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OPP 2.2 > Cervical Spine Lect and Lab > Flashcards

Cervical Spine Lect and Lab Flashcards

1
Q

Functional Anatomic Components of C-Spine

A
  • Osseous
  • Ligamentous
  • Muscular
  • Fascial
  • Neurologic
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2
Q

C- Spine Flexion

A
  • 90 degrees

- Limited by the posterior longitudinal ligament

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3
Q

C- Spine Extension

A
  • 70 degrees

- Limited by direct contact of vertebral lamina, zygapophyseal joints (facets), and spinous processes

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4
Q

C- Spine Rotation

A
  • Approximately 50% of rotation in AA joint

- Approximately 50% rest of the cervical spine

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5
Q

Define Vertebral Unit

A

Two adjacent vertebral segments with their associated intervertebral disk, arthrodial, ligamentous, muscular, vascular, lymphatic and neural elements

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6
Q

Vertebra Unit Conventional Name

A

Named for superior vertebra in pair

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7
Q

Vertebral Unit Joint

A

Inferior facets of superior vertebra on superior facets of inferior vertebra

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8
Q

Vertebra Unit Motion Reference Point

A

Reference point is superior, anterior aspect of superior vertebra

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9
Q

2 Atypical C-Vertebrae

A
  • Atlas (C1) - no body

- Axis (C2) - odontoid process (dens)

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10
Q

4 Typical C-Vertebrae

A
  • C3 - C6

- Have uncovertebral joints both superiorly and inferiorly

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11
Q

Typical C-Vertebral Units

A
  • C2-C7
  • Primary Motion = Sidebending
  • Always sidebend/rotate to same side
  • Will have Flexion/Extension Component
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12
Q

Typical C-Spine Zygapophyseal Joint

A
  • Joints oriented at a 45 degree angle toward the eye.
  • Posterior is inferior
  • Anterior is superior
  • Lateral is superior
    (look at ppt image)
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13
Q

Typical Cervical Vertebrae are Unique Because…

A
  1. Uncinate Process
  2. Transverse Foramen
  3. Large Vertebral Foramen
  4. Body is Convex inferiorly, Concave superiorly
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14
Q

Atlantoaxial Joint (AA) Properties

A
  • Vertebral Unit of atlas (C1) on axis (C2)
  • Embrylogically, Body of C1 was dens, now attached to C2 (can cause congenital malformations)
  • Primary Motion = Rotation; accounts for 50% of entire neck rotation
  • Strong ligamentous attachments limit motion and instability
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15
Q

Atlantoaxial Joint (AA) Ligaments

A
  • Strong ligamentous attachments limit motion and instability
  • Alar Ligament
  • Cruciform Ligament
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16
Q

Alar Ligament

A

Attaches dens to occipital condyles

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17
Q

Occipitoatlantal (OA) Joint

A

= Occipital condyles articulating on C1

  • Primary Motion = Flexion/Extension
  • Sidebending/Rotation will ALWAYS be OPPOSITE
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18
Q

Occipitoatlantal (OA) Joint Properties

A
  • Superior articulatory facet of C1 has anterior medial convergence.
  • Posterior aspect of occipital condyles are more lateral
    and superior.
  • Anterior aspect of occipital condyles are more medial and inferior
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19
Q

8 Ligaments of the C-Spine? Which are C-Spine only?

A
  1. Anterior longitudinal ligament
  2. Posterior longitudinal ligament
  3. Ligamentum flavum
  4. Interspinal ligament
  5. Intertransverse ligament
  6. Supraspinal ligament
  7. Nuchal Ligament
  8. Posterior atlanto-occipital membrane

C-Spine only?

  1. Nuchal Lig - C7 to greater Occipital ridge
  2. Posterior atlanto-occipital membrane
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20
Q

7 Anterior Muscles of the Anterior Deep Neck

A
  1. Rectus capitis lateralis -From TP of C1 to occiput
  2. Rectus capitis anterior -From LM of C1 to occiput
  3. Longus Capitis
  4. Longus Coli
  5. Anterior Scalene
  6. Middle Scalene
  7. Posterior Scalene
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21
Q

6 Posterior Muscles of the Deep Neck

A
  1. Rectus capitis posterior minor
  2. Rectus capitis posterior major
  3. Obliquus capitis superior
  4. Obliquus capitis inferior
  5. Interspinalis Cervecis
  6. Intertransversarii Cervicis
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22
Q

4 Deep Intrinsic MM of Posterior Neck

A

1 and 2. Semispinalis Cervicis and Capitis

  1. Multifidus (Terminates at CV2)
  2. Rotatores (Terminates at CV2)
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23
Q

3 Deep Intrinsic MM of Posterior Neck

A

1 and 2. Longissimus Cervicis and Capitis

3. Iliocostalis (Terminates at lower cervical vertebrae)

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24
Q

4 Deep Intrinsic MM of Posterior Neck

A

1 and 2. Semispinalis Cervicis and Capitis

  1. Multifidus (Terminates at CV2)
  2. Rotatores (Terminates at CV2)
25
Q

3 Deep Intrinsic MM of Posterior Neck

A

1 & 2. Longissimus Cervicis & Capitis

3. Iliocostalis (Terminates at lower cervical vertebrae)

26
Q

2 Superficial Intrinsic MM of Posterior Neck

A

Splenius Cervicis & Capitis

27
Q

1 Extrinsic MM of the posterior neck

A

Descending Trapezius

28
Q

Other MM of the Neck

A
  1. SCM
  2. Strap mm
  3. Pharyngeal MM
29
Q

SCM Actions

A
  • Sidebends and rotates the head in opposite directions when unilaterally contracted
  • Flexes the head when bilaterally contracted
30
Q

Cervical Fascia (7)? Which includes Sibson’s Fascia?

