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The cervical spine

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Emma Farquharson

on 28 September 2017

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Transcript of The cervical spine

Learning Outcomes
Understanding of clinically relevant cervical anatomy
Know the special questions for the cervical spine and have an understanding of their meaning
Knowledge of when to seek further assistance
Red Flags
Red flags are signs and symptoms that indicate the possible or probable presence of serious medical conditions that can cause irreversible disability or untimely death un- less managed properly

Red flags in the cervical spine
Cervical Artery Dysfunction
Upper Cervical Instability
Cervical Myelopathy

Upper cervical instability
Risk factors are associated with the potential for bony or ligamentous compromise of the upper cervical spine:

History of trauma (e.g whiplash, rugby neck injury
Congenital collagenous compromise (e.g. syndromes: Down’s, Ehlers)
Inflammatory arthritides (e.g. rheumatoid arthritis, ankylosing spondylitis)
Recent neck/head/dental surgery

Risk Factors - Cervical Artery Dysfunction
Past history of trauma to cervical spine / cervical vessels
History of migraine type headache
Cardiac disease, vascular disease, previous cerebrovascular accident or transient ischaemic attack
Diabetes mellitus


The cervical spine
and red flags

Signs and symptoms
Upper Cervical Instability
Red Flags
Cervical instability
Cervical Myelopathy
Cervical Artery Dysfunction
Cervical Artery Dysfunction
Risk Factors
Trauma to cervical spine / cervical vessels
Migraine-type headache
Hypercholesterolemia / hyperlipidemia
Cardiac disease, vascular disease, previous CVA/TI
Diabetes mellitus
Blood clotting disorders
Anticoagulant therapy
Long-term use of steroids
History of smoking
Recent infection
Immediately post partum
Absence of a plausible mechanical explanation for the patient’s symptoms.
Cervical Artery Dysfunction
Signs and Symptoms
Vertebral Artery Dysfunction
5 D's & 3N's

Drop attacks


Signs and Symptoms Carotid Artery Dysfunction
Neck pain with sustained postures
Weakness of the neck
Altered ROM
Poor cervical muscle strength
Referred pain in the shoulder
Cervical radiculopathy
Cervical myelopathy
Occipital and frontal headaches
Paraspinal muscle spasm
Decreased cervical lordosis
Cervical Myelopathy
Cervical Myelopathy Signs and Symptoms
Physical Examination
Neurological testing
Blood pressure
Positional testing
Craniovertebral ligament testing
Cranial nerve testing

Clear red flags as part of every assessment
Know the questions that should be routinely be asked in patients reporting neck pain and what this could indicate
Have an understanding of what physical testing could be performed if any concerns seek further advice

Take Home Message
Cranial Nerves
Horner's Syndrome
Positive clonus
General Health Questions
The 5D's and 3N's need to be cleared for all patients with neck pain routinely
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