Transcript
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2.3.1.1:Higher cervical spine c1,c2)The higher cervical spine consists
Of the atlas (C1) and the axis (C2).
These two vertebras have
Distinct features from the other whole of cervical region.
The first vertebra atlas form a joint superiorly with the
Occipital region by forming joint called as Atlanta occipital joint and
inferiorly articulates with the second vertebra through the atlantoaxial joint.
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The joint between C1 andC2 takes part in fifty percent of cervical rotation
while the atlanto-occipital joint takes part in fifty percent of flexion and
extension for movements in saggital plane(flex & ext)
Atlas C1) The C1 vertebra is ring-shape with a body. It is consists anterior and
posterior arcs, two lateral masses, and two transverse processes, the
foramen in vertebra for passage of vertebral artery superior and
inferior facets are present on lateral masses. The superior articular
facets concave, and facing up and inward. These facets are forming
joints with the superior condyles of occiput and faced downward and
outward. Inferior articular facets are flat and are facing downward and
inward for articulation with the superior facets of C1 vertebra.
AXIS C2):C2 is consist of greater body with odontoid process( known as dens
that articulates with the atlas through the anterior articular facet thick
pedicles, transverse processes and laminae).Lower cervical spine:
The C3, C4 spinal process are usually bifid, whereas the C7 spinal
process is usually no bifid. .(Bogduk N ,et al 1991)
Facet joints:The facet joints of the cervical spine basically movable joint that have
synovial fluid within joint and having a layer of fibro cartilage. The capsules
surrounding the joints in lower part of cervical spine are looser as
compared to upper cervical spine and allow gliding movement at facet
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joints. Thejoints are inclined at an angle of 45and85 from the transverse
plane and the sagittal plane thus preventing excessive anterior translation(
Robert E W,1987)[14,15,16]
2.3.1.2Intervertebral disksspecific discs are positioned between the vertebras from C2-C7.this
specific disk is made up of four parts that is including nucleus pulposus in
mid , nucleus pulposis is covered with annulus fibrosis , and second
plates are attach to surroundings vertebral bodies. The basic function of
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disk is transfer the compressive forces during all possible movements.
Anterior region of disk is higher thick when it is compared with posterior
region it is play important role to maintain whole spinal curve .The
intervertebral disks are involved in cervical spine movements , stability, and
load bearing .(Bogduk N ,et al 1991)The annular fibers vulnerable to injury by
rotational forces.[17].
LigamentsThe cervical spine is consist of two columns anterior, and posterior
columns. It can also be useful to think in terms of a third (middle) column,
as follows:
The anterior column consists of the anterior longitudinal ligament andthe anterior two thirds of the vertebral bodies, the annulus fibrosus,
and the intervertebral disks
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The middle column is composed of the posterior longitudinal ligamentand the posterior one third of the vertebral bodies, the annulus
fibrosus, and the intervertebral disks
The posterior column is made up of the posterior arches, includingthe pedicles, transverse processes, articulating facets, laminae, and
spinous processes
1)The longitudinal ligamentsmaintains the integrity of the spinal column2) the anterior and posterior longitudinal ligamentsplay role in
maintaining the structural integrity of the anterior and middle
columns,[17]3) the posterior column alignmentis stabilized by the nuchal and
capsular ligaments, and the ligamentum flavum.
4) The transverse ligamentis the most important ligament for preventingabnormal anterior translation. (Fielding JW, et al 1974)[18]
5)The alar ligamentsrun from the lateral aspects of the dens to theipsilateral medial condyles of occiput and to the ipsilateral atlas. Alar
ligament prevent excessive lateral and rotational movement and
allowing flexion and extension.
6)The supraspinous ligament(runs along the tips of the spinousprocesses) the interspinous ligaments(run between adjacent spinous
processes )and the ligamentum flavum (runs from the anterior
surface of the cephalad vertebra to the posterior surface of the
caudad vertebra )maintain stability between the vertebral arches. The
ligamentum flavum and (interspinous ligament prevent hyper flexion
and anterior translation. Panjabi MM, et al )[19,20,21]
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2.3.1.3: MusclesMuscles of neck & spine includes
1)SternocleidomastoidThe originis the manubrium and the the medial 1/3 of the clavicle.Insertion:into the mastoid process
Function;
Flexion to same side and extension to opposite side.
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2)Scalenes
The origin of the scales are the transverseprocess of the cervical vertebraeInsertion: into the first and second ribs.
Function:When the scalenes contract they help elevate
the top two rib during inspiration and also playa role in flexion of the neck and rotating it.
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3)Splenius musclesThey origin:
runs from the nuchal ridges of the
occipital bone all the way to C7.
Insertion:into the mastoid process.
Function:it helps rotate the head to the same side
and laterally flex the head to the same side.
4)Erector Spinae: lateral to medial: iliocostalis, longissimus,spinalis)
These are 3 separate, long columns of muscles on
either side of the vertebral column that extend the
back and help return the trunk to an upright position.
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1)The iliocostalis runs from the iliac crest to the ribs.2)The longissimus runs medial to the iliocostalis. It runs from the
spinous processes of the lumbar vertebrae to the ribs.
3)The spinalis runs medial to longissimus. It runs from onespinous process to the one above it on the lumbar and thoracic
vertebrae.
Function:They are literally what help straighten your back up.
