Cervical Spine Lecture Flashcards
1
Q
What vertebral level is the hyoid bone located at?
A
Across from C3
2
Q
What vertebral Level is the thyroid cartilage located?
A
C4-C5
3
Q
What level is the 1st cricoid ring located at?
A
C6
4
Q
What important anatomical landmark is located on C6?
A
The coratid tubricle
5
Q
What is the most common symptom of anterior osteophyes?
A
Usually these are asymtomatic
Sometimes = difficulty swallowing
6
Q
What is the difference between the inion and the external occipital pertuberance?
A
The EOP is the bump
the inion is the center of the bump
7
Q
What is the first palpable SP in the cervicle spine?
A
C2
8
Q
What are the typical cervial vertebre?
A
C3-C6
9
Q
Describe a unilateral facet dislocation
A
The superior facet of the contralateral side moves anterior-superior and over the tip of the inferior articular facet of the involved side, resulting in placement in the intervertebral foramen anterior to the inferior facet
What does that mean? The superior articular facet from the segment below reaches up and grabs the bottom of the inferior articular facet from the segment above and pulls it into the intervertebral foramen. (I think?)
10
Q
What injuries are commonly associated with a unilateral facet dislocation?
A
disruption of the non dislocated joint
concomitant fracture of either facet or the complete lateral
mass
partial tearing of the PLL
bony fractures of the remaining cervical spine
11
Q
How many z joints are there in the cerival spine? what kind of cartilage is associated with them?
A
14 (obviously 7 vertebra with 2 zs a pop)
they are synovial joints so the articular cartilage is hyline cartilage, just as all articular cartilage is and will always be.
12
Q
Average horizontal plane of the facets?
A
45 degrees
13
Q
Give the levels, shape, and joint classification of the unconvertebral joints.
A
Levels C3-T1
Shape: Saddle
Classification: diarthrodial
14
Q
What are the major joints that control coupled motion in the cervical spine?
A
Unconvertebral (aka Joint of Luska) and the Z-joints
15
Q
What motions reduce the size of the IVF?
A
full extension and ipsilateral side bending of the cervical spine
16
Q
What is the most common area for pathology in the cervial spine?
A
C5-C6
17
Q
What is a bigger problem, anterior or posterior osteophyes?
A
Posterior
ex: posterior osteorphyes of the uncinate processes can compress the nerve roots in the IVF or the spinal cord
18
Q
Functionally, what makes up the cervicothoracic
junction?
A
The actual junction: C7-T1 segment
Functionally also includes: (3 segments, 2 ribs, one other thing) C7 vertebra T1 and T2 vertebrae ribs 1+2 manubrium
19
Q
Where is the thoracic outlet?
A
at the Cervicothorcic juntion
20
Q
What passes though the thoracic outlet?
A
Neurovasuclar structures of the upper extremity - importantly the brachial plexus and the axillary artery
21
Q
Describe the shape of the ALL in the Cervial/upper thoracic region
A
Like a cello - Narrow at the top of the cervials, gets wide in the mid/lower cervicls, and then narrows again in the upper thoracic
22
Q
What does the ALL attach to?
A
The FRONT of the vertebral bodeis
23
Q
Describe the shape of the PLL in the cervicls compared to the thoracic region
A
This is like an upside triangular thing
Broad and wide up top, narrows and gets less thick as it desends.
24
Q
What does the PLL attach to?
A
The POSTERIOR aspect of the Bodies AND the Discs
25
Traps: OINAB:
O: EOP, medial 1/3 of superior nucal line, SP of C1-T12, and ligamentum nuche
I: Posterior lateral 1/3 of clavicle, spine of the scapula, acromion
N: Spinal Accessory N, C3 and C4 Ventral Rami
A: elevates scapula, upwardly rotates scapula, downwardly rotates scapula, retracts scapula
B: transverse cervial artery
Recognize that the trap connects the head to the thoracolumbar fascia
26
Describe what happens to the neck in a CAD injury
1. Impact: lower body moves forward and head moves superior, so the cervical curve is lost.
2. Head moves posterior and hits the head rest (so keep it at a good spot). - ALL and flexors stretched
3. Head rebounds - flexors contract, extensors and PLL are stretched.
27
What is the largest anterior neck muscle?
Sternoclidomastoid
28
SCM: OINAB
O: Manubrum of the sternum and medial aspect of the clavial
I: mastoid process
N: spinal acessory (m) and ventral rami of C2 and C3 (s)
A: rotates the head in the opposite direction and laterally flexes the head
B: occipital artery and superior thyroid artery
29
What is the AKA for Toticolis?
Wry Neck
30
What is the cause of torticolis?
Generally unknown
| -can result from trama during birth (usually considered congenital in these instances)
31
What is actually happening in toticolis?
The SCM is transformed into a wry cord which cannot grow with the neck. It causes rotation to the opposite side with flexion of the head in the same direction. (like the SCM is contracted/short, since it is).
32
What season are most common for the onset of toticolis?
Spring
| Fall
33
If the torticolis is acquired, what is the usual age of onset? Which sex is more likely to be effected?
