With stability being sacrificed for mobility, the cervical complex is rendered more vulnerable to both direct and indirect trauma.
The cervical complex can be the source of many pain syndromes, including neck, upper thoracic and periscapular syndromes, cervical radiculopathy, and shoulder and elbow syndromes.1 These syndromes may result from a vast array of causes, ranging from acute minor sprains to chronic degenerative changes.2
Neck pain usually resolves in days or weeks, but can recur and become chronic. Due to the proximity of the temporomandibular joint (TMJ) to both the craniovertebral joints and the cervical spine proper, dysfunction of this joint must always be given consideration when examining this complex.
The cervical complex consists of the craniovertebral joints, the cervical spine proper, and the TMJ. The craniovertebral joints connect the cervical spine proper to the head.
The two major ligaments of the craniovertebral joints are as follows:
- Transverse: retains the odontoid process in contact with the anterior arch during cervical flexion and extension.
- Alar functions to limit rotation of the craniovertebral region at C1–2.
The cervical spine proper, consisting of seven vertebrae, is one of the key links in the upper kinetic chain as, together with the craniovertebral joints, it is responsible for the control of head, and thus eye motion. For the most part, the muscles of the cervical complex (Table 11-1) function to support and move the head (Tables 11-2 and 11-3). Given the number of degrees of freedom available at the neck, it is likely that the muscles are organized as functional synergies. Synergies are conceptualized as units of control, incorporating the muscles around the joint that will act together in a functional fashion.3 Under this concept, the central nervous system needs only trigger a synergic unit to produce a specific movement, instead of communicating with each individual muscle.3 Synergistic movement incorporates both agonist and antagonist muscle groups, which results in a greater level of control.
Table 11-1 Attachments and Innervation of Cervical Muscles |Favorite Table|Download (.pdf)
Table 11-1 Attachments and Innervation of Cervical Muscles
|Upper trapezius||Superior nuchal line||Lateral third of clavicle and the acromion process||Spinal accessory|
|Levator scapulae||Transverse processes of upper four cervical vertebrae||Medial border of scapula at level of scapular superior angle||Dorsal scapular C5 (C3 and C4)|
|Splenius capitis||Inferior ligamentum nuchae, spinous process of C7 and T1–4 vertebrae||Mastoid process, occipital bone, and lateral third of superior nuchal line||Cervical spinal nerve and ventral primary rami of cervical spinal nerves|
|Splenius cervicis||Spinous processes of T3–6 vertebrae||Posterior tubercles of C1–3|
| Anterior||Anterior tubercles of C3–6||Superior crest of first rib||Ventral primary rami of cervical spinal nerves|