Cervical Spine Flashcards
ROM and muscles that cause movement
Flexion- 80-90 (SCM, longus colli, longus capitus, rectus capitus anterior, scalenes)
Extension- 70 (trapezius, sub occipital muscles, splenius capitus, deep and superficial ESG, lev scap)
Rotation- 70-90 (trapezius, sub occipital muscles, SCM, deep ES, scalenes anterior)
Side bending- 20-45 (trapezius, sub occipital muscles, SCM, lev scap, ESG, scalenes)
Facet Articulation
Coronal 45 degrees
Facilitates- flexion and extension, prevents simple rotation and side bending.
capsules are lax to allow sufficient movement. At the same time they provide support and a check-rein type of restriction at end range.
Facet joint surrounded by connective tissue to, nourish and lubricate the joint
Greatest flexion-extension of facet joints:
C5-C6 (most)
C4-C5
C6-C7
This can increase likelihood of degeneration being seen at these levels.
Ligaments of CSP
Anterior longitudinal
Posterior longitudinal
Ligamentum flavum
Interspinous ligament
Supraspinous ligament
Alar ligament (only in C2)- 2 strong rounded cords, connect to either side of dens and medial sides of occipital condyles.
(they limit flexion and extension, and stabilise c1, c2 especially in rotation)
Cervicoencephalic (cervicocranial) area
C0-C2, shows relationship between the CSP and occiput.
Injuries in this region have potential to be of the brain, brainstem and spinal cord.
Cervicoencephalic injury symptoms
Headache
Fatigue
Vertigo
Poor concentration
Hypertonia of sympathetic nervous system
Irritability
There may also be cognitive dysfunction, cranial nerve dysfunction and sympathetic system dysfunction.
Atlanto-occipital joint
C0-C1
Principal motion- flexion and extension (15-20)
side bending- 10
rotation- negligible
Atlas has no vertebral body, and during development, the vertebral body of C1 develops into dens of C2.
The tectorial membrane, is a broad band covering the dens and its ligaments, and its found within the vertebral canal and is a continuation of the posterior longitudinal ligament.
– It provides a second line of defence in preventing the dens from compressing the spinal cord
Alar ligaments
2 strong rounded cords found on each side of the upper dens passing upwards and laterally to attach on the medial sides of the occipital condyles.
They:
- limit flexion and rotation
- play a major role in stabilising C1 and C2, especially in rotation.
Atlanto-axial joints (C1-C2)
most mobile articulations of the spine
flexion and extension- 10
side bending- 5
rotation- 50
– odontoid process of C2 acts as a pivot point for rotation
– this middle, median joint is classified as a pivot (trochoidal) joint
main supporting ligament:
- transverse ligament of the atlas.
– holds dens of the axis against the anterior arch of the atlas
this ligament can be weakened or ruptured in RA:
– if this happens, the dens will no longer be anchored and can travel up the cervical spine, causing paralysis.
2 projections coming superiorly and inferiorly off the transverse ligament make the cruciform ligament of the atlas
Vertebral artery
Pass through TP’s starting at C6, can enter as high as C4.
supplies 20% of blood supply to the brain (primary the hindbrain), along with the internal carotid (80%).
The vertebral artery will travel through TP’s close to the facet joints- which with degeneration (OA, cervical facet dysfunction), can be compressed due to osteophyte formation, or injury of the facet joints.
Can be stressed by:
- rotation, extension and traction movements mainly.
- Rotation and extension of as little as 20 degrees have been shown to significantly decrease vertebral artery blood flow.
Greatest stresses of vertebral arteries are placed in 4 different places:
- TP of C6
- within the bony canals of the TP’s between C1 and C2
- between C1 and the entry of the arteries into the skull
Cervicobrachial area
C3-C7
pain in this region usually referred to upper extremity
pathology in this region leads to-
- neck pain alone
- arm pain alone
- neck and arm pain
