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The ventral rami of the cervical spinal nerves innervate: Prevertebral muscles of the neck P t b l l f th k ( (including scalenus, trapezius and g p sternocleidomastoid) Atalanto-occipital and lateral atlantoaxial joints l i lj i
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Flexion
The upper vertebral body tilts and j slides forward on the subjacent vertebra with ventral compression and dorsal distraction of the disc. disc Inferior facets of the upper vertebra move superiorly and anteriorly on the superior facets of the lower vertebra.
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Coupled lateralflexionandrotation
During lateral flexion the inferior facet on the concave side of movement slides down and p back while the superior facet on the convex side of movement slides up and forward with a combined effect of producing lateral flexion and rotation on the same side. Slight medial translation also occurs on the concave side of this movement .
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Dynamicmechanical factorsincervical spondyloticmyelopathy. spondylotic myelopathy (left)duringflexion,the spinalcordisstretched overventralosteophytic over ventral osteophytic ridges.(Right)During extension,the ligamentumflavummay ligamentum flavum may buckleintothespinal cordreducingspacefor thecord. the cord.
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:Torticollis
%79 07 %79-07
)5991 (Cheng et al 1994 Parter et al ,4991
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Scalenus
tubercles transverseprocess 1 -2 scalenes Brachialplexus p -SubclavianArtery
26 0102 Dr Youssef Masharawi
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- 3 LongusColli multiplefascicles multipleattachments "! " ! -TP LongusCapitis occipitalbone occipital bone
Dr Youssef Masharawi 2010
Longus colli
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)5991(QuebectaskForce
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Quebecclassificationofwhiplash injuries
Grade0 Nopain&Nophysicalsigns Grade1 Necksymptoms,nophysicalsigns Grade 1 Neck symptoms, no physical signs Grade2 Necksymptomsandsigns: ROMandtenderness Grade3 Grade2+neurologicalsigns Grade 3 Grade 2 + neurological signs Grade4 Necksymptoms+fracture
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WAD :
: jointpositionsense joint position sense : / NTPT
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consideringthedeepcervicalmuscles,longus considering the deep cervical muscles longus colliandlonguscapitis,arefundamentally importantfortheprovisionofsupportforthe important for the provision of support for the cervicallordosisandthecervicaljoint changesinthefeedforwardresponsemight p leavethecervicalspinevulnerabletostrain
(Fallaetal,.2004)
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PosteriorRegion P t i R i
Superficialgroup: Superficial group: Spleniuscervicis Spleniuscapitis Splenius capitis Deep(suboccipital)group: Rectuscapitis posteriormajor+minor Obliquecapitis Oblique capitis superior+inferior
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capitis cervicis
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ProvocativeElevationTest
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Trapezius Levatorscapula Erectorspinemuscles: S spleneus spinaliscervicis C M Lev.scap spinaliscapitis longissimuscervicis Scalenus Med longissimuscapitis Ant iliocostaliscervicis trapzius Semispinalis omohyoid Multifidus+rotators
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Brachial plexus
: - feedforwardcontrolcontraction !!!!!!
)4002 (D Falla 4002D.Falla
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Forward h d posture F d head t
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Levator scapula L t l
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