Mechanism of injury: Inquire about how, when, and where the injury took place. In elderly persons with osteophyte formation, repetitive neck extension and rotation in certain sports, such as swimming or tennis, may result in a more insidious injury. Additionally, cervical disc herniations can occur with a sudden load with the neck in either flexion or extension. Conversely, a traction injury can occur with a sudden flexion or extension, coupled with lateral bending away from the affected nerve root. These injuries can occur from an extension, lateral bending, or rotation mechanism, which close the neural foramen and result in ipsilateral nerve root injury. 7Ĭervical radiculopathy in athletes can occur from several mechanisms. This compression can occur from osteophyte formation, disc herniation, or a combination of the two. Degenerative changes of the structures that form the foramina can cause nerve root compression. The nerve roots exit above their correspondingly numbered vertebral body from C2-C7 C1 exits between the occiput and atlas, and C8 exits below the C7 vertebral body. Medially, the foramina are formed by the edge of the end plates and the intervertebral discs. The neural foramen is bordered anteromedially by the uncovertebral joints, posterolaterally by facet joints, superiorly by the pedicle of the vertebra above, and inferiorly by the pedicle of the lower vertebra. The nerve root occupies 25% to 33% of the foraminal space. The foramina are largest at C2-C3 and progressively decrease in size to the C6-C7 level. The intervertebral discs are thicker anteriorly and therefore contribute to normal cervical lordosis. The discs are composed of an outer annular fibrosis and an inner nucleus pulposus and serve as force dissipators, transmitting compressive loads throughout a range of motion. Intervertebral discs are located between the vertebral bodies of C2-C7. These joints can develop osteophytic spurs, which can narrow the intervertebral foramina. These articulations are called uncovertebral joints, or the joints of Luschka. On the lateral aspect of the vertebral bodies are sharply defined margins, which articulate with the facet above.
They articulate via the zygapophyseal or facet joints posteriorly. The vertebral bodies of C3-C7 are similar in appearance and function (Figures 1 and 2). This is due to the 45° inclination of the cervical facet joints.
Below the C2-C3 level, lateral bending of the cervical spine is coupled with rotation in the same direction.
The occipitoatlantal joint is responsible for 50% of flexion and extension. The C1-C2 (atlantoaxial) joint forms the upper cervical segment, which allows for 50% of all cervical rotation. The cervical spine consists of seven cervical vertebra and eight cervical nerve roots.
#SPINE2D CHARACTER REALISTIC FULL#
Although acute neck pain generally resolves with conservative treatment, an algorithmic approach should be applied to ensure a full assessment of this complaint. 3-6 However, there remains no definitive consensus on this topic. Several guidelines on the management of neck pain have been published. 1,2 Causes of pain vary from myofascial strain/sprain to myelopathy. Approximately 10% to 15% of the world’s population suffer from an episode of neck pain at any time and 40% of the population will suffer from neck pain over a 12-month period. Neck pain is a common complaint of patients presenting to a primary care office.
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