TOPIC: CERVICAL SPINE

Presented to: Sir Rizwan Haider

Presented by: Saqlain Abbas,

Aliza Tauqeer
Sehrish Noreen
Rizwana Khan
Maira Amir
 CERVICAL SPINE

• Normal anatomy, physiological movements,

• Structures underlying
• Pathologies
• Clinical Assessment
• Differential diagnoses (DD)
• Therapeutics of cervical spine
NORMAL ANATOMY OF CERVICAL SPINES

Total 7 cervical spines

2 Atypical spines
5 typical spines
 ATYPICAL SPINES

• The atlas is the first cervical vertebra

• Ring shaped has no body
• Anterior and posterior arch
• Articulates with occipital bone
• Supports head and rotates on the
facets of axis
. Nerve root in narrow intervertebral foraman
 ATYPICAL SPINE
• Axis
• Bone contains dens
• Projects superiorly
• Articulates a facet above
• Support the weight above
• Strongest vertebrae
• Allow pivotal movement
 TYPICAL SPINE
• Small oval, vertebral bodies
• Large vertebral foramen
• Inferiorly pointing spinous process
• Vertebral arteries and veins
• Transverse process
• Inferior articular surface
• Superior articular surface
VERTEBRAL ARTERY AND VEIN
 CONNECTIVE TISSUES
• Nuchal ligament
• Ligamenta flava
• Intervertebral disc
nucleus pulposus
annulus fibrosis
. Ant. Longitudinal ligament
. Pst. Longitudinal ligament
 MOVEMENTS AT
CERVICAL SPINE
•Flexion/extension(sagittal plane)
•Side flexion (frontal plane)
•Rotation (tranvrse plane)
FLEXION
EXTENSION
SIDE FLEXION
SIDE FLEXION
ROTATION OF NECK
PATHOLOGIES OF CERVICAL SPINE
 PATHOLOGIES

• Rheumatoid arthritis
• autoimmune disorder
• Osteoarthritis/DJD
Damage of Cartilage b/w joints
Age related

. Hypomobility:

tight musculature and joint dysfunction

adaptive behavior
 PATHALOGIES

• Facet syndrome
• multiple pain generator area in neck
• facet joints as source of neck pain(tenderness to palpation)
• Impingement syndrome
• pinched nerve (C5,C6)
• Spinal stenosis
• narrowing of space within spine
put pressure on the nerve along the course
 PATHOLOGIES
• Degenerative disc disease ( Cervical Spondylosis)
• neck pain, stiff neck
• cushioning discs start break down (wear and tear)
• injury may accelerate disease
• Disc bulge /herniation
• impinge on the nerve and cause pain along course
• C2-C7 radiculopathy
• C1/C2 neck flexion/ extension
• C3-neck lateral flexion
 CERVICAL RADICULOPATHY

• C4-shoulder elevation
• C5-shoulder abdution
• C6-elbow flexion/wrist extention
• C7-elbow extention/wrist flexion
• C8-finger abduction
 PATHOLOGIES

• Post concussion syndrome

• headache,dizziness
• mild traumatic injury
• violent shaking
• Hypolordotic/alordotic
• normal curve straighten(reverse kyphotic)
• Cervical scoliosis
• curving out(rare)
 PATHOLOGIES
• Anterior cervical disc fusion
• Impaired joint mobility
• Impaired motor function
• Impaired muscle performance
• Impaired ROM
 PATHOLOGIES

• Whiplash injury:
• Episodes of injury

• Acceleration and Deacceleration injury in RTAs

• You hit the car (Flexsion mechanism)

• Car hits you ( extension mechanism)

 CLINICAL ASSESSMENT

•Test for examination

PATIENT PRESENTATION

• Pain
• Paresthesia/numbness ( ulnar border of hand)
• Dizziness
• Spasm of neck muscles
• Less commonly ( dysphagia, tinnitus, blurring of vision)
• Chest pain
PT MANAGEMENT

• Immobalization by collar
• Mobilization by Active ROM
• Pain management by
• Hot pack/ icing
• SWD
• Pulsed US
• TENS
PT MANAGEMENT

Muscle setting Exercises (isometrics)

• Start with initial range with less effort
• To gain tone of muscle
• Never reach 100% of range
Strengthening exercise
• 4 to 6 weeks
• Force full isometrics
Muscle guarding
• To keep muscle in position that causes less or no pain
CERVICAL SPONDOLYSIS

• Degenerative disease of spine

• Onset is more than 35 years
• Radiation of pain in upper limb
• No any vascular change
PATIENT PRESENTATION

• Pain
• Radiating pain toward upper limb

• Lab investigation
• X-ray, (to check inter vertebral space, curvature of spine ,fractures,alignment)
• MRI ( to check disc lesion, nerve injury)
CAUSES AND ASSESSMENT

• Hypomobility

It is assessed by
1- compression test ( spurling’s test)
2-distraction test
PT MANAGEMENT

• Pain management
hot pack , ultrasound
• Isometrics ( shrugging of shoulder)
• Stretch apply on rounded shoulder
• Traction force
1- 25% or ¼ th of body weight
it may be manual(osteopenia, osteoporosis) or mechanical( is contraindicated in
Osteoporosis)
THORACIC OUTLET SYNDROME

• Boundaries of Thoracic outlet

• Medially, (scaleni muscle , 1st rib)
• Laterally, ( Axilla)
• Posterior, (upper traps )
• Anterior ,(clavical , corocoid process of scapula,
pect.minor,delto-pectoral fascia)
CONTENTS OF THORACIC OUTLET

• Sub-clavian vein and artery

• Brachial plexus (C5-T1)
PT MANGEMENT

• 1st rib mobilization

• Stretching of scaleni muscles( extension of Neck)
CERVICAL RADICULOPATHY

• One of the nerve roots near the cervical vertebrae is

compressed.
• Damage to nerve roots in the cervical area can cause
pain and the loss of sensation along the nerve's
pathway into the arm and hand.
CAUSES OF CERVICAL RADICULOPATHY

• Ruptured disc,
• Degenerative changes in bones,
• Arthritis or other injuries that put pressure on
nerve roots.
SYMPTOMS OF CERVICAL RADICULOPATHY

• The main symptom of cervical radiculopathy is pain that

spreads into the arm, neck, chest, upper back and/or shoulders.
A person with radiculopathy may experience muscle weakness
and/or numbness or tingling in fingers or hands. Other
symptoms may include lack of coordination, especially in the
hands.
PT MANAGEMENT

• Gentle cervical traction

• Mobilization,
• Other modalities to reduce pain.
• If significant compression on the nerve exists to the extent that motor
weakness results,
surgery may be necessary to relieve the pressure.
 EXAMINATION

• Take proper history

• area of pain
• depth of pain
• quality of pain
• pins ,numbness,niddles
• when it goes worse
• when you get relived
• nature of pain from moring to night
• what general activities you do
• general investigation(medication and other dieases)
 EXAMINATION

• Physical examination
• general posture
• active movements
• combined active movements
• gilde each cervical spine gently
• tendon reflex
 EXAMINATION
• Compression test(Spurling's test)
• Assesses facet joint pain and nerve root irritation
• patient seated
• Gently apply axial downword force
• modifications: compression
• lateral flexing ,slightly extending the head
• Positive: increased local pain
• Positive: increased peripheral pain
 EXAMINATION

• Distraction test
• Supine or sitting

• Behind patient
• Hand on patients mastoid process
• Applying distraction force
• Positive: reduction of symptoms
 MOBILIZATION

• Maitland mobilization
• Manual traction
• Mobilization with movement ( NAGs, SNAGs)