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Kinesiology > Cervical, Vertebrae and TMJ > Flashcards

Cervical, Vertebrae and TMJ Flashcards

1
Q

name the craniovertebral ligaments

A
  1. posterior atlanto-occipital membrane
  2. posterior atlanto-axial membrane
  3. anterior atlanto-occipital membrane
  4. anterior atlanto-axial membrane
  5. tectorial membrane
  6. ligamentum nuchae
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2
Q

name the spinal ligaments

A
  1. ligamentum flavum
  2. anterior longitudinal ligament
  3. posterior longitudinal ligament
  4. supraspinous ligament
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3
Q

describe the structure of the atlanto-occipital articulation

A

convex occiptial condyles articulate with concave superior facets of the atlas

synovial plane joint

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4
Q

describe the structure of the atlanto-axial articulation

A

dens and anterior arch of atlas/transverse ligament - synovial pivot joint

inferior facets of the atlas with superior facets of the axis - biconvex with meniscoids

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5
Q

what is the role of the transverse ligament? What motion does it help limit?

A

prevents anterior displacement of C1 on C2

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6
Q

what is the role of the alar ligament? What motion does it help limit?

A

it becomes taut in neck flexion and during axial rotation

limits lateral flexion and prevents distraction of C1 on C2

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7
Q

What conditions can compromise the integrity of the transverse ligament? What does that result in? What are some possible dangers?

A

RA and Down’s syndrome

instability of C1/C2 joint

C1/C2 can slide and compress the spinal cord and even cause paralysis

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8
Q

describe the orientation of lower cervical facet joints

A

approximately 450 off frontal plane and transverse plane

maximizes motion

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9
Q

what osteokinematic motions occur at the cervical spine?

A
  1. Flexion/Extension
  2. Lateral flexion
  3. Rotation
  4. Protraction/Retraction
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10
Q

what produces protraction at the cervical vertebrae

A

combo of

lower C-spine flexion and upper C-spine extension

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11
Q

what produces retraction at the cervical vertebrae?

A

combo of

extension in lower C-spine and flexion in upper C-spine

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12
Q

what is the primary osteokinematic motion at the atlanto-occipital joint?

A

flexion/extension

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13
Q

describe the arthrokinematics at the atlanto-occipital joint?

A

convex (occipital condyle) on concave (superior facets of atlas)

opposite roll and glide/slide

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14
Q

T/F: movements in the transverse plane are limited at the atlanto-occipital joint?

A

TRUE

limited by deep joint congruency

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15
Q

Atlanto-occpital flexion = occipital condyle roll ______ and glide ________

Atlanto-occipital extension = occipital condyle roll _____ and glide _______

A
  1. anterior; posterior
  2. posterio; anterior
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16
Q

what is the primary osteokinematic motion that occurs at the atlanto-axial joint?

A

rotation

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17
Q

describe the arthrokinematics at the atlanto-axial joint

A

inferior facet of atlas/superior facet of axis

gliding → ipsilateral posterior glide with contralateral anterior glide

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18
Q

what limits rotation at the atlanto-axial joint?

A

alar ligaments

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19
Q

what limits movement in the sagittal plane at the atlanto-axial joint?

A

inferior facet of atlas/superior facet of axis → no gliding

limited by transverse ligament

atlanto-axial joint tilt instead

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20
Q

what limits tilting of the axis at the atlanto-axial joint with flexion?

A

transverse ligament

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21
Q

what coupling motion occur in the lower cervical spine?

A

lateral flexion with rotation coupled in the same direction

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22
Q

what would occur if either lateral flexion or rotation was done in isolation rather than in a coupling motion?

