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Y1 TP2 Musculoskeletal System > 6. Cervical Spine And Brachial Plexus > Flashcards

6. Cervical Spine And Brachial Plexus Flashcards

1
Q

Number of cervical vertebrae

A

7

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2
Q

Number of thoracic vertebrae

A

12

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3
Q

Number of lumbar vertebrae

A

5

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4
Q

Number of sacral vertebrae

A

5

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5
Q

Number of coccygeal vertebrae

A

4

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6
Q

3 functions of the vertebral column

A
  • Protect spinal cord and spinal nerves
  • Support weight of the body superior to the level of the pelvis
  • Partly rigid and flexible axis for the body and an extended base on which head is placed and pivots
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7
Q

nucleous pulposus

A

Middle part of intervertebral disc

Remnant of notochord

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8
Q

General structure of vertebrae

A

– x1 spinous
– x2 transverse
– x4 articular

* Pedicle 
* Lamina
* Vertebral body
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9
Q

the facet/zygapophysial joint

A

• Vertebrae articulate at inferior & superior articular processes (forming the facet/zygapophysial joint) - synovial joints

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10
Q

• Superior & inferior vertebral notch

A

• Superior & inferior vertebral notch of adjacent vertebrae form IV foramen (spinal nerves go through here)

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11
Q

Nerve roots - exits

A

• Nerve roots in c-spine exit ABOVE their vertebral body – UNTIL C7/T1

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12
Q

C1 – C7 vertebrae

Nerve exits

A

• Spinal nerves exit above the vertebrae pedicle

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13
Q

C8 nerve ext

A

• Spinal nerve emerges inferior to the vertebrae pedicle

At C7

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14
Q

From t1

- nerve exits

A

Nerves come out inferior to pedicle

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15
Q

Vertebral canal

A

Succession of vertebral foramina form the vertebral canal (which contains spinal cord and spinal nerve roots, meninges, fat, vessels)

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16
Q

Cervical vertebrae

A

Located between the cranium & thoracic vertebrae
• Smallest of the 24 moveable vertebrae

• Thereis no IV disc betweenthe occiput,C1 &C2
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17
Q

Cervical foramen

A

2 openings = Foramen transversarium (aka transverse foramen)
• Vertebral arteries & veins pass through here
• • (except C7, only small accessory veins)
• – C7 transverse foramen are small and sometimes absent

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18
Q

Cervical vertebrae - structure

A

• Anterior & posterior tubercle of transverse process provide attachment for cervical muscles (levator scapulae & scalenes)
• Scalenes anterior and medius, between these are the roots of the spinal nerves C5-T1
– Anterior rami of spinal nerves run in the groove of transverse process

• Anterior tubercle of C6 is called carotid tubercle

Cervical vertebrae have bifid spinous processes

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19
Q

C3-C7 are typical cervical vertebrae

A

– Large foramina (to accommodate cervical enlargement of spinal cord)
– Articulation allows flexion/extension, some lateral flexion

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20
Q

C7

A

• C7 has a long spinous process (C7 sometimes called vertebra prominens)

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21
Q

C1 - arias

A

• C1 has NO body and NO spinous process
– During development, body of C1 fuses with C2 to become the dens of C2 – odontoid peg

• Ring shaped with two lateral masses
– Each mass articulates above with an occipital condyle (atlantooccipital joint), and below with superior articularprocess of C2
• AO joint allows nodding movement

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22
Q

odontoid peg

A

– During development, body of C1 fuses with C2 to become the dens of C2 – odontoid peg

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23
Q

Vertebral artery

A

Vertebral artery runs in the groove on the superior surface of posterior arch
– C1 nerve also runs in this groove

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24
Q

3 branches of Aortic arch

A

• Brachocephalic artery
• Common carotid artery
Subcalivian artery – shows stenosis in subclavian, subclavian goes to vertebral artery

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25
Q

Subclavian steals syndrome

A

○ Subclavian steal syndrome – arm steals blood so less goes to head

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26
Q

C2 - axis

A

• Has two large superior articular facets on which the atlas rotates
• Large bifid spinous process
• Distinguishing feature is the odontoid peg (dens)
– Projects superiorly from the body
• Allows rotation of the head

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27
Q

TRANSVERSE LIGAMENT

A

Dens is held in position by the transverse ligament of the atlas
– Ligament is between lateral masses of atlas
• Runs between dens and spinal cord
– Prevents posterior displacement of the dens and anterior displacement of atlas

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28
Q

ALAR LIGAMENT

A

Alar ligament extends from side of dens to lateral margins of foramen magnum – Prevent excessive rotation at the joints

