Exam 2 Flashcards
Below are flashcards on 2.1 - Whole Spine
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How many specific vertebrae do you have at each level of the spine:
Cervical: 7 Thoracic: 12 Lumbar: 5 Sacral: 5 (sometimes 6 in some) Coccyx: 4 (sometimes 3 if some fuze together)
33 total … some count sacrum as 1, and coccyx as 1
Review the spinal curves of the back:
REMEMBER: Lordosis is LUMBAR … so if Lumbar is Lordosis, so much cervical area. The other two must be opposite = kyphosis.
Cervical: Lordosis
Thoracic: Kyphosis
Lumbar: Lordosis
Sacral: Kyphosis
What is the line of gravity in “Zero” standing position:
From external auditory meatus (lateral side) …
Come down through C2 dens ….
Then down the posterior side of cervical vertebrae (since it is Lordosis going forward) …
Then anterior side of the thoracic vertebrae (since they are kyphosis) …
*** Goes through C2, then C7/T1, then T12/L1, Then L5/S1
What are the main bony features of a typical vertebrae (all vertebrae):
Body Pedicle Lamina Arch Sup / Inf Articular processes Transverse processes Spinous process Intervertebral foramen (for spinal nerve) Vertebral foramen (vertebral foramina for spinal cord) Superior / inferior vertebral notch
A typical vertebral BODY has 2 main parts, explain each:
Which of those two areas is cortical and which is cancellous bone?
1) Epiphyseal end plate: This is the OUTER growth plate of a vertebrae (body). So in an adult skeleton this outer area will be fuzed, but in an immature skeleton you’d see some hyaline cartilage suggesting growth.
2) Cartilaginous end plate: The INNER portion which remains as hyaline cartilage throughout adulthood. It has many holes / perforations in the hyaline cartilage where blood vessels can go through and feed IV discs above/below.
OUTER epiphyseal end plate is hard CORTICAL. INNER cartilaginous end plate is CANCELLOUS bone.
1) What are 2 reasons that having cancellous bone is important in the body of a vertebrae:
2) Can weight / stress placed on a superior articular process, for example, be redistributed to the body of the vertebrae?
3) Can forces on vertebral body be transferred into vertebral arch?
4) Do these cancellous bony parts intersect? Why?
1)
- It helps distribute the stress / weight / forces on spinal column.
- It allows blood vessels (and bone marrow … create new blood cells) to go up/down to IV discs to nourish and supply IV discs.
2) Yes. The cancellous bone has both vertical and horizontal cancellous bone to help distribute weight across the vertebrae.
3) Yes.
4) Yes - the intersection creates the winding/binding together, thus the strength.
1) About what age do blood vessels STOP passing through IV discs and cancellous bone?
What does that mean about injury and aging?
1) After age 8, blood vessels stop passing through vertebrae. The older one gets, the fewer blood vessels pass blood through. So injury at young age gets blood so can heal quicker, but older a person gets they lose blood to those areas so bone can’t heal.
SO, movement makes IV Discs pass fluid through IV discs. So movement is KEY to help spine stay healthy and be able to move. More you move, the more your joints get nourished / lubricated.
What area of a vertebrae is area of WEAKNESS. Why?
An area of weakness in body of vertebrae is ANTERIOR since there are fewer intersections of cancellous bone. Most likely area of a crush or WEDGE or injury is the ANTERIOR part of vertebral body (collapses down).
1) Explain the 2 main structures of an IV disc
1A) Describe the orientation of fibers of the annulus fibrosus … and why
2) What are these 2 composed of
3) What are Sharpey’s fibers?
4) Describe the movement of the 2 parts of the IV disc
5) Does the annulus fibrosus have ability to resist compression forces (from weight above)? Is it as good at resisting compression as nucleus pulposus?
6) You know what a herniated disc is, but where typically does breakdown of an annulus fibrosus take place?
7) If you FLEX back, what part of disc is compressed? If you EXTEND back, what part of disc is compressed?
8) So if you do FLEXION, what happens to the POSTERIOR part of the disc? Does it go on tension or compression?
1) Has an annulus fibrosus on the outside, and nucleus pulposus on inside.
1A) The annulus fibrosus is like a tree - it has rings or layers / lamina. The fibers of the outer ring go in a perpendicular orientation to the next layer down. And it keeps going alternating like this down to the nucleus pulposus. Why? So if you do TORSION, one layer goes on stretch (to RESIST torsion), the other layer just deep goes on slack. The layers rubbing against each other help create grip / friction / resistance to weight pushing IV disc out.
