Rotation cervical spine

FIG. 25-4 Gross motion testing of the cervical spine, rotation,... 

The most common type of injury due to combined tension and extension of the cervical spine is the whiplash syndrome. However, a large majority of such injuries involve the soft tissues of the neck, and the pain is believed to reside in the joint capsules of the articular facets of the cervical vertebrae [Wallis et al., 1997]. In severe cases, teardrop fractures of the anterosuperior aspect of the vertebral body can occur. Alternately, separation of the anterior aspect of the disk from the vertebral endplate is known to occur. More severe injuries occur when the chin impacts the instrument panel or when the forehead impacts the windshield. In both cases, the head rotates rearward and applies a tensile and bending load on the neck. In the case of windshield impact by the forehead, hangman s fracture of C2 can occur. Garfin and Rothman [1983] suggested that it is caused by spinal extension combined with compression on the lamina of C2, causing the pars to fracture. 

In addition to ROM data, other characteristics of the natural joint that should be reflected in the reconstructed joint are the center of rotation (if the motion is two-dimensional), or the helical axis of motion (Kinzel, Hall, and Hillberry 1972) (if the motion is three-dimensional), and the extent and nature of the coupled motions that will accompany a specific motion. For example, because of the shape of the facet joints in the lower cervical spine (C3-C7), axial torsion... 

Injuries and disorders of the mnscles, nerves, tendons, ligaments, joints, cartilage, and spinal disc dne to physical work activities or workplace conditions in the job. Examples inclnde carpal tnnnel syndrome related to long-term compnter data entry, rotator cnff tendonitis from repeated overhead reaching, and tension neck syndrome associated with long-term cervical spine flexion. 

The spine is an engine. The axial pull of the muscles on the thoracic and lumbar spine are transformed by coupled motion into axial torque, which is then applied to the pelvis. The spine is now divided into three segments the lumbar spine, which causes the pelvis to rotate the thoracic spine counter-rotates to dissipate torque and utilizes linked movements of the upper extremities in so doing. The cervical spine de-rotates in the opposite direction to allow the head, eyes and sensory organs to have a stable platform which faces the direction of travel. 

Type I and type II dysfunctions refer only to somatic dysfunctions in the thoracic and lumbar vertebrae because Fryette s principles only apply to these areas. However, in common usage, somatic dysfunctions in the typical cervical spine are often referred to as type II, Motion characteristics of the cervical region dictate that the typical cervical vertebrae side-bend and rotate toward the same side regardless of dysfunction or normal functioning. The distinction is the involvement of a flexion or extension component in the dysfunctional unit. 

The unciform joints (joints of Luschka) act as guide rails for the motions of flexion-extension. They also limit the lateral translatory motion (side slip) that occurs simultaneously with the coupled motions of side-bending and rotation. When one vertebra side-bends and rotates on another, that vertebra will translate laterally in the opposite direction. In the cervical spine, this lateral translatory motion would be excessive to the point of subluxation were it not for the unciform joints. 

Myofascial soft tissue treatment with counterstrain and muscle energy techniques may relieve the facial pain associated with Bell s palsy. The occipitomastoid compression should be released and the temporal bone assisted into normal internal/external rotation. Normal lymphatic flow should be assured by correcting dysfunctions of the cervical spine, cranial motion, and sacrum. C3 should always be evaluated and any dysfunction corrected. 

Perhaps the most significant complication reported is vertebrobasilar accident with rotary cervical manipulation, such as reported by Git-tinger. In some persons, rotation and extension of the cervical spine cause narrowing of the vertebral artery on the side opposite the rotation. Pre-existent compromise of cranial collaterals, such as the carotids, must be considered. Occipital infarction may result, with various neurologic sequelae. Some considerations when using cervi-... 

Zhang QH, Teo EC, Ng HW et al. (2006) Finite element analysis of moment-rotation relationships for human cervical spine. Journal of Biomechanics 39 189-193... 

Some general considerations merit attention. First, only painful calcifications must be treated finding calcification within a rotator cuff tendon does not automatically mean that shoulder pain is related to it. A typical mistake is to treat calcifying tendinitis in patients with shoulder pain derived from other causes, including cervical spine disease. Remember that most calcifications are asymptomatic. Second, the best results are achieved on large calcifications. Treatment of clusters of smaller calcifications is almost invariably unsuccessful. Third, the goal of the procedure is to disrupt the calcification and to remove some but not all calcific material (Fig. 18.14f). Too many needle insertions to remove as much as possible of the calcification should be avoided to prevent tendon tears. Once ruptured, calcification almost invariably evolves toward resorption, and shoulder pain and disability improve in most cases (Fig. 18.16). 

A short leg has numerous effects on the body. Usually, the sacral base lilts toward the side of the short leg. The iliac crest is generally low on the short leg side. Occasionally, the innominate on the shorter side will rotate forward or the opposite side posteriorly as a means of compensating for the leg length discrepancy. The lumbar spine develops a convexity toward the side of the short leg, and once the problem has existed for sufficient time, a compensatory curve will develop in the thoracic spine. The shoulder will be low on one side, depending on whether a secondary thoracic curve is present the scapula will be low on the same side as the shoulder. The cervical angle will be more acute as the head tilts toward the midline to keep the eyes level. 

The first seven vertebrae, called cervical vertebrae, form the neck. Areas of the spine such as the neck, where flexible, can experience strains and sprains. The shoulder consists of a ball and socket joint where the ball of one bone fits into a hollow crevice of another. The shoulder joint allows movement and rotation of the arms inward, outward, forward, or backward. There are several different tendons attached to bones in the shoulder. Bursar reduces friction and cushions the tendons as they slide back and forth. The spine is a column of approximately 30 bones called vertebrae that run from the neck to the tailbone. These vertebrae stacked on top of one another in a shaped column form spinal joints, which move independently. Health spines contain three natural curves a forward curve in the neck, a backward curve in the chest area, and another forward curve in the lower back. The back s three natural curves should align correctly when ears, shoulders, and hips form a straight line. At the end of the spine, the vertebrae fuse together to form the sacrum and the tailbone. The lower back or lumbar area provides the workhorse capacity of the back. It carries most of the weight and load of the body. Aligning and supporting the lumbar curve properly helps prevent... 

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