bones and joints of the neck

Question 1

structures in neck are divided by layers of […] into compartments for 1) bones and muscle, 2)viscera and cartilages and 3)vessels

Answer 1

fascia

Question 2

5 layers of fascia:

Answer 2

superficial fascia, and

4 layers of deep cervical fascia (investing layer, pretracheal, prevertebral, and carotid sheath).

Question 3

what structures/vessels does the carotid sheath contain?

Answer 3

internal jugular vein, common carotid, and vagus nerve (X)

Question 4

which regions make up the anterior and posterior neck?

Answer 4

anterior:

• anterior triangle
• root of the neck

posterior:

• posterior triangle
• back of neck/vertebral region
• sternomastoid region

Question 5

[…] muscles extend the head on the neck, and maintain the […] curvature of the cervical spine.

–>counteract the gravitation pulldown of the head.

Answer 5

postvertebral

lordotic

Question 6

cervical vertebrae possess transverse foramina that allow the [….] artery to pass through on the way to the foramen magnum to end in [….].

Answer 6

vertebral

the circle of willis

Question 7

C3-C6 are unique cervical vertebrae as they posses uncinate processes that function to….

Answer 7

limit lateral flexion.

Question 8

C7 characteristically has the longest [….], referred to as the vertebra prominens

Answer 8

spinous process

Question 9

in general, cervical vertebra have articular surfaces oriented at […..] degrees, [….] foramen, transverse foraminae, bifid [….], and transverse mass - anterior and posterior [….]

Answer 9

45 deg
transverse
spinous processes
tubercles

Question 10

C1, referred to as […] and C2, referred to as […] are atypical cervical vertebrae because [……]

Answer 10

atlas
axis

neither have vertebral bodies. C2 has an odontioid process (“dens”) that articulates with C1 (facet for dens) on anterior arch. Allows rotation on the axis.

Question 11

C1 has saucer shaped upper surfaces for articulation with the [….]. It also has the longest [….]

Answer 11

occipital condyles

transverse processes.

Question 12

a cranial shift results in a [….] rib at vertebrae […]. Not a typical rib, this is actually elongation of [….]. This can result in [….] of the atlas. This has a prevalence of […]

Answer 12

cervical
C7
anterior tubercle.
occipitalization.
1%

Question 13

a caudal shift results in a […] rib at vertebrae [..].

Answer 13

lumbar

L1

Question 14

transverse processes of cervical vertebrae (anterior and posterior tubercles and intertubercular lamina) for attachment of lateral muscles: [….]

Answer 14

scalenus anterior/medius/posterior

Question 15

which important vessels pass between scalenus anterior and medius?

Answer 15

subclavian artery and brachial plexus.

Question 16

the prevertebral muscles are contained anteriorly within the [….] fascia. the longest of these is the [….], which functions to maintain curvature of the cervical spine.

Answer 16

prevertebral fascia

longus colli

Question 17

the spinous process of C2 is the attachment point for the [….] muscle

Answer 17

erector spinae

Question 18

which arterial landmark is associated with the c4 vertebra

Answer 18

bifurcation of common carotid artery

Question 19

which arterial landmark is associated with the anterior tubercle of C6?

clinical significance?

Answer 19

carotid tubercle

(This separates the carotid artery from the vertebral artery and the carotid artery can be massaged against this tubercle to relieve the symptoms of supraventricular tachycardia.
Also used as a landmark for anaesthesia of the brachial plexus and cervical plexus.)

Question 20

which arterial landmark is associated with the transverse foraminae from C1-C6?

Answer 20

vertebral artery.

Question 21

what are the superior (suboccipital) joints of the cervical spine?

Answer 21

atlanto-occipital (O-C1)

atlanto-axial (C1-C2)

Question 22

what are the inferior joints of the cervical spine?

Answer 22

between c2-c7 are intervertebral discs and facet joints

Question 23

intervertebral discs begin at which vertebrae?

Answer 23

C2

*cervical vertebrae have the largest discs in the vertebral column

Question 24

intervertebral discs function to prevent […].

[….] form on the superior margins of the disc body to guide movement.

Answer 24

forward slip and rotation.

uncinate processes.

Question 25

cervical prolapse is less common than lumbar prolapse, but may occur from trauma involving [….] movement with or without […].

This injury may also impinge on […..].

Answer 25

flexion/extension
rotation

cord +/- nerve roots in vertebral canal

Question 26

facet joints are plane synovial joints, with the capsule innervated by [….].

these are oriented at […] degrees between coronal and horizontal planes. they function to permit [….] and […] movements.

Answer 26

posterior rami

45 deg
flexion/extension and rotation.

Question 27

most common way to injure facet joints?

which position is most vulnerable to compression injury?

Answer 27

whiplash injury - acceleration of head in antero/posterior direction.

compression injury most vulnerable in hyperextension postion.

Question 28

the atlanto-occipital joints consist of 2 lateral synovial joints between […..]. These permit […] movements —> 15-20% of all cervical flexion/extension ROM.

Answer 28

atlas upper surfaces and the occipital condyles

nodding

Question 29

the atlanto-axial joints consist of 3 synovial joints specialized for rotation.
1) a median pivot joint between [….]
2 & 3) [….]

Answer 29

the dens of C2 and anterior arch of atlas. (bursa surrounding transverse ligament and dens).

two lateral facet joints allowing approx 50% of rotation of cervical spine.

Question 30

ligaments of the cervical spine include groups:
1)ligamentum nuchae
2)ligaments between atlas and occiput: [….]
and
3) ligaments between axis and occiput: [….]

All these ligaments function resist movement in the [….] plane.

Answer 30

2) posterior atlanto-occipital membrane, anterior atlanto-occipital membrane
3) membrana tectoria, an extension of the posterior longitudinal ligament (PLL).

saggital (flexion/extension)

Question 31

the transverse ligament is specialized to [….]

Answer 31

stabilize the dens, prevent posterior translation of dens into vertebral canal.

Question 32

the alar ligaments are specialized to prevent [….]

Answer 32

excessive rotation of atlas around the dens.

Question 33

the transverse ligament and apical ligament are susceptible to injury when the head is […..]

Answer 33

flexed and rotated and muscles relaxed.

Question 34

with age, both the [….] content and […] reduces in the cervical spine.

the cervical discs tend to degenerate before the [….].

compression of anterior [….] may occur with time, causing vertebral wedging and/or reduced [….] curve.

[….] may develop from uncinate processes and facet surfaces –> irritate nerve roots and possible occlude the [….] artery.

Answer 34

water content and ROM

lumbar discs.

vertebral body.
lordotic

osteophytes may develop
vertebral artery.

Question 35

a hangmans fracture often occurs in motor vehicle accidents in which both pedicles of […] vertebrae are fractures.

Answer 35

C2 (axis).

Question 36

A jefferson’s fracture may occur if you fall onto the top of your skull (diving into shallow water) and fracture […..]

Answer 36

anterior arch of C1 and pedicle.