2)
Nucleus Pulposus: Primarily WATER (glyco cymetoglycan) Fibers (gel / squishy, absorbs weight).
Annulus Fibrosus: Fibrocartilaginous rings (layers)
3) Sharpey’s fibers are what anchor the IV disc to the Vertebral body. Otherwise, how do they stay connected together (lots of ligaments hold vertebrae together, but sharpey’s fibers hold IV disc to vertebral body)? They need to be anchored together - that is what Sharpey’s fibers are.
4) 1A above talks about how the fiber orientation of the annulus fibrosus layers go in diff directions to help with torsion. But also, when force/weight is placed DOWN VERTICALLY onto a IV disc, naturally the nuceus pulposus will get pressed down and squeezed out in all directions. The annulus fibrosus layers will contain it from popping or being compressed too much, and these annulus fibrosus layers will SHEAR during that expansion/tension. As annulus fibrosus resists the expansion, it naturally expands, and the layers of fibers will SHEAR as they act against each other as they expand.
5) Annulus fibrosus can take some compession, but when weight is placed on back, the nucleus pulposus takes most of the compression force.
6) Postero-LATERAL corner of the IV disc.
7) Flexion will make ANTERIOR disc compressed/bulge. Extension will make POSTERIOR disc compressed/bulge.
8) It goes on TENSION
1) If you do back flexion, what happens to the INFERIOR articular process?
2) If you do back FLEXION, will the anterior annulus fibrosus be on compression or tension
3) During flexion, which way does nucleus pulposus want to go (to pop out)?
4) If you do EXTENSION, will anterior annulus go on compression or tension?
5) During back extension, which way does nucleus pulposus want to go (pop out)?
6) Are the intervetebral joints (sup/inf articular processes) being opened or closed during extension?
1) It goes UP … opening that joint.
2) Compression
3) Posterior
4) Tension
5) Anterior
6) Closed
1) If you do back FLEXION, what limits that motion?
2) T or F: All diarthrodial (synovial) joints have a capsule
3) If you do back EXTENSION, what limits that motion?
4) Pushing / pressing two joint surfaces together is called? Is this the same as opposition?
1) CAPSULE and LOTS of Ligaments (supraspinous lig, interspinous lig, ligamentum flavum, somewhat the post. longitudinal lig). So flexion is limited by soft tissues / ligament tissues.
2) True
3) Primarily bony prominences running into each other … Sup and Inf. articular processes limit this movement. Plus, a little from the ant. longitudinal lig.
4) Apposition. Apposition is when two surfaces are pressed together. OPPOSITION is when two surfaces oppose each other.
How does a IV disc and vertebral body get nourished?
Is it active or passive?
Nourishment comes from MOVEMENT. As you move, nucleus pulposus/annulus fibrosus nourishes vertebral bodies.
NUTRITION OF IV DISC IS PASSIVE.
1) Are ligaments innervated and have a nerve supply?
2) Is fibrocartilage innervated with a nerve and blood supply?
2A) Can hyaline cartilage repair itself after an injury?
2B) Is articular cartilage hyaline cartilage
3) Is Annulus fibrosus fibrocartilage?
4) Is annulus fibrosus innervated with nerve and blood supply?
1) YES
2) NO
2A) Cartilage has limited repair capabilities: Because chondrocytes are bound in lacunae, they cannot migrate to damaged areas. … Also, because hyaline cartilage does not have a blood supply, the deposition of new matrix is slow. Damaged hyaline cartilage is usually replaced by fibrocartilage scar tissue.
2B) YES
3) YES
4) Well … no. But since the outer layers are right next to all those lig’s which do get blood and nerve supply, so the few outer layers of the annulus fibrosus do get some nerve and blood supply as a result.
1) Remember he talked about the Nachemson and Wilke study. What was it?
2) What is normal upright standing position =
3) Will IV disc pressure increase or decrease in a slightly FLEXED back position?
4) Will IV disc pressure increase or decrease in a slightly EXTENDED back position?
5) Why is EXTENDED LESS pressure?
5A) Why is FLEXED MORE pressure
6) What will laying sideline or lazy-boy with back inclined do to IV disc pressure
7) What about supine position?
1) They put needles from skin all the way into IV discs AT LUMBAR SPINE AREA of people in varying postures. They measured different changes in IV disc pressure in various posture positions.
2) Normal upright = 100% pressure on IV disc holding weight of body.
3) Flexed position will INCREASE IV disc pressure
4) Extended position will DECREASE IV disc pressure
5) Because instead of the IV disc taking all the weight, the extended position puts the SUP and INF articular processes touching, so bone on bone helps take off pressure from the IV disc.
