Discussion Mechanical factors might be influencing this client’s neck pain. He does a repetitive job (sorting mail) and has some musculoskeletal findings (levator and upper trapezius muscle tightness). In addition, the client discusses some work factors Relevant cervical anatomy The cervical spine supports the head and contains the upper cervical spinal cord as well as the vertebral arteries that contribute to circulation in the posterior brain. There are seven cervical vertebrae along with accompanying intervertebral discs, nerve roots, and blood vessels. Each vertebra in the spine typically has a body, spinous process, vertebral foramen, bilateral The atlas (C1) and axis (C2) are called the upper cervical spine , and they have some distinctive anatomical features. The atlas articulates with the occiput (head) via the occipital condyles and the lateral mass of the atlas. The atlas is ring-shaped and does not have a body or spinous process. It articulates with C2 at the anterior arch of the axis at the atlantoaxial joint. The axis contains the dens or odontoid process, which is a vertical projection from the anterior aspect of C2. The odontoid process has a transverse ligament that runs posterior to the dens, preventing anterior subluxation of the atlas on the axis (Rahman et al., 2021). Odontoid fractures are considered one of the most common and controversial injury types in the cervical spine, with an associated high incidence of nonunion, morbidity, and mortality (Carvalho et al., 2019). Cervical spine structure and function Upper cervical spine (C1–C2) Healthcare consideration: Odontoid fractures occur with low-energy falls in the elderly (as compared with high-energy trauma in younger patients). These fractures are the most common cervical fracture in the elderly. Unfortunately, patients older than age 80 have a high morbidity and mortality rate with this type of injury, regardless of whether it is treated operatively or nonoperatively (Moore et al., n.d.). Lower cervical spine (C3–C7) The lower cervical vertebrae are similar in structure, with a vertebral body, uncinate process, spinous process, and superior and inferior articular process. The uncinate process is a projection from the anterior aspect of the cervical vertebral body that articulates with a depressed area of the upper vertebral body (Rahman et al., 2021). The superior notch and inferior notch of corresponding vertebrae form the intervertebral foramina, which creates a tunnel for the spinal nerves to exit the spine. The cervical spinal nerves C1 to C7 exit the spinal canal through the superior notch of the corresponding cervical vertebrae, while C8 exits through the inferior notch of the C7 vertebrae (Rahman et al., 2021). Self-Assessment Quiz Question #28 The nerve roots at levels C1 to C7 exit ______________ the corresponding cervical vertebrae. At the C8 vertebral level, the nerve root exits __________ the corresponding cervical vertebrae.
that have been known to increase the probability of neck pain: Low work control, low ability to influence working conditions, low job satisfaction, and high job strain are all present, per the client’s report.
transverse processes, and pairs of superior and inferior articular facets. There are three elements that distinguish the cervical vertebrae: (1) Bifid spinous processes, (2) triangular shape of spinal cord, and (3) the presence of transverse foramen that allow for transmission of the vertebral arteries (Rahman et al., 2021).
Self-Assessment Quiz Question #29 The dens, or odontoid process, is a vertical projection of: a. The occiput.
b. C1, or the atlas. c. C2, or the axis. a. C7. Cervical spine dermatomes and myotomes
Each cervical nerve contributes specific sensory and motor function to the upper extremities. In addition, specific upper extremity reflexes correlate with cervical spine levels. Knowledge of the dermatomes, myotomes, and reflexes by segmental level is important in differential diagnosis, as it allows the clinician to better determine the source of dysfunction. Healthcare consideration: Involvement of level-specific neural structures involves assessment of myotomes, dermatomes, and reflexes. Manual muscles testing is often the most common assessment strategy employed to distinguish nerve root involvement. Dermatome testing is ideally done with a pin or with a cotton ball. Testing of specific dermatomes is done and compared bilaterally. In addition, reflex testing in the upper extremity should include the biceps, triceps, and brachioradialis C-Spine Level Dermatome Myotome Reflex C1 -- -- -- C2 Temple, forehead, occiput. -- -- C3 -- --
Entire neck, posterior cheek, temporal area, prolongation forward under mandible. Shoulder area, clavicular area, upper scapular area. Deltoid area, anterior aspect of entire arm to base of thumb. Anterior arm, radial side of hand to thumb and index finger. Lateral arm and forearm to index, long, and ring fingers. Medial arm and forearm to long, ring, and little fingers.
C4
--
--
C5
Shoulder abduction.
Biceps.
C6
Elbow flexion, wrist extension.
Biceps; brachioradialis.
a. Above; above. b. Below; below. c. Below; above. d. Above; below.
C7
Elbow extension.
Triceps.
C8
Finger abduction.
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