Cervical Spine Lect and Lab Flashcards
Functional Anatomic Components of C-Spine
- Osseous
- Ligamentous
- Muscular
- Fascial
- Neurologic
C- Spine Flexion
- 90 degrees
- Limited by the posterior longitudinal ligament
C- Spine Extension
- 70 degrees
- Limited by direct contact of vertebral lamina, zygapophyseal joints (facets), and spinous processes
C- Spine Rotation
- Approximately 50% of rotation in AA joint
- Approximately 50% rest of the cervical spine
Define Vertebral Unit
Two adjacent vertebral segments with their associated intervertebral disk, arthrodial, ligamentous, muscular, vascular, lymphatic and neural elements
Vertebra Unit Conventional Name
Named for superior vertebra in pair
Vertebral Unit Joint
Inferior facets of superior vertebra on superior facets of inferior vertebra
Vertebra Unit Motion Reference Point
Reference point is superior, anterior aspect of superior vertebra
2 Atypical C-Vertebrae
- Atlas (C1) - no body
- Axis (C2) - odontoid process (dens)
4 Typical C-Vertebrae
- C3 - C6
- Have uncovertebral joints both superiorly and inferiorly
Typical C-Vertebral Units
- C2-C7
- Primary Motion = Sidebending
- Always sidebend/rotate to same side
- Will have Flexion/Extension Component
Typical C-Spine Zygapophyseal Joint
- Joints oriented at a 45 degree angle toward the eye.
- Posterior is inferior
- Anterior is superior
- Lateral is superior
(look at ppt image)
Typical Cervical Vertebrae are Unique Because…
- Uncinate Process
- Transverse Foramen
- Large Vertebral Foramen
- Body is Convex inferiorly, Concave superiorly
Atlantoaxial Joint (AA) Properties
- 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
Atlantoaxial Joint (AA) Ligaments
- Strong ligamentous attachments limit motion and instability
- Alar Ligament
- Cruciform Ligament
Alar Ligament
Attaches dens to occipital condyles
Occipitoatlantal (OA) Joint
= Occipital condyles articulating on C1
- Primary Motion = Flexion/Extension
- Sidebending/Rotation will ALWAYS be OPPOSITE
Occipitoatlantal (OA) Joint Properties
- 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
8 Ligaments of the C-Spine? Which are C-Spine only?
- Anterior longitudinal ligament
- Posterior longitudinal ligament
- Ligamentum flavum
- Interspinal ligament
- Intertransverse ligament
- Supraspinal ligament
- Nuchal Ligament
- Posterior atlanto-occipital membrane
C-Spine only?
- Nuchal Lig - C7 to greater Occipital ridge
- Posterior atlanto-occipital membrane
7 Anterior Muscles of the Anterior Deep Neck
- Rectus capitis lateralis -From TP of C1 to occiput
- Rectus capitis anterior -From LM of C1 to occiput
- Longus Capitis
- Longus Coli
- Anterior Scalene
- Middle Scalene
- Posterior Scalene
6 Posterior Muscles of the Deep Neck
- Rectus capitis posterior minor
- Rectus capitis posterior major
- Obliquus capitis superior
- Obliquus capitis inferior
- Interspinalis Cervecis
- Intertransversarii Cervicis
4 Deep Intrinsic MM of Posterior Neck
1 and 2. Semispinalis Cervicis and Capitis
- Multifidus (Terminates at CV2)
- Rotatores (Terminates at CV2)
3 Deep Intrinsic MM of Posterior Neck
1 and 2. Longissimus Cervicis and Capitis
3. Iliocostalis (Terminates at lower cervical vertebrae)
4 Deep Intrinsic MM of Posterior Neck
1 and 2. Semispinalis Cervicis and Capitis
- Multifidus (Terminates at CV2)
- Rotatores (Terminates at CV2)
3 Deep Intrinsic MM of Posterior Neck
1 & 2. Longissimus Cervicis & Capitis
3. Iliocostalis (Terminates at lower cervical vertebrae)
2 Superficial Intrinsic MM of Posterior Neck
Splenius Cervicis & Capitis
1 Extrinsic MM of the posterior neck
Descending Trapezius
Other MM of the Neck
- SCM
- Strap mm
- Pharyngeal MM
SCM Actions
- Sidebends and rotates the head in opposite directions when unilaterally contracted
- Flexes the head when bilaterally contracted
Cervical Fascia (7)? Which includes Sibson’s Fascia?
- Investing fascia
- *Infrahyoid fascia
- *Pre-tracheal fascia
- Buccopharyngeal fascia
- Alar fascia
- *Pre-vertebral fascia – includes Sibson’s
- Carotid sheath
Sympathetic Innervation of the Head and Neck
- Superior cervical ganglia - Anterior to C1-2
- Middle cervical ganglia - Anterior to C6
- Inferior (stellate) ganglia - Anterior to C7 (inferior)
May fuse with T1 (stellate)
Parasympathetic Innervation to most of the body?
- Vagus Nerve
- Affected by OA and C1 somatic dysfunction
Phrenic Nerve
- From cervical plexus (C3-5)
- Exits neck between clavicular and sternal heads of the SCM
Greater Occipital Nerve
- From C2
- Can cause tension HA d/t course through descending traps (C3 may also contribute through lesser occipital nerve)
Brachial Plexus
- Contributions from cervical nerves 5, 6, 7, and 8.
- Passes between anterior and middle scalenes
C-Spine Landmarks: C1
First transverse process palpated
C-Spine Landmarks: C2
First spinous process palpated
C-Spine Landmarks: C3
At the level of the hyoid bone
C-Spine Landmarks: C4/C5
At the level of the thyroid cartilage
C-Spine Landmarks: C6
At the level of cricoid cartilage
C-Spine Landmarks: C7
The most prominent spinous process
General considerations for Palpation
- 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
Bottom Up Approach to Palpation
- Locate post. rib 1
- Follow medially to vertebrae
- C7 located superior to articulation of Rib 1 to TV 1
Top Down Approach to Palpation
- Locate mastoid process posterior to external auditory meatus
- From inferior tip of mastoid process move medially to contact CV1
Hangman’s Fracture
- Caused by forceful extension of the neck
- Bilateral Fx of pars interarticularis
- Can result in death
Den’s Fracture
- 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
Erbs Palsy
- C5/C6
- Waiters Tip
Klumpke’s Palsy
- C8/T1
- Claw Hand
Winged Scapula
Long Thoracic Nerve (C5/C6/C7)
Stingers and Burners Def and Dx?
= 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
Spinal Cord Injuries Can Result in ____
Paralysis
Torticollis Def? What can it lead to? Causes?
- 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
Hiccoughs/Hiccups Cause? Tx?
- Can be Caused By Inbalance of phrenic nerve
- Can be treated by balancing the anterior fascia of the neck
Anterior Cervical Tender Points (AC1-8) Location? Tx?
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
Lateral Cervical Tender Points (LC1-7) Location? Tx?
LC1: Lateral aspect of lateral masses
LC2-7: Lateral aspect of transverse processes
Tx = Sidebend towards, slight rotation away, slight flexion/extension as needed
Posterior Cervical Tenderpoints (PC2-C8) Location? Tx?
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
Posterior Occipital Tenderpoints Location? Tx?
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
MM that make up the Suboccipital triangle?
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
