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OPP 2: Exam 1 > Cervical Spine > Flashcards

Cervical Spine Flashcards

1
Q

Vertebral segment

A

Two adjacent vertebrae with their associated intervertebral disk, arthrodial, ligamentous, muscular, vascular, lymphatic and neural elements

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2
Q

Naming vertebral segments

A

Convention – named for superior vertebra in pair

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3
Q

Vertebral joint

A

inferior facets of superior vertebra on superior facets of inferior vertebra

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4
Q

reference point for motion of a vertebral segment

A

superior anterior aspect of superior vertebra

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5
Q

The cervical vertebrae

A

7 Cervical Vertebrae

2 atypical: Atlas (C1) – no body; Axis (C2) – odontoid process (the dens)

4 typical C3-C6

-Uncovertebral joints present

1 semi-atypical: C7 –Cervical and thoracic mechanics, Vertebrae Prominens

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6
Q

cervical spine biomechanics

A

Fryette’s first 2 laws do NOT apply to the cervical spine

Guided by unique anatomy

Fryette’s 3rd law Motion in one plane will affect motion in all planes This is because of tensegrity and that doesn’t change

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7
Q

C spine rules: OA

A

Sidebends and rotates to OPPOSITE sides (i.e. OA F SLRR)

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8
Q

C spine rules: AA

A

Only significant motion (for dysfunction) is ROTATION (i.e. AA RL)

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9
Q

C spine rules: typical cervical joints (C2-C7)

A

Sidebend and rotate to SAME side (i.e. C3 E RSL)

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10
Q

Anterior “column” of c spine

A

Functions: weight bearing, shock absorption, flexibility Example structures: Vertebral body, lognitudinal ligaments, IV discs

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11
Q

Posterior “elements” of c spine

A

Functions: protect the neural elements, act as fulcrum for motion, guide movement of the spine as a functional unit Example structures: osseous canal, zygopophyseal joints, erector spinae muscles

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12
Q

Atlas (C1)

A
  1. No vertebral body 2. No true spinous process. Instead, it has a “posterior tubercle”. 3. Articulates in a “third” joint with the odontoid[1] process of the axis. 4. Prominent, palpable transverse processes. 5. There is no disc between the occiput and atlas (C1).
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13
Q

OA joint

A

Occipital condyles articulating with the superior facets of the atlas (C1)

Condyles are convex and fit into the concave facets of C1 like a cup in a saucer

Allows for the nodding action of the head (flexion and extension)

Designed for both weight bearing and mobility

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14
Q

OA joint motions

A

Major Motions Flexion/Extension Motion at both condyles in the same direction

Minor Motions Side-bending & Rotation Always in OPPOSITE directions

Always occurs in relative flexion or extension Ex. OA F RRSL; OA F RLSR

Motions that typically are the source of the somatic dysfunction

One condyle will create a pivot point

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15
Q

Axis

A
  1. It has the odontoid process. 2. There is no disc between the atlas (C1) and the axis (C2).
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16
Q

Atlantoaxial joint- discuss connection to the skull

A

The superior crus of the transverse ligaments attaches from the odontoid to the anterior rim of the foramen magnum

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17
Q

Motions of the atlanto-axial joint

A

Major Motion – Rotation Accounts for 50% of rotation of the cervical spine Minor motions are flex/ext and sidebending Typically not the planes of motion where the dysfunction is found so not commonly diagnosed or documented Ex. C1 RR or AA RR

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18
Q

ligaments of the AA joint

A

Alar Ligament- Attaches dens to occipital condyles

Cruciform Ligament

Transverse ligament with superior and inferior crus- Attaches C1 to C2

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19
Q

typical cervical vertebrae characteristics

A

Uncinate processes form the uncovertebral joints

Saddle-shaped vertebrae

Short transverse processes that are modified to contain a transverse foramen (Allows passage of the vertebral artery)

Large vertebral foramen

Facets oriented in the coronal plane

Short bifid spinous processes

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20
Q

Motion of the typical cervical joints

A

Dictated by the zygophophyseal joints - Intervertebral facet joint - On a 45⁰ angle toward the eye - Synovial joint Rotation and Sidebending are always coupled motions Ex. C3 FRSL, C7 ERSR

21
Q

Uncovertebral Joints– aka Joints of Luschka

A

Uncinate processes –Lateral margins for C3-C7 Exist due to lack of full intervertebral disc coverage between the bodies Limits side-slipping during flexion/extension –Act as guiderails –Helps to prevent herniation in the cervical spine

22
Q

Gross motion of the cervical spine

A

Flexion 90⁰ Limited by the posterior longitudinal ligament

Extension 70⁰ Limited by direct contact of vertebral lamina, zygapophyseal joints (facets), spinous processes

