Spine Anatomy

Question 1

Uncovertebral joints

Answer 1

AKA Joints of Luschka; ucinated processes C3-T1

• lateral/superior surface of inferior vertebrae and inferolateral surface of superior vertebrae
• Develop w/in first 12 years life, fully developed by 33
• Guides cervical F/E, reduces SB of c-spine, prevents posterior translation of neighboring vertebrae, reinforces posterolateral aspect of IVD
• *Impairments of uncovertebral joints unaffected by F/E

Question 2

Tectorial Membrane:

Answer 2

• Connects occipital bone to C2
• superior continuation of PLL
• Important limiter in upper cervical flexion; holds occiput to atlas

Question 3

Alar Ligament:

Answer 3

• dens to medial occipital condyles
• resists flexion, C/L SB, and C/L OA rotation
• *Insufficiency increases OA instability

Question 4

Cervical spine Transverse Ligament:

Answer 4

• part of cruciform ligament
• connects C1 to Dens
• limits flexion b/t C1 and C2

Question 5

ALL

Answer 5

C-spine: Narrower in upper c-spine, wider in lower c-spine; firmly attached to inferior end plates but NOT to IVD; restricts extension

Question 6

PLL

Answer 6

C-Spine: up to C2 where it is continuous with tectorial membrane; prevents disk protrusions, restrains segmental flexion

*Broader and thicker in c-spine than thoracic/lumbar

Question 7

Ligamentum Nuchae:

Answer 7

External occipital protuberance fo C7 SP
-When OA joint flexed, tightens and pulls on deep laminae and muscular attachments AKA limits anterior translation in flexion

Question 8

Dysfunction with shortened Rectus Capitus Anterior muscle on R

Answer 8

Decreased L translation in extension at OA

Question 9

Suboccipital muscles:

Answer 9

RCP Major, RCP minor, Obliques inferior, Obliques superior
-Innervated by posterior ramus C1
Strongly linked to trigeminal nerve
b-supply from vertebral artery
-RCP Major and OCI: I/L rotate head
-RCP Major and Minor: extend head
-OCS: I/L SB

Question 10

Scalenes:

Answer 10

Anterior: C3-C6 TPs–>1st rib
Middle: C2-C7 TPs–> 1st rib
Posterior: C4-C6 TPs–>2nd rib

Ant & Middle: if neck fixed elevates first rib; if rib fixed I/L SB and C/L rotation
Post: if neck fixed elevates 2nd rib; if rib fixed I/L SBs

Question 11

What muscle does the greater occipital nerve (C2) pierce through?

Answer 11

Semispinalis Cervicis

Question 12

Where do nerves exit?

Answer 12

C-spine: ABOVE level (C1-2) = C2

t-spine: BELOW level (T1-T2)= T1

Question 13

OA joint motion:

Answer 13

F/E

*Hypermobility considered if axial rotation >8 deg here

Question 14

AA joint motion

Answer 14

rotation
–To decrease compression of vert A as rotating, I/L C1 facet moves posteriorly while C/L facet moves anteriorly (each move inferiorly)

Question 15

C-spine Arthrokinematics for F/E, rotation, SB

Answer 15

Flexion: Superior lateral glide of IAP of superior vertebra
Ext: inferior medial glide of IAP of superior vertebra
Rotation: I/L extension (closing), C/L flexion
SB: I/L extension (closing), C/L flexion (opening)

Question 16

C-spine flexion: 3 sequential phases

Answer 16

Initially at C4-7 (most at C6-7)
2nd at C0-2
last at C2-3, C3-4

Question 17

C-spine facet orientation, innervation, and % load bearing

Answer 17

45 deg to sagittal

• innervated by dorsal rami
• bear 9-25% load; if spine arthritic facets may bear 50% of load

Question 18

C spine motions at upper, middle, and lower segments

Answer 18

C0-1: 10-15 deg F/E, 8 deg SB; minimal rotation
C1-2: 10 deg F/E; 45 deg rotation; minimal/no SB
C3-7: 64 deg F 24 deg E; 40 deg SB and rotation

