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Gabe's Endocrinology > Bones and Joints of the Neck > Flashcards

Bones and Joints of the Neck Flashcards

1
Q

How many cervical bones are there?

A

7

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2
Q

What is the name of the first cervical bone?

A

Atlas

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3
Q

What is the name of the second cervical bone?

A

Axis

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4
Q

What can happen to cartilages with age?

A

They can ossify

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5
Q

What are the posterior neck regions?

A
  1. Back of the neck/Vertebral region
  2. Posterior triangle
  3. Sternomastoid region
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6
Q

What are the anterior neck regions?

A
  1. Anterior triangle
  2. Root of the neck
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7
Q

What does sternocleidomastoid do?

A

Rotates and flexes the neck.

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8
Q

What lies deep to sternocleidomastoid?

A

Nerves

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9
Q

What forms the roof of the neck?

A

The lower part of sternocleidomastoid, giving direct access to the thorax.

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10
Q

What are anterior and posterior to sternocleidomastoid?

A

Anterior and posterior triangles.

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11
Q

Where does the anterior triangle extend from?

A

Base from above across the mandible to down below to the root of the neck.

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12
Q

Where does the posterior triangle extend?

A
  • Its apex is located above just behind sternomastoid and broadens out into a base below.
  • It’s important in transmitting structure to the upper limb and back (nerves, arteries and veins).
  • E.g. brachial plexus passes via posterior triangle into upper limb.
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13
Q

What is the posterior triangle important in transmitting?

A

Nerves, arteries and veins to the upper limb and back

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14
Q

What passes via the posterior triangle to the upper limb?

A

Brachial plexus, arteries and veins.

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15
Q

What are the 5 different fascial layers of the neck?

A
  1. Superficial fascia
  2. Deep cervical fascia (4 layers):
  3. Investing layer
  4. Pretracheal layer
  5. Prevertebral layer
  6. Carotid sheath
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16
Q

What sits in the carotid sheath?

A

Common carotid, internal jugular vein and vagus nerve tucked behind.

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17
Q

What does the investing layer invest?

A

Sternomastoid and trapezius.

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18
Q

Why is the fascia of the carotid sheath thin and expansible?

A

To allow for distension of the internal jugular vein.

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19
Q

What effect do the fascial layers have on infection in the neck?

A

They allow blood, pus and infective material to track up or down, but are partitioned off by the fascia.

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20
Q

What shape does the cervical spine have?

A

Lordosis

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21
Q

Why does the cervical spine have a lordotic curve?

A

Due to the shape and size of the IV discs

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22
Q

How is the cervical lordosis maintained?

A

‘Postvertebral’ muscles extend the head on the neck, extend the cervical spine & help maintain cervical lordosis.

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23
Q

How does the lordotic curve develop?

A
  • As posterior neck muscles develop, infant is able to lift its head up, creating a secondary curvature in the cervical spine, referred to as a lordotic curve.
  • This is primarily due to the shapes of the IV discs, not so much due to the vertebrae themselves.
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24
Q

Why does the head tend to rotate forwards?

A
  • Because the centre of gravity tends to sit anterior to the axis of rotation.
  • Hence why powerful posterior extensor muscles are required to maintain position of the head.
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25
Q

What are the transverse masses off the cervical vertebrae?

A

Anterior and posterior tubercles joined by the transverse bar.

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26
Q

What are the transverse foraminae?

A

The hole located in the transverse mass between the anterior and posterior tubercles.

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27
Q

How is the transverse mass positioned?

A

Not positioned directly laterally, rather somewhat oblique.

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28
Q

What does the transverse foramen transmit?

A

Vertebral artery

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29
Q

Why are the spinous processes of the cervical spine bifid?

A

Because there are so many muscles and ligaments trying to gain attachment that it increases its surface area to allow for attachment.

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30
Q

Which cervical vertebra has the longest spinous process?

A

C7 (atypical)

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31
Q

Why is C7 an atypical vertebra?

A

Atypical because its much bigger and has much more prominent spinous process

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32
Q

What is the angle of the cervical spinous processes ?

A

45 degrees

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33
Q

Which cervical vertebrae have uncinate processes?