5A) Because no bony prominences to help distribute weight, so much more of the weight / pressure falls on IV disc.
6) These will decrease IV disc pressure.
7) Supine will take off LOTS of pressure.
For the ligaments below … explain where they start, where they end, and their function:
- Anterior Longitudinal Lig:
- Posterior Longitudinal Lig:
- Supraspinous Lig:
- Interspinous Lig:
- Ligamentum Flavum:
- Intertransverse Lig’s:
- Anterior Longitudinal Lig: From occiput to anterior body of vertebrae (and IV discs) down to sacrum. Purpose is to hold vertebrae together and prevent too much EXTENSION.
- Posterior Longitudinal Lig: TECHNICALLY it begins at C2. From Occiput or foramen magnum down to C2 it is the TECTORIAL MEMBRANE. But then goes from posterior bodies (and IV discs) of vertebrae down to coccyx. It’s purpose is to hold vertebrae in place, and prevent too much FLEXION.
- Supraspinous Lig: From ext. occipital protuberance down (is the nuchal lig in cervical area) to posterior part of spinous processes down to L5/S1. It prevents too much movement of spinous processes / holds them together. First to go on stretch during flexion. Becomes slack during extension.
- Interspinous Lig: Between adjacent spinous processes from C2 to L5/Sacrum. Same purpose as supraspinous lig.
- Ligamentum Flavum: Lig between adjacent lamina. From C2 to Sacrum (above C2 they are the ant/post occipital membrane/lig). Attach to the joint capsules of the facets and between lamina’s. High elastic fiber content to assist in upright posture, and pull joint capsule out of the way when capsule placed on slack.
- Intertransverse Lig’s: Lig’s between adjacent transverse processes. Small role in restraining side bending, and place for muscle attachment.
(*** These all thicken as you descend inferiorly).
1) Facet joints in Vertebrae are what type of joint:
2) IV discs are what type of joint:
3) Would posterior long. ligament be placed on compression or tension during back flexion?
4) Would a compression stress, tension stress, or shearing stress be strongest, or be able to resist the most amount of stess/force? Rank them.
1) Diarthrodial (synovial) - Plane synovial
2) Fibrocartilaginous
3) Tension
4) Compression is strongest/most, then tension, and shearing is weakest.
1) Which spine region allows greatest amount of movement, and why?
2) Which back area has very limited ROTATION movement, and why?
3) Which back area has very limited FLEXION/EXTENSION movement, and why?
1) Cervical. Specifically upper cervical. Because sup/inf articular processes are basically flat (facing up) on top of each other, allowing flexion/extension, rotation, side bending. Angle changes as you go caudally down cervical vertebrae.
2) LUMBAR, because sup /inf articular processes are angled postero-medially. So you can do some flexion/extension, but little rotation.
3) THORAX area, because the sup articular processes is angled posteriorly and sup/inferiorly, and inf. articular process (facet) is angled anteriorly (and up/down). And giraffe spinous process beaks run into each other. So flexion/extension is limited.
1) What provides STABILITY to Back
2) What do muscles specifically do to help with stability?
3) T or F: The amount of movement of the back is limited by all the things listed in point #1?
4) T or F: The amount of movement of the back is not impacted by the thickness of the IV disc?
5) T or F: The facet joint orientation impacts the back’s stability and mobility?
1)
- Intact nucleus pulposus and annulus fibrosus (IV discs)
- Orientation of facet joints (with associated capsules)
- Muscles
- Lig’s
- Ribs and sternum
- Inter-abdominal and inter-thoracic pressure
2) Muscles help create a compressive force to counter any tension or shearing stress movement.
3) True
4) FALSE. A thicker disc would naturally allow more movement (more flexion/extension, side bending). One of the other reasons you can do more flexion/extension in lumbar region.
5) True. If sup/inf. facet joints are apposed, they help create stability during movement or weight bearing. Plus, they ultimately determine how much / little movement can take place based on their orientation.
What is the term for creating Inter-abdominal and inter-thoracic pressure?
What is it and why would you do it (and how)?
Valsalva maneuver
Take huge breath in, fill up lungs, close off your glottis and anus, and just hold pressure in, it will create inner abdominal pressure area that creates stiffness, helping support the spine.
1) T or F: If you imagine a ligament around a joint, the further out the ligament fiber is from the AOR, the less it will be stretched?
2) So during back flexion, which lig is going to be stretched the most?
3) Which lig will go on stretch first during back extension?
4) What lig is placed on SLACK during flexion?
