Neck/ Trunk Flashcards
In which axis does the vertebral column reside?
Longitudinal
What does the vertebral column help to provide?
Upright vertical position of the body
Protects the spinal cord and visceral organs
Provides pivot point for motion and support of the head at the cervical region
Establishes a link b/t the upper and lower extremities
Organizes column segments in an effective formation to provide shock absorption from force transmission placed upon the body
Transmits weight of head, shoulder girdle, UE and trunk through the vertebral column to pelvis
Provides stable base for attachments of bones, ligaments, tendons, muscles of extremities, pelvis and rib cage
How does the vertebral column present?
Multi-jointed rod structure
Motions occur due to combine motions of individual vertebrae (provides movement as a unit but each segment has specific motions)
How many vertebral segments are there? How many are found in each segment?
33 Cervical =7 Thoracic= 12 Lumbar = 5 Sacral= 5 Coccygeal = 4
Which vertebra does tucking your chin involve?
Flexing on C1
Extending C2-C7
*referred to axial extension or cervical retraction
What is a facet joint?
Articulation b/t the superior articular process of the vertebra below w/ the inferior articular process of the vertebra above
In what plane/ axis does flexion/ext/hyperextension occur?
Sagittal plane
Frontal axis
In what plane/ axis does lateral bending occur?
Frontal plane
Sagittal axis
In what plane/ axis does rotation occur?
Transverse plane
Vertical axis
What motions occur at the Atlanto-occipital joint?
Flex/ext
Minimal lateral bending
No rotation
What structures make up the Atlanto-occipital joint?
C1 and Head
C1 and C2 make up what joint?
Atlantoaxial joint
Which vertebra are concave ANTERIORLY and convex POSTERIORLY? What type of curve does this provide?
Thoracic and Sacrococcygeal
Kyphosis
Which vertebra are convex ANTERIORLY and concave POSTERIORLY? What type of curve does this provide?
Cervical and Lumbar
Lordosis
What is the negative consequence of the natural spinal curve?
the existence of shear forces
What are the areas of transition in the axial skeleton?
C6,7- T1
T10-T12
L5-S1
By how much does the curve of the spine increase its strength?
Up to 10 times
How many intervertebral discs are there?
Where do they begin?
23
B/t C2 & C3
What is the function of the intervertebral discs?
To absorb and transmit shock and maintain flexibility of the vertebral column
What % of the length of the vertebral column do the discs comprise?
25%
Where does the line of gravity pass through the axial skeleton
Passes through the mastoid process > anterior to the 2nd sacral vertebra > posterior to the hip > anterior to the knee and ankle
Which structures located on the vertebrae dictate movement of the spine?
Facets
What types of bone make up the vertebrae?
Trabeculae (resists compressive forces)
Cortical (shell that reinforces the vertebral body)
Where is the Dens located? What does it allow for?
C2
Bone protrusion that allows articulation w/ the atlas (C1) to produce head rotation
The atlantoaxial joint allows for which motion to occur?
rotation
What happens to the vertebrae from C3-S1? Why?
The become progressively larger
What is the function of the pedicle on the vertebrae?
Transmits tension and forces from the vertebral bodies
What is the most prominent posterior projection on the vertebrae?
Spinous process
What is the opening formed by the joining of the body of the neural arch through which the spinal cord passes?
Vertebral foramen
What is the posterior portion of the neural arch that unites from each side in the midline?
Lamina
This structure is formed at the union of the lamina and pedicle, the lateral projections of the arch to which muscles and ligaments attach?
Transverse process
What opening is formed by the superior vertebral notch of the vertebra below and the inferior vertebral notch above?
Intervertebral foramen
What depressions are located on the superior and inferior surfaces of the pedicle?
Vertebral notches
This structure projects superiorly and inferiorly off the posterior surface of each lamina?
Articular process
What is the portion of the neural arch just posterior to the body and anterior to the lamina?
Pedicle
What is the anterior portion of C1?
Anterior arch
Name the structure that is also called the odontoid process?
Dens
Which vertebrae has the most prominent spinous process?
C7
What holes or openings in the transverse process of each vertebra allow for vertebral arteries to pass?
Transverse foramen
Pulpy, gelatinous substance in the center of the disk? At birth, it is comprised of what % water and it decreases to what as we age?
Nucleus pulposus
80% at birth
70% by age 60
This vertebra is ring shaped and has no spinous process. The cranium rests upon it?
