Bones and Joints of the Neck Flashcards
(124 cards)
1
Q
What is the general shape of the neck?
A
Cylinder
2
Q
What does the neck link together?
A
Head above
Thorax below
3
Q
What parts of the body does the neck communicate with?
A
Back
Upper limb
4
Q
How does the neck communicate with the upper limb?
A
Brachial plexus
Subclavian artery
5
Q
What are the three Vs of the neck?
A
Vertebral column
Visceral column
Vascular column
6
Q
What is the vertebral column?
A
Large mass of muscle around vertebrae
In gutter between transverse and spinous processes
7
Q
What is the muscle group called in the vertebral column?
A
Post-vertebral muscles
8
Q
What is the function of the post-vertebral muscles?
A
Maintain position of head
9
Q
What are the superficial muscles of the neck?
A
Sternoclydomastoid
Trapezius
10
Q
What are the attachments of the three scalene muscles?
A
Transverse process
Top 2 ribs
11
Q
What is the function of the scalene muscles?
A
Accessory muscles of respiration > lift ribs
12
Q
Compared to the post-vertebral muscles, how do the pre-vertebral muscles differ in size and number?
A
Smaller
Fewer
13
Q
What is in the visceral cylinder?
A
Trachea
Oesophagus
Thyroid gland
14
Q
Which nerve is the visceral cylinder associated with?
A
Recurrent laryngeal nerve
15
Q
What is the name of the fascia around the sternoclydomastoid and trapezius?
A
Investing layer
16
Q
What structure is formed when the fascia around the trapezius fuses to the spinous process?
A
Nuchal ligament
17
Q
What is the fascia surrounding the thyroid called?
A
Pre-tracheal layer
18
Q
Where is the vascular cylinder located?
A
Laterally on either side of visceral cylinder
19
Q
What is in the vascular cylinder?
A
Common carotid artery
Internal jugular vein
Vagus nerve behind
20
Q
Is the fascia around the internal jugular vein thinner or thicker than that around the common carotid artery?
A
Thinner, because veins stretch with increases in blood volume
21
Q
Is the internal jugular vein inside or outside the carotid sheath?
A
Outside
22
Q
What fascia surrounds the pre-vertebral muscles?
A
Pre-vertebral layer
23
Q
What is created between the various fascia of the neck?
A
Vertical potential spaces
24
Q
What can track along the potential spaces between the fascia of the neck?
A
Infection
25
What are the five regions of the neck?
```
Posterior
1. Back of neck/vertebral region
2. Posterior triangle
3. Sternomastoid region
Anterior
4. Anterior triangle
5. Root of neck
```
26
What makes up the vertebral region of the neck?
Vertebrae
| Post-vertebral muscles
27
What are the borders of the posterior triangle of the neck?
Apex = mastoid process
Posterior border = trapezius
Anterior border = sternoclydomastoid
Base = clavicle
28
What divides the anterior and posterior triangles of the neck?
Sternomastoid region
29
What is deep to the sternoclydomastoid?
Common carotid artery
Internal jugular vein
Lacerations to muscle can damage vessels
30
Which nerve comes out of the posterior border of the sternoclydomastoid muscle to innervate the trapezius?
CN XI = accessory nerve
31
Which area of the neck communicates with the thorax?
5. Root of neck
32
What passes through the root of the neck?
Major vessels pass up to head/down to upper limb
33
How many vertebrae make up the cervical spine?
7
34
Why is the trachea surrounded by a series of incomplete rings of cartilage?
To maintain lumen
35
What is the Adam's apple?
Angle of thyroid cartilage
36
What does the hyoid bone provide attachments for?
Supra- and infra-hyoid muscles
37
What is the function of thee supra- and infra-hyoid muscles?
Muscles of floor of mouth
| Muscles continuing to sternum
38
What is the shape of the a neonate's spine?
C shaped
39
Where are the primary curves maintained in the spine?
Thoracic
| Sacral
40
When does the secondary lordosis in the cervical spine start to develop?
At 6 months, when baby starts to be able to support head
41
When does the cervical spine start to deteriorate and why?
In older age because of degenerative processes
42
What is the function of post-vertebral muscles?
Resist gravity
Extend head on neck
Extend cervical spine
Help maintain cervical lordosis
43
Where is the centre of gravity of the head?
Pituitary fossa
44
Where is the axis of rotation of the head?
