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Q1. Describe the course of the vertebral artery commencing from the
subclavian Artery in the body.
- Arise from subclavian arteries bilaterally proximal to the thyrocervical
trunk and distal to the common carotid artery
- Divided into 4 segments as they ascend the cervical spine
1. From subclavian artery to transverse foramen of C6
2. Remains within transverse foramen from C6-C2.
3. From superior of C2 foramen to the dura.
4. From the dura into the cranium.
Q4. According to the literature what is the patient profile of those who have
developed post manipulative VBA strokes?
It is patients which are younger than 45 and do not have a history circulatory
issues and complain of head, neck and shoulder pain for no apparent reason. It
is common for these patients to seem quite healthy also.
Q6. There are a number of functional tests for the vertebral arteries e.g.
(Georges, de Klyens, Hautants, Houles, Wallenberg tests). They all aim to
what? Are they used in clinical practice today?
These various tests involve taking the cervical spine into deep extension and
rotation which ultimately is aimed at provoking signs involved in VBI. Due to
the risks involved in these tests, they are no longer used in clinic today.
Q7. What are the potential warning signs or risk factors for cervical artery
dissection (CAD)? According to Triano J Kawchuck
Initially, a patient may present with dizziness, unsteadiness, migraines,
giddiness or vertigo which may encourage them to see a chiropractor. In
addition to this, a sudden onset of indifferent pain in the head and in particular
patterns may also be suspicious.
Q8. It is absolutely imperative that the clinician be able to recognise the signs
of VBI and take appropriate steps to minimise the pathological effects. If they
do occur, specific steps must be followed. A) The most important first step is
what? Do not adjust the patient again! An adjustment is only to be taken once
the previous effects have resided.
B) What are the other steps to follow with possible post manipulative stroke
patient?
1. Do not allow patient to stand or walk. Keep them comfortable.
2. Note all physical and vital signs.
3. Check pupils and size shape and equality.
4. Check eyes for light and reflexes.
5. Test lower cranial nerves for anything abnormal. (EG. paresis, swallowing,
gag reflex, numbness, slurred speech)
6. Test cerebellar function (nystagmus, tremor, dysmetria of extremities)
7. Strength and tone test.
8. Sensation to pinprick.
9. Muscle stretch and pathologic reflexes.
10. If condition does not abate referral is necessary, medical emergency
transport patient to hospital, relay all findings recommend MRA and consider
anticoagulant therapy within 3 hours to effectively dissolve an offending clot.
Q10. Name the joints in the neck that do not have IVD.
Atlanto-occitpital (AO) and atlanto-axial (AA) joint complexes.
Q17. How do the occipital condyles move differently at the atlanto occipital
joint?
The occipital condyles on the atlanto-occipital joint only allows for three slight
degrees of motion and these are:
Lateral flexion (z axis)
Axial rotation (y axis)
Flexion/extension (x axis)
Q18. Discuss the tissues that are influenced with the movement of flexion in
the mid neck region.
During flexion, the upper vertebral body tilts and slides anteriorly while the
intervertebral space is closed anteriorly and opened posteriorly. The nucleus
pulposus is pushed posteriorly. This movements is limited by the ligaments
including ligamentum flavum, ligamentum nuchae and posterior longitudinal
ligament.
Q19. Name the muscles that help in maintaining the cervical lordosis.
The muscles which aid in maintaining cervical lordosis are:
- Splenius Cervicis
- Semispinalis Cervicis
- Levator Scapulae
- Transverso Spinalis
- Longismus Capiis
- Spenius Capitis
- Trapezius
The muscles which aid in straightening the cervical spine while holding it
upright are:
- Rectus capitis minor
- Longus cervicis
- Rectus capitis major
Muscles which support cervical spine at rest are:
- Suprahyoid
- Infrahyoid
- SCM
- Scalenes (anterior, posterior and medius)
Q20. What functions do the Alar ligaments serve in the cervical spine
The main function of the alar ligament in the cervical spine is to prevent
displacement or slipping of C1 on C2. Therefore, it also prevents distraction of
C1 on C2.
Note: Axal rotation of the neck tightens the alar ligaments.