30-60 years old
| both sexes
34
Levator Scapule: OINAB
O: upper cervical transverse processes
I: superior angle of scapula
N: Dorsal Scapular Nerve (C5) some involvement from C3 C4
A: 1. elevates the scapulae, 2. Side bending (unilateral) 3. Extension of head (bilateral)
B: transverse cervical artery
35
Rhomboid Major: OINAB
O: SP of T2-T5
I: Medial Scapule (spine to inferior angle)
N: Dorsal Scapular Nerve (C5)
A: retracts the scapula
B: transverse cervical atery/dorsal scapular artery
36
Rhomboid Minor: OINAB
O: SP of C7 and T1
I: Medial border of the scapule above the spine
N: Dorsal Scapular Nerve (C5)
A: retracts the scapule
B: transverse cervial artery/dorsal scapular artery
37
True or False: Both Rhomboids are involved in isolated cervical movements.
False: Rhomboid minor has some association but rhomboid major has nothing to do with isolated cervical movements
38
What range of motion is associated with a clay shovler's fracture?
Hyperflextion/sudden flextion
Specifically they are caused by sudden exertion of the muscular attachments at the base of the spinous processes
39
Which segments are more likely to have a clay shovler's fracture. Why?
C7
C6
T1
This is a transitional area, so it takes more of the stress.
40
Can a clay shovler's fracture ever effect the spinal cord?
Yes. if the fracture extends anteriorly into the lamina, it could potentially damage the cord.
That being said this is usually considered a stable fracture (so if it hasn't gone to the lamina it isn't too scary).
41
What do I want to at to evaluate if the clay shovler's fracture has extended into the lamina?
Spinolaminar juntion line
42
What muscle's relationship to the subclavian artery is most clinically significant?
The scaleans
43
Anterior scalean: OINAB
```
O: Anterior tubrical of C3- C6 TPs
I: 1st rib
N: ventral rami of c3-c6
A: 1. elevates the ribs during inspiration. 2. contralateral rotation 3. ipsilateral lateral flexion
B: inferior thyroid artery
```
44
Middle scaleans: OINAB
```
O: TP of all cervial vertebrae
I: 1st rib (behind the anterior scalean)
N: ventral rami c3-c8
A: 1. elevates the ribs during inspiration. 2. contralateral rotation. 3. ipsilateral lateral flexion
B: ascending cervical atery
```
45
Posterior Scaleans: OINAB
```
O: Posterior tubricles of C5 and C6 TPs
I: 2nd or 3rd rib
N: ventral rami of C5-C7
A: elevates the ribs during inspiration. 2. contralateral rotation. 3. ipsilateral lateral flexion.
B: ascending cervical atery
```
46
What syndrome is associated with shorting of the scaleans?
Thoracic outlet syndrome
When these muscles shorted they will pull the ribs which compresses/narrows the outlet space that the biracial plexus/subclavian artery are supposed to pass though.
47
Who is at risk for Throacic outlet syndrome?
Anyone who carries heavy loads on their shoulders
Anyone who is required to do a lot of overhead reaching (athletes etc)
Anyone who is required to stand all day and might not have the best posture (casiers etc)
Those with bad posture, muscle tightness, poor form when exersizing, some tramas, or a cervical rib closing the space.
**note, cervical rib is less likely than all of the other stuff.
48
What are the symtoms of TOS?
1. tingling or numbness in the upper limb/neck
2. weakness in the hand or the arm (I feel like i can't hold a cup of coffee)
3. Hand or arm swelling
4. aching in shoulder or neck
49
What position will exascerbate the symptoms of TOS?
Overhead reaching, since it will further compress the space.
50
What level is the thyroid gland located at?
C4 C5 vertebre
51
Where is the parotid gland located?
over the angle of the mandible
52
There are a number of things that a swollen parotid gland may indicate? Which is the one that is all over the news right now?
mumps
53
What is unique about the nurology in the cervical spine?
It is the only area that had more nerve roots than segments
54
Where does the C1 nerve root exit?
Between C0 and C1
55
Where does the C1 disc sit?
There is no C1 disc! Trick Questions!
56
Explain how the discs and the nerve roots are named in the cervicl spine.
Segment - disc named for the segment above - nerve root named for the segment below - segement
57
C2 nerve root is compromised: What symptomantology do you expect to see?
Head aces, neck pain
| In general, structures supplied by the upper 3 cervical nerves can cause neck and head pain
58
C5 nerve root is compromised: what general symptomantolgy do you expect to see?
Shoulder Pain, chest pain
| in general lower cervical nerves can refer symptoms to the shoulder, anterior chest, upper limb, and scapular area
59
C5 muscle test: which muscles, actions and nerves?
Shoulder Abduction - Deltoid - Axilary Nerver
| Forearm Flexion - Biceps Braccii - Musculocutenous nerver
60
Why do we ask the patient to put themselves into the position that we want them in to muscle test?
So that we can start to check for muscle grading. If they can move against gravity without any external pressure being applied they at least get a 3 on the oxford scale.
61
What does the Van Allen's Scale measure?
AKA Oxford scale
| This is a muscle grading chart so it measures muscle contractility/strength
62
What is the normal rating on the oxford scale?
