Functional Anatomy and Kinematics of the Cervical Spine Flashcards
1
Q
why is there greater motion in the lower thoracic spinal segments?
A
bc there are no ribs in the way anymore
2
Q
what is the suboccipital region of the cervical spine?
A
the occiput, C1-2
3
Q
what is the mid-cervical region of the cervical spine?
A
C5-7 and T1
4
Q
what ligaments prevent the dens of C2 from translating anterior into the SC?
A
the transverse and cruciform ligaments
5
Q
t/f: the occiput and C1 move together
A
true
6
Q
what is our “yes” and “maybe” joint?
A
the occipitoatlanto (OA) joint
7
Q
how many deg of fwd/bwd nodding is normally availablet the OA jt?
A
14-30 deg
8
Q
how many deg of active side nodding is normally available at the OA jt? passively?
A
5 deg active, 11 deg passive
9
Q
what is our “no” joint?
A
the atlantoaxial (AA) joint
10
Q
what kind of surfaces are the 2 articulating surfaces of the AA jt?
A
two convex surfaces
11
Q
what motion does the alar ligament restrict? what motion does it create?
A
it restricts SB and creates rotation
12
Q
what is the only imaging view in which the dens can be seen?
A
open mouth x rays
13
Q
if someone had a recent neck trauma or is experiencing any neuro signs with their neck issue, what should we ask them about?
A
if they had an open mouth x-ray
14
Q
in the cervical spine, what is the angulation of the facet joints?
A
about 45 deg
15
Q
how many deg FB is normally available in the cervical spine?
A
80-90 deg
16
Q
how many deg BB is normally available in the cervical spine?
A
70 deg
17
Q
how many deg SB is normally available in the cervical spine?
A
45 deg
18
Q
how many deg rotation is normally available in the cervical spine?
A
45 deg
19
Q
what are the “laws” of cervical kinematics?
A
in the MC spine, FB creates upglide with anterior translation and BB create downglide with posterior translation
in the MC spine, SB/rotation are coupled and occur ipsilaterally
the atlas always follows the occiput
AA will attempt to keep the eyes facing fwd during SB
OA will attempt to keep the eyes level during rotation
20
Q
with FB, in the MC spine, what is the glide?
A
upglide with anterior translation
21
Q
with BB, in the MC spine, what is the glide?
A
downglide with posterior rotation
22
Q
with FB, what is the roll and glide of the occiput on C1?
A
posterior glide
anterior roll
23
Q
with BB, what is the roll and glide of the occiput on C1?
A
anterior glide
posterior roll
24
Q
with backward nodding (retraction) does the OA space increase or decrease?
A
increased
25
with forward nodding (protraction) does the OA space increase or decrease?
decrease
26
what motion is C1/2 largely responsible for? ?
rotation
27
does the lower cervical spine upglide or downglide with cervical retraction?
downglides
28
does the lower cervical spine upglide or downglide with cervical protraction?
upglides
29
R rotation create downglide on the ____ and upglide on the ____
right, left
30
with R rotation, the atlas will SB ____ to keep the eyes horizontal
left
31
with R rotation, the occiput and atlas will glide ____
left
32
L rotation creates downglide on the ____ and upglide on the _____
left, right
33
with L rotation, the atlas will SB___ to keep the eyes horizontal
right
34
with L rotation, the occiput and atlas will glide ____
right
35
how many deg of motion do we get from each spinal segment in rotation?
about 2.1-6.9 deg each
36
how many deg of motion do we get from each spinal segment in SB?
about 2-6 deg each
37
with R SB, the occiput rolls ____, glides _____ on the atlas, then the axis follows and glides____
right, left, right
38
with R SB, the left alar ligament will do what?
stop too much R SB and create R rotation of the atlas
39
with L SB, the occiput rolls _____, glides ______ on the atlas, then the axis follows and glides ____
left, right, left
40
with L SB, the right alar ligament will do what?
stop too much L SB and create L rotation of the atlas
41
as R SB increases, more ____ rotation is needed to keep the eyes fwd
left
42
as L SB increases, more ____ rotation is needed to keep the eyes fwd
right
43
what is nonfunctional SB?
SB and rotation in opposite directions
44
what is functional SB?
SB and rotation in the same directions
45
is L rotation with R SB functional or non-functional SB?
non-functional SB
46
if R SB with R rotation functional or non-functional SB?
functional SB
47
is functional or non-functional SB a suboccipital (SO) motion?
non-functional SB
48
is functional or non-functional SB a midcervical (MC) motion?
functional SB
49
if a pt has full pain-free functional SB, but painful non-functional SB, there is likely what kind of issue going on?
subocciptal issues
50
if the pt can do non-functional SB, but not functional SB, we should consider what kind of syndrome?