Atlas (C1)
What is the outer portion of the disk consisting of several concentrically arranged fibrocatilaginous rings that serve to contain the nucleus pulposus?
Annulus fibrosus
What is a half facet called? Where is it located?
Demifacet
Located laterally on the superior and inferior edges of the vertebral body where ribs articulate w/ thoracic vertebrae
What is the small prominence in the center of the occiput?
Occipital protuberance
This bone forms the posterior, inferior part of the cranium?
Occiput
Forms the base and lateral inferior sides of the cranium?
Temporal bone
Refers to the base or inferior portion of the occiput?
Basilar area
Ridge that runs horizontally along the back of the head from the occipital protuberance toward the mastoid processes?
Nuchal line
Opening in the occipital bone through which the spinal cord enters the cranium?
Foramen magnum
Located lateral to the foramen magnum on the occiput, provides articulation w/ the atlas (c1)?
Occipital condyles
Bony prominence behind the ear to which the SCM muscles attaches?
Mastoid process
Cylindrical mass of cancellous bone, not present in the atlas
Body
What type of joint is a facet joint?
Synovial joint w/ a synovial membrane and enclosed in a joint capsule ligament
How many facet joints does each vertebra have?
2
What is the orientation of the facet joints in the lumbar, thoracic, and cervical segments?
Lumbar = sagittal plane - flex/ext Thoracic = frontal plane - rotation/ lateral flex Cervical = triplanar- all motion
What limits motion in the thoracic spine?
The ribs, shape of the vertebral bodies and length of the spinous processes
Which ligament extends from the 7th cervical vertebra distally to the sacrum posteriorly along the tips of the spinous processes?
Supraspinal ligament
This ligament runs along the vertebral bodies posteriorly, inside the vertebral foramen? Its thick superiorly to support the skull, but thin inferiorly which contributes to instability and disk injury in the lumbar region
Posterior longitudinal ligament
What does the posterior longitudinal ligament prevent?
Excessive flexion
Which ligament runs b/t successive spinous processes?
Interspinal ligament
Which ligament runs down the anterior surface of the vertebral column? It is thin superiorly and thick inferiorly where it fuses to the sacrum. It is located in the thoracic and lumbar regions just deep to the aorta.
Anterior longitudinal ligament
What does the anterior longitudinal ligament prevent?
Excessive hyperextension
What ligament takes the place of supraspinal and interspinal ligaments in the cervical region?
ligamentum nuchae (nuchal ligament)
What ligament connects adjacent lamina anteriorly?
Ligamentum flavum
What are the 4 anatomical units of the cervical spine?
Atlas, Axis, C2-C3 junctions, and remainder of the vertebral spine
The anterior atlanto-occipital membrane is an extension of which ligament?
Anterior longitudinal ligament
The tectorial membrane is an extension of which ligament?
Posterior longitudinal ligament
Concave-Convex relationship of Atlanto-occipital condyles
The convex Atlanto-occipital condyles of the occipital base are in a posterolateral direction, these articulate w/ the anteriomedial orientation of the concave superior processes of the Atlas
How many joints compose the cervical spine?
36
What is the function of the Atlas?
Cradles the occiput
Transmits forces from the head to the cervical spine
Attachment for ligaments and muscles
Has a posterior tubercle/ no spinous process
Smooth, small internal facet articulates w/ the Dens
No bony process b/t C1 & C2
C1 inferior facets articulate w/ superior facets of C2
What is the function of the Axis?
Transitional vertebrae
Located b/t craniovertebral region and traditional cervical vertebrae
Includes Dens (odontoid process)
Functions as a pivot for upper cervical joints
Provides center of rotation for the atlantoaxial joint
Atlanto-occipital joint
C1-C2, Synovial, pivot joint
Formed by the condyles of the occiput that articulate w/ the superior articular processes of the atlas
Very strong and supports weight of the head
Anterior atlanto-occipital membrane is an extension of the anterior longitudinal ligament
Tectorial ligament
Sling shaped
Supports the spinal cord as it enters the vertebral column
Continuation of the posterior longitudinal ligament
Median atlantoaxial joint
Synovial articulation b/t the Dens (odontoid process) of the axis and the anterior arch of the atlas anteriorly and the transverse ligament posteriorly
Lateral atlantoaxial joint
Located b/t the articular processes of the vertebrae
Functions of the Lower cervical spine (C3-C7)
Carry load bearing structures- head, stability, and mobility
Vertebral bodies have inferior and superior end plates- greater transverse diameter
Superior surface is concave, in frontal plane, slopes in a forward and downward direction
Inferior vertebrae is convex
Superior and inferior surfaces of the transverse processes have grooves for spinal nerves exiting the spinal cord
Transverse process contains anterior tubercle and posterior tubercle
What muscles attach to the anterior tubercle?