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29
Q

6 Ligaments of vertebral column

A
  • Anterior longitudinal ligament = strongest, prevent hyperextension of neck
    • Posterior longitudinal ligament
    • Ligamenta flava
    • Supraspinous ligaments
    • Interspinous ligaments
    • Intertransverse ligaments
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30
Q

Interspinous ligament

A

Between spines

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31
Q

• Ligamenta flava

A

– Thin broad elastic ligaments
• Form part of posterior surface of vertebral canal
– Extends from superior lamina to cervical lamina below
» Help preserve normal spinal curvature

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32
Q

• Nuchal ligament

A

– Sheet of strong fibrous tissue
• Found in medial saggital plane
– From external occipital protuberance to foramen magnum, to spinous process of C7

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33
Q

• Supraspinous ligament

A

– Band connecting tips of spinous processes from C7 to sacrum
• Merges superiorly with nuchal ligament

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34
Q

Anterior longitudinal ligament

A

– strongest = Strong broad fibrous band
• Prevents hyperextension
– Attached to vertebral bodies & IV discs
» Extends from pelvic surface of sacrum to anterior tubercle C1

• Continues superiorly as anterior atlanto-axial membrane and atlantooccipital membrane

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35
Q

• Posterior longitudinal ligament

A

– Narrower, weaker band
• Runs within vertebral canal on posterior part of vertebral bodies
– Attached mainly to IV discs from C2 to sacrum

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36
Q

• Tectorial membrane

A

– Is the upper part of posterior longitudinal ligament connecting C2 to inside of base of skull

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37
Q

Dislocation of cervical vertebrae

A

Cervical vertebrae articular facets are more horizontal than other vertebrae
• Can slip over each other more easily

  • Can be dislocated with less force than is required to fracture them
  • Because of large vertebral canal, slight dislocation can occur without damaging spinal cord
  • Dislocation may self-reduce (slip back into place) so X-ray may not show any damage
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38
Q

Fracture and dislocation of atlas C1

A

Taller side of the lateral mass is on the outside
– vertical forces (e.g. striking the bottom of the pool in a diving accident) compress the lateral masses between occipital condyles & axis, driving lateral masses apart
• Fracture of anterior/posterior arches can occur

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39
Q

Fracture and dislocation of axis C2

A

• Fracture of vertebral arch most common
– Usually occurs in pars interarticularis (bony column formed by superior & inferior articularprocesses)

• Fracture here is called traumatic spondylolysis
– Usually occur because of hyperextension of head on the neck (anterior longitudinal ligament prevents hyperextension)
• Aka hangman’s fracture

• Severe injuries cause C2 to displace anteriorly leading to quadriplegia or death

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40
Q

Fracture of the dens of axis

A

• Most common dens fracture occurs at its base – inferior to base of dens

• Often fractures are unstable (do not reunite)
– Transverse ligament becomes interposed between fragments
– Dens no longer has blood supply resulting in avascular necrosis

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41
Q

Fractures of vertebral body

A

• Fractures of vertebral body occur inferior to base of dens
– Heals more readily as fragments retain blood supply

42
Q

Cervical spondylosis

A

• Degenerative disorder of cervical IV discs leading to:
– osteophyte formation = rough regrows of bone can cause pain, like little spurs
– Hypertrophy of adjacent facet joints & ligaments
– Loss of disc height
• Pressure on nerve roots leads to radiculopathy
• Pressure on the spinal cord leads to myelopathy

43
Q

Cervical myelopathy

A

Cord compression resulting from spondylitic disease

• Myelopathy due to cervical degenerative change is most common cause of spinal code dysfunction aged 55 & over

44
Q

Thoracic vertebrae

A

Bilateral costal facets (demifacets)on the vertebral bodies
– For articulation with the head of the rib

• Costal facets on the transverse processes (costa means rib – 2 costal facets on each side of body)
– For articulation with the tubercles of ribs
• (Except for inferior two or three thoracic vertebrae)

• Long, inferiorly slanting spinous processes

45
Q

T1 - t4

A

• T1-T4 share some features with cervical vertebrae

46
Q

T5- t8

A

• T5-T8 show all typical features

47
Q

T9-t12

A

• T9-T12 show some features of lumbar vertebrae

48
Q

Axilla

A

—> Irregularly shaped pyramidal space

  • Inferior to glenohumeral joint and superior to axillary fascia at the junction of arm and thorax
    • Allows thing to pass through
49
Q

Cords

A

Cords names are derived from relationship to the second part of the axillary artery (posterior to pec minor)
– E.g. lateral cord is lateral to axillary artery

