Lecture 2- Intro to the Vertebral Column, Cervical Spine, Temporomandibular Joint Flashcards
1
Q
How many total vertebrae are there?
How many intervertebral discs are there?
A
- 33 (7 cervical, 12 thoracic, 5 lumbar, 5 sacral, 4 coccygeal)
- 23
2
Q
Where are the two primary kyphotic curves located?
Where are the two secondary lordotic curves locates?
A
- thoracic, sacral
- cervical, lumbar
3
Q
Why is our vertebrae curved?
A
Helps to resist compressive forces
4
Q
What is the drawback of our vertebrae being curved?
A
It can create shearing forces, particularly at curve transitions
5
Q
What is the motion segment and what does it consist of?
A
- It is the functional unit of the spine
- Consists of 2 adjacent vertebrae, intervertebral disc, and the soft tissue connecting them
6
Q
The typical vertebrae consists of what 2 parts?
A
- Vertebral body
- Vertebral (Neural) arch
7
Q
What makes up anterior portion of the vertebral arch?
What makes up the posterior portion of the vertebral arch?
A
- Pedicle
- Lamina, articular processes, spinous and transverse processes
8
Q
The shell of the vertebrae is made up of what type of bone?
The interior of the vertebrae is made up of what type of bone?
What is the purpose of this structural formation?
A
- Shell=cortical
- Interior=cancellous
- Allows for minimal weight of the vertebrae while also allowing for weight bearing due to the shell.
9
Q
What is the role of the vertebral body?
A
weight bearing portion of spinal column
10
Q
What is the role of the pedicles?
A
transmit tension and bending forces from posterior elements to vertebral body
11
Q
What is the role of the laminae?
A
- connects spinous and transverse process
- connects inferior and superior articular processes
12
Q
What is the role of the articular facet processes?
A
connect vertebrae together forming the articular pillar
13
Q
What is the articular pillar?
A
Combination of multiple vertebrae and their superior and inferior articulations
14
Q
What is the role of the spinous process?
A
Serves as muscle attachment and provide mechanical lever; may also serve as bony block to motion
15
Q
What is the role of the transverse process?
A
Serves as muscle attachment and provide mechanical lever
16
Q
If someone has a part interarticularis fracture, where is this fracture?
Where is this most common?
A
- at the laminae between the articular processes of the vertebrae
- Lumbar
17
Q
If someone has a bilateral pars interarticularis fracture, what concerns do you have?
A
slipping forward of the bone, thus affecting the spinal cord
18
Q
What is the main job of the vertebral foramen?
A
Passage and protection of the spinal cord
19
Q
What percentage of vertebral height is attributed to the intervertebral disc?
A
20-33%
20
Q
What is the purpose of the intervertebral disc?
A
- seperate two vertebral bodies and therefore increase motion
- transmit load from one vertebral body to the next
- stabilization of the spine
- provides space between vertebrae for exiting spinal nerves
21
Q
What are the components of the intervertebral discs?
A
- nucleus pulposus
- anulus fibrosis
- vertebral end plate
22
Q
The nucleus pulposus and anulus fibrosis are mostly composed of what?
A
Water
- nucleus pulposus is 70-90%
- anulus fibrosis is 60-70%
23
Q
The anulus fibrosis and vertebral end plate do what?
A
Help keep the nucleus pulposus inside the vertebral disc
24
Q
A dysfunction at the vertebral disc that allows the nucleus pulposus to leak out is called what?
A
Intervertebral disc herniation
25
What position increases the pressure on the disc the most? The least?
- Disc pressure is large when holding load in front of the body, especially with forward bending
- Lifting a load with knees flexed places less pressure on discs than with knee straight
26
What makes up the intervertebral joints?
body of 2 vertebrae with intervertebral disc
27
What makes up the zygopophyseal joint?
superior articular facet and inferior articular facet
28
What are the 6 main ligaments at the spine?
| What do they limit?
- Anterior longitudinal- limits extension and reinforces anulus fibrosus and intervertebral joints
- Posterior longitudinal- limits forward flexion and reinforces posterior anulus fibrosus
- Ligamentum flavum- limits forward flexion, mainly at lumbar
- Interspinous- limit forward flexion
- Supraspinous- limit forward flexion
- Intertransverse limit contralateral lateral flexion
29
What is the purpose of coupled motions at the spine? Give an example.
- Consistent association of one motion about an axis with another motion around a different axis.
- Example is lateral flexion and rotation. Pure lateral flexion and pure rotation do not occur at any region of the spine. In order for either motion to occur, at least some degree of the other must also occur.
30
What influences the coupling patterns?
- spinal posture
- spinal curvature
- orientation of articulating facets
- fluidity/elasticity/thickness of the disc
- extensibility of the muscles, ligaments, and joint capsules
31
What occurs osteokinematically at the spine?