A

the facet joints would come into contact with one another blocking the motion

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23
Q

describe the arthrokinematics that occur during flexion/extension of C3-C7

A

flexion = inferior facet (of superior vertebrae) glides anterior and superior to superior facet (of inferior vertebrae)

extension = inferior facet (of superior vertebrae) slides posterior and inferior to superior facet (of inferior vertebrae)

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24
Q

describe the arthorkinematics that occur during rotation in C3-C7

A

same side as rotation = inferior facet glides posterior and slightly inferior

opposite side as rotation = inferior facet glides anterior and slightly superior

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25
Q

descibe the arthrokinematics that occur during lateral flexion of C3-C7

A

same side - inferior facet glides inferior and slightly posterior

opposite side - inferior facet glides superior and slightly anterior

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26
Q

describe the arthrokinematics of R rotation of C4-5

A

R (ipsilateral) C4 facet glides posterior and slightly inferior on C5 facet

L (contralateral) C4 facet glides anterior and slighly superior on C5 facet

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27
Q

what is the overall function of the cervical spine?

A

stability and protection

C-spine demonstrates most flexibility

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28
Q

what are concerns with muscular imbalance and poor posture?

A

prolonged protraction results in forward head posture

lengthening of deep neck flexors and scapular retractors and tightening of the pecs and upper trap/levator scapulae

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29
Q

what is the benefit of lordotic and kyphotic curves? Drawback?

A

increased ability to resist compressive load

opportunity for shear forces to act, particularly at regions of transition between curves

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30
Q

what is the role of the vertebral body?

A

weight-bearing structure of spinal column, resist compressive loads

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31
Q

what is the role of the pedicles?

A

transmit tension and bending forces from posterior elements to vertebral body

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32
Q

what is the role of the laminae?

A

transmit force from articular, transverse and spinous processes to the pedicles

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33
Q

what is the pars articularis?

A

portion of the laminae between the superior and inferior articular processes

subject to bending forces

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34
Q

what is the role of the articular facet processes?

A

form facet joints and contribute to the articular pillar

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35
Q

what is the role of the spinous process?

A

serve as a muscle attachment and provide mechanical lever

may also serve as boney block to motion

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36
Q

what is the role of the transverse processes?

A

serve as muscular attachment and provide mechanical lever

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37
Q

what are some concerns you may have if someone has a bilaterally pars interarticularis fracture?

A

spondylolisthesis (forward slipping of the vertebrae)

can lead to compression of the spinal cord leading to neurological deficits

most commonly occurs at L5/S1 secondary to angulation of this segment

38
Q

what is the purpose of the intervertebral discs?

A
  1. increase available motion
  2. transmit load
  3. stabilization of spine
  4. provide space betwen vertebrae and exiting spinal nerves
39
Q

What are the components of the intervertebral disc?

A
  1. nucleus pulposus
  2. annulus fibrosus
  3. vertebral end plate
40
Q

what is the annulus fibrosus?

A

fibrous outer ring of the intervertebral disc

60-70% water

collagen and elastin arranged in 15-25 concentric layers

fibers oriented 650 from vertical

41
Q

what is the role of the annulus fibrosus?

A

helps keep the nucleus pulposus inbetween the vertebrae

capable of resisting distraction, sheer and torsion forces

42
Q

what is the vertebral end plate?

A

cartilaginous layer covering the S/I surfaces fo the disc

0.6-1 mm of cartilage in adults

strongly attached to annulus fibrosis but not the vertebral body

43
Q

what can occur with an end plate fracture?

A

nuclues pulposus starts to herniate

44
Q

T/F: 80% of force is transmitted through the intervertebral disc

A

TRUE

45
Q

what position increase the pressure on the disc the most?

A

Most = forward bending w/load in front of body

slouching > sitting erect

46
Q

What motions are available at an interveterbral joint?

A
  1. gliding
    • AP, ML and torsional
  2. distraction and compression
  3. rotation (also called tilt)
    • AP, lateral direction
47
Q

T/F: zygapophyseal (facet) joints do not contain any fibromeniscoids?

A

FALSE
they do have them

48
Q

define coupling

A

consistent association of one motion about an axis with another motion around a different axis

lateral flexion with rotation is an example

49
Q

what influences spinal coupling patterns?