5) Rotation of the spine is based primarily on what?
1) FALSE. The point or fibers furthest from the AOR will experience the most stretch, pull, tension.
2) Supraspinous lig. (It’s the farthest away from AOR during flexion movement)
3) Anterior longitudinal ligament
4) Anterior longitudinal ligament
5) Orientation of the facet joints
Remember the diagrams that show where the instantaneous AOR is in cervical, thoracic, and lumbar vertebrae during movement. For those listed below, describe where AOR is:
Cervical:
- Flexion/Extension:
- Lateral Side bending:
- Rotation:
Thoracic:
- Flexion/Extension:
- Lateral Side bending:
- Rotation:
Lumbar:
- Flexion/Extension:
- Lateral Side bending:
- Rotation:
Cervical:
- Flexion/Extension: Anterior vertebral body
- Lateral Side bending: ?
- Rotation: Middle vertebral body
Thoracic:
- Flexion/Extension: Middle vertebral body
- Lateral Side bending: R/L side of vertebral body
- Rotation: Middle vertebral body
Lumbar:
- Flexion/Extension: ** Flexion in front vertebral body, extension in back of vertebral body
- Lateral Side bending: R/L side of vertebral body
- Rotation: Middle vertebral body
COUPLING:
1) What is a coupling pattern?
2) Generally, if you go from erect spinal position and laterally bend left, the RIGHT side of the facet joints will _______, and the LEFT side of the facet joints will ________
3) So with coupling though, if you side bend to the left, what happens in each area of the spine:
1) When you do one motion, what other motions secondarily occur as a result?
2)
RIGHT: Pull apart (open)
LEFT: Go together (close)
3)
C2-T1:
- Vertebral body will also rotate left, and so spinous process will go right. **
- Rotation and side bending (coupling) goes to SAME side
T1-T4:
- Same as above.
T4-T8 and T8-L1:
- There is no predictable pattern. You can’t predict it in Thoracic spine because of the rib cage attached.
Lumbar Spine:
- In left side bending, spinous process moves same direction (LEFT), but that means the vertebral body is moving to the RIGHT.
- Rotation and coupling goes to OPPOSITE side
1) What is ‘lower cervical spine’
1A) Most of the cervical motion occurs where?
2) T or F: In lower cervical spine, vertebral body rotation and side bending occur to same side
2A) In cervical area, if I rotate or side bend to the left, what happens to spinous process?
3) T or F: Upper thoracic spine behaves the same as lower cervical spine?
4) T or F: The upper thoracic spine (T1-T4) act as a “unit” together with lower cervical spine (C2-T1)
5) T or F: In middle to lower thoracic spine, there is NO predictable pattern for movement to right or left with side bending and rotation
6) In lumbar spine, if you do left side bending, which way will spinous process go?
7) In lumbar spine, if you do left side bending, which way will vertebral body go?
8) In cervical spine, rotation and side bending are coupled to _______ side.
9) In lumbar spine, rotation and side bending are coupled to _______ sides?
1) C2-T1
1A) C1 and C2 (O/A joint and A/A joint)
2) True. If I side bend to the left, rotation of vertebral body to the left also naturally occurs.
2A) Goes to the RIGHT
3) True
4) True
5) True
6) Spinous process goes LEFT
7) Vertebral body goes RIGHT
8) SAME
9) Opposite
1) Is Dura tough and resiliant, or soft and elastic?
2) Dura starts where and ends where?
3) Would Dura get stretched during flexion or extension? WHY?
4) Is dura innervated?
5) If dura gets impinged (in IV foramina), how do you relive pressure?
1) Dura is a tough covering, non-compliant, or resiliently elastic.
2) Dura goes from foramen magnum down to sacrum … and goes out to periosteum around IV foramen.
3) Dura gets stretched during FLEXION, but shortens during extension. Why? Because spinal cord is POSTERIOR to the AOR during Flexion. AOR is vertebral bodies, which are ANTERIOR to spinal cord. Thus, it compresses during extension.
4) Yes. Dura is well innervated (Pia and arachnoid mater have little nerve supply).
5) STRAIGHT LEG RAISE / CHIN TUCK. If dura gets pinched, you’d need to relieved pressure. How? Raise patients leg (keeping knee extended and hip flexed) to stretch out those nerves, and put chin to their chest. This stretches out entire. NERVE FLOSSING. So pt raises leg and that hurts in back. Then separately they do a chin tuck and that hurts same place in back … probably a dura impingement.
1) Borders of IV foramina where spinal nerves come out?
