Upper cervical spine

Question 1

I. Cervical Spine

Answer 1

a. Vertebrae are the smallest & most mobile
b. Transverse foramina for vertebral artery
c. Atypical vertebrae
i. C1, C2, C7
d. Typical vertebrae
i. C3 – C6

Question 2

I. Atlas (C1)

Answer 2

a. Primary function is holding the head
b. Has NO: body, pedicle, lamina, SP
c. 2 large lateral masses joined by anterior and posterior arches
d. Concave superior articular facet articulates with convex occipital condyles
e. Flat inferior articular facet sloped downward 20°
f. Largest TP’s in cervical region

Question 3

Axis (C2)

Answer 3

a. Tall body with dens on anterior side
b. Slightly convex superior articular facets oriented 20° from horizontal allow for increased rotation
c. Has pedicles, lamina, short TP’s, & bifid SP

Question 4

I. Atlanto-Occipital Joint (AO)

Answer 4

a. Convex occipital condyles roll on concave superior articular facets (roll & glide in opposite directions)
b. Primary movement = Flex/Ext 10-30°
Very little translation, rotation, or side bending

Question 5

AO arthro:

Answer 5

i. Flexion: roll anterior, slide posterior
ii. Extension: roll posterior, slide anterior
iii. Lat flexion: roll to one side, slide to opposite (very small)
iv. Rotation: restricted
v. Coupled motion: Lateral flexion & rotation occur in opposite directions
1. Ex: Lat flex to right with rotation to the left

Question 6

I. Atlanto-Axial Joint (AA)

Answer 6

a. Inferior atlantal & superior axial facets are both slightly convex (biconvex z-joints)
b. Primary movement = axial rotation 40-45° (almost ½ of all cervical rotation)

Question 7

AA arthro:

Answer 7

i. Flexion: C1 tilts anteriorly relative to C2
ii. Extension: C1 tilts posteriorly relative to C2
iii. Lateral flexion: very limited
iv. Rotation: C1 rotates around dens
v. Coupled motion: Lateral flexion & rotation occur in opposite directions
1. Ex: Lat flex to right with rotation to the left

Question 8

a. Musculature

i. Longus capitis

Answer 8

1. From occiput to anterior tubercles of C3-C6

Flexion, nodding, some ipsilateral rotation

Question 9

i. Longus colli

Answer 9

1. Anterior surfaces of C1-T3

2. Nodding, maintain cervical lordosis

Question 10

i. Sub-occipital mm (posterior)

Answer 10

1. Fine control over AO & AA joints (position eyes, ears, nose)

Question 11

i. Alar ligament

Answer 11

1. From lateral side of dens to medial side of occipital condyles
2. Resists axial rotation of head & atlas relative to dens

Question 12

i. Transverse cruciate ligament

Answer 12

1. From atlas to axis

2. Holds dens in place on posterior aspect

Question 13

i. Tectorial membrane

Answer 13

1. Continuation of PLL
2. From posterior C2 to occiput
3. Limits flexion and adds stability

Question 14

I. Vertebral Artery

Answer 14

a. Transverse foramina C6-C1

b. Must test before performing neck manipulations

Question 15

I. TMJ Structure

Answer 15

a. Condyle of mandible articulates with temporal bone
b. Classified as synovial, but no hyaline cartilage, instead joint surfaces have dense collagen
c. Articular surfaces both convex incongruent joint

Question 16

a. Articular disc

Answer 16

i. Inferior TMJ: mandibular condyle & inferior surface of disc = hinge jt.
ii. Superior TMJ: temporal bone & superior surface of disc = gliding jt.
iii. Function:
1. Create congruency for joint articulations
2. Stability
3. Minimize loss of mobility
4. Reduce friction
5. Decrease stress on TMJ

Question 17

Motions TMJ

Answer 17

i. Depression (40-50 mm): suprahyoid mm & lat. pterygoid
ii. Elevation (10-12 mm): temporalis, masseter, med. pterygoid
iii. Lateral deviation (6-9 mm): contralateral med/lat. pterygoid, ipsilateral temporalis
iv. Protrusion (6-9 mm): masseter, med/lat. pterygoid
v. Retrusion (6-9 mm): temporalis, anterior digastrics

Question 18

I. Arthorkinematics

Answer 18

a. First 11°: rotation
i. Condyle rolls relative to inferior surface of disc
b. Translation of condyle & disc along articular eminence
c. Early phase of opening:
i. 35-50% of ROM
ii. Condyle rolls posteriorly, body of mandible moves posterior & inferior
d. Late phase of opening:
i. Final 50% ROM
ii. Condyle & disc move together forward & inferior

Question 19

a. Closing

Answer 19

i. Reverse order of opening (translation first, rotation last)
ii. Retrodiscal lamina retracts disc

Question 20

I. Dysfunction of the TMJ

Answer 20

a. TMD:
i. Face, ear, mm, neck pain
ii. Tinnitus
iii. Dizziness/headache
iv. Joint sounds/limited ROM
b. Clicking
i. If the disc is anterior to the condyle:
1. Click on opening when the condyle meets the disc
2. Click on closing when the condyle slides back off the disc