Occipital condyles
45
How do degenerative changes in the post-vertebral muscles contribute to a change in posture?
Degenerative change > loss of tone
46
At what angle are the pedicels to the body of the cervical vertebra?
45 degrees
47
Compared to vertebrae in other areas of the spine, what is the size of the cervical vertebral body?
Quite small
48
What is the lip projecting upwards on the lateral margins of the body of vertebrae C3 to C6?
Uncinate process
49
What is the function of the uncinate process?
Encapsulates intervertebral discs to some extent
Keeps range of cervical spine primarily in sagittal plane
Partly aids in flexion and extension
50
What is the association between uncinate processes and degeneration of the cervical spine?
Irritates associated structures
51
What is the shape and size of the vertebral foramen of the cervical vertebrae?
Large
| Triangular
52
What is the foramen in the transverse process of the cervical vertebra called?
Transverse foramen
53
What runs in the transverse foramina of C6 to C1?
Vertebral artery
54
What does the transverse process of the cervical vertebrae terminate in?
Anterior tubercle
Posterior tubercle
Intertubercular bar
55
What do the anterior and posterior tubercles, and intertubercular bar make together?
Costal element of cervical vertebra
56
What part of the rib does the anterior tubercle correspond to?
Head of rib
57
What part of the rib does the intertubercular bar correspond to?
Neck of rib
58
What part of the rib does the posterior tubercle correspond to?
Tubercle of rib
59
In what direction do the intervertebral foramina exit?
Obliquely rather than laterally
60
What attaches to the spinous processes of the cervical vertebrae?
Many post-vertebral muscles
| Ligaments
61
How is the surface area of the spinous processes increased?
Tip split = bifid
62
Which cervical vertebra doesn't have a bifid spinous process?
C7
63
What is the name of C7's very long spinous process?
Vertebra prominens
64
Why are the transverse foramina of C7 small?
Because vertebral artery enters at C6
65
In some variations, where can the vertebral artery enter they spine?
C5 or even C4
66
What is the carotid tubercle?
Slightly larger anterior tubercle of C6
67
What can happen at the anterior tubercle?
Can compress carotid artery here > decrease flow to head
68
What are the scalene muscles?
Scalenus anterior
Scalenus medius
Scalenus posterior
69
What are the attachments of scalenus anterior?
Anterior tubercle of transverse process
| 1st rib
70
What are the attachments of scalenus medius?
Posterior tubercle of transverse process
| 1st rib
71
What are the attachments of scalenus posterior?
Posterior tubercle of transverse process
| 2nd rib
72
What emerges between scalenus anterior and medius?
Brachial plexus
| Subclavian artery
73
Where does the vertebral column show variations?
At transitional regions
74
What happens in cranial shift at the cervico-thoracic region?
Cervical rib
| Occipitalisation of atlas
75
What are the features of the cervical rib?
Quite short usually
Rarely see entire bone coming down towards sternum
More commonly fibrous band closes circle
76
What structures can be endangered by the cervical rib?
Lower trunk of brachial plexus
- Present with ulnar nerve type issues
- Loss of sensation in C8 and T1 dermatomes
Some obstruction of subclavian artery less common
77
What are the features of occipitalisation of the atlas?
Rarely complete
| Usually anterior part fuses with anterior aspect of foramen magnum
78
What are the atypical cervical vertebrae?
```
C1 = atlas
C2 = axis
```
79
What are the features of the atlas?
Essentially ring of bone
Doesn't have body
Has no intervertebral discs above or below
Instead has space for body of axis
Anterior and posterior arches
Facet for dens
Groove for vertebral artery and C1 dorsal ramus
Saucer-shaped upper surfaces for occipital condyles
Long transverse process
80
What do the occipital condyles of the atlas allow?
Nodding movements
81
Does the atlas have a spinous process?
No
82
Is there any rotation between the atlas and the skull?
No
83
What are the features of the axis?
Body = dens = odontoid process
Surfaces on dens for articulation with anterior arch of atlas
Strong spinous process
84
What structures are the uncinate processes modified into in the atlas and axis?
Anterior arch of atlas
| Much more anterior facets
85
Why is the spinous process of C2 so big?
Powerful muscles attach here, including erector spinae
86
What does erector spinae do to C2?
Anchors C2 > allows head and C1 to rotate
87
What are important bony landmarks of arteries in the neck?
