Cervical Spine Lect and Lab Flashcards

(58 cards)

1
Q

Functional Anatomic Components of C-Spine

A
  • Osseous
  • Ligamentous
  • Muscular
  • Fascial
  • Neurologic
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2
Q

C- Spine Flexion

A
  • 90 degrees

- Limited by the posterior longitudinal ligament

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3
Q

C- Spine Extension

A
  • 70 degrees

- Limited by direct contact of vertebral lamina, zygapophyseal joints (facets), and spinous processes

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4
Q

C- Spine Rotation

A
  • Approximately 50% of rotation in AA joint

- Approximately 50% rest of the cervical spine

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5
Q

Define Vertebral Unit

A

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

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6
Q

Vertebra Unit Conventional Name

A

Named for superior vertebra in pair

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7
Q

Vertebral Unit Joint

A

Inferior facets of superior vertebra on superior facets of inferior vertebra

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8
Q

Vertebra Unit Motion Reference Point

A

Reference point is superior, anterior aspect of superior vertebra

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9
Q

2 Atypical C-Vertebrae

A
  • Atlas (C1) - no body

- Axis (C2) - odontoid process (dens)

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10
Q

4 Typical C-Vertebrae

A
  • C3 - C6

- Have uncovertebral joints both superiorly and inferiorly

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11
Q

Typical C-Vertebral Units

A
  • C2-C7
  • Primary Motion = Sidebending
  • Always sidebend/rotate to same side
  • Will have Flexion/Extension Component
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12
Q

Typical C-Spine Zygapophyseal Joint

A
  • Joints oriented at a 45 degree angle toward the eye.
  • Posterior is inferior
  • Anterior is superior
  • Lateral is superior
    (look at ppt image)
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13
Q

Typical Cervical Vertebrae are Unique Because…

A
  1. Uncinate Process
  2. Transverse Foramen
  3. Large Vertebral Foramen
  4. Body is Convex inferiorly, Concave superiorly
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14
Q

Atlantoaxial Joint (AA) Properties

A
  • Vertebral Unit of atlas (C1) on axis (C2)
  • Embrylogically, Body of C1 was dens, now attached to C2 (can cause congenital malformations)
  • Primary Motion = Rotation; accounts for 50% of entire neck rotation
  • Strong ligamentous attachments limit motion and instability
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15
Q

Atlantoaxial Joint (AA) Ligaments

A
  • Strong ligamentous attachments limit motion and instability
  • Alar Ligament
  • Cruciform Ligament
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16
Q

Alar Ligament

A

Attaches dens to occipital condyles

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17
Q

Occipitoatlantal (OA) Joint

A

= Occipital condyles articulating on C1

  • Primary Motion = Flexion/Extension
  • Sidebending/Rotation will ALWAYS be OPPOSITE
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18
Q

Occipitoatlantal (OA) Joint Properties

A
  • Superior articulatory facet of C1 has anterior medial convergence.
  • Posterior aspect of occipital condyles are more lateral
    and superior.
  • Anterior aspect of occipital condyles are more medial and inferior
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19
Q

8 Ligaments of the C-Spine? Which are C-Spine only?

A
  1. Anterior longitudinal ligament
  2. Posterior longitudinal ligament
  3. Ligamentum flavum
  4. Interspinal ligament
  5. Intertransverse ligament
  6. Supraspinal ligament
  7. Nuchal Ligament
  8. Posterior atlanto-occipital membrane

C-Spine only?

  1. Nuchal Lig - C7 to greater Occipital ridge
  2. Posterior atlanto-occipital membrane
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20
Q

7 Anterior Muscles of the Anterior Deep Neck

A
  1. Rectus capitis lateralis -From TP of C1 to occiput
  2. Rectus capitis anterior -From LM of C1 to occiput
  3. Longus Capitis
  4. Longus Coli
  5. Anterior Scalene
  6. Middle Scalene
  7. Posterior Scalene
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21
Q

6 Posterior Muscles of the Deep Neck

A
  1. Rectus capitis posterior minor
  2. Rectus capitis posterior major
  3. Obliquus capitis superior
  4. Obliquus capitis inferior
  5. Interspinalis Cervecis
  6. Intertransversarii Cervicis
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22
Q

4 Deep Intrinsic MM of Posterior Neck

A

1 and 2. Semispinalis Cervicis and Capitis

  1. Multifidus (Terminates at CV2)
  2. Rotatores (Terminates at CV2)
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23
Q

