominant shoulder usually depressed!!
Level of shoulder??
unilateral spasm
Lateral flexion position of the head may indicate?
Torticollis ("wry neck")
Chin rotation --
____________ - congential or acquired spasm of the SCM muscle
- equality of mass, tone, and texture
- atrophy may cause impingement
- dominant side may be hypertophied
Cervical musculature -- notes (3)
C3-C4
When discussing bony landmarks for palpation the ________ vertebrae are located posterior to hyoid bone.
40-70
Degrees of flexion
60-80
degrees of extension
40-50
degrees of lateral flexion
70-90
degrees of rotation
isometrically
MMT of cervical spine should be performed how??
Compensation of range of motion. If one segment is hypomobile then the other segment become hypermobile to make up for the lost ROM.
Explain why hypomobility at one segment may result in hypermobility at the segment above or below??
false
anterior longitudinal ligament
True or false?
Interspinous ligament is stressed during extension
upper limb nerve tension test
Sometimes referred to as the "straight leg test of the upper extremity" the ________________________ assesses the impact of changing nerve tension on provoking symptoms.
6 seconds
for each upper limb nerve tension test position hold for how long???
provocation of symptoms & restricted ROM
(+) positive - upper limb nerve tension test
hyperirritability of the peripheral nerve due to adaptive shortening, entrapment, or impingmenet (disk herniation)
Implications - upper limb nerve tension test
Babinski test
Oppenheim test
Test for upper motor neuron lesions (2)
great toe extends & toes splay
(+) positive - babinski test
great to extends & toes splay - reports of hypersensitivity
(+) positive - oppenheim test
upper motor neuron
Implication of babinski & oppenheim
compression or forces past its normal ROM
MOI cervical injuries
cervical radiculopathy
_______________ - pressure place on the cervical nerve roots that causes pain and spasm in the cervical region; pain & paresthesia in the affected dermatome
disk herniation
osteophyte formation
Common causes of cervical radiculopathy.
30-40 year olds
Cervical nerve root compression is most common in _________ year olds.
C6-C7
Most commonly affected nerves of cervical nerve root compression
cervical compression test
Narrowing of the intervertebral foramen secondary to exostosis of the vertebrae, enlargement or irritation of the dural sheath surrounding the cervical nerve root, and degeneration of the facet joints can be confirmed via the ______________________ test.
pain or reproduction of symptoms
(+) positive - cervical compression test
facet compression & narrowing of the foramen
implication - cervical compression test
spurling test
____________ is a modification of the cervical compession test that increases the compression of the cervical nerve root by unilaterally decreases the size of the foramen.
pain or reproduction of symptoms radiating down arm
(+) positive - spurling test
nerve root impingment by narrowing of the foramen
implication - spurling test
cervical distraction test
____________________ attempts to relieve the patient's symptoms by decreasing pressure on cervical nerve roots.
symptoms relief
(+) positive- cervical distraction test
facet compression and/or stenosis of the neural foramen
implication - cervical distraction test
vertebral artery test
A test for patency (freely open) of the vertebral artery, the ______________ determines whether there is a potential for claudication & interruption of blood flow
30 seconds
W/ vertebral artery test head is rotated to one side & held for _____________.
dizziness, confusion, nystagmus (uncontrollable shaking of eyes), unilateral pupil changes, nausea
(+) positive - vertebral artery test
occlusion of vertebral artery
implicaiton - vertebral artery test
head or c-spine position
Disk herniation and vertebral impingements, pain is often influenced by:
C5-C6 or C6-C7
Common site for disk herniation
shoulder abduction test
______________________ is a clinical test used for the presence of a herniated disk and may be a position that the patient describes using to decrease symptoms.
decrease of symptoms
(+)postive - shoulder abduction test
herniated disk or nerve root compression
implications - shoulder abduction test
- joint pain
- cervical stiffness
- AROM & PROM may be limited b/c pain & stiffness
Signs & Symptoms of degenerative joint & disk disease
not gross instability
Clinical cervical instability is not... what??
- tender to palpation
- muscle spasm
- poor control in mid-range of active motions
Signs & Symptoms of clinical cervical instability
- poor posture
- repetitive movements
- muscular weakness
- damage to passive restraints
Clinical cervical instability is caused by: (4)
whiplash or repetitive motion
Facet joint dysfunction MOI: Acute trauma - ?
- post. neck pain during extension & rotation
- localized pain, lateral to spinous process
Signs & Symptoms of facet joint dysfunction
burner" or "stinger
Brachial plexus pathology is also know as ""?
traction or impingement
Brachial plexus injury MOI?
located 2 to 3 cm above clavicle
Erb's point is located?
opposite
Brachial plexus stretch symptoms occur on the ___________ of lateral bending.
Toward
Brachial plexus compression symptoms occur on the side ____________ the lateral bending.
involved arm hangs limply at side, but resolve w/ time.
Inspection of brachial plexus trauma
brachial plexus traction test
With _______________________ examiner duplicates the MOI and replicates the patient's symptoms, pain radiates down patient's arm.
reproduction of pain and/or parastesia symptoms throughout the involved upper extremity.
(+) positive - brachial plexus traction test
brachial plexus neurapraxia
implications - brachial plexus traction test
tension (stretching)
Brachial plexus
Radiating pain on the side opposite of lateral bending =
compression
Brachial plexus
Radiating pain on the side toward lateral bending
medial cord brachial plexus
subclavian artery
subclavian vein
Thoracic outlet syndrome is caused by pressure on which structures?
vascular
neurogenic
nonspecific
Types of thoracic outlet syndrome
- correcting posture
- correct muscle testing
Management of TOS (2)
Adson
Allen
Military brace
Roos
Tests for thorcic outlet syndrome (4)
Adson's test
Test identifies occlusion of the medial cord of the brachial plexus, subclavian artery, and subclavian
vein.
-- shoulder abducted 30
-- thumb up -- inhale deep breath
radial pulse diminishes or disappears
(+) positive - adson's, allen, & military brace
allen test
TOC caused by pectoralis minor muscle may be detected via ________________.
90 - 90 - horizontally abduct - look away
military brace test
Costoclavicular etology is test via the ______________ which identifies occlusion of subclavian artery by the costoclavicular structures.
- humerus is extended and abducted to 30
- extends neck
subclavian artery is occluded between ant. and middle scalene
implication of adson test
pectoralis minor is compressing neurovascular bundle
implication of allen test
subclavian artery is occluded by the costoclavicular structures
implicaiton of military brace
roos test
The __________ test has demonstrated accuracy in identifiying the presence of TOC resulting fron neurologic or vascular abnormalities
elevated arm stress test
EAST stands for...
inability to maintain testing position, replication of sensory and/or motor symptoms in extremity
(+) positive - Roos test
TOC of neurologic origin
Implications - roos test
- normal neurologic examination
- no weakness
- full pain-free ROM
RTP brachial plexus injury (3)