Suboccipital

Question 1

Occiput embryology

Answer 1

. Formed in 4 parts
. Each part is separated by synchondrosis
. Ossifies before adulthood
. Diagnosis in infants and adults is different

Question 2

Occiput in infants

Answer 2

. Asymmetric molding of bones can cause functional disturbances (strabismus, poor feeding, recurrent otitis media)
. Screen newborn for infantile torticollis
. Back to bed movement

Question 3

Suboccipital dysfunctions

Answer 3

. Headaches
. Neck and head pain
. ANS

Question 4

Sympathetics in suboccipital region

Answer 4

. Sympathetic fibers to head and neck begin in T1-4
. After leaving spinal cord fibers enter sympathetic chain and for sup., middle., and inf., cervical ganglion
. Sympathetic fibers synapse w/ these ganglia and post ganglionic branches. Ascend to reach the structures in head and neck

Question 5

Parasympathetics in suboccipital region

Answer 5

. Exit via jugular foramen and descend ant. To axis
. Receive additional innervation from greater and lesser occipital nn. At C2
. Innervate viscera above diaphragm, kidneys, and upper ureters
. Hyperactivity assoc. w/ high cervical spinal segmental facilitation and segmentally related tissue texture change and tenderness

Question 6

vagus in heart

Answer 6

. Right innervates SA node

. Left innervates AV node

Question 7

Vagus in GI tract

Answer 7

. Right innervates lesser curvature of stomach, small intestine, ascending part of transverse colon
. Left innervates greater curvature of stomach and dueodenum
. Symptoms: hyperchlorhydria, hypermobility, IBS

Question 8

Nn. In suboccipital region

Answer 8

. Cervical plexus: lesser occipital, greater auricular, and supraclavicular
. Phrenic n.
. CN XI

Question 9

Occipital neuralgia

Answer 9

. Headache pain assoc. w/ compression/irritation of lesser or great occipital nn. Or occipital a.
. Severe pain in upper neck and back of head, often radiating toward the eye
. Intermittent or constant
. Causes: trauma, tumor compression of n./a. At C1-2, AA joint dysfunction, sprain of atlantoaxial ligament, muscular tension/strain, repetitive postural strain

Question 10

Occipital region superficial mm.

Answer 10

. SCM
. Trapezius
. Erector spinae

Question 11

Deep suboccipital mm.

Answer 11

. Common cause of tension headaches
. Pain from occipital triangle mm. Typically penetrates deep to skull
. Other headache mm.: occpitalis and frontalis, semispinalis capitis, SCM and trapezius

Question 12

Torticollis

Answer 12

. Acute muscular stiff neck

. Dystonia of SCM: n. Supply to SCM disrupted from congenital, trauma, drug reaction, tumor, inflammation

Question 13

T/F the OA and AA do not demonstrate true Type I or II motion mechanics

Answer 13

T

Question 14

Occiput on atlas

Answer 14

. Atypical vertebrae inn terms of structure and motion

. Follows type I like mechanics, sidebending and rotation in opposite sides despite flexion, extension., or neutral

Question 15

Atlas on axis

Answer 15

. Atypical vertebrae
. Primary motion is rotation
. Very minor motions of fl/extension and sidebending

Question 16

OA joint articulation and motion

Answer 16

. Occipital condyles are convex and articulate w/ concave surface of atlas.
. Allow rocking/gliding motions incorporated into fl/extension
. 50% of all cervical fl/extension occurs at OA
. Minor sidebending and rotation exist
. Extension accompanies by slight ant. Glide
. Flexion accompanied by post. Glide

Question 17

Occiput shape and motion

Answer 17

. Convex occipital condyles converge ant. At 30 degree angle at downward slope
. Shape and ankle allows not only the rocking/gliding motions of fl/extension and sidebending and rotation to opposite sides
. Motions is type I like

Question 18

OA dysfunctions

Answer 18

. 2 sides to every OA dysfunction

. If left condyle extends glides ant. The right condyle flexes glides post. And vice versa

Question 19

Atlas characteristics

Answer 19

. No vertebral body
. Modified transverse processes that contain foramen for vertebral a.
. Sits on bifid process of axis
. Rotation is major motion, contributes to 50% cervical spine rotation

Question 20

Atlantoaxial ligaments

Answer 20

. Transverse ligament fails from trauma or disease the dens isn’t anchored and can move sup. And cause paralysis
. Death is dens reaches medulla
. Alar ligaments: weaker ligaments and can be over stretched in trauma/disease leading to inc. in pathological motion up to 30%