Anterior Scalenes, Longus capitis, Longus colli
What muscles attach to the posterior tubercle?
Illiocostalis cervicals, mid and post scalenes, and levator scap
Anterior longitudinal ligament
Runs along anterior surface of vertebral bodies
Prevents excessive hyperextension
Thin superiorly/ thick inferiorly
Fuses w/ the sacrum
Found in deep thoracic and lumbar/ deep to the aorta
Posterior longitudinal ligament
Run along posterior surface of vertebral bodies
Prevents excessive flexion
Thick superiorly/ thin inferiorly which contributes to instability of the lumbar spine, increasing the risk of disk injury
Location of Supraspinal ligament
From C7 to sacrum posteriorly
Along tips of spinous processes
Features of Cervical vertebrae
Smallest body
Largest vertebral foramen
Short spinous process
Features of Thoracic vertebrae
Intermediate body
Smallest vertebral foramen
Long spinous process
Features of Lumbar vertebrae
Largest body
Intermediate foramen
Thick spinous process
Where are the apophyseal joints oriented?
In the frontal and sagittal planes
This ligament limits flexion and serves as an attachment point for trapezius, splenius capitis and cervicus?
Ligamentum nuchae
This segment of the spine is the most injured and absorbs the majority of the body’s weight?
Lumbar
At which lumbar spinal segment does the majority of movement occur?
L4-L5 and L5-S1
What muscles cause lateral flexion of the cervical spine?
Traps (upper fibers) Levator Scapula SCM Scalenes group Splenius capitis and cervicis Longus capitis, longus colli Oblique capitis superior, intertransversarii
Muscles that perform cervical extension
Traps (upper fibers) Levator scapula Splenius capitis and cervicis Rectus capitis posterior major and minor Oblique capitis superior and inferior Semispinalis capitis Interspinalis Multifidi Rotatores Intertransversarii Longissimus cervicis, capitis, and iliocostalis cervicis (assist)
Muscle that perform cervical flexion
SCM
Anterior scalene
Longus capitis and longus colli
What is the origin and insertion of the Anterior scalenes
O= Transverse process of C3-C6 I = 1st rib
What is the origin and insertion of the middle scalenes
O= transverse process of C2-C7 I= 1st rib
What is the origin and insertion of the post scalenes
O= transverse process of C5-C7 I= 2nd rib
What is the origin and insertion of the splenius capitis
O= Spinous process of C7-T3 I= Mastoid process
What is the origin and insertion of the splenius cervicis
O= Spinous process of T3- T6 I= Transverse process of C1-C3
Muscle that perform cervical rotation
Levator scapula Splenius capitis and cervicis Rectus capitis posterior major Oblique capitis inferior Longus colli and capitis SCM and scalenes group Traps (upper fibers) and iliocostalis cervicis Multifidi Rotatores Longissimus capitis and cervicis
What separates the two sides of the rectus abdominis?
Linea alba
Origin and insertion of rectus abdominis
O= pubis I= xiphoid process and coastal cartilages of 5th, 6th, and 7th ribs
Action of the rectus abdominis
Trunk flexion and compression of the abdomen
Origin and insertion of the External oblique
O= Lateral on the lower 8 ribs I= Iliac crest and linea alba
Action of the external oblique
Bilaterally- trunk flexion, compression of abdomen
Unilaterally- lateral bending and rotation to OPPOSITE side
Origin and insertion of internal oblique
O= inguinal ligament, iliac crest, thoracolumbar fascia I= 10th-12th ribs and abdominal aponeurosis
Action of the internal oblique
Bilaterally- trunk flexion, compression of abdomen
Unilaterally- lateral bending and rotation to SAME side
Origin and insertion of transverse abdominis
O= inguinal ligament , iliac crest, thoracolumbar fascia, and last 6 ribs I= Abdominal aponeurosis and linea alba
Action of transverse abdominis
Compresses abdomen
During trunk rotation the right external oblique and left internal oblique function as ________.
Agonists- rotating to the same side
A muscle that attaches spinous process to spinous process will perform what action? Which muscles are being activated?
Extension
Spinalis and Interspinales
A muscle that attaches transverse process to transverse process will perform what action? Which muscles are being activated?