5: against gravity with full resistance, complete ROM is evident
63
What dose a 1 on the Van Allen's scale mean?
Trace: slight contractility with no joint motion evident
64
Go though the Oxford scale.
5 - normal - against gravity with full resistance, complete ROM is evident
4 - Good - aginst gravity with some resistance, complete ROM is evident
3 - fair - against graviy, comlete ROM is evident
2- Poor - gravity eleminated, complete ROM is evident
1 - trace - slight contractility with no joint motion evident
0 - zero - contractility is not evident
65
What doe the Wexler scale measure?
Reflex grading chart
66
What is normal on the wexler scale?
2+
67
Go though the wexler scale.
5+ highly increased responce, sustained clonus, possibility of disease pathology exists
4+ highly increased responec, increase possibility disease pathology exists
3+ slighly increased responce, possibility of disease pahtology exists
2+ normal
1+ slightly deminished, lower than normal responce, hypoactive
0 no responce
68
What reflex checks the C5 nerve root?
Distal Biceps tendon reflex
69
Where is the purest patch of the axillary nerve?
Covering the lateral portion of the deltoid muscle
70
C6 muscle testing: action, muscles, nerve.
wrist extension
extensor carpi radilis longus and brevis, extensor carpi ulnaris
radial nerve
71
C6 reflex?
Bracioradialis
72
C7 muscle test: action, muscle, nerve
forearm extension - triceps - radial nerver
wrist flexion - flexor carpi radialis (median nerver)
flexor carpi ulnaris (ulnar nerve)
finger extension: extensor digitorm communican, extensor digiti minimi, extensor indicis profundus (radial nerve)
73
C7 reflex
Distal radial tendon (just proximal to the olecronon fossa)
74
C8 muscle test: action muscle, nerve
Finger Flextion - flexor digitorm superficialis and profundus , lumbricls (median and ulnar nerves)
75
C8 refelx.
There is no reflex for this nerve root
76
T1 muscle test: action, muscle, nerve
T1 is finger fun!
ABduction: Palmar interossesi
ADDuction: Dorsal interossei
both are ulnar nerve
77
T1 reflex:
There is no reflex for this nerve root
78
How do the z-joints move during flextion and extension?
Extension: inferior facet from segment above moves DOWN, IN, and BACK (or inferior, medial, and posterior gliding of the inferior facet on the superior facet)
Flexion: inferior facet from the segment above more UP, OUT, and FOWARD (or glides superior, lateral, and anterior)
79
What motion is rotation coupled with in the cervical spine?
Ipsilateral side bending
80
What is the AKA for a Jefferson's fracture?
Burst Fracture
81
When are you likely to see a moderately unstable burst fracture?
Axial Load or vertebral compression
- head first dive into a shallow pool
- car accident that throws someone though the windshild
82
When are you likely to see a highly unstable burst fracture?
When the transverse ligament is also unstable
- RA
- Down Syndrome
- other degenerative processes
83
What does a jefferson's fracture look like on film?
Asymmetric lateral bodies on odontoid view, increased predental space
(so when I look at the APOM the lateral masses have a weird over hang. on a lateral view the ADI is way off).
84
What is a Hangman's fracture?
Fracture of C3 PARS (articular pillar?) and disruption of the C2 C3 juntion
- this is a spondyloslisthesis of C2
85
What ligament are we likely to damage in a hangman's fracture?
PLL
86
Neurological Damage occuing after a hangman's fracture usually presents with what anatomical changes?
1. Horizontal translation
2. PLL damage
3. possible damage to the C2 C3 interspace
87
What causes a Hangman's fracture?
blow on the forehead forcing the neck into extension
| classic is a hanging
88
What are the clinical signs and symptoms that may occur in the cervial spine that point to a more serious pathology?
```
Unexplained weight loss
Night pain
Involvement of more than 1 nerve root
Expanding pain
Weak and painful resisted testing (4 findings and their interpretations)
Spasm with Passive range of motion
T1 palsy
```
89
What is the preferd order of the upper quadrent scan?
appropriate for upper thoracic, upper extremity, and cervical problems
Active ROM: C5-T1 in order
Passive ROM: C5-T1 in order
Deep Tendon Reflex
Senstation
90
Where does most of the Flexion and Extension in the cervical spine occur?
At C0-C1: 50% of flexion and extention
91
Where does most of the rotation in the cervical spine occur?
Between C1-C2: 50% of rotation
92
What is Klippel – Feil Deformity?
When the bodies of 2 or more cervical vertebre are are fused. will also present with short, broad necks; restricted movement; and low hairlines.
93
What are the peripheral nerves that come off of the brachial plexus which may lead to loss of MOTOR function?
```
Long thoracic
Thoracodorsal
Subscapular
Suprascapular
Dorsal scapular
Medial pectoral
Lateral pectoral
Axillary
Musculocutaneous
Radial
Median
Ulnar
```
94
What are the peripheral nerves that come off of the brachial plexus which may lead to loss of Sensory function?
```
Musculocutaneous
Axillary
Radial
Median
Ulnar
```
95
What does Halstead’s test indicate?
TOS
| + is radial pulse disappears