Antranik,Muscles of neck and vertebral column.antranik.org 2011;)
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2.4: Biomechanics of NeckMovements of neck: There are various types of movements at neck That
are included
Flexionit is the type of neck movement that show chin is movedownward toward chest. This is known as neck flexion
Extension it is the type of movement in which the neck extends, andlooking up towards the roof this is known as extension of neck
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Lateral rotation of neck ,to the left side and to the right side it is thetype of movements in which simply direct lateral rotation of neck to either
side is occur
Lateral flexion can be define as it is a type of movment in which attempts
to place the ear on the shoulder by a lateral movement of the neck, try to
leading the ear to the tip of the shoulder .
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There are total six movements of neck that can directly perform if patienthad no any type of fusion.
The movements of neck play important role in activities of daily living with
full ranges.(Timothy, et al)
Biomechanics of the Neck2.4.1: Neck injury mechanismsThe human neck is consist of very complicated mechanics , which is
contain very essential neurological system ,vascular system and
respiration mechanism and seven cervical vertebra and spinal contents .
The total neck injury chanches that are occur in road accidentsseemsrelatively less when compared to head injury, except for specific accident
in which the collision occurs is greater than 50% in
The cervical spine is most important segment of the whole body. Neck is
the slender column that can be affected various types of bending loads with
axial loads. the injury mode of neck region can be classified in to
Compression injuries of neck Tension flexion injuries of neck Tension extension injuries of neck Compression extension injuries of neck Compression flexion injuries of neck Lateral bending injuries of neck
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2.4.1.1: Compression injuries.It is a type of injury that is occur due to crown
impact of head that is produce compression load on the neck which is
associated with bending load and are depended on the head
orientation,. Neck configuration , and friction of surface , in compression
injuries compression may comes from the total body mass that is
followed by the head, and is stopped by resistanting type of force.
2.4.1.2:Tension Extension injuriesTension extension injuries are the injuries that are most
commonly occur in neck. these are included
Whiplashed injuries
Hangman s fractures
Structural injuries of the spine2.4.1.3: Tension Flexion Injuries:It is a type of injury that are uncommon because the complain of chronic
severe pain in neck by belted occupants that are involve in the frontal
crashe . in case of severs frontal crashe atlento-occupit separation can
occur at neck.
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2.4.1.4 Compression Extension injuries:It's the kind of injuries that occur when the head hits the windscreen
Neck is place in forward and backward direction at the same time. Such
type of sudden impact is sustained the one or more spinous processes
fractures, and injuries of the pedicles, or injuries of facets, and lamina.
2.4.1.5: Compression Flexion injuries:In this kind of injuries the vertebra(vertebral body ) compression is
resulted due to combination of excessive flexion and compressive loads of
vertebral segment s that is occur due to compressive stresses.2.4.1.6: Lateral Bending Injuries:
It is a type of injuries that are occur due to side or oblique impact and also
associated with shear and axial loading. This type of loading leads toward
the lateral wedge fracture and fracture of posterior element of vertebral
column.[22]
2.5: Neck painNeck pain is discomfort in the muscles, nerves, bones (vertebrae), and the
intervertebral disks
2.5.1: CausesNeck pain can result from a variety of causes, including:
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Whiplash Muscle strain. Degenerative disc disease Herniated disc Cervical spondylosis Cervical spinal canal stenosis Rheumatoid and osteoarthritis Tumor/cancer/systemic .( Melbourne,.Therapeutic Guideline 2012
Nov.)
2.5.2: ClassificationNeck pain is classified in to different catagrioy most commonoly
classification is based on
Neck pain Duration
Neck pain Causes
Classifcation based on Duration. Acute neckache. Chronic neckache Acute neck pain Acute neck pain can be define as the neck pain ranges from I to 6
weeks
Chronic neck pain
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Chronic neck pain can be define as neck pain ranges from more
than 6 to 12 weeks. (Encyclopedia of pain)
Classification based on cause.
Non specific causes of pain Specfic causes of pain
Non specific causes of neckache.
In non specific causes of neckache it is including Radiculopathy or
narrowing of spinal canal
Specfic causes of neck ache.
In specific causes of neckache there is including any type 0f infection
or cancer. .( Curtis W. Slipman, et al)
Non specific pain is type of pain which shows that the basic causeof pain not known accurately . but it is believe that pain is araises
from the soft tissues structures such asmuscles,fascia,andligaments..( Curtis W. S, et al)[23,24]
2.6: Assessment of neck pain include
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Subjective History Objective history Investigation
Subjective historyinclude name,sex,occupation,Occupation, past medicalhistory,past surgical history , history of fever,psychological
history,occupational history sould be considered.because mostly neck pain
is occupational related and common in dentists , industrial, and agricultural
workers [25,26].Objective history
Includes inspection, palpation (tenderness), and assessment ofrange of motion (ROM).
Questions about Pain characteristicsintensity,duration,frequency,relieving factors,aggravating
factors and its quality.
Any abnormality in appearance ,ROM, and a tenderness atcervical spine indicates that there is any cervical spine
pathology. In case of neck pain nuchal rigidity is also assessed
and this is assessed by following two tests Kernig's sign and
Brudzinski's sign (reflective flexion of the knees when patient is
on his/her back and the neck is bent forwards) are tests used to
demonstrate nuchal rigidity. Examination of upper limb is also
important for the exclusion of cause neck pain.
Neurological exam:Includes testing of dermatomes ,myotomesor strength, reflexes, The hallmark sign of cervical
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radiculopathies are pain, loss of sensation and weakness in
motor activities. Spurling test: It is a type of test that May be
performed to test for cervical nerve releated pain .if the pain isradiated in to upper extremity on the same side toward head is
rotated then spurling test will be positive . A +ve test is highly
suggestive of cervical radiculopathy.[27,28,29,30]
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