Cervical Spine and Thorax Flashcards
Characteristics of typical cervical vetebra
bifid spinous process and transverse process.
foramen transversarium for vertebral artery and vein.
small in size b/c does not carry much weight
kidney shaped body
pedicles pass laterally and backwards
Characteristics of Atlas (C1)
ring of bone (thin anterior and posterior arches)
no vertebral body or spine
large superior articular facets 9concave)
Articulates with the condylar processes of occipital bone of the skull
Characteristics of Axis
odontoid process (dens) projects upwards into atlas forms a pivot joint allowing rotation strongest of the cervical vertebra
Joints of the cervical spine
atlanto-occipital articulation
atlanto-axial articulation
cervical intervertebral joints (facet joints)
Articulatar surfaces of atlanto-occipital + ROM
synovial ellipsoid joint
concave on upper surface of atlas
convex occipital condyles on base of the skull
ROM = 20 degrees total flexion/extension
- 8 degrees of lateral flexion both ways
Atlanto-axial joint
two joints = lateral and medial
- both synovial plane joints
transverse ligament of atlas
- holds dens in place against atlas
- with longitudinal bands forms cruciform ligament
- attaches to small tubercle on medial side of each lateral mass of atlas
alar ligaments
- from dens to occipital condyles
ROM
- rotation 15 degrees both ways
- minimal flexion and extension
Cervical intervertebral joints
synovial plane/facet joints
facets sloped anterior to posterior (allow for flex and ext)
ROM:
- flexion = 25 degrees
- extension = 85 degrees
- lateral flexion = 40 degrees
- rotation = 50 degrees each side
ligamentum nuchae supraspinous lig ligamentum flavum interspinous lig intertransverse lig
Ligamentum Nuchae
triangular midling ligament extending upwards from C7 to external occipital protrusion of skull
function:
- increase surface area for muscle attachment due to absence of longer spinous processes of cervical vertebra
- also serves as an origin point for trapezius
typical thoracic vertebra
costal facets on the body ad on the transverse processes
sloping spinous (allows for rotation)
heart shaped vertebral bodies
thoracic intervertebral joints
facet joints
- facets almost vertically A-P to allow for rotation
ROM:
- flexion/extension = 50-70
- rotation 35 both ways
- lateral flexion = 20-25 both ways
Iliocostalis thoracis and cervicis (erector spinae)
O: (common origin)
- iliac crest and tuberosity
- sacrum
- spinous processes of T11-L5 and supraspinous ligaments
R:
- up and out via slips
I:
- thoracis = upper 6 ribs and transverse process of C7
- cervicis = posterior tubercles on the transverse processes of C4-C7
A:
- unilateral = ipsilateral side flexion and rotation
- bilateral = trunk/neck extension
NS:
- adjacent posterior primary rami
Longissimus cervicis and capitis (erector spinae)
O:
- Cervicis = transverse processes of T1-T6
- Capitis = Articular processes of C4-C7 and Transverse processes of T1-T5
R: up and out
I:
Cervicis: posteiror tubercles of transverse processes of C2-C6
Capitis: posterior aspect of the mastoid process
A:
unilateral = ipsilateral side flexion and rotation
bilateral = trunk/neck extension
NS:
adjacent posterior primary rami
Spinalis Cervicis and Capitis (erector spinae)
no clear origin and insertion
O = generally spinous process to spinous process
R = upwards
I = poorly developed and blend with muscles
A:
- unilateral = ipsilateral side flexion/rotation
- bilateral = trunk/neck extension
NS: adjacent posterior primary rami
semispinalis cervicis and capitis (transversospinal)
O:
Cervicis: transverse process of T1-T6 (same as longissimus cervicis)
Capitis: transverse processes of T1-T6 and articular processes of C4-C7 (same as longissimus capitis)
R: upwards and inwards (rotational so must run inwards)
I:
Cervicis: spinous processes of C2-C6
capitis: medial impression between superior and inferior nuchal lines on base of skull
A:
unilateral = contralateral rotation
bilateral = trunk extension
NS:
adjacent posterior primary rami
Longus colli
O & I (3 sections on anterior aspect of cervical spine)
- upper section
- FROM (Origin) transverse processes below TO (Insertion) anterior tubercle of atlas
- runs up and in
- Middle section
- FROM (Origin) vertebral bodies below TO (Insertion) vertebral bodies above
in between vertebral bodies - runs up
- Lower Section
- FROM (Origin) vertebral bodies below TO (Insertion) transverse processes above
- in between vertebral bodies to transverse processes