50
Q

Structure of vessels in axial

A

Roots C5 – T1 lie between scalaneus anterior and medius
Trunks 1,2,3 upper, middle and lower run across posterior triangle of neck
Divisons occur under clavical
Subclavian artery – under surface of clavicle –as cords form out from the clavicle they are related to the axilalry artery

51
Q

axillary inlet margins

A

– Medial margin: lateral border of rib I
– Anterior margin: posterior surface of clavicle
– Posterior margin: superior border of the scapula
– Apex formed by medial aspect of coracoid process

52
Q

Walls of axilla

A

Anterior wall
– Lateral pectoralis major, pec minor, subclavius & clavipectoral fascia

• Medial wall
– Upper thoracic wall & serratus anterior

• Lateral wall
– Intertubercular sulcus of humerus

• Posterior wall
– Costal surface of scapula & subscapularis, lat dorsi, teres minor, long head of triceps

Base
– Formed by skin, subcutaneous tissue,axillary fascia

53
Q

Axilalry contents

A

Blood vessels
– Axillary artery & vein + branches of both

• Lymph vessels & axillary lymph nodes
• Fat
• Nerves
– Brachial plexus

54
Q

Axillary sheath

A

extension of cervical fascia - covers contents of axilla

55
Q

5 main groups of Lymph nodes

A 
– Pectoral (anterior) 
– Subscapular (posterior) 
– Humeral (lateral)
 – Central 
– Apical
56
Q

• Pectoral nodes

A

– 3-5 nodes along the medial wall of the axilla

– Receive lymph from the anterior thoracic wall, including most of the breast

57
Q

• Subscapular nodes

A

– 6-7 nodes along posterior axillary fold

– Receive lymph from the posterior aspect of thoracic wall & scapular region

58
Q

• Humeral nodes

A

– 4-6 nodes along lateral axillawall

– Receive lymph from upper limb (except that carried by vessels accompanying the cephalic vein)

59
Q

Lymph drainage

A
  • central
    • apical
    • Subclavian lymphatic trunk
    • Right lymphatic duct or left thoracic duct
60
Q

Roots of brachial plexus

A

Roots C5-T1

  • Anterior rami of C5-T1
  • Receive gray rami sympathetic fibres from cervical ganglia
  • Enter posterior triangle of the neck by passing between anterior and middle scalene muscles, lie superior & posterior to subclavian artery
61
Q

Parts of brachial plexus

A
  • Roots
  • Trunks – superior, middle, inferior
  • Divisions
  • Cords – lateral, posterior, medial
  • Terminal nerves/ branches
62
Q

What is the brachial plexus

A

• Major nerve network supplying the upper limb
– Starts in neck, extends into axilla
– Formed by the union of anterior rami of C5-T1

63
Q

3 nerves that come off from the roots

A
  • Dorsal scapular (C5) supply rhomboids
    • Subclavius nerve supplies subclavian muscle (C5,6)
    • Long thoracic (C5,6,7) supply sorateus anterior muscle
64
Q

Nerve that comes off trunk

A

Only 1 nerve comes from the trunks – suprascapular nerve

65
Q

3 nerves from lateral cord

A
  • Musculocutaneous nerve – supply briceps bracheolous and coraco brachiallis
    • Lateral pectoral nerve supplies pectorus major muscle
    • Median nerve – supply forearm flexors
66
Q

5 nerves from posterior cord

A
  • Thoracodorsal – supplie litimus dorsal muscle (c6,7,8\0
    • Upper and lower subscapular nerves (C5,C6)
    • Axillary nerve
    • Radial nerve – supply forearm extensor muscles (c5,t1)
67
Q

5 nerves from medial cord

A

• Medial pectoral nerve
• Ulna nerve
• Cutaneous nerve of arm and forarm
Part that forms medial nerve

68
Q

Dorsal horn

A

Sensory nerves go into dorsal horn

69
Q

Ventral horn

A

Somatic motor merves go out of ventral horn

70
Q

Trunks

A
  • 3 trunks originate from roots
  • Pass laterally over rib 1 & enter axilla
  • Superior trunk = C5 + C6
  • Middle trunk = C7
  • Inferior trunk = C8 + T1

• Each trunk divides into anterior & posterior

71
Q

Divisions

A

• Each trunk divides into an anterior & posterior division

72
Q

Anterior division - brachial plexus

A

– Ant divisions supply anterior(flexor) compartments of upper limb

73
Q

Posterior division - brachial plexus

A

– Post divisions supply posterior (extensor) compartments

74
Q

Cords

A

• 3 cords formed from the divisions

– Lateral cord, formed from superior & middle trunk anterior divisions
– Medial cord, formed from inferior trunk anterior division
– Posterior cord, all three trunk posterior divisions

