Functional Anatomy of the C-Spine 3/25 Flashcards
how does the cervical spine have the greatest motion and variety of movement
which portion has foramen and what foramen is it
thicker discs
more horizontal facets
less body mass
only vertebrae with transverse foramen–> C1-C6 transmit vertebral arteries
what are the atypical cervical spine vertebrae
C1
C2
C7–> semi-atypical
why is C1 atypical
what are the lateral masses
no body
no spinous process (just a small posterior tubercle)
widest cervical vertebra
lateral masses–> act like body, articulate with occipital condyle
has a groove for the vertebral artery
why is C2 atypical
strongest cervical vertebra
has an odontoid process
- “the dens”
- ANTERIOR to the spinal cord
- pivot point for head
bifid spinous process-> can feel this in the nuchal groove
which cervical vertebrae have bifid spinous processes
C2-C6
what are the typical vertebrae
what are the components
what is different about the superior and inferior aspects of the bodies of the vertebrae
what direction are the superior facets facing ?
C3-C6
superior aspect of body (concave)
inferior aspect of body (convex)
transverse foramen
superior facets
=directed superoposteriorly at 45 degrees
Bifid spinous process
what is significant about C7
most prominent spinous process (in 70% of people)
S-process not bifid
Smaller transverse foramen -does NOT transmit vertebral artery
how do you find cervical transverse processes
Step 1: Find the EOM Step 2: Drop inferior from EOM, just posterior to the angle of the mandible Step 3: That’s C1 Step 4: Now just work your way down Step 5: Stay Posterior to SCM
landmarks for C1
first TRANSVERSE process palpated
landmarks for C2
first SPINOUS process palpated
C3 landmarks
C3 is at the level of the hyoid bone
C4/C5 landmarks
at the level of thyroid cartilage
C6 landmarks
at the level of the cricoid cartilage
C7 landmarks
most prominent spinous process
each vertebrae is about a finger width thick
what is the OA joint
what are the major motions
what is the minor motion and in what directions
in which motions are the somatic dysfunctions FOUND
occiput moving on the atlas
major–> flexion and extension
minor –> rotation and sidebending
must occur in opposite directions due to the anterior convergence of occipital condyles
rotation and sidebending are the motions where somatic dysfunction are found
what is the AA
what is the major motion
what is the minor motion
atlas (C1) moving on the axis (C2)
Major motion = Rotation
40-50% of all rotation of c-spine
Minor motions = F/E/SB
Don’t contribute to somatic dysfxn of C1
what are the typical joints
C2 moving on C3 to C7 moving on T1
why does the OA have to have opposite motions ?
anterior and inferior convergence of the occipital condyles… the lateral aspect of the condyle is more cephalid than the medial aspects
the superior facets of the atlas slope inferiorly as they converge anteriorly
how do you diagnose the OA
Step 1: Contact the occipital condyles with middle fingers
Contact C1 with index fingers to stabilize and isolate motion to OA
Cradle head with rest of hands
Step 2: Translate head to induce sidebending to opposite side
which way does it sidebend more freely?
Step 3: Push anterior on one condyle, then the other
which way does it rotate more freely?
Step 4: Move fingers slightly to superior aspect of condyles (inducing flexion) and rotate in restricted direction
Does it now rotate freely to the restricted side?
Step 5: Move fingers slightly to inferior aspect of condyles (inducing extension) and rotate in restricted direction
Does it now rotate freely to the restricted side?
Step 6: Put it all together (are R & SB opposite?)
OA is ____ (F/E), rotated ____ (R/L), and sidebends ____ (R/L).
how do you diagnosis C1 (AA joint–> C1 moving on C2)
Step 1: Find the transverse processes of C1
Step 2: Drop just slightly posterior to transverse processes of C1
this is the articular pillar
Step 3: Flex C-spine up to C1 in order to lock out the uncinate processes
that’s a lot of flexion (you may want to stand)
Step 4: Rotate head + C1 as a unit
which way does it rotate more freely?
Step 5: Put it all together
C1 rotated ____ (R/L)
what are the uncinate processes?
the joints of Luschka
small lips on superior surface of vertebral bodies
improve the stability during movement
what is the motion of the typical C-spine
rotation and SB occur to the same side due to the orientation of the articular facets
what planes do the somatic dysfunction of the typical C-spine joints involve
all three planes!!
F/E, sidebending , rotation
open vs. closed facet joints cause speed bumps . what are these?
vertebrae usually rotates around closed facet
but open facet irritates tissues and can produce speed bumps
typical C - spine joints have rotation and SB to the same side
how do you diagnose the typical cervicals
Step 1: Screen neck for TART changes
Step 2: Find the transverse processes
Step 3: Translate (push) to one side and then the other
Which way does it like to sidebend?
Remember, translation left = right SB
Step 4: Drop just posterior to transverse processes (this is the articular pillar), push anterior on one side, then the other
Which way does it like to rotate?
Step 5: Move fingers slightly to superior aspect of transverse processes (inducing flexion) and rotate in restricted direction
Does it now rotate freely to the restricted side?
Step 6: Move fingers slightly to inferior aspect of transverse processes (inducing extension) and rotate in restricted direction
Does it now rotate freely to the restricted side?
Step 7: Put it all together
C? is ____ (F/E), rotated ____ (R/L), and sidebends ____ (R/L).
when you push on a transverse process from the back to incur rotation, what are you acutally pushing on?
articular pillar
what are the major muscles that can affect my treatment of the C-spine
suboccipital muscles trapezius SCM Scalenes paraspinal muscles levator scapulae
subocciptial muscles attach what to what
attach occiput to C1 and C2
scalene muscles attach what to what
attach C3-C7 to 1st and 2nd ribs
paraspinal muscles attach what to what
attach occiput and C-spine to thorax
levator scapulae attaches to what
Origin at t-processes of C1-C4 b/l
Insertion at superior angle of scapula
where are all the important superficial neovascular structures of the neck
anterior and medial to the SCM
the carotid triangle is anterior to the border of the SCM
what pages in my manual should i read for this lecture?
76-78
