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Anatomy II Fall 2023 > Cervical Region > Flashcards

Cervical Region Flashcards

1
Q

What are the regions of the spine and how many vertebrae are in each?

A

Cervical -> 7
Thoracic -> 12
Lumbar -> 5
Sacral -> 5

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2
Q

Explain the difference between Kyphosis and Lordosis

A

Kyphosis: Primary, posterior convexity in the Thoracic and Sacral regions

Lordosis: Secondary, anterior convexity in the Cervical and Lumbar regions

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3
Q

What are the typical parts of a vertebra?

A

Body
2 lamina
2 pedicle
Vertebral Foramen
Intervertebral Foramen

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4
Q

What is a vertebral end plate?

A

The superior and inferior surfaces are covered with them

made up of discs of hyaline cartilage on top of the vertebral bodies

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5
Q

What are the defining features of a typical cervical vertebra?

A

-smaller/wider bodies
-concave superior
-convex inferior
-discs are thinner
-Anterior/posterior tubercles on Transverse processes
-Transverse foramen for vertebral arteries
-grooves for anterior rami of spinal nerves
-short, Bifid spinous processes
-Large vertebral foramen
-Uncinate Processes

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6
Q

What cervical vertebra are considered typical?

A

C3-C6

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7
Q

What vertebra are considered atypical?

A

C1, C2, C7

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8
Q

What are some characteristics that make up an atypical vertebra?

A

C1 Atlas:
- No vertebral body or spinous processes
- Superior articular surface attaches to Occipital condyles of skull
- widest
- posterior arch has groove for vertebral artery

C2 Axis:
- strongest
- large superior facets connecting to C1
- large bifid spinous process
- Dens (odontoid process): pivot for C1 and head to rotate (located anterior to spinal cord)

C7 Vertebra Prominens:
- no transverse foramen
- longest spinous process

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9
Q

Describe the parts of the intervertebral discs

A

1) Anulus Fibrosus
- Ring, outer circumference of discs
- inserts at cartilage end plate
- concentric fibrocartilage layers that alternate each layer @ 60 degrees that restricts rotation
- thinner posteriorly, thicker anteriorly
-only outer 1/3 is vascularized and innervated

2) Nucleus Pulposus
- gelatinous core
- acts as semifluid fulcrum during movement
- positioned b/w center & posterior aspect of disc (doesn’t sit directly in the center)
- Avascular, aneural but gets its nutrients from vertebral body and anulus periphery via diffusion

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10
Q

Anterior Longitudinal Ligament (ALL)

A

Runs on anterior surface of vertebral bodies
- prevents hyperextension

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11
Q

Posterior Longitudinal Ligament (PLL)

A

Runs on posterior side of vertebral bodies BUT connects more to discs
- resists hyperflexion weakly BUT mainly prevents/redirects posterior disc herniations

Lots of nocireceptors

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12
Q

Ligamentum Flavum

A

Lamina to lamina
- yellow in color
- thin -> thick as moving down the vertebral column
- assists return from flexion

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13
Q

Supraspinous Ligament

A

connects tips of spinous processes

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14
Q

Interspinous Ligament

A

between spinous processes

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15
Q

Intertransverse Ligament

A

between transverse process of each vertebrae

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16
Q

Nuchal Ligament

A

Continuation of supraspinous ligaments (C6 to occiput)
-back of the neck
-thick fibroelastic tissue

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17
Q

Transverse Ligament

A

Holds Dens against atlas
- prevents posterior displacement of dens
-prevents anterior displacement of atlas pressing posterior arch onto spinal cord

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18
Q

Alar Ligament

A

sides of dens to Foramen Magnum
- checks ligaments to limit rotation

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19
Q

What joints are considered Craniovertebral joints?

A

Atlanto-Occipital (A-O) (C0-C1)

Atlanto-Axial (A-A) (C1-C2)

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20
Q

Describe the Atlanto-Occipital joint

A
  • atlas & occipital condyles
  • capital flexion/extension (nodding head)
  • capital side bend
  • synovial joint with a thin loose capsule
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21
Q

Describe the Atlanto-Axial joint

A
  • 2 lateral facets connect to C1 which are gliding synovial joints
  • 1 median joint which dens connects to atlas (pivot joint)
  • rotation of the cranium and C1 rotate on C2 as a unit
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22
Q

What happens if the transverse ligament breaks?

A

The dens could move backward onto the spinal cord

Atlas could move forward which would pull the posterior arch against the spinal cord

Both of these could result in quadriplegia or death

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23
Q

What happens if the Alar ligament breaks?

A

Excessive rotation
- 30% more movement to contralateral side

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24
Q

What structures of the spine help guide its movements in each region?