75
Q

Axillary artery

A
  • Is a continuation of the subclavian artery, and eventually continues as the brachial artery
  • Divided into 3 sections based on location relative to pectoralis minor

– First part: location between lateral border of 1st rib & medial border of pec minor muscle
– Second part: posterior to pec minor
– Third part: extends from lateral border of pec minorto inferior border of teres major

76
Q

Branches of axillary artery

A

– First part has 1 branch: superior thoracic artery
– Second part has 2 branches: thoracoacromial, lateral thoracic arteries
– Third part has 3 branches: subscapular, anterior circumflex humeral, posterior circumflex humeral arteries

77
Q

Cervical ribs

A

• Common anomaly
• 1-2% of people
• Extra rib, of varying length articulating with C7
– May put pressure on structures e.g. subclavian artery,impinge on brachial plexus
• Can cause thoracic outlet syndrome

Each vertebrae has transverse processes – sometimes these can grow out to form cervical ribs

78
Q

Location of roots

A

• Between scalenus anterior and medius

79
Q

Location of trunks

A

• Posterior triangle of neck

80
Q

Location of division

A

• Behind the clavicle

81
Q

Location of cords

A

• In the axilla

82
Q

Location of nerves/branches

A

• Junction axilla/upper limb

83
Q

Identifying site of injury in brachial plexus

A

—> different lesions and things

If damage is at the roots = no movement of upper limb – dangerous

If lesions are distal – some parts are still preserved

84
Q

Supraclavicular injury

A
  • Injury above clavicle affecting trunks

* – high energy, result in stretch injury

85
Q

Avulsion V’s rupture

A

• Traction, pulling, stretching out = too much stretching = rupture

Disc compression of the nerve

86
Q

Cervical disc prolapse

A
  • Aka “slipped disc”
  • Herniated disc material protrudes through a tear in the annulus fibrosus causing compression on a root – annular rings like a tree trunk round nucleus pulposus, due to tear the nucleous pulposus bulges through
  • Tear in annulus due to compression& rotation of disc
87
Q

Leffert classification

A
  1. Open
  2. Closed
    2a supraclavicular
    2b infraclavicular
  3. Radiation
  4. Obstetric 4a Erbs 4b Klumpkes 4c mixed
88
Q

Obstetric brachial plexus injury

A

• Similar to the supraclavicular motorcycle injury – stretch involving upper parts of the brachial plexus

89
Q

Erb’s palsy C5/6

A

“waiter’stip” positon adducted, internally rotated shoulder; pronated forearm, extended elbow
• Can’t supinated
• Biceps is c5,6

90
Q

Klumpke’s palsy c8,t1

A

—> lower trunk, ulnar nerve

Deficit of all of the small muscles of the hand →“claw hand”
• wrist in extreme extension because of the unopposed wrist extensors
• hyperextension of MCP due to loss of hand intrinsics (lumbricals)
• flexion of IP joints due to loss of hand intrinsics (lumbricals)

91
Q

Horner’s syndrome

A

• Lesion of cervical sympathetic trunk in neck results in sympathetic disturbance
T1 can convey autonomotic sympathetic symptoms
• Constriction of pupils
• Ptosis – of the eyelids – drooping
• Anhydrosis – absence of sweating on forehead

92
Q

Diagnosis of brachial plexus injury

A

Nerve injury
Spontaneous recovery
Clinical examination
Intervention vs Observation

93
Q

Nerve injury

A
  • Motor loss

* Sensory loss

94
Q

Spontaneous recovery

A
  • Complete

* Incomplete

95
Q

Clinical examination

A
  • Imaging Nerve

* conduction studies

96
Q

Intervention vs Observation

A

Optimal time frames for repair so:
• Have brachial plexus injury on your radar
• Assess patient carefully and serially
• Liaise with specialist unit early

97
Q

Wallarian degernation of distal segment

A

• Regernation of the nerves

Axon (fibre) transected, proximal cell body is “OK”
*Myelin sheath - phagocytosed by macrophages (neurilaemmal sheath unaffected)
Schwann cells proliferate rapidly and fill the tube
Proximal end undergoes regeneration and grows down the tube

98
Q

Neuropraxia

A

• endoneurial tube in tact

99
Q

Neurotmesis

A

• epineurium divided, damaged, no recovery potential

100
Q

Axonotmesis

A

• endoneurial tube NOT in tact but epineurium in tact

101
Q

Nerve grafting

A
  • use the Sural nerve – superficial nerve beteen gastronemius
    • Supplies lateral aspect of foot
    • Can be used as a graph
102
Q

Whiplash

A

Nerve injury
-Damage to anterior longitudinal ligaments
Can dislocate cervical vertebrae

Y1 TP2 Musculoskeletal System (10 decks)

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