2) Of the borders of the IV foramina, what parts are innervated.
3) As spinal nerve exits the IV foramina, what covers or surrounds it?
4) Is IV foramen longer or shorter in cervical spine?
4A) What is found in IV foramina, or what’s its contents?
5) After the dorsal and ventral roots get to the IV foramen, they join to become a “spinal nerve” … but there is a part that loops back around and back into IV foramen and then back into spinal cord. What is that called (two names)?
6) Does the nerve from #5 carry somatic (muscle) or autonomic nerve fibers? And why?
7) Do ligaments have blood vessels?
8) Do joint capsules have blood vessels?
9) How does posterior longitudinal ligament get innervated?
1) IV foramina (canal) is formed by: pedicles (above and below), lamina (above and below posteriorly), facet joints, and IV discs anteriorly with the post. long. Lig.
2) Bone (periosteum) is innervated, IV disc is not too much, but post. Long. Lig and ligamentum flavum are very innervated. Facet capsules are innervated. So IV foramina is very well innervated.
3) Dura mater
4) Longer in cervical, shorter in thoracic and lumbar spine.
4A) The nerve roots take up only 20 - 25% of the total available space in the IV foramen. The remaining space is filled with fat, blood vessels, connective tissue and lymph
vessels which form a protective envelope. The sinu-vertebral nerve is also found in the IV Foramen
5) The recurrent spinal meningeal nerve (also called SINU vertebral nerve).
6) Autonomic … so has sensory (not motor) fibers. Ligaments and joint capsules all have vessels and nerves - so the recurrent spinal meningeal nerve goes BACK into spinal column to give nervous innervation to meningies, ligaments, periosteum in spinal column.
7) YES
8) YES … all diarthrodial (synovial) joints have blood vessels.
9) The recurrent spinal meningeal nerve (also called SINU vertebral nerve).
1) So as spinal nerve (combined dorsal and ventral roots) joins and exits IV foramina, it branches into how many - and what nerve branches?
2) Explain details and function of each of the nerves from #1
3) What is special about recurrent spinal meningeal nerves C1-C3:
3A) This special nerve is called: **
4) Why is injuring the nerve from #3A bad?
1 ) 4 total. Dorsal primary ramus, ventral primary ramus, ramus communicans, recurrent spinal meningeal nerve.
2)
- Dorsal Primary Ramus: gives sensory innervation to back and skin in back. And gives Motor innervation to back muscles
- Ventral Primary Ramus: Sensory and motor innervation to front
- Ramus Communicans: Innervation to sympathetic trunk/chain
- Recurrrent Spinal Meningeal Nerve: See flashcard above, but primarily innervates inside spinal canal: lig’s, meningies, blood vessels, periosteum, external lamella of IV disc.
3) The recurrent spinal meningeal nerves of C1, C2 and C3 join inside the spinal canal to ASCEND UP into the skull via the foramen magnum and supply the dura of the posterior cranial fossa.
3A) The joined nerve is called the Posterior Meningeal Nerve.
4) Since the Posterior Meningeal nerve innervates dura and periosteum of cerebellum area, you injure that nerve and you’ll get dizzyness and vision problems since the cerebellum has those functions.
Internal spinal pain (meningies) is specific or general?
Why?
It is general, but specific by region. So you know it is in lumbar or cervical region, but can not pin point pain specifically to a certain area.
Why? Cause the recurrent spinal meningeal nerve innervates the area with it’s friends a few levels up/down … pain radiates between 3-6 levels.
1) What is the straight leg raise test (with chin tuck)?
2) What is the slump test?
3) Why are these tests used?
1) Patient will lift leg out with knee extended. Do a chin tuck too for added measure. This stretches spinal cord (dura mater) and sciatic nerve all the way up to spinal cord to brain to tips of toes.
2) Patient slumps over flexing (to elongate spinal cord and dura mater). Then lifts leg out with knee extended, and dorsiflexes foot. Basically elongate the entire spinal cord down through sciatic nerve from head to toe.
3) Why? To detect and hopefully relieve nerve impingement (or dura impingement) at a spinal root / IV foramina. Nerve flossing.
Another name for the Recurrent Spinal Meningeal nerve?
Sinu-vertebral nerve
Below are flashcards for 2.2 Cervical Spine
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1) Why do vertebral bodies get larger as you move down the spinal column?
2) Is a cervical vertebrae body wider from side to side, or from front to back?
3) What is the small upward bony prominence on lateral sides of cervical vertebrae body? What is it and why?
4) What is the Lushka joint? Is it an actual joint?
(** how to remember)
5) What are the “typical” cervical vertebrae?
