C Spine
C Spine
C Spine
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Presented by
1 Kaushal sinha
1st year PG
Dept. of panchakarma
SDM college of ayurveda
CONTENT:-
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Introduction
Region of spine
Function of spine
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INTRODUCTION
Foramen
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33 vertebrae magnum
31 pair nerve roots
23 disc
Spinal cord-
Contained in epidural space
Network of sensory and motor Conus
nerves medularis
Firm, cord-like structure
Cauda
Conus medullaris equina
Filum terminale
Cauda equina
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SAGITTAL PLANE CURVES
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Cervical Lordosis 20°- 40
Sacral Kyphosis
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REGION OF THE SPINE
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Cervical
Upper cervical: C1-C2
Lower cervical: C3-C7
Thoracic: T1-T12
Lumber: L1- L5
Sacrococcygeal: 9 fused
vertebrae in the sacrum and coccyx
FUNCTIONS OF SPINE:-
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Posture
Weight transmission
Posture
Muscles attachment 6
WHAT IS CERVICAL SPINE
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Consist of 7 vertebra
8 nerves
Give two plexuses:-
Cervical plexus ( C1-C5)
Phernic ( C3,C4,C5
Lesser occipital (C2)
Supraclaviclular ( C3,C4)
brachial plexus ( C5-T1)
mucocutanous n (C5-C7)
axillary n (C5-C6)
median n (C5-T1)
radial N (C5-T1)
ulnar n (C8-T1) 7
CERVICAL DISORDER
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Cervical spondylosis
Cervical radiculopathy
Cervical myelopathy
Cervical Strain/spasm
Cervical Sprain
Cervical Stenosis
Fractures/subluxation etc.
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COMMON CONDITIONS AFFECTING THE
CERVICAL SPINE
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Herniated disc- The two most common levels in the cervical spine to herniate are the C5
- C6 level (cervical 5 and cervical 6) and the C6 -C7 level. The next most common is the
C4 - C5 level, and rarely the C7 - T1 level may herniate4
Cause- some sort trauma & injury
Bone spur- Cervical osteophytes are bone spurs that grow on any of the seven
vertebrae in the cervical spine (neck), involving the spine from the base of the skull to the
base of the neck (C1 - C7 vertebrae)
Cause- inflamed or damaged tissue, cervical osteoarthritis, cervical spondylosis
Other types of arthritis, traumatic injury, and poor posture
Narrow disc space- cervical foraminal stenosis (narrowing of the cervical disc space)
may arise without any disc herniation. The majority of symptoms with this type of
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cervical stenosis are usually caused by one nerve root on one side
EXAMINATION OF CERVICAL SPINE
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History
General Examination
Inspection
Palpation
Special Test
Range of Movement
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EXAMINATION TECHNIQUE:-
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Introduce yourself
Ask permission to perform examination
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HISTORY
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Male / Female
Occupation
Treatment history
Past history
Personal history
Family history
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ASK FOR…
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H/o Trauma
H/o constitutional symptoms
H/o Hemoptysis
Treatment histoy
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PAST HISTORY
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Similar complains
Prolonged history
Previous surgery
DM
HTN
Tuberculosis
Hematological disorder
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PERSONAL HISTORY
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Smoking
Alcohol
Drug addiction
Diet
Appetite
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FAMILY HISTORY
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Similar illness
Tuberclosis
HTN
DM
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INSPECTION
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(A) Standing
Look from the side
normal spine
> cervical
lordosis
Increased lordosis
– muscular weakness or
imbalance
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Head should be seated symmetrically on cervical
spine
Lateral flexion -
from unilateral spasm of muscles – strain and/or
spasm (guarding)
Rotation –
from unilateral spasm of sternomastoid muscle –
strain and/or spasm (guarding) or torticollis
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PALPATION
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Local rise in temperature
Palpate all spinous process
Prominent spinous process
Feel
→ The midline spinous
processes
→ The paraspinal soft tissues
→ The supraclavicular fossae –
for cervical ribs or enlarged
lymph nodes
→ The anterior neck structures
including the thyroid
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SPECIAL TESTS
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Cervical spine : Range of motion:
Spurling test
Compression test Active
Distraction test Passive
Valsalva test
Swallowing test
Adson test
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SPECIAL TEST:-
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Movement
(A) Flexion
- ask the patient to
bend the head
forwards
- chin should be able
to touch the chest
- normal : 80°
(B) Extension
- ask the patient to look
up and back
- normal : 50° 22
RANGE OF MOTION TESTING
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Active:- Passive:-
Best done in sitting or Best done laying supine
standing
Flexion – firm end feel
Flexion – touch chin to
chest Extension – hard end feel
(occiput on cervical
Extension – look straight spinous processes)
above head
Lateral flexion – Lateral flexion – firm end
approximately 45 feel (stabilize opposite
degrees shoulder)
Rotation – nose over tip
of shoulder Rotation – firm end feel 23
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(C) Lateral flexion
- ask the patient to touch
his shoulder with the ear
- involve atlanto-axial and
atlanto-occipital joints
- normal : 45°
(D) Rotation
- ask the patient to look
over his shoulder
- normal : 80°
- restricted and painful in
cervical spondylitis
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COMPRESSION TEST
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Testing for compression of cervical
nerve root or facet joint irritation in the
lower cervical spine
Ask the patient seat the table
Positive sign –
Radiating pain or other neurological
sign in the same side arm(nerve root)
and pain local to the neck or shoulder
A narrowing of neural foramen,
pressure on the facet joints or muscle
spasm can cause increase pain upon 25
compression
SPURLING TEST
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Same positioning as cervical
compression test
Positive sign:-
Radiating pain or other
neurological sign in the same
side arm(nerve root) and pain
local to the neck or shoulder
(facet joint irretation)
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DISTRACTION TEST To relive the pressure on the
cervical roots (may be used
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after spurlling or
compression test)
Place the open palm of one
hand under the pt’s chin,
and the other hand is upon
occiput & tempolallis
Then, gradually lift
(distract) the head to
remove its weight from the
neck
To demonstrate the effect
that neck traction might
have help in relieving the
pain by decreasing pressure
on the joint capsules around
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the facet joints.
VALSALVA TEST
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Ask pt to hold his breath and bear
down as if he were moving his bowels
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Difficulty or pain upon
swallowing can
sometimes caused by
cervical spine pathology
such as :
Bony protuberance
Bony osteophytes
Soft tissue swelling
due to hematomas,
infection or tumor in
ant portion of cervical
spine
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LHERMITTE’S SIGN
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This sign detects protrusion
of cervical intervertebral disc
or an extradural spinal
tumour irritating the spinal
duramater.
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Pull the arm downwards
Palpate the radial pulse
Turn the pt’s head to the same side and extend the neck
Abduct, extend, and laterally rotate the shoulder.
From this position, have the patient take a deep breath and
hold
Feel the radial pulse
Fading of the radial pulse indicates positive thoracic outlet 31
obstruction
CONCLUSION:-
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Facet joint spondylosis and herniation of the intervertebral
disc are the most common causes of nerve root compression.
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Thank you......
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