Cervical Spine

Clinical Biomechanics: The Cervical Spine

By Frank M. Painter|July 28, 2010|Cervical Spine, Diagnosis, Education|

Clinical Biomechanics: The Cervical Spine

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 7 from RC’s best-selling book:

“Clinical Biomechanics: Musculoskeletal Actions and Reactions”

Second Edition ~ Wiliams & Wilkins

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 7: CLINICAL BIOMECHANICS OF THE CERVICAL SPINE

This chapter considers those factors that are of biomechanical and related clinical interest imperative to the satisfactory evaluation of common or not infrequent cervical syndromes. The discussion assumes that the physician is skilled in taking a thorough clinical history and performing the basic physical, orthopedic, neurologic, and roentgenographic examination procedures. The kinesiology and kinematics of the neck, the effects and mechanisms of cervical trauma, and a number of clinical problems are discussed that are pertinent to the diagnosis and management of musculoskeletal cervical disorders.

General Aspects of Cervical Trauma

Blows to the head or neck may result in unconsciousness, but most blows do not. Rather, the effect is a “subconcussive” or “punch drunk” effect for a few moments. This state may be the effect of a severe blow to the head or the cumulative effects of many blows. It is assumed that the reader is well acquainted with the proper emergency procedures involved in head and neck trauma.

The anterior and lateral aspects of the neck contain a wide variety of vital structures that have no bony protection. Partial protection is provided by the cervical muscles, the mandible, and the shoulder girdle. After spinal injury, a careful neurologic evaluation must be conducted. Note any signs of impaired consciousness, inequality of pupils, or nystagmus. Do outstretched arms drift unilaterally when the eyes are closed? Standard coordination tests such as finger-to-nose, heel-to-toe, heel-to-knee, and for Romberg’s sign should be conducted, along with superficial and tendon reflex tests. For reference, the segmental functions of the cervical nerves are listed in Table 7.3.

Cervical spine injuries can be classified as being:

(1) mild (eg, contusions, strains);(2) moderate (eg, subluxations, sprains, occult fractures, nerve contusions, neurapraxias);(3) severe (eg, axonotmesis, dislocation, stable fracture without neurologic deficit); and(4) dangerous (eg, unstable fracturedislocation, spinal cord or nerve root injury).Soft-Tissue Injuries of the Posterolateral Neck

CERVICAL CONTUSIONS

Contusions in the neck are similar to those of other areas. They often occur in the cervical muscles or spinous processes. Painful bruising and tender swelling will be found without difficulty, especially if the neck is flexed. They present little biomechanic significance unless severe scarring occurs.

DIRECT NERVE TRAUMA

Nerve trauma occurs from contusion, crushing, or laceration.

Neurapraxia. Recovery of nerve contusion usually occurs within 6 weeks. Nerve contusion may be the result of either a single blow or through persistent compression. Fractures and blunt trauma are often associated with nerve contusion and crush. Peripheral nerve contusions exhibit early symptoms when produced by falls or blows. Late symptoms arise from pressure by callus, scars, or supports. Mild cases produce pain, tingling, and numbness, with some degree of paresthesia. Moderate cases manifest these same symptoms with some degree of motor and/or sensory paralysis and atrophy.

Axonotmesis. After nerve crush, recovery rate is about an inch per month between the site of trauma and the next innervated muscle. If innervation is delayed from this schedule or if the distance is more than a few inches, surgical exploration should be considered.

Neurotmesis. Laceration from sharp or penetrating wounds is less frequently seen than tears from a fractured bone’s fragments. Surgery is usually required. Stretching injury typically features several sites of laceration along the nerve and is usually limited to the brachial plexus.

Review the complete Chapter (including sketches and Tables) at the ACAPress website

Motion Palpation of the Cervical Spine

By Frank M. Painter|October 7, 2009|Cervical Spine, Diagnosis, Education, Motion Palpation|

Motion Palpation of the Cervical Spine

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 3 from RC’s best-selling book:

“Motion Palpation”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 3: The Cervical Spine

This chapter describes the basic biomechanical, diagnostic, and therapeutic considerations related to motion palpation and the cervical spine. Emphasis will be on relating the general concepts previously explained about the chiropractic fixation-subluxation complex to specific entities that can be revealed by motion palpation and frequently corrected by dynamic chiropractic. Some aids to differential diagnosis are also included.

