Cervical Spine Biomechanics Flashcards
1
Q
What did Takala determine about neck pain in the population based on gender
A
Men: 16%
Women: 18%
2
Q
What did Aryanpur determine about the percent of the population that will have neck pain
A
10%
3
Q
What Dvorak determine was the percent of soft tissue injuries
A
87.5%
4
Q
What percent of soft tissue injuries were due to MVA
A
53%
5
Q
What percent of soft tissue injuries were due to falls and sports
A
45%
6
Q
True or False:
You have to have to have radicular symptoms or referred symptoms with neck pain
A
False
7
Q
How many cervical vertebrae are there
A
7
8
Q
What are the atypical cervical vertebrae
A
1 and 2
9
Q
What are the typical cervical vertebrae
A
3-6
10
Q
What is C1
A
Cradle/Atlas
11
Q
What is C2
A
Axis
12
Q
What is C3
A
The root
13
Q
What are C4-7
A
Column
14
Q
What is C7
A
A transitional vertebrae
15
Q
What is a transitional vertebrae
A
A vertebrae is starting to look like the next set of vertebrae
16
Q
What is another name for C7
A
Vertebral Prominens
17
Q
What i transegrity
A
Balance between mobility and stability
18
Q
What are the size of cervical vertebrae bodies
A
Small
19
Q
Why are cervical vertebrae bodies small
A
Wolffe’s Law… They don’t support a lot of weight
20
Q
What are cervical vertebrae made for stability or mobility
A
Mobility
21
Q
What is the neutral zone
A
The OA AA complex
22
Q
How much more neutral is the OA AA complex than the lower cervical vertebrae
A
50%
23
Q
True or False:
Cervical vertebrae have general laxity to capsule and ligaments
A
True
24
Q
What is looser the upper cervical or lower cervical spine
A
Upper cervical spine
25
Where are the uncinate processes located
Posterolateral superior and inferior surfaces of vertebral bodies
26
What do the uncinate processes form
The uncovertebral joints
27
What is another name for the uncovertebral joints
Joints of VonLuschka
28
How are the transverse processes oriented in the cervical vertebrae
Anterolateral
29
True or False:
| The transverse processes of the cervical vertebrae have lateral grooves
True
30
What do the lateral grooves predispose the vertebrae to
Fracture
31
What is the angle of the facet joints in the typical cervical spine
45 degrees
32
What are housed in the lateral grooves
Spinal nerves
33
What are the transverse processes of C1-4 usually called
Lateral masses
34
What do the bifid processes allow for
Greater surface area for attachment of soft tissue
35
What can cause vertebral artery compromise (3)
1. Skeletal muscle and fascial bands near transverse foramen
2. Osteophytes adjacent to C4/5 and C5/6 and C6/7
3. Gliding motion at the AA articulation
36
What are osteophytes
Bone spurs
37
True or False:
| C6 is a level of high mobility
True
38
How does flexion affect the vertebral artery
Nothing
39
How does extension affect the vertebral artery
Usually nothing
40
How does side bending affect the vertebral artery
Slight decrease in ipsilateral artery and normal contralateral artery
41
How does rotation affect the vertebral artey
Slight decrease in ipsilateral artery and slight superficial decrease in contralateral artery
42
How does extension and rotation affect the vertebral artey
Bilateral decrease
43
Where is the exclusion of the artery slightly worse during rotation and extension
Contralateral artery
44
How does flexion and rotation affect the vertebral artery
Bilateral decrease
45
True or False:
| Atlas/C1/Cradle has no body or spinous process
True
46
What does atlas have for weight bearing
Lateral masses
47
True or False:
| The superior facets of atlas are convex
False
48
What do the superior facets of atlas accept
Convex occipital condyles
49
What type of joint is the OA joint
Planar synovial joint
50
How much flexion does the OA joint account for
About 20 degrees
51
How much extension does the OA joint account for
About 20 degrees
52
How much side bending does the OA joint account for
About 5 degrees
53
How much rotation does the OA joint account for
About 1 degree
54
True or False:
| The inferior facets of atlas are slightly convex
True
55
True or False:
| Atlas has a facet on the internal surface of the anterior arch
True
56
What does the internal facet on atlas do
Accepts the dens (odontoid process)
57
Which way is the roll with side bending right
Right roll
58
Which way does the right and left OA move during right lateral flexion
Right: Inferomedial
Left: Superolateral
59
During right rotation what happens to the left and right OA
Right: Posterior and superior
Left: Anterior and superior
60
What is the vertical extension of C2
Dens/Odontoid process
61
What shape are the superior zygapophyseal joints
Convex
62
How are the inferior facets of C2 oriented
40 degrees
63
Which way do the inferior facets of C2 face
Medial and anterior
64
How many joints compose the AA joint
3
65
What are the 3 joints of the AA joint
1 Median atlanto-axial joint
| 2 Lateral atlanto-axial joints
66
What type of joint is the median AA
Synovial trochoid (pivot)
67
What type of joint are the lateral AA joints
Synovial planar
68
How much rotation does the AA allow
40 degrees
69
How much flexion and extension does the AA joint allow
0
70
How does the AA joint prevent flexion and extension
Ligament restrictions
71
Why does the AA prevent flexion and extension
To protect the brainstem/spinal cord
72
What are the arthokienmatics of the median AA joint
Spin
73
During right rotation which way do the right and left zygapophyseal joints of C1 and C2 move
Right: Posterior Inferior
Left: Anterior Inferior
74
What is Fryette's Law I
Within the spine rotation and sidebending occur in opposite directions
75
So if you had right sidebending and applied Fryette's Law I which way is the rotation
Left
76
Is the rotation noticeable
No
77
What is Fryette's Law II
Within the spine rotation and sidebending occur in the same direction
78
So if you had right sidebending and applied Fryette's Law II which way is the rotation
Right
79
Which degree are the superior facets of C3 oriented
40 degrees
80
What does neutral or non-neutral refer to
