MSK Session 9 - Cervical and Thoracic Spine Flashcards
(40 cards)
Describe the structure of the thoracic and cervical spine.
- Vertebrae: 7 cervical, 12 thoracic
- Discrete Single Vertebrae
I. 19 separable vertebrae
II. All capable of individual movement
- Cervical Spine: Mobile
- Thoracic Spine: Immobile
Describe the characteristics of a typical cervical vertebrae.
- Smallest of the discrete vertebrae
- Form skeleton of the neck
- Bifid Spinous Process (except C7)
- Transverse foramen in transverse process
I. Foramen transversarium
II. Conduit for vertebral artery and vein (except C7)
iii. C7 foramen transmits the accessory vertebral vein
- Large triangular vertebral (neural) foramen
- Body is small and broad from side to side.
- Superior articular facet faces upward and backward while inferior articular facet faces downward and forward.
Describe the properties of the first cervical vertebrae: Atlas
- Articulates with:
I. Occiput of skull superiorly (atlanto- occipital joint → 50% of Total flexion and extension – “nodding”)
II. Axis (C2) inferiorly – atlanto-axial joint → 50% Total rotation – shaking the head)
- No vertebral body (Body is fused with axis to form dens or odontoid process)
- No spinous process
- Widest cervical vertebra
- Vertebral arches are thick and strong to form a powerful lateral mass
Describe the properties of the second cervical vertebrae: Axis
- Strongest cervical vertebra
- Characterised by 3 main features:
I. The Odontoid Process or Dens
II. Rugged lateral mass
III. Large spinous process
- Dens and transverse ligament prevent horizontal displacement of atlas as well as the independent movement of C1 on to C2 which could give rise to neurological problems.
Describe the properties of the seventh cervical vertebrae.
- Vertebra prominens.
- Longest spinous process
- Spinous process is not bifid.
- The transverse process is large, but the foramen transversarium is small and only transmits the accessory vertebral veins.
Have an understanding of the bony and neural structures of the spinal vertebrae.
Outline the structure of the ligamentum nuchae.
- Nuchal ligament
- Thickening of the Supraspinous Ligament
- Attached to:
I. External occipital protruberance
II.. Spinous processes of all cervical vertebrae
III. Spinous process of C7
Outline the functions of the ligamentum nuchae.
- Maintains secondary curvature of cervical spine
- Helps the cervical spine support the head
- Major site of attachment of neck and trunk muscles (e.g. Trapezius, Rhomboids)
Identify and describe the structure of the ligaments of the vertebral column.
- Provide stability
- Major ligaments: anterior longitudinal and posterior longitudinal ligament (anterior and posterior to vertebral bodies)
- Anterior is stronger than posterior
Outline the movements of the cervical spine.
Describe the structure of the thoracic vertebrae.
- Demi-facets on sides of body for articulation with head of rib (T2-T8); whole facets T9-10
- Costal facets on transverse processes for articulation with tubercle of rib (except T11 and T12)
- Vertebral foramen is small and circular
Have an understanding of the articulating surfaces of the thoracic spine.
Describe the neuroanatomy of the anterior and posterior cord.
- Anterior Cord – Sensory and Motor Light Touch, Pinprick and Pain
- Posterior Cord (Dorsal Columns)– Vibration and Proprioception
- More central tracts move the arms and more lateral tracts move the legs
Describe the pathophysiology of Anterior Cord Syndrome.
- Sensory problems
- Motor problems depending on the level (part of spine affected)
Describe the pathophysiology of Central Cord Syndrome.
Arm problems more so than leg problems (inverted paraplegia)
Describe the pathophysiology of Posterior Cord Syndrome.
- Loss of proprioception
- Loss of co-ordination
Have a detailed understanding of the dermatomes of the upper limbs.
Have a detailed understanding of the dermatomes of the lower limbs.
Most muscles in the upper and lower limbs receive innervation from more than one spinal nerve root. They are therefore comprised of multiple myotomes.
Outline the myotomes for the main body movements.
The list below details which movement is most strongly associated with each myotome:
- C1/C2: Neck flexion/extension
- C3: Neck lateral flexion
- C4: Shoulder elevation
- C5: shoulder abduction and lateral rotation plus weak contribution to elbow flexion
- C6: Elbow flexion/wrist extension/supination /medial rotation of shoulder
- C7: Elbow extension/wrist flexion/pronation / weak contribution to finger flexion and extension
- C8: finger flexion / finger extension / thumb extension / wrist ulnar deviation
- T1: finger abduction and adduction
- L2: hip flexion
- L3: knee extension and hip adduction
- L4: ankle dorsiflexion
- L5: great toe extension /ankle inversion / hip abduction
- S1: ankle plantar-flexion/ankle eversion/ hip extension (or L5)
- S2: knee flexion /great toe flexion
- S3-S4: anal wink
What is a neural level?
- Last functioning (sensory and motor function) level of a neuron
- Remember level of the nipples is the junction between C4 and T4
Describe the neuroanatomy of the nerve roots.
- The nerve roots exit more horizontally in the cervical spine
- Nerve Roots in cervical spine exit above their vertebral body until the C7/T1 junction
X Rays are good at observing bony landmarks and any associated pathology.
Be able to identify structures on an X-ray of the cervical spine.
MRI’s are good at observing soft tissue and any associated problems. However they are not very good at observing bony land marks.
Outline cervical spondylosis.
- Degenerative osteoarthritis of intervertebral joints in cervical spine
- Pressure on nerve roots leads to radiculopathy:
I. Dermatomal sensory symptoms: paraesthesia, pain
II. Myotomal motor weakness
- Pressure on the cord leads to myelopathy (less common):
I. Global weakness
II.Gait dysfunction
III. Loss of balance
IV. Loss of bladder and bowel control