A
  1. spinal posture
  2. spinal curvature
  3. orientation of articulating facets
  4. fluidity/elasticity/thickness of the disc
  5. extensibility of the muscles, ligaments and joint capsules
50
Q

describe the kinematic role that intervertebral joints have

A
  1. determine magnitude of movement
  2. distribute load
  3. create space for movement and passage of the spinal nerve roots
51
Q

describe the kinematic role of facet joints

A

determine the direction of the movement

“train tracks”

52
Q

Spinal osteokinematics decribe the movement based on the direction of what?

A

superior segment’s anterior portion

(front of inferior facet of the superior vertebrae)

53
Q

what are the arthokinematic motions that occur at the intervertebral joints with each osteokinematic motion?

A
  1. approximation/distraction and gliding
  2. tipping
54
Q

what are the arthokinematic motions that occur at each facet joint with each osteokinematic movement?

A

approximation/gapping and gliding

55
Q

what is the overall function of the spinal musculature?

A
  1. control posture
  2. stabilize axial skeleton
  3. protect spinal cord and internal organs
  4. generate intra-thoracic and intra-abdominal pressure
  5. produce torque for movement of the body
  6. mobility of head and neck for optimal place of eyes, ears, and nose
56
Q

what bones make up the TMJ?

A

mandible and temporal bone

57
Q

what is the purpose of the articular disc at the TMJ?

A

separate upper and lower articulation

cushions the large repetitive force of mastication

58
Q

describe the articular surfaces of the TMJ joint

A

articular eminence and mandibular condyle are both convex resulting in incongruent joint

59
Q

T/F: the TMJ joint is covered in hyaline cartilage

A

FALSE

covered with fibrocartilage

60
Q

if both articular surfaces of the TMJ are convex, how does it move?

A

articular disc is biconcave to allow both surfaces to remain congruent throughout ROM

result → joint is separated into a S/I joint

61
Q

describe the articulations of the superior and inferior joint in the TMJ

A

superior ⇒ articular eminence with superior disc

inferior ⇒ condyle with lower disc

62
Q

what are the attachments of the articular disc at the TMJ?

A
  1. medial and lateral poles of condyle
  2. joint capsule and lateral pyterygoid anterioly
  3. bilaminar retrodiscal pad posteriorly
63
Q

what does the attachment of the articular disc on the medial and lateral poles of condyle allow for?

A

the condyle to rotate freely on the disc in the AP direction

64
Q

what does the attachment of the articular disc to the joint capsule and lateral pyerygoid at the TMJ allow for?

A

it restricts posterior translation of the disc

65
Q

what does the attachment of the articular disc to the bilaminar retrodiscal pad allow for?

A

superior lamina - assists the disc with translating anteriorly with mandibular depression

inferior lamina - limits forward translation

66
Q

what is the makeup of the joint capsule of the TMJ?

A

capsule in thin and loose AP and relatively firm ML

67
Q

what is the most common direction of dislocation of the TMJ and why?

A

anterior, due to lack of strength of anteiror capsule and the incongruence of the articular surfaces

68
Q

name the ligaments of the TMJ and describe their function

A
  1. lateral (TM) ligament
    • stabilize lateral portion of capsule, help guide movement of condyle during opening
  2. Sylomandibular ligament
    • weakest of 3 with questionable function
  3. Sphenomandibular ligament
    • swinging hinge that suspends the mandible
69
Q

what is the normal resting position of the TMJ?

A

lips closed and teeth several mm apart

maintained by low level activity of the temporalis muscle

70
Q

what are the osteokinematic motions at the TMJ?

A
  1. elevation/depression
  2. protrusion/retrusion
  3. L/R lateral excursion
71
Q

how and at which part of the joint does the first part of the mouth opening occur?

A

50% of motion occurs as rolling the lower joint

posterior roll (depression)

disc remains stationary, condyle on temporal bone is where movement occurs

72
Q

how and at which part of the joint does the second part of the mouth opening occur?

