Cervical Spine and TMJ

Question 1

Cervical Spine Levels

Answer 1

C1-C7

Question 2

CS Junctions

Answer 2

Upper Cervical (Craniovertebral): Occiput, atlas, axis | Atypical
-Atlanto-Occipital Articulation - C0-C1
-Atlanto-Axial Articulation - C1-C2

Lower Cervical: C3-C7 | Typical

Question 3

CS Osteokinematic Motions

Answer 3

Flexion/Extension
Lateral flexion (Sidebending)
Rotation

Question 4

Atlanto-Occipital Articulation (AO) - C0-C1

Answer 4

Between the head and the neck
Occipital condyles (concave) -> superior articular fossa of Atlas (convex)

Question 5

AO Arthrokinematics

Answer 5

Boney structure supports:
Sagittal plane movement - majority
Frontal plane movement - minor
Transverse - negligible

Question 6

Atlanto-Axial Articulation (AA) - C1-C2

Answer 6

Between C1 (atlas) and C2 (axis)
Considered a pivot joint
Ondontoid process (dens) from C2 articulates with anterior arch of atlas and transverse ligament
Supports rotation movement the most

Question 7

Lower cervical Arthrokinematics
Flex/Ext

Answer 7

Facet Joint
Up and forward = up slide [Flexion]
Down and back = downslide [Extension]

Interbody Joint
Anterior tilt and slide [Flexion]
Posterior tilt and slide [Extension]

Question 8

Lower cervical Arthrokinematics
Lateral Flexion/Sidebending

Answer 8

Facet Joint
Right bend: Left bend:
Ipsilateral: downslide R downslide L
Contralateral: upslide L upslide R

Interbody Joint
Right bend: Left bend:
Right lateral tilt and slide Left lateral tilt and slide

Question 9

Lower cervical Arthrokinematics
Rotation

Answer 9

Just Facet Joint
Right: Left:
IpL-downslide R downslide L
CL-upslide L upslide R

Question 10

Temporomandibular (TM) joint
Articulation

Answer 10

Articular eminence Temporal Bone
Mandibular condyles

Question 11

Bones that merge to form the structure and contribute to the function of the TMJ

Answer 11

Mandible
Maxilla
Temporal
Zygomatic
Sphenoid
Hyoid

Question 12

TMJ Classification

Answer 12

Synovial
3 DOF
Shape: Both Convex = incongruent joint

Question 13

TMJ Osteokinematics

Answer 13

Elevation/Depression
Protrusion/Retrusion
Left & Right lateral excursion (deviation)

Question 14

TMJ Open-Packed position

Answer 14

Jaw slightly open

Question 15

TMJ Closed-Packed position

Answer 15

Teeth clenched OR mouth maximally opened

Question 16

TMJ Articular Disc

Answer 16

Biconcave - Allows the convex surfaces to remain congruent
Separates each TMJ into:
-Superior and Inferior Joint

Question 17

Superior Joint

Answer 17

Plane joint
Articular eminence temporal bone
superior surface of disc

Question 18

Inferior Joint

Answer 18

Hinge joint
Mandibular condyle
Inferior surface of disc

Question 19

TMJ Disc Function

Answer 19

Increase stability
Minimizes loss of mobility
Decrease friction
Decrease biomechanical stress

Question 20

TMJ Disc Attachments

Answer 20

Medial/lateral poles mandibular condyle
Joint capsule->Anteriorly
Tendon of lateral pterygoid
Bilaminar retrodiscal pad: superior/inferior lamina
Vascularized & Innervated anteriorly/posteriorly
-Avascular & aneural centrally

Question 21

Superior lamina

Answer 21

Consists of elastic fibers that allow the superior band to stretch
Allows the disc to translate anteriorly along the articular eminence during mandibular depression
Assist in repositioning the disc posteriorly during mandibular closing

Question 22

Inferior lamina

Answer 22

Tether on the disc, limiting forward translation but does not assist with repositioning the disc during mandibular closing

Question 23

TMJ Capsule

Answer 23

Lax superiorly, taut inferiorly
Stronger laterally
Highly vascularized and innervated

Question 24

TMJ Ligaments

Answer 24

TM ligament
Stylomandibular
Sphenomandibular

Question 25

TM ligament

Answer 25

Strong
Oblique fibers-suspensory ligament, limits downward and posterior motion of the mandible, and rotation of the condyle during mandibular depression
Horizontal fiber-resist posterior motion of the condyle, limits the posterior translation of the condyle protects the retrodiscal pad

Question 26

Stylomandibular ligament

Answer 26

Weakest
May limit protrusion

Question 27

Sphenomandibular ligament

Answer 27

Strong
Swinging hinge
May protect from excessive anterior translation