AA syndrome
51
if the pt can't do non-functional SB, what should we do?
test the other side and consider thoracic syndrome
52
if the pt can do both functional and non-functional SB, and our PPIVMs and PAIVMs are positive, what syndrome might be present?
midcervical syndrome (literally no clue why y'all)
53
if the pt can do non functional SB but cant do functional SB and our PPIVMs and PAIVMs are positive, what syndrome may be present?
AA syndrome (again, literally no clue bc shouldn't this be MC fxn missing???)
54
the demifacets of the cervical spine articulate with what?
the ribs heads
55
the superior demifacets face ______, ______ and ______
backward, posterior, and lateral
56
the inferior demifacets face ______ and ______
anterior and medial
57
why are the vertebral foramina larger?
bc of the brachial and cervical plexuses coming out
58
does the size of the cervical vertebral bodies increase going up or down the spine?
the size of the vertebral bodies increases going down the spine
59
what is the alignment of the facets in the thoracic spine?
frontal
60
bc of the orientation of the thoracic facets in the frontal plane, what motion is the greatest?
SB
61
what are the costovertebral joints?
articulation bw the head of the rib and the body of the vertebra
62
what are the costotransverse joints?
articulation bw the tubercle of the rib and the transverse process for the vertebra
63
at the costovertebral joint, the rib articulates with the ______ demifacets of the segment below and the _____ demifacets of the segment above
superior, inferior
64
t/f: the costovertebral and costotransverse joints are synovial joints with articular cartilage
true
65
t/f: disc herniations in the thoracic spine are very common
false, they are not common at all
66
t/f: at the costotransverse joints, the rib is named for the segment it articulates with (ie rib 6 with T6)
true
67
what should we do for ALL thoracic issues?
CLEAR THE NECK
68
what is the fxn of the rib cage?
to protect the heart, lungs, liver, spleen, etc
69
in what directions do the ribs angle?
anterior and inferior
70
what are the true ribs?
ribs 1-7
71
what are the ribs with cartilagenous attachments to the sternum
ribs 8-10
72
what are the floating ribs?
ribs 11-12 with no sternal attachments
73
according to the rule of threes, what SPs are AT the level of the spine?
T1-3
74
according to the rule of threes, what SPs are 1/2 a level below their spinal segments?
T4-6
75
according to the rule of threes, what SPs are a full level below their spinal segments?
T7-9
76
according to the rule of threes, T10 is...
a full level below its spinal segment
77
according to the rule of threes, T11 is ...
1/2 a level below its spinal segment
78
according to the rule of threes, T12 is...
at the same level as its spinal segment
79
how much FB is normally available at the thoracic spine?
63 deg
80
how much BB is normally available at the thoracic spine?
63 deg
81
how much SB is normally available at the thoracic spine?
68 deg
82
how much rotation is normally available at the thoracic spine?
62 deg
83
does the combo of SB and rotation occur more at the upper thoracic spine or lower thoracic spine?
upper thoracic spine
84
what is the alignment of the facets in the thoracic spine?
frontal plane alignment
85
is rotation greater in the thoracic spine of the lumbar spine?
rotation is greater in the thoracic spine than the lumbar spine
86
what are the 3 motions of the ribs?
pump handle motion
bucket handle motion
caliper motion
87
in what plane does the pump handle motion of the ribs occur?
in the sagittal plane
88
in what plane does the bucket handle motion of the ribs occur?
in the frontal plane
89
in what plane does the caliper motion of the ribs occur?
the transverse plane
90
what ribs create the pump handle motion?
the upper ribs (1-3)
91
what ribs create the bucket handle motion?
the middle ribs (4-10)
92
what ribs create the caliper motion?
the lower ribs (11-12
93
do the upper or middle ribs have more motion?
the middle ribs have more motion than the upper ribs
94
with inspiration, what happens to the ribs?
they elevate and upwardly rotate (ER)
95
with expiration, what happens to the ribs?
they depress and internally rotate (IR)
96
t/f: rib motion occurs largely like a hinge
true
97
t/f: ribs largely move together in a relatively symmetrical motion
true
98
____ rotation of the ribs allows a lot of the motions to occur
sagittal
99
what are the "laws" of the thoracic-costal cage kinematics?
costal motion is linked to the thoracic spine
in the sagittal plane, rib motion exceeds vertebral motion
in the frontal plane, vertebral motion exceeds rib motion
100
what happens in FB to the vertebral body?
the vertebral body translates and rotates anteriorly
101
what happens in BB to the vertebral body?
the vertebral body translates and rotates posteriorly
102
in FB, the anterior ribs ____ and the posterior ribs _____
depress, elevate
103
anteriorly, in FB, the ribs go into _______
internal torsion
104
what happens at the costotransverse joints with FB?