A

50% of motion occurs in the upper joint as gliding

anterior glide in upper portion

disc pulled anteriomedially by lateral pterygoid and then slides along with condyle

73
Q

how and at which part of the joint does the first part of mouth closing occur?

A

50% motion occurs in the upper joint as a posterior glide

74
Q

how and at which part of the joint does the second part of mouth closing occur?

A

last 50% of motion occurs in the lower joint as an anterior roll

75
Q

how and at which part of the joint does protraction of the TMJ occur?

A

anterior and slighlty inferior glide of condyle and disc

76
Q

how and at which part of the joint does retraction of the TMJ occur?

A

posterior and slightly superior glide of the condyle and disc

77
Q

T/F: no rotation (or rolling) occurs with protrusion and retraction of the TMJ?

A

TRUE

78
Q

what occurs on the ipsilateral side during TMJ lateral excursion?

A

primarily side-to-side translation of condyle and disc within the fossa

ipsilateral condyle glides posteriorly (retrusion)

79
Q

what occurs on the contralateral side during TMJ lateral excursion

A

primarily side-to-side translation of condyle and disc within fossa

anterior glide on the contralateral condyle

80
Q

what muscles and forces act on the TMJ during opening?

A
  1. primarily gravity
  2. digastric
  3. suprahyoids
  4. inferior lateral pterygoid
81
Q

what muscles and forces act on the TMJ during closing?

A
  1. temporalis
  2. masseter
  3. medial pterygoid
  4. control of disc vis lateral pterygoid (eccentric control)
82
Q

what muscles and forces act on the TMJ during protrusion?

A
  1. bilaterally superior masseters
  2. bilaterally M/L pterygoids
83
Q

what muscles and forces act on the TMJ during retrusion?

A
  1. bilaterally posterior fibers of temporalis
  2. bilateral deep fibers of masseter
  3. bilateral anterior digastric
84
Q

what muscles and forces act on the TMJ during lateral excursion?

A
  1. contralateral M/L pterygoid (pull condyle forward)
  2. ipsilateral temporalis (pull condyle posterior)
85
Q

what is the normal ROM for the different motions of the TMJ?

A
  1. opening - 35-55 mm
    • function = 25-35 (2 knuckles)
  2. lateral excursion - 10-15 mm
  3. protrusion - 3-9 mm
  4. retrusion - about 3 mm
86
Q

what is TMD?

A

a broad/vague term used to describe dysfunctions associated with TMJ

87
Q

what symptoms are associated with TMD?

A
  1. pain
  2. popping
  3. reduced bite force
  4. reduced ROM w/mouth opening
  5. HA
  6. tinnitus trigger points
88
Q

what factors are associated with TMD?

A
  1. stress/emotional disturbance
  2. daily oral parafunction habits (teeth grinding)
  3. asymmetric muscle activity
  4. sleep bruxism (teeth clenching during sleep)
  5. chronic forward head posture
  6. C-spine pathology
  7. sensitization of the CNS
89
Q

describe what is occuring during mouth opening/closing when there is disc replacement with reduction

A

disc sits anterior, not in anatomical position

the disc does not move with the condyle like it normally would, instead it relocates during opening and subluxes during closing

90
Q

what is a reciprocal click?

A

an click that occurs during jaw opening as the disc relocates

then when the jaw is closing, there is a click as the disc gets squeezed abnormally and subluxes anteriorly

91
Q

what is occuring during mouth opening/closing when there is disc displacement without reduction?

A

there is a partial displacement or dislocation of the disc in resting position

thus the mandiblar condyle is unable to pass over the posterior border of the disc during opening

since the disc doesn’t relocate it blocks translation and limits motion at durng opening/closing

92
Q

how does posture and the cervical spine impact the TMJ?

A

head and neck position may affect tension in cervical muscles which can influence the function of the mandible

Kinesiology (13 decks)

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