- runs up and out
A: bilateral = neck flexion
NS = ventral rami of C3-C6
longus capitis
O: - transverse process R: - upwards and medially I: - anterolateral occipital bone A: - bilateral = neck flexion NS - Ventral rami of C1-C3/4
Scalenes
O: - transverse process of cervical spine R: - down and laterally I: - anterior and middle = first rib - posteiror = 2nd rib - brachial plexus and axillar artery emerges between middle and anterior scalene
A:
Anterior:
- bilateral = neck flexion
- unilateral = ipsilateral lateral flexion and contralateral rotation
Middle and posterior
- unilateral = ipsilateral lateral flexion
all accessory muscles for respiration
NS:
ventral rami of C3-C8
Sternoclediomastoid
O: (two heads)
- sternal = upper surface of the manubrium
- clavicular = upper surface of medial 1/3rd of the clavicle
R: upwards
I: mastoid process of the skull
A:
- assist with respiratioin
- bilateral = neck flexion
- unilateral - ipsilateral lateral flexion and contralateral rotation
NS:
Motor = spinal part of accessory nerve (Cranial XI)
sensory = ventral rami C2-C3
4 suboccipital muscles name
rectus capitis posterior minor
rectus capitis posterior major
obliquus capitis superior
obliquus capitis inferior
A:
ipsilateral = rotation
biliateral = extension of the neck
NS:
- dorsal rami of C1
Rectus capitis posterior minor
from C1 to skull
runs vertically
Rectus capitis posterior major
from C2 to skull (longer)
runs up and laterally
obliquus capitis superior
from transverse process of C1 to skull
runs vertically
obliquus cervicis inferior
from spinous process of C2 to C1 transverse process
runs up and laterally
Splenis Cervicis
O:
upper spinous process of T3-T6
R:
upwards
I:
transverse processes of C1-C4
A:
bilateral = neck extension
unilateral = ipsilateral lateral flexion and rotation
NS:
Dorsal rami of C5,6,7
Splenis Capitis
O
- spinous process of T4-C7
R:
upwards
I:
mastoid process
lateral 1/3 of superior nuchal line
A:
bilateral = neck extension
unilateral= ipsilateral lateral flexion and rotation
NS: dorsal rami (C3,4,5)
Triangles of the neck
SCM separates neck into anterior and posterior triangles
anterior:
hyoid muscles
posterior:
- scalenes
- levator scap
- splenius
- nerves
- veins
Arterial Supply of Upper Limb (pathway)
- all upper limb blood supply originates from the subclavian artery
- subclavian artery decends until LATERAL BORDER of 1st Rib
- becomes axillary artery until INFERIOR BORDER of teres major
- becomes Brachial artery (giving off a deep branch = profunda brachii)
- at the elbow it splits into the radial and ulnar arteries
Brachial Plexus notes
travels over the 1st rib, behind the clavicle and into the axilla
C5-C8 and T1
features of the axilla
pyramid shaped region inferomedial to the shoulder joint
contains: brachial plexus and vessels for upper limb
location: space between the thorax and the arm to allow for passage of brachial plexus between the upper limb and arm
Roots of the brachial plexus
ventral rami of C5-T1
trunks of the brachial plexus
Upper = C5-C6
Middle = C7
Lower = C8-T1
Divisions of the brachial plexus
Upper anterior = C5-C6
Upper posterior = C5-C6
Middle anterior & posteiror = C7
Lower anterior = C8-T1
Lower posterior = C8-T1
Cords of the brachial plexus
Lateral = C5-C7
Medial = C8-T1
Posterior = C5-T1
Major Terminal Branches of brachial plexus
axillary = C5-C6 musculocutaneous = C5-C7 median = C5-T1 radial = C5-T1 ulnar = C7-T1
Branches arising from roots
Dorsal Scapular Nerve = C5
- rhomboid major, minor and levator scap
long thoracic nerve = C5-C7
- serratus anterior
Branches arising from trunks
Nerve to subclavius = C4-C6 - subclavius Suprascapular nerve = C4-C6 - supraspinatus and infraspinatus - articular supply = GHJ and AC joint
branches from MEDIAL cord (C8-T1)
medial pectoral nerve = C8-T1
- pec minor and major (major also innervated by lateral pec nerve C5-C7)
medial cutaneous nerves of arm and forearm (C8-T1)
- skin over lower part of biceps, medial side of forearm as far as the wrist and medial side of posterior forearm
Branches from POSTERIOR Cord C5-T1
upper subscapular nerve = C4-C7
- subscapularis
Lower subscapular nerve = C5-C7
- subscapularis + teres major
Thoracodorsal nerve = C6-C8
- latissimus dorsi
Branches from LATERAL cord (C5-C7)
Lateral pectoral nerve = C5-7)
- pec major
what do spinal cord injuries affect
roots of the brachial plexus
what do trauma to the 1st rib affect
trunks of the brachial plexus
what does dislocation of the GHJ affect
cords and divisions of the brachial plexus