6) Many cervical vertebrae’s spinous process is unique. What is it and what is it called?
6A) Why do cervical vertebrae have bifid spinous processes?
7) What passes through the transverse foramen / foramina in cervical vertebrae?
8) Cervical transverse processes function is primarily for what?
9) Is the angle of facet joints different in C1 to C3 to C7? How?
10) The “average” angle of facet joints in cervical vertebrae is what?
11) What is the type of articulation of these facet joints?
12) Which way does the Superior articular process face in the ‘typical’ cervical vertebrae?
13) Which way does the Inferior articular process face in cervical vertebrae?
14) What is unique about C1, C2, C6, and C7 vertebrae:
1) Because the body holds the weight of everything above, so the lower you go, the more weight it needs to carry.
2) Side to side is wider.
3) Uncinate process. It essentially is a bumper that holds the upper vertebral body above in place during movement. So it is primarily for SIDE BENDING block.
4) It is where the uncinate processes come up … but it is not a joint with a joint cavity with blood supply. Just a bumper.
(The ‘luge’ is a narrow track with big bumpers on the side so you don’t fly off track)
5) C3-C6. C1 and C2 are unique, and even C7 has unique spinous process and looks like a thoracic vertebrae.
6) Bifid spinous process projection at end of spinous process.
6A) For the nuchal ligament to run through.
7) Vertebral artery
8) Muscle attachment for scalenes, splenius cervicis, levator scapulae, and longissimus muscles.
9) YES. The angle goes from very flat in C1 to almost straight up and down in C7 (like in thoracic vertebrae).
10) 45 degrees
11) They are diarthrodial (synovial) … but PLANE joints. A plane joint is a flat surface on another flat surface. Apposition.
12) Posterior and superiorly (at increasing angle as you descend)
13) Anterior and inferiorly
14)
C1: atlas, holds skull, does “yes” nodding
C2: dens, does “no” rotation
C6: Palpable tubercle of C6 = carotid tubercle (then you can’t palpate transverse processes after this point)
C7: Vertebral prominence (palpable spinous process)
Know in general how many degrees of movement C-spine allows in Flexion, Extension, Side Bending, and Rotation.
And specifically how much of that total movement is made at AO and AA joints compared to lower C3-C7 spine.
Total Upper Lower
C-spine C-spine
(OA and AA)
Flexion: 60 - 75 5 and 5 50 - 65
Extension 50 - 75 10 and 5 35 - 60
Side Bending (one side) 40 - 65 2 and 5 33 - 58
Rotation (one side) 80 - 95 2 and 45 33 - 48
1) Why is cervical spine Lordosis?
2) T or F: The annulus fibrosus forms the majority of the IV disc in cervical spine?
*** how to remember
1) Because the annulus fibrosus or IV disc is bulged anteriorly naturally in c-spine.
2) False. The nucleus pulposus forms the majority of IV disc in cervical spine area.
(You need more annulus fibrosus down lower to help constrict the increasing weight placed on nuclues pulposus down lower in spine)
C1:
1) Another name for C1
2) Does C1 have a vertebral body?
3) Is there a disc between C1 and skull?
4) Is there a disc between C1 and C2?
4A) Is there a disc between C2 and C3
5) Can you palpate posterior tubercle of C1?
6) How many synovial joints are on C1
6A)
- The joint of the dens with C1 is what type of joint?
- The joint with condyles of occipital bone are what type of joints?
- The joint between C1 and C2 is what type of joint?
7) The peanut shaped joints of C1 are what:
8) Explain the route of the vertebral artery
9) What happens if you injure vertebral artery?
10) Are condyles of skull the concave or convex members in that AO joint? So where does AOR go through?
11) Does AO joint allow more flexion or extension?
1) Atlas
2) NO
3) NO
4) NO
4A) YES
5) Not usually … very hard to palpate in most people
6) 5 TOTAL: 1 on posterior side of anterior arch for articulation with dens, 2 lateral masses / sup. articular processes to hold up skull (articulate with condyles of foramen magnum), 2 below for A/A joint
6A)
- Pivot joint
- Condylar joints
- Plane joint
7) They are the superior articular processes of C1 that articulate with condyles of skull.
8) The vertebral artery runs up the transverse foramina of cervical vertebrae, but above C1, it actually then goes posterior and medial (through groove for vertebral artery) to go to vertebral foramen to then ascend up into foramen magnum (to supply blood to posterior cranial fossa).