A
  • long and short ligaments that “check” or restrict certain movements
  • disc size and shape
  • facet orientation
  • vertebral body shape (uncinate processes for cervical vertebrae)
  • long shaped spinous processes for thoracic vertebrae
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25
Q

Why does the cervical spine have more movement than the rest of the spine?

A
  • thin discs compared to lumbar vertebral discs
  • loose facet capsules
  • less surrounding tissue bulk
  • nucleus serves as axis for movement
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26
Q

What are the two muscles categories of the back and what are their sub-categories?

A

Extrinsic (starts in a region but doesn’t stop in the same region)
- Superficial
- Intermediate

Intrinsic (starts and stops in the same region)
- Superficial
- Intermediate
- Deep

  • all intrinsic muscle groups are enclosed by deep fascia (Thoracolumbar)
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27
Q

What muscles of the back are considered extrinsic and which sub-category do they belong in?

A

Superficial
- Trapezius
- Latissimus Dorsi
- Levator Scapulae
- Rhomboids

Intermediate
- Serratus Posterior (superior/inferior)

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28
Q

What muscles of the back are considered intrinsic and which sub-category do they belong in?

A

Superficial
- Splenius (cervicis & capitis)

Intermediate
- Erector Spinae
-> Illiocostalis
-> Longissimus
-> Spinalis

Deep (all between transverse & spinous processes)
- Transversospinalis
-> semispinalis
-> multifidus
-> rotatores

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29
Q

What is a spinal cord segment and how is it named?

A
  • the portion of the spinal cord that gives rise to rootlets & roots that form bilateral pairs of spinal nerves
  • named the same as spinal nerves coming from it
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30
Q

Why are there 8 cervical spinal nerves but only 7 cervical spine?

A
  • C1 exits ABOVE the cervical vertebra and the rest of the vertebra follow the same pattern
  • T1 switches to run below the vertebra but there is a space missing between C7 and T1 so another spinal nerve comes out creating a C8
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31
Q

What do the Posterior (dorsal) rami of the spinal nerves innervate?

A
  • the post-vertebral muscles and the skin of the back
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32
Q

What do the Anterior (ventral) rami of the spinal nerves innervate?

A
  • sensory and motor fibers of most of the muscles and joints of the lateral and ventral body
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33
Q

What do the Recurrent Meningeal Nerves innervate?

A

Outside nerves
- Anterolateral vertebral bodies/discs
- Periosteum
- ALL

Inside nerves
- Periosteum (posterior vertebral bodies, pedicles, laminae)
- Ligamentum Flavum
- Posterior anulus
- PLL
- Dura mater
- Blood vessels

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34
Q

Describe the superficial fascia of the neck

A
  • lies between the dermis and investing layer of deep fascia
  • cutaneous nerves, blood, lymphatics, lymph nodes, fat, and platysma
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35
Q

Describe the deep investing fascia of the neck

A
  • surrounds the entire neck
  • invests Trapezius & SCM at the four corners of the neck
36
Q

Describe the deep pretracheal fascia of the neck

A
  • Anterior only
  • from hyoid to thorax (blends w/ pericardium covering the heart)
  • Muscular part that invests infrahyoid
  • visceral part invests thyroid, trachea, & esophagus
37
Q

Describe the deep prevertebral fascia of the neck

A
  • surrounds the vertebral column & muscles associated with it
  • surrounds axillary vessels & brachial plexus
38
Q

What lives/runs through the neck?

A
  • muscles
  • glands
  • arteries/veins
  • nerves
  • lymphatics
  • trachea
  • esophagus
  • vertebrae
39
Q

What are the contents of the Carotid Sheath?

A
  • common & internal carotids
  • IJV
  • vagus nerve
  • Deep lymph nodes
  • carotid sinus nerve
  • sympathetic nerves
40
Q

Describe the submental triangle

A
  • submental lymph nodes and small veins that unite to form anterior jugular vein
41
Q

Describe the submandibular triangle

A
  • submandibular gland almost fills triangle
  • submandibular lymph nodes
  • hypoglossal nerve (CN XII)
  • mylohyoid nerve
  • parts of facial artery and vein
42
Q

Describe the carotid triangle

A
  • carotid sheath and all containing aspects
  • superior root of ansa cervicalis
  • spinal accessory nerve
  • thyroid gland
  • larynx
  • pharynx
  • deep cervical lymph nodes
  • branches of cervical plexus
43
Q

Describe the muscular triangle

A
  • sternothyroid and sternohyoid muscles
  • thyroid and parathyroid glands
44
Q

Describe the occipital triangle

A
  • part of external jugular vein
  • posterior branches of cervical plexus of nerves
  • spinal accessory nerve (XI)
  • cervicodorsal trunk
  • cervical lymph node
45
Q

Describe the omoclavicular (subclavian) triangle

A
  • subclavian artery (third part)
  • trunks of brachial plexus
  • part of subclavian vein (sometimes)
  • suprascapular artery
  • supraclavicular lymph nodes
46
Q

Describe the posterior region

A
  • trapezius muscle
  • cutaneous branches of posterior rami of cervical spinal nerves
  • suboccipital region or triangle lies deep to superior part of this region
47
Q

What are the regions of the neck and those subregions?