Side-bending

Rotation 50% of rotation in AA joint 50% rest of the cervical spine

23
Q

Anterior longitudinal ligament

A

Anterior aspect of the vertebral bodies from the occiput to the sacrum

Superiorly becomes the anterior occipito-atlantal ligament

Connects the foramen magnum to the anterior arch of the atlas

24
Q

Posterior longitudinal ligament

A

Posterior aspect of the vertebral bodies from the occiput to the coccyx

Extends to become the tectorial membrane

25
Q

Ligamentum flavum

A

Posterior of the spinal cord overlying the vertebra

Extends superiorly to become the posterior atlanto-occipital membrane

Connects the foramen magnum to the posterior arch of the atlas

26
Q

Nuchal ligament

A

–Connects the posterior aspects of the cervical vertebrae to the occiput

–Broad and thick, providing a broad area of attachment for cervical muscles

–Limits flexion

27
Q

three ligaments of the cervical spine that we don’t go into any extra detail on

A

Interspinal ligament

Intertransverse ligament

Supraspinal ligament

28
Q

cervical fascia

A

Investing fascia

Infrahyoid fascia

Pre-tracheal fascia

Buccopharyngeal fascia

Alar fascia

Pre-vertebral fascia – includes Sibson’s Carotid sheath

29
Q

what do anterior strap muscles do?

A

coordinate the hyoid bone to assist in stages of swallowing

30
Q

Prevertebral musculature

A

Rectus capitis lateralis

Rectus capitis anterior

Longus Capitis

Longus Coli

  • All are primary flexors of the neck
  • The rectus muscles also add slight sidebending
31
Q

Posterior deep musculature

A

muscles of the sub-occipital triangle and short restrictors of the spine

32
Q

Posterior musculature of the neck

A

Erector Spinae

  • Iliocostalis
  • Longissimus cervicis and capitis
  • Spinales cervicis

Extensors and the longissimus induce some sidebending

Semispinalis Splenius Cervicis and capitis

33
Q

Lateral neck musculature

A

Anterior, Middle and Posterior Scalene When contracting b/l they raise ribs 1 and 2 in order to assist in respiration (During respiratory insufficiency or distress) Act u/l to sidebend the neck towards that side Levator Scapulae B/l contraction causes the medial upper borders of the scapula to rise and the cervical spine to extend

34
Q

Superficial muscles

A

SCM - Extends from the mastoid process of the temporal bone to the clavicle and sternum via two separate attachments

  • Sidebends and rotates head in opposite directions with u/l contraction
  • Flexes the head when bilaterally contracted

Trapezius - Extends from the occiput to the spine of T12

  • Attaches to every spinous process and to the shoulder as well
  • Stabilizes the shoulder girdle and elevates the scapula
  • U/l contraction causes extension of the head with sidebending to the same side and rotation away
35
Q

Sympathetic innervation to the head and neck

A

Superior cervical ganglia: Anterior to C1-2 Sympathetics to the eye, nose and throat

Middle cervical ganglia: Anterior to C6 Sympathetics to the cardiac plexus

Inferior (stellate) ganglia: Anterior to C7 May fuse with T1

36
Q

parasympathetic innervation to most of the body

A

Vagus nerve (CN X) Affected by OA and C1 somatic dysfunction

37
Q

Phrenic nerve

A

Phrenic Nerve From cervical plexus (3, 4, and 5) Exits neck between clavicular and sternal heads of SCM

38
Q

Greater occipital nerve

A

Greater Occipital Nerve

From C2

Can cause tension HA due to course through descending traps

C3 may also contribute through lesser occipital nerve

39
Q

clinical correlation: torticollis

A

The head is side-bent towards and rotated away from the affected side

Often spontaneous and idiopathic in children

Unilateral sternocleidomastoid contracture is the most common cause

40
Q

Injury to the dens

A

People at risk:

Down syndrome - May have congenital absence of stabilizing ligaments (cruciform, alar) - Must obtain Xrays before participating in Special Olympics

Rheumatoid arthritis - May have damage at the joint space Dens Fx - May result in avascular necrosis - Concomitant cruciate ligament rupture - Death or quadriplegia

41
Q

Whiplash

A

Damage to the anterior and posterior longitudinal ligaments - From hyperextension/hyperflexion Most commons: - Rear-end collisions - Front-seat passengers - 2x more likely in women - In tall/slender people The use of seatbelts slightly increases the incidence

42
Q

Hiccups

A

Can be caused by imbalance of the phrenic nerve Can be treated by balancing the anterior fascia of the neck = the best party trick!

43
Q

Neurologic injuries: erb’s palsy, klumpke’s palsy, winged scapula

A

Erb’s palsy (C5/C6) Waiter’s tip Klumpke’s palsy (C8/T1) Claw Hand Winged scapula Long thoracic nerve (C5/C6/C7)

44
Q

C5 neuologic level

A
45
Q

C6 neurologic level

A
46
Q

C7

A
47
Q

C8 neuological level

A
48
Q

The three rules of the C-Spine

A

•OA

–Sidebends and rotates to OPPOSITE sides (i.e. OA F SLRR)

•AA

–Only significant motion (for dysfunction) is ROTATION (i.e. AA RL)

•Typical cervical joints (C2-C7)

–Sidebend and rotate to SAME side (i.e. C3 E RSL)

OPP 2: Exam 1 (5 decks)

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