Cervical Instability

Question 1

Cervical Instability

Answer 1

Question 2

Cervical Instability Symptoms

Answer 2

• Muscle Spasms
• Reluctant to move head
• soft or empty feel
• lump in throat sensation
• lip or facial paraesthesia
• headaches
• dizziness
• nystagmus
• nausea
• vomitting
• pupillary changes

Can be provoked by active or passvie movement of the head

Question 3

Cervical Instability Clinical Indications

Answer 3

• Poor tolerance to prolonged static postures
• fatigue and inabilty to hold head up
• improvment with external support
• frequent need for self manipulation
• feeling of instability, shaking or lack of control
• sharp pain with sudden movements

Diagnostic Test Accuracy

• Sensitivity is poor - high false negative
• Specificity - good

Pre screening for cervical instability in a clinical setting is difficult

Question 4

Cervical Instability Clinical Notes

Answer 4

• Tests are designed to detect instability in the segments that make up the cervical spine
• All procedures should be done with care
• only be done if you plan on doing end range techniques
• if instability is present then they are contraindicated

Question 5

Sharp-Purser Test

Answer 5

Purpose:

• To determine potential subluxation of the atlas on the axis
• indicates insufficiency of the transverse ligament which maintains the postion o the odontoid process relative to c1
• if the transverse ligament is torn, c1 will translate forward on c2 during flexion of the cervical spine
• test may be postive if pt has a fractured odontoid process

Procedure:

• Pt is sitting and practitioner is at the side
• Primary is thumb on pt’s C2 and secondary is on forehead
• pt flexes neck and apply slow, gentle AP pressure to create a posterior shear of atlas on axis

Postive:

• Positive if there is a head slide as pressure is applied
• a clunk can indicate relocation of atlas
• pt can have symptoms as head flexes

Indication of positive:

• Cervical instability could mean potential rupture of the transverse ligament
• Odontoid fracture

Question 6

Rotational Alar Ligament Stress Test

Answer 6

Purpose:

• Test for instability at the atlanto-axial joint and test integrity of the alar ligament
• was first designed to assess for instabilty for pt’s with RA

Procedure:

• Pt is seated with head in neutral and practioner is to the side
• primary is on the lamina and c2 sp, gently. Secondary is ontop of the head
• Rotate pt’s head, C1 on C2

Positive:

• more then 20-30 of rotation without c2 movement indicates injury to the contralateral alar ligament
• if this test is positive then the alar ligament stress test should be positive in the same direction

Indication of postive:

• Cervical instability
• alar ligament disruption
• odontoid dysplasia
• odontoid dysplasia

Note:

• Alar ligament restrains rotation

Question 7

Transverse Ligament Stress Test

Answer 7

Purpose:

• Potential subluxation of the atlas on the axis, which can indicate cervical instability, odontoid fracture, atlanto-axial hypermobility or transverse ligament disruption

Procedure:

• pt is supine and examiner’s hands are supporting the occiput with palsm and both hands
• primary and secondary are index fingers on the posterior arch
• with head in neutral, lift the head and c1 contacts
• creates anterior shear of c1 on c2 and is held for 10-20 seconds

Positive:

• Production of cervical instability symptoms , lump in throat, vomitting, dizziness

Indication of Positive:

• Cervical instability
• rupture of transverse ligament
• odontoid fracture
• hypermobilty of atlanto-axial

Question 8

Atlantoaxial Lateral Shear Test

Answer 8

Purpose:

• To assess for possible instabilty at the atlanto-axial articulation, odontoid process fracture, transverse ligament tear or odontoid dysplasia

Procedure:

• Supine with head on pillow
• Examiner places 1 index on TP of c1 and contralateral TP of C2
• push both L-M direction causing a shearing on one vertebrae on another

Positive:

• This test is positive if there is excessive movement between the vertebrae and/or symptoms are reproduced

Indication of positive:

• Cervical Instability
• Rupture of tranverse ligament
• odontoid fracture
• atlanto-axial hypermobility

Notes:

• Explain that there may be pain due to contacts
• Test can be done c1-c7

Question 9

Lateral Flexion Alar Ligament Stress Test

Answer 9

Purpose:

• Test of instability of the atlanto-axial joint and test the alar ligament
• suspect of cervical instability, odontoid fracture or odontoid dysplasia

Procedure:

• Supine with head in neutral
• Practitioner places pincer grip to stablize c2
• primary on top of the head
• lateraly flex the head while stablizing c2

Positive:

• Excessive movement or reproduction of instability symptoms can indicate a positive test

Indication of Positive:

• Cervical instability
• Alar ligament rupture
• Dens fracture
• Odontoid dysplasia

Question 10

Saggital Stress Test

Answer 10

Purpose:

• Test integrity of supporting structures, ligaments and joint capsule or if suspect cervical instability, myelopathy or spondylolisthesis

Procedure:

• Supine with head neutral on pillow
• Practitioner places bilateral contacts on articular pillar on the segment to be tested
• Then slowly and carefully apply an anterior force to create an above and below shear
• feel for tissue stretch follwed by a stop in a normal spine

Positive:

• positive if there is excessive between two vertebrae and or symptoms are produced that indicate cervical instability

Indication of Positive:

• Cervical instability
• cervical myeopathy
• cervical spondylolisthesis

Clinical Note:

• Can be performed c1 to c7
• Excessive force is not needed