A

C3-C6

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34
Q

Which vertebrae are typical vertebrae?

A

C3-C6

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35
Q

What are uncinate processes?

A

Uncinate processes are on the lateral sides of the bodies on the typical vertebrae (C3-C6), responsible for keeping movements in a sagittal plane – flexion/extension.

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36
Q

What do the lateral vertebral muscles attach to?

A

Anterior and posterior tubercles of transverse processes.

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37
Q

What are the lateral vertebral muscles?

A

Scalenes

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38
Q

What are the attachments of the scalenes?

A

Attach from typical vertebra and attach to the rib.

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39
Q

What are the 3 scalene muscles?

A

Anterior, medius and posterior

40
Q

Which scalene is a key landmark in the neck?

A

Scalenus anterior - arises from anterior tubrcle and attaches to first rib.

41
Q

Where does scalenus medius originate from?

A

Posterior tubercles.

42
Q

What sits on the anterior surface of scalenus anterior?

A

Phrenic nerve

43
Q

What passes between scalenus anterior and medius?

A

Subclavian artery and brachial plexus.

44
Q

Where are the scalenus muscles located?

A

Deep to prevertebral fascia

45
Q

Where are the prevertebral (anterior vertebral) muscles located?

A

Deep to prevertebral fascia

46
Q

What comprises the prevertebral muscles?

A

Longus colli

47
Q

What does longus colli do?

A

Maintains the curvature of cervical lordosis

48
Q

What do the prevertebral muscles provide access to?

A

Cervical spinal cord - these muscles will need to be separated to provide a neurosurgeon with access to the cervical cord through the anterior aspects of the vertebral column and IV discs.

49
Q

What are the 2 variants of the cervical vertebral column?

A

Cranial and caudal shift.

50
Q

What can be a consequence of cranial shift?

A
  • C8-T1 lower trunk coming up from the thorax and then (with a cervical lift) may become trapped or compressed in particular movements.
  • Cervical ribs may have consequences for entrapment of brachial plexus. This will affect movements of the hand and sensory problems at T1 dermatomes (medial aspect of arm).
51
Q

What are the features of the atlas?

A
  • No body
  • Anterior & posterior arches
  • Facet for dens
  • Saucer-shaped upper surfaces for occipital condyles
  • Long(est) transverse process
52
Q

What are the features of the axis?

A
  • Dens (odontoid process) –developmental body C1
  • Surfaces on dens for articulation with anterior arch of atlas
  • Strong spinous process
53
Q

What is special about the spinous process of C2 (axis)?

A
  • 2nd cervical vertebra must be kept stable for rotation of C1 around the dens
  • Therefore a mass of muscles stabilise it
54
Q

What are the features of cervical nerve roots that make them different?

A

Nerve roots are short & horizontal

55
Q

True or false: the spinal cord and nerves follow a different pattern to the back?

A

False - they follow the same pattern.

56
Q

What do the C1 and C2 nerve roots pass behind?

A

Facet joints

57
Q

What do the nerve roots of C3 and beyond pass between?

A

Face joints and body

58
Q

What are the 2 important arteries of the neck?

A
  • Common carotid
  • Vertebral artery
59
Q

What does the common carotid bifurcate into?

A

External (posterior) and internal) anterior.

60
Q

What is the difference between the internal and external carotid arteries?

A

The external gives off branches.

61
Q

What protects the vertebral artery?

A

Transverse foraminae

62
Q

Why is the anterior tubercle of C6 (the carotid tubercle) an important landmark?

A

Because the common carotid can be compressed against it.

63
Q

Why is the C4 vertebra an important landmark?

A

It’s the bifurcation of the common carotid and the upper border of the thyroid cartilage.

64
Q

What are the inferior joints of the cervical spine?

A

Joints between C2-C7 comprising the IV discs and facet (zygapophyseal) joints.

65
Q

What are the superior joints of the cervical spine?

A

Suboccipital joints:

  • Atlanto-occipital (0-C1)
  • Atlanto-axial (C1-2)
66
Q

What creates the cervical lordosis?

A

The IV discs.

67
Q

Where are the largets IV discs in the vertebral column relatively?

A

In the cervical spine.

68
Q

What do the IV discs of the cervical spine prevent?