A

Anterior Region
- submental triangle
- submandibular triangle
- carotid triangle
- muscular triangle

Lateral Region
- occipital triangle
- omoclavicular (subclavian) triangle

Posterior Region

48
Q

What is the difference between the carotid sinus and carotid body?

A

Carotid Sinus
- dilation of internal carotid artery
- this is a baroreceptor

Carotid Body
- mass of tissue between internal and external carotids
- this is a chemoreceptor

49
Q

What is the “road map” of arterial blood flow from the heart to the neck?

A

Aorta -> arch of aorta -> Brachiocephalic (splits to R common carotid & R. subclavian), L. common carotid, L. subclavian -> R. & L. common carotid -> R. & L. internal/external carotid artery ->

1) Internal carotid artery -> travels to brain through carotid canal
2) External carotid artery -> superficial temporal artery & Maxillary artery

A) Maxillary artery -> gives rise to middle meningeal artery

50
Q

What is the “road map” of venous drainage from the head through the neck to the heart?

A

Sigmoid sinus (exits jugular foramen) -> Internal jugular vein -> merges w/ subclavian vein to form brachiocephalic vein -> SVC

External Jugular Vein drains most of scalp & side of face -> subclavian vein -> Brachiocephalic vein -> SVC

51
Q

What happens to each vertebral artery at the atlas during head rotation

A
  • vulnerable to tears at the atlas
    -contralateral side is pulled taut during rotation
52
Q

Describe the cervical plexus and structures innervated by it

A

Path:
- loops between C1-C4/5
- Dorsal sensory branches
- anteromedial motor branches

Innervated:
- skin of neck and scalp
- skin over mastoid process
- skin over anterior cervical region
- skin crossing clavicle & over shoulder
- Rhomboids, serratus anterior, & nearby prevertebral muscles

53
Q

Describe the Vagus nerve and structures innervated by it

A

Path:
- exits jugular foramen -> inferior through neck in carotid sheath
1) R. vagus -> passes anterior so subclavian artery & posterior to brachiocephalic vein & SC joint
2) L. Vagus -> passes between L. common & L. subclavian artery & posterior to SC joint

Innervation:
- a lot of digestive organs
- GI tract

54
Q

Describe the Phrenic nerve and structures innervated by it

A

Path:
- C3, 4, 5
- Runs lateral boarder of anterior scalene -> posterior to internal jugular vein & SCM

Innervated:
- Diaphragm

55
Q

Describe Sympathetic trunks and structures innervated by them

A

Path:
- C1-C7
- Superior -> C1-C2 fibers to cranium

  • Middle -> C6 fibers to C5-C6
  • Inferior -> C7 superior to 1st rib

Innervation:
- cranium
- heart
- thyroid

56
Q

Explain how nerve signals get from the thoracic region to the cervical sympathetic trunks

A
  • sends signals up the sympathetic chain via gray communicantes
57
Q

What are the boundaries of the suboccipital triangle?

A
  • made from muscles surrounding it
  • Between rectus capitus posterior major & 2 obliqvus muscles
58
Q

What structures run through the suboccipital triangle?

A
  • suboccipital nerve
  • vertebral artery starts to run deep to head here
59
Q

How can the suboccipital triangle cause problems?

A
  • compression of this triangle leads to headaches due to compressing of the suboccipital nerve
60
Q

What muscles are responsible for flexion of the neck?

A
  • longus coli
  • scalenes
  • SCM
61
Q

What muscles are responsible for extension of the neck?

A

Extrinsics:
- levator scapula
- trapezius

Intrinsics:
- splenius capitis & cervicis
- iliocostalis cervicis
- longissimus capitis
- semispinalis cervicis & capitis
- multifidus

62
Q

What muscles are responsible for lateral flexion of the neck?

A
  • iliocostalis cervicis
  • longissimus cervicis & capitis
  • splenius cervicis & capitis
  • intertransversarii
  • scalenes
63
Q

What muscles are responsible for rotation of the neck?