APPLIED ANATOMY CONSIDERATIONS

There are seven sites of possible “articular” fixation in the cervical spine. They are at the bilateral apophyseal joints, the bilateral covertebral joints, the superior and inferior intervertebral disc (IVD) interfaces, and the odontal-atlantal articulation (Table 3.1).

Table 3.1. The 27 Sites of Possible Spinopelvic Articular Fixation

In the cervical spine (7 possible sites of fixation)
Bilateral apophyseal joints	2
Bilateral covertebral joints	2
Superior and inferior IVD interfaces	2
Odontal-atlantal articulation	1
In the thoracic spine (8 possible sites of fixation)
Bilateral apophyseal joints	2
Superior and inferior IVD interfaces	2
Bilateral costovertebral joints	2
Bilateral costotransverse joints	2
In the lumbar spine (4 possible sites of fixation)
Bilateral apophyseal joints	2
Superior and inferior IVD interfaces	2
In the pelvis (8 possible sites of fixation)
Bilateral superior sacroiliac joints	2
Bilateral inferior sacroiliac joints	2
Sacrococcygeal joint	1
Pubic joint	1
Bilateral acetabulofemoral joints	2

The Apophyseal Joints of the Spine

Throughout the spine, paired diarthrodial articular processes (zygapophyses) project from the vertebral arches. The superior processes (prezygapophyses) of the inferior vertebra contain articulating facets that face somewhat posteriorly. They mate with the inferior processes (postzygapophyses) of the vertebra above that face somewhat anteriorly. Each articular facet is covered by a layer of hyaline cartilage that faces the synovial joint. The angulation of vertebral facets normally varies with the level of the spine and can be altered by wear and pathology.

In visualizing the motion of any joint, it is helpful to keep in mind that the hyaline-coated articulating surface is not the shape of the often flat bony surface exhibited on an x-ray film. Most apophyseal joints of the spine have a convex-concave shape.

Fisk states that the posterior joints of the spine are more prone to osteoarthritic changes than any other joint in the body: “Evidence of disc degeneration precedes this arthritis in the lumbar spine, but there is no such relationship in the cervical spine.” However, most authorities agree with Grieve that the presence of arthrotic changes in the facet planes does not, of itself, necessarily have any effect on ranges of movement, neither does the presence of osteophytosis.

Regional Structural Characteristics

Review the complete Chapter (including sketches and Tables) at the ACAPress website

Physical Examination of the Neck and Cervical Spine

By Frank M. Painter|October 2, 2009|Cervical Spine, Diagnosis, Education|

Physical Examination of the Neck and Cervical Spine

The Chiro.Org Blog

We would all like to thank Dr. Richard C. Schafer, DC, PhD, FICC for his lifetime commitment to the profession. In the future we will continue to add materials from RC’s copyrighted books for your use.

This is Chapter 8 from RC’s best-selling book:

“Spinal and Physical Diagnosis”

These materials are provided as a service to our profession. There is no charge for individuals to copy and file these materials. However, they cannot be sold or used in any group or commercial venture without written permission from ACAPress.

Chapter 8: Physical Examination of the Neck and Cervical Spine

In general, the neck viscerally serves as a channel for vital vessels and nerves, the trachea, esophagus, spinal cord, and as a site for lymph and endocrine glands. From a musculoskeletal viewpoint, the neck provides stability and support for the cranium, and a flexible and protective spine for movement, balance adaptation, and housing of the spinal cord and vertebral artery. Cervical flexion, extension, and rotation contribute to one’s scope of vision.

From a biomechanical viewpoint, primary cervical dysarthrias may reflect themselves in the total habitus; from a neurologic viewpont, insults many manifest themselves throughout the motor, sensory, and autonomic nervous systems. Many peripheral nerve symptoms in the shoulder, arm, and hand will find their origin in the brachial plexus and cervical spine. Nowhere in the spine is the relationship between the osseous structures and the surrounding neurologic and vascular beds as intimate or subject to disturbance as it is in the neck.

Neck pain must be differentiated as to its date of onset and chronology, site and distribution, type (intermittent, constant), duration (acute, chronic), character (sharp, dull, lanciating), relation to posture (rest, occupation, recreation), and associated problems. Nonpharyngeal pain on swallowing may be traced to an anterior cervical spinal pathology such as bony protuberance or osteophytes, infection, mass or tumor. Pain is often referred to the neck from the TMJ, mandibular or dental infection, or sinus infection.

Inspection of the Neck (more…)