3 Deep Intrinsic MM of Posterior Neck

A

1 and 2. Longissimus Cervicis and Capitis

3. Iliocostalis (Terminates at lower cervical vertebrae)

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24
Q

4 Deep Intrinsic MM of Posterior Neck

A

1 and 2. Semispinalis Cervicis and Capitis

  1. Multifidus (Terminates at CV2)
  2. Rotatores (Terminates at CV2)
25
3 Deep Intrinsic MM of Posterior Neck
1 & 2. Longissimus Cervicis & Capitis | 3. Iliocostalis (Terminates at lower cervical vertebrae)
26
2 Superficial Intrinsic MM of Posterior Neck
Splenius Cervicis & Capitis
27
1 Extrinsic MM of the posterior neck
Descending Trapezius
28
Other MM of the Neck
1. SCM 2. Strap mm 3. Pharyngeal MM
29
SCM Actions
- Sidebends and rotates the head in opposite directions when unilaterally contracted - Flexes the head when bilaterally contracted
30
Cervical Fascia (7)? Which includes Sibson's Fascia?
1. Investing fascia 2. *Infrahyoid fascia 3. *Pre-tracheal fascia 4. Buccopharyngeal fascia 5. Alar fascia 6. *Pre-vertebral fascia – includes Sibson’s 7. Carotid sheath
31
Sympathetic Innervation of the Head and Neck
1. Superior cervical ganglia - Anterior to C1-2 2. Middle cervical ganglia - Anterior to C6 3. Inferior (stellate) ganglia - Anterior to C7 (inferior) May fuse with T1 (stellate)
32
Parasympathetic Innervation to most of the body?
- Vagus Nerve | - Affected by OA and C1 somatic dysfunction
33
Phrenic Nerve
- From cervical plexus (C3-5) | - Exits neck between clavicular and sternal heads of the SCM
34
Greater Occipital Nerve
- From C2 | - Can cause tension HA d/t course through descending traps (C3 may also contribute through lesser occipital nerve)
35
Brachial Plexus
- Contributions from cervical nerves 5, 6, 7, and 8. | - Passes between anterior and middle scalenes
36
C-Spine Landmarks: C1
First transverse process palpated
37
C-Spine Landmarks: C2
First spinous process palpated
38
C-Spine Landmarks: C3
At the level of the hyoid bone
39
C-Spine Landmarks: C4/C5
At the level of the thyroid cartilage
40
C-Spine Landmarks: C6
At the level of cricoid cartilage
41
C-Spine Landmarks: C7
The most prominent spinous process
42
General considerations for Palpation
- Landmarks are guides, they may not align exactly with the anatomy - Each vertebrae is about a finger’s width thick - The body and vertebral arches are much wider than the majority of the thoracic spine. - Transverse processes are much smaller than in other areas of the spine
43
Bottom Up Approach to Palpation
1. Locate post. rib 1 2. Follow medially to vertebrae 3. C7 located superior to articulation of Rib 1 to TV 1
44
Top Down Approach to Palpation
1. Locate mastoid process posterior to external auditory meatus 2. From inferior tip of mastoid process move medially to contact CV1
45
Hangman's Fracture
- Caused by forceful extension of the neck - Bilateral Fx of pars interarticularis - Can result in death
46
Den's Fracture
- Results in avascular necrosis - Concomitant cruciate ligament rupture - Results in Death or quadriplegia - Children with Down Syndrome may have a congenital absence of stabilizing ligaments
47
Erbs Palsy
- C5/C6 | - Waiters Tip
48
Klumpke's Palsy
- C8/T1 | - Claw Hand
49
Winged Scapula
Long Thoracic Nerve (C5/C6/C7)
50
Stingers and Burners Def and Dx?
= Shooting or singing pain traveling down an upper extremity - Possibly followed by numbness or weakness (should eventually resolve) - Dx? Consider a spine (not spinal cord) injury
51
Spinal Cord Injuries Can Result in ____
Paralysis
52
Torticollis Def? What can it lead to? Causes?
- Unilateral SCM contracture is the most common cause of idiopathic torticollis in children - Causes sidebending and rotation of neck in opposite directions with SCM involvement; OA restrictions - Can lead to top down scoliosis
53
Hiccoughs/Hiccups Cause? Tx?
- Can be Caused By Inbalance of phrenic nerve | - Can be treated by balancing the anterior fascia of the neck
54
Anterior Cervical Tender Points (AC1-8) Location? Tx?
AC1: Posterior edge of ascending ramus of mandible AC2-6: Anterior to transverse processes AC7: 2-3 cm lateral to clavicular head on superior aspect of clavical AC8: Medial aspect of clavicular head Tx = Flexion/Rotation away, sidebending towards
55
Lateral Cervical Tender Points (LC1-7) Location? Tx?
LC1: Lateral aspect of lateral masses LC2-7: Lateral aspect of transverse processes Tx = Sidebend towards, slight rotation away, slight flexion/extension as needed
56
Posterior Cervical Tenderpoints (PC2-C8) Location? Tx?
PC2: C2 spinous process centrally PC3-7: spinous process centrally or paracentrally (Bifid spinous processes may have TPs on each tip) PC8: between transverse process of C7 and rib 1 Tx = Extension/rotation away, Sidebending towards
57
Posterior Occipital Tenderpoints Location? Tx?
PC2: 1 cm lateral to external occipital protuberance Tx = Extension/rot/sb towards PC1-F: External occipital protuberance Tx= flex/sb towards, rot away PC1-E: 2 cm lateral to external occipital protuberance Tx= ext/sb towards, rot away
58
MM that make up the Suboccipital triangle?
Rectus capitis posterior major - above and medially Obliquus capitis superior - above and laterally Obliquus capitis inferior - below and laterally Rectus capitis posterior minor is in the region but does not make up the triangle