A
  1. Investing fascia
  2. *Infrahyoid fascia
  3. *Pre-tracheal fascia
  4. Buccopharyngeal fascia
  5. Alar fascia
  6. *Pre-vertebral fascia – includes Sibson’s
  7. Carotid sheath
31
Q

Sympathetic Innervation of the Head and Neck

A
  1. Superior cervical ganglia - Anterior to C1-2
  2. Middle cervical ganglia - Anterior to C6
  3. Inferior (stellate) ganglia - Anterior to C7 (inferior)
    May fuse with T1 (stellate)
32
Q

Parasympathetic Innervation to most of the body?

A
  • Vagus Nerve

- Affected by OA and C1 somatic dysfunction

33
Q

Phrenic Nerve

A
  • From cervical plexus (C3-5)

- Exits neck between clavicular and sternal heads of the SCM

34
Q

Greater Occipital Nerve

A
  • From C2

- Can cause tension HA d/t course through descending traps (C3 may also contribute through lesser occipital nerve)

35
Q

Brachial Plexus

A
  • Contributions from cervical nerves 5, 6, 7, and 8.

- Passes between anterior and middle scalenes

36
Q

C-Spine Landmarks: C1

A

First transverse process palpated

37
Q

C-Spine Landmarks: C2

A

First spinous process palpated

38
Q

C-Spine Landmarks: C3

A

At the level of the hyoid bone

39
Q

C-Spine Landmarks: C4/C5

A

At the level of the thyroid cartilage

40
Q

C-Spine Landmarks: C6

A

At the level of cricoid cartilage

41
Q

C-Spine Landmarks: C7

A

The most prominent spinous process

42
Q

General considerations for Palpation

A
  • Landmarks are guides, they may not align exactly with the anatomy
  • Each vertebrae is about a finger’s width thick
  • The body and vertebral arches are much wider than the majority of the thoracic spine.
  • Transverse processes are much smaller than in other areas of the spine
43
Q

Bottom Up Approach to Palpation

A
  1. Locate post. rib 1
  2. Follow medially to vertebrae
  3. C7 located superior to articulation of Rib 1 to TV 1
44
Q

Top Down Approach to Palpation

A
  1. Locate mastoid process posterior to external auditory meatus
  2. From inferior tip of mastoid process move medially to contact CV1
45
Q

Hangman’s Fracture

A
  • Caused by forceful extension of the neck
  • Bilateral Fx of pars interarticularis
  • Can result in death
46
Q

Den’s Fracture

A
  • Results in avascular necrosis
  • Concomitant cruciate ligament rupture
    • Results in Death or quadriplegia
    • Children with Down Syndrome may have a congenital absence of stabilizing ligaments
47
Q

Erbs Palsy

A
  • C5/C6

- Waiters Tip

48
Q

Klumpke’s Palsy

A
  • C8/T1

- Claw Hand

49
Q

Winged Scapula

A

Long Thoracic Nerve (C5/C6/C7)

50
Q

Stingers and Burners Def and Dx?

A

= Shooting or singing pain traveling down an upper extremity

  • Possibly followed by numbness or weakness (should eventually resolve)
  • Dx? Consider a spine (not spinal cord) injury
51
Q

Spinal Cord Injuries Can Result in ____

A

Paralysis

52
Q

Torticollis Def? What can it lead to? Causes?

A
  • Unilateral SCM contracture is the most common cause of idiopathic torticollis in children
  • Causes sidebending and rotation of neck in opposite directions with SCM involvement; OA restrictions
  • Can lead to top down scoliosis
53
Q

Hiccoughs/Hiccups Cause? Tx?

A
  • Can be Caused By Inbalance of phrenic nerve

- Can be treated by balancing the anterior fascia of the neck

54
Q

Anterior Cervical Tender Points (AC1-8) Location? Tx?

A

AC1: Posterior edge of ascending ramus of mandible
AC2-6: Anterior to transverse processes
AC7: 2-3 cm lateral to clavicular head on superior aspect of clavical
AC8: Medial aspect of clavicular head

Tx = Flexion/Rotation away, sidebending towards

55
Q

Lateral Cervical Tender Points (LC1-7) Location? Tx?

A

LC1: Lateral aspect of lateral masses
LC2-7: Lateral aspect of transverse processes

Tx = Sidebend towards, slight rotation away, slight flexion/extension as needed

56
Q

Posterior Cervical Tenderpoints (PC2-C8) Location? Tx?

A

PC2: C2 spinous process centrally
PC3-7: spinous process centrally or paracentrally (Bifid spinous processes may have TPs on each tip)
PC8: between transverse process of C7 and rib 1

Tx = Extension/rotation away, Sidebending towards

57
Q

Posterior Occipital Tenderpoints Location? Tx?

A

PC2: 1 cm lateral to external occipital protuberance
Tx = Extension/rot/sb towards

PC1-F: External occipital protuberance
Tx= flex/sb towards, rot away

PC1-E: 2 cm lateral to external occipital protuberance
Tx= ext/sb towards, rot away

58
Q

MM that make up the Suboccipital triangle?

A

Rectus capitis posterior major - above and medially
Obliquus capitis superior - above and laterally
Obliquus capitis inferior - below and laterally

Rectus capitis posterior minor is in the region but does not make up the triangle

OPP 2.2 (5 decks)

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