Extension and lateral bending
Longissimus and intertransversarii
A muscle that attaches spinous process to transverse process will perform what action? Which muscles are being activated?
Extension and Rotation
Splenius cervicis
A muscle that attaches transverse process to spinous process will perform what action? Which muscles are being activated?
Extension and rotation
Semispinalis, multifidus, rotatores
A muscle that attaches transverse process to rib or rib to rib will perform what action? Which muscles are being activated?
Extension and lateral bending
Iliocostalis
Shorter muscles are better at ________. Longer muscles are better at ______.
Rotation
Extension
What line of pull occurs in a muscle that attaches from spinous process to spinous process?
Vertical line of pull
They extend
What line of pull occurs in a muscle that attaches from transverse process to transverse process?
Vertical line of pull lateral to the middle line
Bilaterally: extend
Unilaterally: laterally bend
*same for muscles that attach rib to rib
What line of pull occurs in a muscle that attaches from spinous process to transverse process and vice versa?
Oblique line of pull
Bilaterally: extend
Unilaterally: rotate
What muscles comprise the erector spinae group (ES)?
Spinalis
Longissimus
Iliocostalis
What do the erector spinae group connect?
Run parallel to the vertebral column and connect spinous processes (spinalis) , transverse processes (longissimus), and ribs (iliocostalis)
The ES group are prime movers in what motion?
Trunk extension
What muscles comprise the transversospinalis group (TS)
Semispinalis
Multifidus
Rotatores
What line of pull does the TS group have? Where do they attach?
Oblique
From a transverse process to the spinous process of the vertebrae above
Motions of the TS group?
Extension and rotation
Origin and insertion of the quadratus lumborum
O= iliac crest I= 12th rib, transverse process of all 5 lumbar vertebrae
What action is perform by the quadratus lumborum and what line of pull does it have?
Trunk lateral bending
Vertical line of pull
What is the reversal of muscle action for the quadratus lumborum?
Hip hiking or hip elevation in the pelvis
Thoracic Outlet Syndrome
Compression of the neurovascular structures (brachial plexus and subclavian artery and vein)
Where is the thoracic outlet located?
B/t the 1st rib, clavicle, and the scalene muscles
Torticollis
deformity of the neck in which the person’s head is laterally bent to one side and rotated toward the other side.
Aka- wry neck
Cervical sprains
Occurs when the head suddenly and violently hyperextends then flexes
Sciatica
Pain that runs down posterior thigh and leg.
Caused by pressure on the sciatic nerve roots
Symptomatic of an underlying pathology such as a herniated disk
Lordosis
an abnormally increased curve of the lumbar spine
aka- sway back
Flat back
abnormally decreased lumbar curve
Kyphosis
Abnormally increased thoracic curve
Scoliosis
Any amount of lateral curve in the spine
Spondylosis
Spinal osteoarthritis, degenerative disorder that may result in bone spurs, thickening of ligaments, decreased disk height that results from reduced water content of the nucleus pulposus
May lead to nerve root and spinal cord compression
Spinal stenosis
narrowing of the vertebral canal that houses the spinal cord.
Its also possible to have stenosis of the intervertebral foramen through which the nerve roots pass
Herniated disks
weakness or degeneration of the annulus fibrosus, allowing the nucleus pulposus to bulge or herniate through the annulus
L4-L5 most common sites for disk lesions
Ankylosing spondylitis
chronic inflammation of the vertebral column and sacroiliac joints, leads to fusion
Progressive rheumatic disease that can lead to total loss of spinal mobility
Spondylolysis
a vertebral defect of the pars interarticularis, most commonly seen in L5
Spondylolisthesis
usually results from a fracture or giving away of the defective pars interarticularis. One vertebra slips forward in relation to the adjacent vertebra, usually L5 slips anterior on S1
Osteoporosis
disease in which bone is removed faster than it can be laid down results in decreased bone mass and density.
Commonly seen in hip, thoracic vertebra, and the wrist
Compression fractures
results in the collapse of the anterior portion of the vertebra usually caused by trauma in the lumbar region or osteoporosis in the thoracic region.
Does not usually cause spinal cord damage or paralysis b/c this is a stable fracture.
A stable fracture does not have progressive displacement or dislocation
Fractures w/ dislocations
usually result in spinal cord injury and paralysis.
Hangman’s fracture
fracture involving C2, typically occurs when there is a forceful, sudden hyperextension of the head.
Striking the head against a windshield in a MVA is often the cause