Question 19

T Spine AROM

Answer 19

Flexion: 6 deg
Extension: 20 deg
SB: 20-24 deg each direction

Question 20

T spine facet orientation

Answer 20

60 deg inclination from sagittal and 20 deg from frontal planes

Question 21

Disc ratios in cervical vs thoracic vs lumbar spine

Answer 21

Cervical: 2:5
thoracic: 1:5
Lumbar 1:3

Question 22

Rib TP connections vs v.body connections

Answer 22

Ribs 1-10 attach corresponding TP
Ribs 11-12 no costotransverse joints
Ribs 1, 10, 11, 12 attach to corresponding v. body only
Rib 2 attaches t T1-2, manubrium and sternum
Ribs 3-9 have superior and inferior facets that attach to superior and inferior T-spine bodies

Question 23

thoracic biomechanics: SB, with UE elevation

Answer 23

–SB: I/L translation of superior segment on inferior

With UE elevation, T-spine extends, rotates, and SB to I/L side

Question 24

Thoracic biomechanics: rotation

Answer 24

Greatest at upper T-spine, decreases with lower t-spine

• Slight C/L glide of superior segment
• Ribs: posterior rotation of I/L, anterior rotation of C/L

Question 25

Inspiration/expiration ribs movements

Answer 25

- Ribs 1-10 inspiration: lateral and superior glide (pump handle) sagittal plane elevation - Ribs 11-12 caliper motion (bucket handle) frontal plane flaring

Question 26

Serratus Anterior influence on ribs when scapula fixed

Answer 26

Will pull ribs posteriorly

Question 27

Pec major action on ribs when humerus fixed and flexed

Answer 27

pulls rib cage anteriorly, superiorly and laterally

Question 28

What happens with shortening/hypertonicity of pec minor

Answer 28

protraction and anterior tipping of scapula

Question 29

External intercostals vs internal intercostals

Answer 29

EI: direction superoposterior-->inferoanterior; pulls lower rib towards upper rib (results in inspiration) II: inferoposterior-->superoanterior; deep to and runs obliquely to EI; during forced expiration pulls upper rib down on lower rib

Question 30

Muscles of forced expiration

Answer 30

``` -Primary: Internal and external obliques RA TrA internal intercostals (posterior) transversus thoracics transversus intercostals -Secondary: Lats, Serr Post, QL, iliocostalis lumborum ```

Question 31

Muscles of inspiration

Answer 31

``` -Primary: Diaphragm, levator costorum external intercostals internal intercostals (anterior) -Accessory: Scalenes, SCM, traps, SA, SP, pec major and minor, lats, subclavius ```

Question 32

Where does subcostal nerve supply sensory innervation to ? What can happen and cause pain?

Answer 32

Supplies abdominal wall skin, lateral hip region, and over iliac crest Dysfunction of TL junction can cause pain in hip region

Question 33

T-spine biomechanics: flexion

Answer 33

F: IAP of superior vert glides superior and anterior on SAP of inferior * *Results in concomitant forward rotation of rib head at costovertebral joint * *Concave rib tubercle glides superiorly on convex facet on TP at costotransverse joint - Initiated by abdominals and continued by gravity (if unresisted) with e-spinae eccentrically controlling - Can also occur due to (B) scapular protraction

Question 34

t-spine biomechanics: extension

Answer 34

IAP of superior vert glides inferior and posterior on SAP of inferior vert * *Concomitant posterior rotation of rib head at costovertebral joint * *Concave rib tubercle glides inferiorly on convex facet on TP at costotransverse joint

Question 35

t-spine biomechanics: Side bending

Answer 35

- I/L IAP of superior vert glides inferolaterally and C/L IAP glides superomedially - I/L ribs approximate - C/L ribs seperate - -Gradually increases from T1-T12

Question 36

Lumbar neurodynamics

Answer 36

with forward being, movement at L1-L3 roots only | -With SLR greater lumbar nerve movement at lower levels

Question 37

positions for optimal disc nutrition

Answer 37

80% disc nutrition absorbed during 1st hr - Sidelying or supine optimizes nutrition - prone not recommended unless pillow under abdomen

Question 38

lumbar disc innervation:

Answer 38

Sinuvertebral nerve and gray ramus communicans from sympathetic chain