A

Forward slipping and rotation.

69
Q

What are the uncovertebral joints?

A

The joints between the uncinate process above and below between C3 and C7. They allow for flexion and extension and limit lateral flexion in the cervical spine.

70
Q

Are the uncovertebral joints synovial?

A

No

71
Q

What do the uncinate processes protect?

A

IV discs

72
Q

What happens to the uncinate processes with aging?

A

As disc disappears with ageing, uncinate processes rub together, stimulating osteophytes

73
Q

Can IV disc prolapse occur at the cervical level?

A

Yes, usually in F/E +/- rotation. May impinge on cord +/- nerve roots in vertebral canal.

74
Q

What are the facet joints?

A

Plane synovial joints

75
Q

What is the facet joint capsule innervated by?

A

Posterior rami

76
Q

What is the orientation of the facet joints?

A

Oriented at 45° between coronal & horizontal planes (more horizontal in childhood).

77
Q

How can the facet joints be injured?

A
  • Whiplash injury - acceleration of head in an antero/posterior direction
  • Injury of facet capsule & articular surfaces, + supporting ligaments
  • Particularly susceptible to compression injury in hyper-extension
78
Q

What are the atlanto-occipital joints?

A
  • 2 lateral synovial joints between occipital condyles and upper surfaces on atlas
  • Loose fibrous capsule permits nodding movements (F/E). ROM = 15=20% of all cervical F/E
79
Q

What are the atlanto-axial joints?

A
  • 3 synovial joints specialised for rotation (no IV disc!)
  • Median pivot joint between dens of C2 & anterior arch of atlas
  • 2 lateral facet joints
  • Allow approx. 50% of rotation of cervical spine
80
Q

What holds the dens in position?

A
  • Transverse ligament
  • Only allows approx. 5˚ of anterior/posterior movement.
81
Q

Why are people with rheumatoid arthritis in danger regarding the atlanto-axial joints?

A
  • Transverse ligament holds dens in position – only allows approx. 5˚ of anterior/posterior movement.
  • This joint allows 50% of the cervical rotation, the rest occurs through the remainder of the spine
82
Q

What are the 4 ligaments of the cervical spine?

A
  1. Posterior and anterior atlanto-occipital membrane.
  2. Ligamentum nuchae
  3. Membrana tectoria
83
Q

Where does the posterior atlanto-occipital ligament run?

A

Between the atlas and occiput.

84
Q

Where do membrana tectoria and the anterior atlanto-occipital membrane run?

A

Between axis and occiput.

85
Q

What is membrane tectoria a continuation of?

A

Posterior longitudinal ligament

86
Q

What is ligamentum nuchae a continuation of?

A

Supraspinous ligament

87
Q

What do all cervical ligaments resist?

A

Movements in the sagittal plane (flexion/extension)

88
Q

What are the 3 specialised ligaments between the occiput and C2?

A

Transverse ligament, alar ligaments and cruciform ligament.

89
Q

What does the transverse ligament do?

A

Stabilises dens, prevents posterior translation of dens into vertebral canal

90
Q

What do the alar ligaments do?

A

Checks range of rotation of atlas around dens

91
Q

When are the alar ligaments susceptible to injury?

A

When head flexed & rotated + muscles relaxed

92
Q

What does the cruciform ligament do?

A

Prevents the dens from moving posteriorly into the spinal canal.

93
Q

What are the effects of aging on the cervical spine?

A
  • Water content of nucleus reduces with age (90%-~65%) as does function
  • Cervical discs degenerate sooner than lumbar
  • Compression of anterior vertebral body – vertebral wedging, reduces lordosis
  • Osteophytes may develop from uncinate processes & facet surfaces – may irritate nerve roots & occlude vertebral artery
94
Q

What is a Hangman’s fracture?

A
  • A special type of extension fracture of the axis where both pedicles are fractured.
  • Typically seen when drive of a vehicle is in a head on collision and not wearing a safety belt.
95
Q

What is a Jefferson’s fracture?

A
  • Mechanism: Fall onto vertex of skull e.g. dive into shallow water.
  • Bilateral fracture anterior arch + pedicle

Gabe's Endocrinology (17 decks)

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