the rib glides superiorly and the internally
105
in BB, the anterior ribs ____ and the posterior ribs ____
elevate and externally rotate, depress and externally rotate
106
what happens at the costotransverse joints with BB?
the rib glides inferiorly and externally
107
during R SB, what do the ribs do on the R do? on the L?
on the R, the ribs depress and internally rotate
on the L, the ribs elevate and externally rotate
108
what happens at the costotransverse jt on the R with R SB?
the tubercle of the rib glides superiorly and rolls anteriorly, creating internal torsion
109
what happens at the costotransverse jt on the L with R SB?
the tubercle of the rib glides inferiorly and rolls posteriorly, creating external torsion
110
during L SB, what do the ribs do on the L? on the R?
on the L, the ribs depress and internally rotate
on the R, the ribs elevate and externally rotate
111
what happens at the costotransverse joint on the L with L SB?
the tubercle of the rib glides superiorly and rolls anteriorly, creating internal torsion
112
what happens at the costotransverse joint on the R with L SB?
the tubercle of the rib glides inferiorly and rolls posteriorly, creating external torsion
113
with R rotation, the L ribs rotate ____ and the R ribs rotate _____
anteriorly, posteriorly
114
with L rotation, the R ribs rotate______ and the L ribs rotate _____
anteriorly, posteriorly
115
with R rotation, the vertebrae translate _____, glide superiorly ______ and glide inferiorly ____
left, left, right
116
with L rotation, the vertebrae translate ___, glide superiorly _____, and glide inferiorly ____
right, right, left
117
with R rotation at the costotransverse joint, the rib below on the R glides _____ and ______ _______; the rib below on the L glides ______ and ______ ______
inferiorly, externally rotates; superiorly, internally rotates
118
with L rotation at the costotransverse joint, the rib below on the L glides ______ and _____ _______; the rib below on the R glides _____ and ______ _______
inferiorly, externally rotate; superiorly, internally rotates
119
t/f: when there is rotation in the thoracic spine, the rib in the costotransverse joints will glide inferiorly and ER ipsilaterally and superiorly and IR contralaterally
true
120
what is involved in the examination of the cervico-thoracic-costal cage complex?
PMH
HPI
red and yellow flags
systems review
121
what should be included in the PMH of the examination of the cervico-thoracic-costal cage complex?
assessment of their overall general health
previous hx of cervical spine pathology and their course of care for it
122
what should be included in the PMH of the examination of the cervico-thoracic-costal cage complex?
details of their CC and pain behavior
details of the MOI and onset
meds
diagnostic testing
pt goals
123
what are red flags?
clinical indicators of possible serious underlying conditions requiring further medical intervention
124
what are yellow flags?
psychosocial indicators suggesting increased risk of progression to long-term distress, disability, and pain
125
what is a Pancoast's tumor?
tumor in the apex of the lung that can cause shoulder pain, weakness in the arm/hand (C8-T1 typically) due to brachial plexus entrapment
126
what may we suspect in a systems review if we see Horner's syndrome, scapular sx, and ulnar nerve sx?
Pancoast's tumor
127
what is pericarditis and its associated sx we may see in our systems review?
inflammation around the heart causing sharp pain in the neck/shoulder
128
what relieves pain with pericarditis?
rest and fw learning
129
what is cholecystitis?
inflammation of the gallbladder
130
what are some sx of myocardial infarction?
Chest pain
LE pain
Fatigue
Dyspnea
Pallor
131
what in a pts hx puts them at risk for MI?
Hx of CAD, HTN, DM, tobacco use
132
t/f: the kidneys can refer pain to the shoulder
true
133
what are the s/s of pulmonary embolism?
dyspnea, shoulder/UE pain
134
what are the s/s of pleuristy?
severe pain on inspiration, dyspnea, recent hx of respiratory disorder
135
what may we see on examination that makes us suspect a pneumothorax?
one side doesn’t expand as much as the other, decreased breath sounds
136
if a child presents with chest pain, what are we concerned may be going on? what should we do?
we are concerned about a pneumothorax
we should refer out for an x-ray
137
what are the s/s of pneumonia?
fever, malaise, rales/rhonci
138
what is low pain on the VAS?
0-2
139
what is moderate pain on the VAS?
3-5
140
what is high pain on the VAS?
6-10
141
what is the most common number of the VAS for magnifiers?
7
142
what is the NDI?
Revised Oswestry
10 item scale
0-5 scoring for each section
143
what is the Northwick Park Disability Questionnaire?
a questionnaire where the pt responds to 9 individual categories of fxnal activities with points assigned based on pt response to specific phrases that describe their fxn
144
what does a higher % on the Northwick Park Disability Questionnaire mean?
greater disability
