MSK Week 3

• intervertebral foramen

  • created between two articulating vertebra
• • Suboccipital nerve: derives from dorsal primary ramus of C1 nerve root

  • Greater occipital nerve: derives from dorsal primary ramus of C2 nerve root

  • Lesser occipital nerve: derives from ventral primary ramus of C2 nerve root (via cervical plexus – may have C3 contribution)

  • Third occipital nerve: derives from dorsal primary ramus of C3 nerve root • Greater auricular nerve: derives from ventral primary ramus of C2-C3 nerve root (via cervical plexus)
• Nerve Root

  • Nerve root sensory patterns (aka dermatomes)

  • Specific pattern of muscles based on nerve level innervation (aka myotomes)

  • Deep tendon reflexes
• Peripheral Nerve

  • Peripheral nerve sensory patterns

  • All muscles innervated by that nerve could be diminished

  • Deep tendon reflexes
• Nerve Root Disease (Cervical Radiculopathy) due to:

  – ZAJ degeneration or instability

  – UVJ degeneration or instability

  – Disc herniation

  – Loss of vertebral body height

  • Osteoporosis • Cervical spondylosis
• Many conditions simulate cervical radiculopathy type findings

  – Scalene Anticus Syndrome: pressure over brachial plexus and subclavian artery at 1st rib

  – paresthesia and vascular symptoms

  – Claviculocostal syndrome : pressure on brachial plexus and subclavian artery between clavicle and 1st rib

  – Pectoralis Minor Syndrome : pressure at rib cage compressing ulnar nerve and axillary artery
• many conditions simulate cervical radiculopathy type findings

  – Fibrositis : inflammation and spasm of neck and shoulder muscles

  – Tumors : Pancoasts Tumor : Pulmonary Sulcus Tumor : Horner’s Syndrome present, weakness of small muscles of hand, erosion of 1st and 2nd ribs

  – TOS, Acute MI, CRPS, T4 syndrome
• Compressive forces = sitting, muscle contraction

  Sustained postures = resulting in ligamentous creep

  Shear = forward head

  Torsion and twisting = self manipulation

  Sudden loading

  Repetitive loading
• Stenosis

  • Narrowing of the spinal canal

  • Caused by: Changes in bone and soft tissue

  • Results in: Mechanical compression of spinal nerve roots

  – Affects men and women

  – Men have stenosis at younger age than women
• Cervical Spondylosis

  • Progressive disc degeneration and facet arthropathy

  • Results in: Discogenic neck pain (mechanical pain) , Radiculopathy (root compromise) , Myelopathy (cord compression)

  • Occurs in: Men > women ages 40-50 years

  Risk factors – lifting, smoking, driving, extreme sports, trauma
• Cervical Instability:

  Causes

  Ligament laxity

  Trauma

  Syndromic

  Iatrogenic

  Congenital

  Inflammatory
• Cervical Instability:

  Risk Factors

  Chronic patholaxity

  Down syndrome

  Connective tissue disorder

  Falls/MVA

  Rheumatoid arthritis