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MSK Upper Quadrant > (2) Cervical Spine Functional Anatomy / Biomechanics > Flashcards

(2) Cervical Spine Functional Anatomy / Biomechanics Flashcards

1
Q

Purpose of Vertebral Column

A

Stability allowing full mobility

Protect SC and axial neural tissues

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2
Q

Curves within Vertebral Column allow ___.

A

increased flexibility

shock-absorbing capabilities (flattening of any curve decreases shock-absorbing capability)

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3
Q

Anterior Vertebral Column

A

Vertebral Bodies

IVDs

Hydraulic and WB portion provides shock absorption

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4
Q

Posterior Vertebral Column

A

Articular Processes

Zygapophyseal (Facet) Joints

Provides gliding mechanism for movement

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5
Q

Joints Within Each Spinal Segment

A

Anterior: 2 Vertebral Bodies / IVD

Posterior: Articulations between superior articular processes of inferior vertebra and inferior articular processes of superior vertebra

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6
Q

Horizontal vs. Vertical Articular Surfaces

A

Horizontal favor axial rotation

Vertical (sagittal / frontal) block axial rotation

C-spine falls in between (mostly horizontal)

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7
Q

How does the position of the C-Spine change as you move down each level?

A

Starts mostly horizontal / moves toward 45 degrees in lower segments

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8
Q

When looking at the spine, where does the line of gravity fall?

A

On the concave side of each of the 3 curves

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9
Q

The amount of available spinal motion is affected by ___.

A

Disc-vertebral height ratio

Compliance of fibrocartilage

Dimensions / shape of adjacent vertebral end plates

Age / Disease / Gender

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10
Q

The type of spinal motion available is governed by ___.

A

Shape / orientation of articulations

Ligaments / muscles of segment

Size / location of segment’s articulating processes

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11
Q

What is the largest avascular structure in the body?

A

IVD

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12
Q

Parts of IVD

A

NP

AF

End Plate

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13
Q

Cervical / Lumbar IVDs vs. Thoracic IVDs

A

Cervical / Lumbar IVDs thicker in anterior portion (creating Lordosis)

Thoracic IVDs uniform in thickness

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14
Q

Does the IVD have the ability to move by itself?

A

No!

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15
Q

What 5 major stresses does the IVD resist?

A

Axial Compression

Shearing

Bending

Twisting

Combined motion

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16
Q

Which combined motion is a common MOI for disc herniations?

A

Bending and twisting

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17
Q

Spinal Junctions

A

Common areas for symptoms / pathologies

Craniovertebral (CV): Atlas / Axis / head

CT: Mobile lower c-spine meets stiffer upper t-spine

TL: Between t-spine (large ability to rotate) and l-spine (limited rotation abilities)

LS: Mobile l-spine meets relatively stiff SI joints

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18
Q

Mechanical (Static) Stability

A

State of equilibrium when body is still

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19
Q

Controlled (Dynamic) Stability

A

Passive System: Ability to resist forces of translation / compression / torsion (especially at end ranges)

Active System: Muscles must be coordinated within hierarchy of interdependent levels to control body relative to environment

If passive system is damaged, active picks up the slack (structures fatigue more quickly)

CNS: Feedforward / feedback control to augment stiffness
*Insufficiency results in active and passive systems working harder to maintain control (fatigue faster)

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20
Q

What two components contribute to Spinal Stability?

A

Local mobility

Global stability

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21
Q

How is spinal stability taxed / tested?

A

Through perturbations

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22
Q

Injuries in Upper Cervical Spine can involve / result in:

A

Involve brain / brainstem / SC

Can result in death / HAs / vertigo / cognitive and sympathetic system dysfunction (poorer prognoses and more lengthy recoveries)

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23
Q

Foramen Magnum (C0)

A

Alar Ligaments attach to anterior surface

Brainstem / SC junction housed posteriorly

Occipital Condyles

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24
Q

Atlas (C1)

A

Ring-like structure

Transverse Ligament attaches here

Does NOT have a SP (CV extension > CV flexion)

