Bones and joints of the neck

Question 1

Describe the bones and cartilages present in the anterior neck?

Answer 1

Hyoid bone

Thyroid cartilage

Cricoid cartilage

Tracheal cartilage

Question 2

Describe the bones and cartilages present in the posterior neck?

Answer 2

Atlas (C1)

Axis (C2)

C3-7

Question 3

What can happen to the cartilages in the neck with age?

Answer 3

Ossification

Question 4

When are the bones and cartilages of the neck susceptible to injury?

Answer 4

Manual forces applied to neck

Manual strangulation

Question 5

Describe the five neck regions?

Answer 5

1 Back of neck/vertebral region

2 Posterior triangle

3 Sternomastoid region

4 Anterior triangle

5 Root of the neck

Question 6

What does the posterior triangle of the neck transmit?

Answer 6

Structures to the upper limb and back

Question 7

What does the root of the neck transmit structures to?

Answer 7

Thorax

Question 8

Where does the anterior triangle of the neck transmit structures to?

Answer 8

Head

Question 9

Describe the shape of the cervical spine?

Why is it this shape?

Answer 9

Lordosis (inward curvature)

Due to shape and size of IV discs

Maintained by postvertebral muscles, which extend the head on the neck and extend the cervical spine

Question 10

Describe a typical cervical vertebra?

Answer 10

Body

Transverse mass with anterior and posterior tubercles

Transverse foraminae (between anterior and posterior tubercles)

Bifid spinous process

Long spinous process

IV foramen

Unicnate process (C3-C6)

Articular surfaces oriented at 45 degress

Question 11

Describe the purpose of bifid spinous processes in cervical vertebrae?

Answer 11

Increased surface area for several muscles and ligaments that attch at this location

Question 12

How can vertebrae be counted externally?

Answer 12

Use C7 (vertebra prominens) as landmark

Question 13

Describe the purpose of uncinate processes on C3-C6?

Answer 13

Keeps majority of movements in sagittal plane

Question 14

Describe the lateral vertebral muscles?

Answer 14

SCALENES

Scalenus anterior, scalenus medius and scalenus posterior

Located deep to prevertebral fascia

Question 15

Describe the attachments of the scalenus muscles?

Answer 15

Attach to transverse processes (anterior and posterior tubercles)

Question 16

Describe the importance of scalenus anterior?

Answer 16

Key landmark in neck

Scalenus medius behind (arises from posterior tubercles)

Subclavian artery and brachail plexus lie between scalenus anterior in front and scalenus medius behind

Phrenic nerve sits on scalenus anterior

Question 17

Where are the prevertebral muscles located?

Answer 17

Deep to prevertebral fascia

Question 18

Describe some of the variations of the vertebral column that may occur?

Answer 18

Cranial or caudal shift > cervical or lumbar ribs

Question 19

Describe the consequences of a cervical rib?

Answer 19

Nerve entrapment

Lower trunk (C8/T1) coming up from thorax and may be irritated/compressed/trapped by rib

Question 20

Describe the atlas?

Answer 20

No body (ring of bone)

Anterior and posterior arches

Facet for dens (anterior arch)

Facet for occipital condyles

Longest transverse processes

Question 21

Describe the axis?

Answer 21

Dens (odontoid process)

Surfaces on dens for articulation with anterior arch of atlas

Strong spinous process

Question 22

Describe the spinal cord and nerves within the cervical spine?

Answer 22

Nerve roots short and horizontal

C1 and C2 nerve roots pass behind facet joints

Below C2, nerve roots pass between facet joint and transverse foramen

Question 23

Describe the effects of ageing on the cervical vertebrae?

Answer 23

Osteophytic outgrowths can develop

Involve facet region and region where unicinate process is

Osteophytes can migrate towards transverse foramen and area of nerve root

Question 24

What is the significance of the anterior tubercle of C6?

Answer 24

Carotid tubercle

Separates common carotid from vertebral artery

Question 25

How are the vertebral arteries transmitted in the neck?

Answer 25

Transverse foraminae C6-C1

Question 26

Where is the point of bifurcation of the common carotid artery?

Answer 26

C4 vertebra

Question 27

Describe the IV discs of the cervical spine?

Answer 27

Relatively largest in body

Question 28

Describe the role of the IV discs in the cervical spine?

Answer 28

Form cervical lordosis Prevent forward slip and limit rotation

Question 29

What is the joint between C1 and the skull called?

Answer 29

Atlanto-occipital joint

Question 30

What is the joint between C1 and C2 called?

Answer 30

Atlanto-axial joint

Question 31

Can disc prolapse occur in the cervical spine?

Answer 31

Yes Less common than in lumbar spine Usually occur in anterior direction Usually trauma related

Question 32

Describe the orientation of the facet joints in the cervical spine?

Answer 32

Oriented at 45 degrees between coronal and horizontal planes

Question 33

What innervates the capsules of the facet joints in the cervical spine?

Answer 33

Posterior rami

Question 34

Describe the injuries that can occur at facet joints? Which structures can be damaged?

Answer 34

Whiplash injury (acceleration of head in AP direction) Compression injury in hyper-extension Injury to facet capsule, articular surfaces, supporting ligaments

Question 35

Describe the structure of the atlanto-occipital joints?

Answer 35

2 lateral synovial joints Between occipital condyles and facets on atlas Loose fibrous capsule

Question 36

Describe the structure of the atlanto-axial joints?

Answer 36

3 synovial joints Median pivot joint between dens of C2 and anterior arch of atlas 2 lateral facet joints

Question 37

What holds the pivot joint in the atlanto-axial joint in place?

Answer 37

Transverse ligament

Question 38

Which movements does the atlanto-occipital joint allow?

Answer 38

Flexion/extension

Question 39

Which movemements does the atlanto-axial joint allow?

Answer 39

Rotation

Question 40

Describe the ligamentum nuchae?

Answer 40

Continuous wih supraspinous ligament From external occipital protuberance to spinous process of C7

Question 41

Describe the posterior atlanto-occipital membrane?

Answer 41

Ligament between atlas and occiput Equivalent to ligamentum flavum at other vertebral levels

Question 42

Describe the anterior atlanto-occipital membrane?

Answer 42

Connects atlas to occiput anteriorly Equivalent to anterior longitudinal ligament

Question 43

Describe the membrana tectoria?

Answer 43

Connects atlas to occiput Equivalent to posterior longitudinal ligament

Question 44

Describe the function of the ligaments in the cervical spine?

Answer 44

Resist movements in sagittal plane (F/E)

Question 45

Describe the specialised ligaments between the occiput and the axis?

Answer 45

Transverse ligament : stabilises dens Alar ligaments: resist range of rotation of atlas around dens

Question 46

When are the alar ligaments susceptible to injury?

Answer 46

Head flexed and rotated and muscles relaxed