The sagittal plane
81
Which one of Fryette's Law applies at C2/C3 junction
Fryette's Law I
82
What type of joint is between the zygapophyseal joints of C3-C7
Plane synovial
83
What is the meniscoid properties of C3-C7
Soft tissue structure like menisci in the knee located between the zygapophyseal joints
84
What is the zygapophyseal joints composed of for C3-C7
Joint lined by hyaline cartilage surrounded by a capsule with menicsal inclusions
85
What do the meniscal inclusions between the Z-joints do
Guide/direct motion (keep train on track)
86
True or False:
| You can impinge the menisci in the Z-joints
True
87
What are the menisci innervated by
Medial branches of cervical posterior rami C2-C8
88
Can the menisci of the Z-joints be a source of referred pain
Yes
89
Where does the C6/7 Z-joint refer
To the inferior angle of the scapula
90
Do the cervical IV discs have annulus in the back
No
91
What is the back of the cervical IV disc called
Uncovertebral cleft
92
Do the cervical IV disc have a concentric annulus
No
93
How much of the disc does the nucleus pulposus comprise in the cervical IV disc at birth
25%
94
How much of the disc does the nucleus pulposus comprise in the lumbar IV discs at birth
50%
95
What is the composition of the IV disc of the cervical vertebrae in adults
Fibrocartilage with no gelatinous component
96
What does genic mean
Produced by or from
97
What are possible sources of disc related pain in the cervical spine (2)
1. Strains or tears of annulus fibrosous
| 2. Strains of the lateral parts of PLL
98
What Fryette's Law refers to the typical vertebrae
Fryette's Law II
99
Can we sidebend left and rotate right in the cervical spine
Yes
100
How can we sidebend left and rotate right in the cervical spine
Rotation at AA and side bending left in colum
101
Which way do the facet joints move during flexion
Superior and anterior
102
Do the facet joints have a roll
No
103
Why don't the facet joints have roll
They are planar joints
104
What happen to IV foramen during flexion
Open or gapping
105
Which way do the facet joints move during extension
Inferior and posterior
106
What happens to the IV foramen during extension
Approximation or closing
107
Which way do the facet joints move during right side bending
Right: Posterior inferior
Left: Anterior superior
108
What happens to the IV foramen during right side bending
Right: Close
Left: Open
109
During right sidebending what do the facet joints move like
Right: Extension
Left: Flexion
110
During right rotation what happens to the facet joints
Right: Posterior inferior
Left: Anterior superior
111
Where does the most flexion and extension occur in the C-spine
The lower C-spine
112
When is the alar ligament taught ad slack
Taught: Flexion
Slack: Extension
113
During right rotation what happens to the alar ligaments
Right: Slack
Left: Taught
114
At what point does the alar ligament get sprained
Greater than 20 degrees
115
What is the sequence of whiplash for a rear end accident (5)
1. Body rises
2. Head goes into extension and mouth opens
3. Body descends
4. Head goes into flexion and mouth closes
5. Back to normal position
116
What way does the head move first
The direction the force is applied
117
What happens to the articular processes during a whiplash injury
The tip of the inferior articular process of superior vertebra chisels into the surface of the superior articular facet of inferior vertebra
118
Why does the articular process chisel into the articular facet
Compression during whiplash move the IAR causing it to be in the vertebral body causing a greater inferior component
119
What does IAR mean
Instantaneous axis of rotation
120
True or False:
| The IAR can change at any moment
True
121
What happens to the facet joints with extension
They come together
122
What happens to the annular fibers with a disc protrusion
The annular fibers are still intact
123
What are the 2 types of disc protrusion
1. Localized annular bulge
| 2. Diffuse annular bulge
124
What direction is a localized annular bulge
Usually lateral
125
What direction is a diffuse annular bridge
Usually posterior
126
What happens to the annular fibers with a disc prolapse
Annular fibers disrupted (tiny hole)
127
What has occurred with a disc prolapse
The nucleus has migrated through the inner laminar layers, but is still contained
128
What happens to the annular fibers with a disc extrusion
Annular fibers are disrupted
129
What has occurred with a disc extrusion
Nucleus has broken through the outer most layer
130
What happens to the annular fibers with a disc sequestration
Annular fibers disrupted
131
What has occurred with a disc sequestration
Nucleus separate from disc and now is in the spinal or IV canal
132
When do disc sequestrations require surgery
When the disc is irritating the spinal cord
133
What happens if no surgery is needed to fix a disc sequestration
The body sees it as a foreign object and gets rid of it
134
What part of the disc is innervated
Outer 1/3
135
What percent of people 40 and older have a herniation
60%
136
What type of repeated movement does an upper cervical posterior derangement respond to
Protrusion because the upper cervical spine extends
137
What do the suboccipital ghost muscles do
Put compression on the suboccipital nerve
138
What does compression of the suboccipital nerve cause
Headaches overtime
139
What are guy wires
Wires on cellular towers that support the tower
140
What is there a balance of with guy wires
Tension, length, and strength
141
True or False:
| Guy wires don't need to be in balance
False
142
What can a forward head cause overtime
Retrusion and depression of the mandible
143
What happens because of the depression to the muscles
Adaptive lengthening of elevators and adaptive shortening of depressors
144
What happens because of the retrusion to the TMJ
Compression overload of the TMJ articular cartilage
145
What are the 4 types of disc herniation
1. Disc protrusion
2. Disc prolapse
3. Disc extrusion
4. Disc sequestration
146
Motivation
IT'S ALMOST TIME TO BALL HARD