Carotid artery can be compresses against anterior tubercle of C6 = carotid tubercle
Bifurcation of common carotid artery at C4
Vertebral artery travels in transverse foraminae from C6-C1
88
Compared to the rest of the spinal cord, what is the size and orientation of the nerve roots in the cervical spine?
Short
| Horizontal
89
Where do the nerve roots pass at C1 and C2?
Behind facet joint
90
Where do the nerve roots pass at C3-C7?
Between facet joint and transverse foramen
91
What do osteophytic outgrowths as a result of ageing affect?
Nerve root
| Potentially vertebral artery
92
What are the inferior joints (C2-C7)?
Intervertebral discs
| Facet joints
93
What are the superior (suboccipital) joints?
Atlanto-occipital between head and C1
| Atlanto-axial between C1 and C2
94
What are the features of the intervertebral discs of the cervical spine?
Thick
Central nucleus
Form cervical lordosis
Annulus and nucleus like with lumbar discs
Relatively largest throughout vertebral column
95
What do the intervertebral discs prevent in the cervical spine?
Forward slip
| Rotation
96
What are the intervertebral discs protected by to some extent?
Uncinate processes
97
What is the joint between the intervertebral discs and the uncinate process called?
Uncovertebral joint/joint of Luschka
98
What do the uncinate processes do to the intervertebral discs?
Keep intervertebral discs in position
| Limit rotation
99
Can prolapse occur in the cervical spine, and why?
Yes, because of degeneration
100
Is prolapse in the cervical or lumbar spine more common, and why?
Lumbar spine due to structure and loading
101
Why does prolapse in the cervical spine usually occur?
Trauma related to flexion and extension with rotation
102
What can a prolapse in the cervical spine affect?
Impinge on cord and possibly nerve roots in vertebral canal
103
What kind of joint are facet joints?
Plane synovial joints
104
What is the capsule of the facet joints innervated by?
Posterior rami
105
What is the orientation of the facet joints?
45 degrees between coronal and horizontal planes
106
What movement do the facet joints allow?
Flexion and extension with rotation
| - Orientation means you get lateral flexion with rotation
107
In what type of injury can you get injury to the facet joints?
Whiplash injury = acceleration of head in antero/posterior direction
108
What injury happens to the facet joints during hyper-extension in whiplash injury?
Articular surfaces become impacted
Damage to cartilage
Possible fracture of bone
109
What injury happens to the facet joints during hyper-flexion in whiplash injury?
Stretch of capsule and longitudinal ligaments
110
What are the atlanto-occipital joints?
2 lateral synovial joints between occipital condyles and upper facets on atlas
111
What movement do the atlanto-occipital joints allow?
Flexion and extension
| About 15-20 degrees
112
What are the atlanto-axial joints?
3 synovial joints specialised for rotation
Median pivot joint between dens of C2 and anterior arch of atlas
Bursa between transverse ligament and dens
2 lateral facet joints
113
What movement do the atlanto-axial joints allow?
~50% of rotation of cervical spine
| Rotation accompanied by lateral flexion
114
Where is the transverse ligament in the axis?
Across back of dens
115
What is the function of the transverse ligament in the axis?
Maintains position of dens against anterior facet
| Permits dens 3-4 mm of antero-posterior movement
116
What can damage to the transverse ligament in the axis result in?
Dens moves back > touches spinal cord
117
What is the cruciform ligament?
Has vertical and transverse (most important) bands to stabilise dens
118
What are the alar ligaments?
Go up side of dens
| Check range of rotation of atlas around dens
119
When are the alar ligaments susceptible to injury?
When head flexed and rotated and muscles relaxed
120
Why shouldn't people with rheumatoid arthritis have their head manipulated by physiotherapists and chiropracters?
Cruciform and alar ligaments lax > danger that dens will move posteriorly
121
What are the effects of ageing on the cervical spine?
Water content of nucleus reduces
Range of movement decreases
Cervical discs degenerate earlier than lumbar
Compression of anterior vertebral body > vertebral wedging > reduced lordosis
Osteophytes can develop from uncinate processes and facet surfaces > narrowing of space for cervical spinal cord > irritate nerve roots and possibly occlude vertebral artery
122
In what direction is the cervical spine particularly susceptible?
Anterio-posterior direction
123
What is the hangman's fracture?
Pars fracture of C2
124
What is Jefferson's fracture?
Fall onto top of skull > bilateral fracture of anterior arch and pedicle