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25
Atlanto-Occipital (OA) Joint
Articulation between C0 and C1 ONLY vertebral level where convex condyles move on concave facet of Atlas (contralateral coupling of roll and glide)
26
Axis (C2)
Extends far posteriorly due to long SP Odontoid Process (Dens): Extends superiorly until just above C1 / susceptible to fracture / Transverse Ligament passes along posterior surface
27
Atlanto-Axial (AA) Joint
Articulation between C1 and C2 ROTATION is main function
28
Transverse Ligament
Stretches between lateral masses of C1 / connects C1 with dens of C2 Counteracts anterior translation of C1 on C2 (particularly during cervical flexion) - excessive translation in this case could cause dens to compress SC / epipharynx / vertebral artery / superior cervical ganglion
29
Alar Ligaments
Connect postero-lateral aspect of Dens to medial surface of Occipital Condyles and lateral masses on C1 Main passive restraint to contralateral axial rotation and SB in CV region
30
Anterior OA Membrane
Connects upper border of Atlas to Foramen Magnum
31
Posterior OA Membrane
Attaches posterior arch of Atlas (C1) to posterior margin of Foramen Magnum
32
Tectorial Membrane
Arises from posterior Axis and eventually becomes continuous with Dura Mater
33
Anterior Suboccipital Muscles
Rectus Capitis Anterior Rectus Capitis Lateralis
34
Posterior Suboccipital Muscles
Rectus Capitis Posterior Major Rectus Capitis Posterior Minor Obliquus Capitis Inferior Obliquus Capitis Superior
35
Cranio-Vertebral Nerve Supply
Posterior (Dorsal) Ramus of C1 - follows vertebral artery Posterior (Dorsal) Ramus of C2 - easily compressed between C1 and C2 during c-spine extension (making the movement painful) / AKA Greater Occipital Nerve
36
What areas of the Cervical Spine are implicated as primary causes of Cervicogenic HAs?
OA / AA / C2 spinal nerve
37
Cranio-Vertebral Blood Supply
Cervical Spinal Cord supplied by 2 arterial systems: central / peripheral Anterior Spinal Artery supplies central and parts of peripheral systems - makes unilateral spinal cord infarctions rare
38
Upper Cervical Spine is responsible for ___% of ROM throughout cervical region.
~50
39
Which 2 articulations permit pure axial rotation?
AA Joint (C1 / C2) T-L Junction (T12 / L1)
40
OA Joint Biomechanics
Deep sockets on C1 + no IV disc means increased bony congruency (stability) Joint design encourages flexion / extension and impedes other movements
41
___% of total cervical rotation occurs at AA Joint.
60
42
___ nature of AA Joint means ___ motions occur between lower C-Spine and Atlas.
Biconvex, opposite Lower C-Spine flexion w/ Upper C-Spine extension
43
Upper C-Spine flexion ___ space between Atlas (C1) and Dens (C2).
increases
44
Excessive gapping (instability) at C1/C2 can lead to what? In what populations do we often see this occur?
SC compression Increased age / history of trauma / severe ligamentous laxity (RA) / cancer / down syndrome / malformation of Dens
45
Where are the SPs in relation to the TPs in the Cervical Spine?
Bifid SPs at same level as TPs
46
Uncovertebral Joints / Facet Joints
Uncinate processes on supero-lateral portion of VBs - Uncovertebral Joints limit SB and stabilize IVDs Facet Joints at 45 degrees from frontal plane - allows rotation
47
Cervical IV discs are named for the vertebra ___.
above C4 disc sits between C4 and C5
48
Progression of NP
NP rapidly fibroses (by 3rd decade of life is fibrocartilaginous) Most >40 y/o's have evidence of cervical disc degeneration
49
In Degenerative Disc Disease (DDD), ___ disc height results in ___ load.
decreased, increased
50
Cervical Foramina vs. Vertebral Canal
Foramina house 8 spinal nerve root pairs / large nerve roots nearly fill diameter / susceptible to compression in the case of uncovertebral osteophytes, extension and ipsilateral SB motions Vertebral Canal houses 8 spinal cord segments / narrow space between SC and bony walls / susceptible to compression in the case of disc herniation secondary to AF being thin and weak posteriorly Small changes in either space result in significant compression of spinal nerve roots or SC
51
Cervical Ligaments
Anterior Longitudinal Ligament (ALL) Posterior Longitudinal Ligament (PLL) Ligamentum Nuchae Interspinous Ligaments Ligamentum Flavum
52
Muscles that Affect Cervical Spine (Deepest)
Cervical Flexors: Longus Capitis / Longus Colli Rectus Capitis Anterior / Lateralis
53
Muscles that Affect Cervical Spine (Intermediate Depth)
Splenius Capitis / Cervicis Semispinalis Capitis / Cervicis Erector Spinae
54
Muscles that Affect Cervical Spine (Superficial)
Trapezius SCM Levator Scapulae Rhomboids Scalenes
55
Cervical Nerve Referral Patterns
C1-3: Head and neck pain C4-8: Shoulder / anterior chest / UE / scapula
56
The Vertebral Artery is most vulnerable to compression / stretching at ___. What are the implications of this?
C1 / 2 This is why we rotate the neck in the VBI Screen completed during the series of 3 cervical clearing tests
57
Common Carotid bifurcates near ___. This artery senses changes in what?
mid to upper c-spine level (Internal / External) Carotid Artery structures sense changes in O2 and CO2 levels / BP
58
C2-C7 Flexion / Extension (Facet Movement)
Flexion: Facets move up and forward Extension: Facets move down and back
59
C2-C7 R SB / R Rotation (Facet Movement)
R SB: R facet moves down and back / L facet moves up and forward R Rotation: R facet moves down and back / L facet moves up and forward
60
Rotation is ___ coupled with SB.
ALWAYS Does not occur in isolation SB and Rotation coupling more consistent in lower c-spine (same side, L rotation occurs w/ L SB)
61
Closing Restriction in Cervical Spine
Restriction of extension / R side bending / R rotation (same side of pain)
62
Opening Restriction in Cervical Spine
Restriction of flexion / L side bending / L rotation (opposite side of pain)

MSK Upper Quadrant (8 decks)

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