9) If cervical spine gets injured or twisted you can ruin vertebral artery (and nerves). So a lot of PT’s avoid doing neck manipulations to avoid doing injury of cervical spine. It is so dangerous. If you are not careful, you can impinge the vertebral artery, which can cause major issues / headaches / head pain / dizziness / vision problems. Be so careful.
10) Convex … AOR goes through the Convex member.
11) Extension.
C2:
1) Another name for C2
2) Does C2 have a body?
3) Unique feature of C2 (and another name for this is:)
4)
- How many facets are part of C2 - what are they?
- Type of joint with Dens and C1
- Type of joint with sup. articular processes
- Type of joint with inf. articular processes
5) Is Dens articulation with Atlas a synovial joint?
6) Describe uniqueness of C2’s body
7)
- Can you palpate spinous process of C1?
- Can you palpate transverse process of C1?
- Can you palpate spinous process of C2?
- When can you NOT palpate transverse processes?
8) Where is AOR for C2?
1) Axis
2) Yes (although it’s not a typical one like all others below)
3) Dens (Odontoid process)
4) 6 total - 1 is the anterior facet at anterior tip of dens to allow rotation with C1. 1 posterior on the dens to articulate with the transverse/cruciform ligament. 2 superior articular processes / facets to articulate with C1. 2 inferior articular processes / facets. - Pivot joint - Plate / Plane joint - Plane
5) Yes
6) Not a typical body, and the bottom part protrudes / projects down like a beak (probably to hold IV disc of C3 in place).
7)
- No
- Yes
- Usually yes you can.
- About C6
8) Tip of the dens
1) Describe the joint and interaction of C1 and C2 at the sup. articular surface of C2 with the inferior articular surface of C1.
2) T or F: Whether rotating to the Right or Left, the AA joint will experience the Atlas descending down onto Axis during both movements? Explain.
3) Is joint capsule on stretch or slack during normal position (for AA joint)
4) So if someone hurts their neck at AA joint, what will they naturally do?
1) Remember the AA joint is unique where the inf. articular processes of C1 are convex, and sup. articular process of C2 are also convex. SO in neutral position, the sit on the high points of the facet (like a dinner plate on a shoulder)
2) True. Because it is a “plate on a shoulder” it will slide DOWN whether you look left or right.
3) Stretch.
4) They will go to a LEAST packed position and put capsule on slack, by slightly bending or TURNING head to the side to give relief.
LIGAMENTS BETWEEN C1 and C2:
1) Are there IV discs for the AO and AA joints? Why is that important to know?
2) So what gives STABILITY to the Upper c-spine (C1 and C2)?
3) Explain extrinsic and intrinsic lig’s of upper c-spine … and explain each’s function/purpose.
1) NO. So IV discs (like in lower spine) help provide stability during compressive forces, and OA and AA don’t have those, so they have to get their stability elsewhere …
2) Ligaments
3)
Extrinsic Lig’s:
- Anterior longitudinal lig
- Capsular Ligaments
- Anterior atlanto-occipital membrane (A/O lig)
- Anterior atlanto-axial lig
- Posterior atlanto-occipital membrane (A/O lig)
- Posterior atlanto-axial ligament
- Lateral atlanto-occipital membrane (ligament) which joins the anterior and posterior a/o ligaments like a shower curtain.
Intrinsic Ligaments (inside spinal canal)
- Tectorial membrane (becomes post. long. lig)
- Alar ligaments (odontoid ligaments -or- check ligaments)
- Transverse lig
- Longitudinal lig
- Cruciform lig
- Apical lig (Suspensory ligament)
- Alar lig: goes from each side of dens to condyles of occipital bone (foramen magnum). Stability for dens, and limits flexion and rotation. Depending on which way you rotate, one will go on stretch.
- Transverse lig: goes across the posterior side of dens to hold it in place
- Cruciform lig: Has 2 bands, the transverse lig and longitudinal lig. Both hold dens in place.
- Tectorial membrane: Comes off occipital bone down into spinal column to hold dens and vertebrae in place … become posterior longitudinal lig. at around C3
- Capsular lig’s of FACET joints between Atlas and Axis
- Apical lig: goes from tip of dens up to ant. part of foramen magnum. Most say there is no real function … but maybe to help stabilize dens.
1) Do the anterior and posterior (and thus lateral) atlanto-occipital membrane/ligaments attach to C1?
2) Explain how the name of the lig in #1 changes as you descend down cervical spine
3) The layer of ligaments closest to the actual spinal cord in the spinal column on the anterior side (but posterior the vertebral bodies) is called what in the upper c-spine, and what in lower c-spine?
4) SO what is deep to the ligament from #3 above?
