Cervical Spine Dysfunction

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Cervical Spine Dysfunction
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• CRANIOFACIAL PAIN OF CERVICAL ORIGIN
• Recognize craniofacial pain of cervical origin
• Understand basic anatomy and physiology of the
  upper cervical spine
• Overview of craniovertebral testing and
  treatment

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Occipital/supraorbital syndrome (C1)
OA unilateral lesion, unilateral pain,
retroorbital nausea
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Arnolds neuralgia - Greater Occipital Nerve
Impingement (C2) Unilateral Pain from
posterior rami C2, sharp shooting attacks of
pain, pain at posterior neck to vertex, pain at
retromastoid region
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Otic Syndrome- Ventral Rami C2-lesser occipital
nerve and greater auricular nerve Pain,
buzzing, vertigo symptoms related to ears without
ear pathology
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Auriculomandibular Neuralgia - C3 Pain
corresponds to C3, occipital headache, pain
radiating to auricular lobe and angle of
mandible, generally unilateral
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Facet Joint Referred Pain Patterns C2 - C3 and C3
- C4 refer pain into head
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The cervical spine connection Trigeminal system
and C1-C3 nerves along with CN VII, IX,X Pain
fibers descending from the brain stem converge in
the posterior horn of the upper cervical spine.
This convergence gives an anatomical basis for
pain referral from the neck to the head.
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A Single Combined Nucleus-Trigeminocervical
Nucleus terminals of the trigeminal nerve and
the upper three cervical nerves ramify in a
continuous column of grey matter formed by the
par caudalis of the spinal nucleus of the
trigeminal nerve and dorsal horns of the upper
three cervical segments Bogduk, 1995 Kraus, 1988
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Transmits PAIN Nociceptive information from
cervical spine tissues is transmitted to the
trigeminocervical nucleus, which in turn gives
the patient the perception of symptoms in the
head, face and jaw area.
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• Cervicogenic Headache
• pain sensitive structures in the neck
• pathological processes or physiologic
  dysfunctions within the neck
• ipsilateral pain and stiffness
• decreased cervical ROM
• tenderness at cervical facets
• pain elicited with active or passive exam of the
  neck

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Basic Cervical ROM
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CO - C1 - C2
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Suboccipital Triangle

• Superior Oblique occiput to TP C1
• Inferior Oblique TP C1 to C2
• Rectus Capitus Post Major occiput to
• spinous process C2

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Greater Occipital Nerve

• Between C1 and C2
• Emerges under inferior oblique
• At semispinalis
• At upper trapezius

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The Atlas- ring shaped without vertebral body-
articulates with occipital condyles and axis
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The Axis

• Pacifier shaped
• Convex shoulder of axis are built to allow
  rotation

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Upper Cervical Spine AA Testing
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OA Testing

• Occipital / Atlas Testing (OA)
• Imbalance of the occiput as it meets the first
  vertebrae (C1) can create head and facial pani.
• Testing and treatment to the occiput(O) and atlas
  (A) complex can help eliminate pain.

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PHYSICAL THERAPY

• MANUAL THERAPY to correct the upper cervical
  alignment and restore normal biomechanics of the
  upper cervical spine and restore the normal
  lordosis or arch to the neck
• Neuromuscular Reeducation Exercise to balance the
  craniocervical, craniomandibular, and the
  scapulothoracic systems.
• Mechanical Home Cervical Traction Set Up

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Live life at ease.

• Call 216-682-0413 for your comprehensive
  craniomandibular cervical evaluation and
  treatment.