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
C-Spine Level
Dermatome Shoulder area, clavicular area, upper scapular area.
Myotome Reflex
C4
--
--
C5
Deltoid area, anterior aspect of entire arm to base of thumb. Anterior arm, radial side of hand Lateral arm and forearm to index, long, and ring fingers. Medial arm and forearm to long, ring, and little fingers. to thumb and index finger.
Shoulder abduction.
Biceps.
C6
Elbow flexion, wrist extension. Elbow extension.
Biceps; brachioradialis.
C7
Triceps.
C8
Finger abduction.
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cervical vertebrae. a. Above; above. b. Below; below. c. Below; above. d. Above; below.
Self-Assessment Quiz Question #30 A common location for cervical radiculopathy is the C6–C7 level. What are the possible sensory and motor radicular symptoms related to this spinal level? a. Numbness in the shoulder area, weak shoulder abduction, and decreased triceps reflex. b. Numbness on the anterior arm and radial side of the hand, weak shoulder abduction, and decreased triceps reflex. c. Numbness on the anterior arm and radial side of the hand, weak finger abduction, and decreased biceps and brachioradialis reflexes. d. Numbness on the anterior arm and radial side of the hand, weak elbow flexion and wrist extension, and decreased biceps and brachioradialis reflexes. Cranial nerves Serious pathologies of the neck can potentially result in cranial nerve palsy, especially cranial nerves V, VI, VII, IX, I, and XII (Mourad et al., 2021). Subtle cranial nerve palsy is known to be a preischemic feature of carotid artery dissection due to the proximity of the lower cranial nerves (IX, X, XII) to the carotid sheath (Taylor et al., 2021). The lower cranial nerves should be considered in cases of both headache and neck pain. As such, a thorough physical examination should include assessment of the cranial nerves. Evidence-based practice: A thorough evaluation of the cervical spine should include assessment of cranial nerve function. Six of the cranial nerves have been shown to be more frequently affected by serious pathologies of the neck. These include cranial nerve V (trigeminal nerve), cranial nerve VI (abducens nerve), cranial nerve VII (facial nerve), cranial nerve IX (glossopharyngeal nerve), cranial
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. d. 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.
nerve I (olfactory nerve), and cranial nerve XII (hypoglossal nerve) (Mourad et al., 2021).
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