A

Intrinsics:
- splenius cervicis
- semispinalis cervicis & capitis
-multifidis
-rotatores

64
Q

What muscles are responsible for capital flexion?

A
  • longus capitis
  • rectus capitis anterior
  • suprahyoids & infrahyoids
  • SCM (if with other muscles)
65
Q

What muscles are responsible for capital extension?

A
  • SCM
  • trapezius
  • splenius capitis
  • longissimus capitis
  • rectus capitis posterior major/minor
  • obliqvus capitis superior
66
Q

What muscles are responsible for capital lateral flexion?

A

-SCM (with contra rotation)
- rectus capitis lateralis
- splenius capitis
- longissimus capitis
- obliqvus capitis superior

67
Q

What muscles are responsible for capital rotation?

A

Ipsilateral:
- splenius capitis
- longissimus capitis
- suboccipitals (obliqvus capitis inferior & rectus capitis posterior major/minor)

Contralateral:
- semispinalis capitis
- SCM

68
Q

Describe the location and function of the Thyroid gland

A

Location:
- lies deep to sternothyroid & sternohyoid
- C5-T1 region
- anterior to trachea

Function:
- produces hormones ( thyroid hormone & calcitonin)

69
Q

Describe the location and function of the parathyroid glands

A

Location:
- 4 lobes on posterior thyroid

Function:
- produces parathyroid hormone (PTH)

70
Q

How is sound produced in the Larnyx?

A
  • C3-C6
  • combination of movements from cricothyroid joint & arytenoid cartilage that changes the length of the vocal cords
70
Q

What is the cricothyroid joint?

A
  • rotates, glides thyroid cartilage to change length of vocal folds (cords)
71
Q

What is the Arytenoid cartilage?

A
  • sit at the back of the larynx and are the primary site for vocal cord attachment
  • helps with sound production
72
Q

Describe the parts of the pharynx

A
  • Nasopharynx: posterior to nasal cavity, respiratory function
  • Oropharynx: posterior to oral cavity; soft palate to epiglottis
  • Laryngopharynx: Epiglottis to cricoid cartilage (C4-C6)
73
Q

What is considered the Adam’s Apple?

A
  • thyroid cartilage (C4)
74
Q

Where are the tonsils located?

A
  • Pharyngeal: nasopharynx
  • Tubal: nasopharynx
  • palatine: fauces (ones we can see)
  • Lingual: fauces (base of tongue)
75
Q

What is unique about the musculature of the esophagus?

A
  • has a mix of voluntary & involuntary muscles
  • upper 1/3rd: striated voluntary
  • lower 1/3rd: smooth involuntary
  • middle 1/3rd: mix
76
Q

How is the cervical esophagus innervated?

A
  • superior 1/2: motor & sensory nerve (Recurrent Laryngeal)
  • Inferior 1/2: parasympathetic/sympathetic, visceral sensory (cervical sympathetic trunks via Inferior arterial plexus)
77
Q

What problems could a cervical rib cause?

A
  • elevates & puts pressure on structures emerging from superior thoracic aperture
  • could lead to thoracic outlet syndrome
78
Q

What are some fracture locations in the C2 vertebra and what are the potential consequences?

A
  • Pars Interarticularis area
  • usually caused from abrupt hyperextension and could lead to paralyses of all limbs or death
79
Q

What is Torticollis?

A
  • contraction or shortening of SCM
  • abnormal positioning pre-delivery
  • could be from Cervical Dystonia
  • this is abnormal tonicity of cervical muscles
80
Q

What is a goiter?

A
  • an enlargement of the thyroid gland due to lack of iodine
  • could compress the trachea/esophagus
81
Q

What is the Valsalva Maneuver?

A
  • bearing down maneuver
  • vocal cords open during inspiration but close during the maneuver
  • abdominal muscles contract & increase intra-abdominal pressure then diaphragm relaxes passively transmitting pressure to thoracic cavity
  • NOT encouraged for people with low back pain because it puts more pressure on the intervertebral discs
82
Q

How does the Heimlich maneuver work?

A
  • mimics the Valsalva maneuver
  • the air expelled from the lungs after a sudden compression of the abdominal causes the food to become dislodged from the trachea
83
Q

What happens during a tonsillectomy?

A
  • surgical removal of tonsils (usually the palatine)
84
Q

What is adenoiditis?

A
  • inflammation of pharyngeal tonsils
  • obstructs airflow
85
Q

What is Otitis Media and how is it related to adenoiditis?

A
  • this is a middle ear infection
  • the inflammation from the pharyngeal tonsils can spread to the middle ear via pharyngotympanic tube

Anatomy II Fall 2023 (11 decks)

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