5) T or F: transverse lig. is part of the cruciform lig
6) Explain why the Alar and Cruciform lig’s are SO important
7) Is their an articular disc between the dens and posterior part of the anterior arch of C1?
8) Is the posterior part of dens and the cruciate lig articulation a synovial joint?
9) If you look / rotate head to the left, which Alar ligament will get placed on stretch, which will be on slack?
1) They actually go from Occipital bone to C2, and C1 acts as a WASHER between.
2) It comes off skull as ant/post atlanto occipital membrane, then between C1 and C2 is ant/post atlanto axial ligament. Then after C2 it is essentially the ligamentum flavum (continuing down spinal column).
3) Upper c-spine it is tectorial membrane, then becomes post. longitudinal lig. (AT C3) in lower c-spine. But it is the SAME ligament, just a name change.
4) Cruciform lig (transverse lig and longitudinal lig), and Alar lig from dens to condyles, and also Apical lig.
5) True (so is longitudinal lig)
6) They hold the dens in place with ant. arch of C1. If they are broken, C1 can drift forward, and impinge the spinal cord. That would be paralysis or death!
7) Yes. It is a synovial joint.
8) NO. But it does have a bursa to reduce friction between the dens/bone and ligaments holding it in place.
9) Right Alar lig on stretch, Left Alar lig on slack.
What nerve keeps you breathing? How do you remember
First place an IV disc shows up?
Phrenic nerve … it innervates diaphragm … comes off of C3, C4, C5 … keeps you alive.
Between C2 and C3
1) Explain the rythm or the movement of CERVICAL FLEXION. What happens in succession?
2) What will stretch first during flexion, the ligamentum flavum or the posterior longitudinal lig?
3) What happens to the inferior facets as you do flexion in c-spine?
4) So how does the return from flexion happen?
1) First thing to move is skull on C1 (chin to chest). First 10 degrees is O/A/A joint (5 degress from O/A). When posterior atlanto-occipital lig stretches, then lower c-spine movement occurs. So now C2 moves, and joint capsule and cruciate lig restricts it. So C3 moves. Then ligamentum flavum and supraspinous lig restricts it. Then C4, etc. The farther you flex, the more these tighten.
2) Tightening happens from outer to inner / superficial to deep. And movement happens cranially to caudally. So because post. long. lig. is more interior, it will get stretched LAST.
3) The inferior facets of the lower c-spine glide symmetrically UPWARD on the superior facets during flexion.
4) The return from full flexion to neutral is the reverse of this process.
1) Explain the rhythm or movement of CERVICAL EXTENSION. What happens in succession?
2) So what primarily limits cervical flexion? What primarily limits cervical extension?
1) The first 10 to 15 degrees of motion is due to movement at the O/A/A joint complex. This movement is blocked when the posterior edges of the superior facets of C1 lock into the condylar fossa of the occipital bone. The A/A joint then moves and locks when further tipping of the atlas on the dens is blocked. The sup/inf articular processes bump into each other as you move down, and ant. long. lig gets stretched.
A cephalo-caudal progression of extension is carried out from C2 through C7. The inferior facets of the lower c-spine glide symmetrically DOWNWARD over the superior facets. As movement of the cranial segment is checked by approximation of the joint surfaces, tightening of the ANTERIOR LONGITUDINAL LIGAMENT and progressive compression of the nucleus pulposus, the next most caudal segment begins to move.
The return from hyperextension to neutral is the reverse of this process.
2) Flexion is limited by soft tissues - lig’s stretched. Extension is limited by ant. long. lig yes, but mainly sup/inf articular processes blocking each others’ further movement (bone on bone).
1) For rotation of c-spine, explain steps of movement
2) In lower cervical spine, do side bending and rotation happen on same side, or opposite sides?
3) Return from rotation is what process?
1)
- There is little rotation allowed at the A/O joint thus the skull and C1 essentially function as a single unit during most of the cycle of rotation.
- The first ~40 degrees comes from C1/C2 (AA joint). Around 40 ish degrees, the Alar lig and facet joint capsules prevent more movement.
- Then from C2-C7 … it goes cephalo to caudal.
- In the lower c-spine, the inferior facet ON THE SIDE TO WHICH ROTATION IS OCCURRING glides downward on the superior facet below it. The inferior facet ON THE SIDE OPPOSITE TO THAT WHICH ROTATION IS OCCURRING glides upward on the superior facet below it.
2) SIDE BENDING AND ROTATION OCCUR TO THE SAME SIDE.
3) The return to neutral is the reverse of this process.