- flexion/extension
- lateral flexion
- rotation
32
Osteokinematically, the description of movement is based on what?
direction of superior segments anterior portion
33
What are the arthrokinematic motions that occur at the intervertebral joints with each of the osteokinematic motions?
What arthrokinematically occurs at the facet joints with the osteokinematic movement?
- approximation/distraction
- sliding or gliding
- tipping
- approximation/gapping
- sliding or gliding
34
Flexion of the vertebrae results in anterior ____ and anterior _______ arthrokinematically. This results in a widening of the intervertebral foramen and seperation of spinous processes and facet joints. This will also result in anterior _________ of the anulus fibrosis and posterior _________ of the anulus fibrosis.
- tilt, glide
| - compression, stretching
35
Extension of the vertebrae results in posterior ______ and posterior _______ of the superior vertebrae. This results in a narrowing of the intervertebral foramen and spinous processes and facet joint __________. This will also result in posterior _______ of the anulus fibrosis and anterior _______ of the anulus fibrosis.
- tilt, glide
- approximation
- compression, stretching
36
Lateral flexion of the vertebrae results in _______ tilt, _________, and __________ of the superior vertebrae over the vertebrae below. This results in ________ of the intervertebral foramen and seperation of _____ joints on the contralateral side. This also results in ______ of the anulus fibrosis on the ipsilateral side of movement, and _________ on the contralateral side.
- lateral, rotation, translation
- widening
- facet
- compression, stretching
37
Rotation varies widely by region and results in _________ of the contralateral facet and ___________ of ipsilateral facet joints.
- approximation
| - distraction
38
The vertebral column is subject to what forces?
| The ability to resist these loads varies by region and depends on what?
- axial compression
- tension
- bending
- torsion
- shear
- type/duration/rate of loading
- age
- posture
- various structural elements (vertebral bodies, joints, discs, muscles, joint capsules, and ligaments)
- integrity of NS
39
What is the overall function of the spinal musculature?
- control posture
- stabilize axial skeleton
- protect spinal cord and internal organs
- generate intra-thoracic and intra-abdominal pressure
- produce torque for movement of the body
- mobility of head and neck for optimal place of eyes, ears, and nose
40
CERVICAL SPINE
CERVICAL SPINE
41
What are the 4 divisions of the cervical spine and what vertebrae fall within each division?
```
Upper Cervical (craniovertebral)
-occiput, C1, C2
Lower Cervical
-C3 to C7
Atypical Vertebrae
-C1, C2, and C7
Typical Vertebrae
-C3 to C6
```
42
What is unique about C1, C2, and C7?
C1 (Atlas)
-shaped like a ring
-has no vertebral body or spinous process
-has 2 lateral masses seperated by anterior and posterior arch
C2 (Axis)
-anterior portion of the body extends inferiorly
-vertical projection from the superior surface of the body known as the dens
-spinous process is large/elongated and bifid
C7
-largest cervical vertebrae
-has many characteristics of a thoracic vertebrae
-large spinous process
43
What is the structure of the typical cervical vertebrae?
- body is small
- transverse foramen on transverse process
- intervertebral disc is crescent shaped and thicker anteriorly
- posterior longitudinal ligament "stops" nucleus posteriorly
44
The atlantoaxial joint has how many articulations, what are they?
- 3
| - dens to anterior arch, 2 convex on convex articulations between the inferior and superior facets of C1 and C2
45
What helps with the biconvex articulations at the atlantoaxial zygopophyseal joints?
Meniscoid- cartilage that offsets and makes articulation more congruent
46
What are the 6 main craniovertebral ligaments?
| What are the 4 ligaments that go to the cervical but originate lower on the spine?
- posterior atlanto-occipital membrane
- posterior atlanto-axial membrane
- anterior atlanto-ocipital membrane
- anterior atlanto-axial membrane
- tectorial membrane
- ligamentum nuchae
- ligamentum flavum
- anterior longitudinal ligament
- posterior longitudinal ligament
- supraspinous ligament
47
What is the role of the transverse ligament? What motion does it help limit?
- Keeps the dens in place
| - Prevent anterior displacement of C1 on C2
48
What is the role of the alar ligament? What motion does it help limit?
- Keeps the dens in place
| - Prevent distraction of C1 on C2
49
What are the two most common conditions that can compromise the integrity of the transverse ligament resulting in instability of C1/C2.
- Rheumatoid arthritis
| - Down Syndrome
50
What is the danger of instability at the upper cervical spine?
If sliding is occuring, it could pinch down on the spinal cord and could even cause permanent paralysis.
51
The joint capsules are lax in the cervical vertebrae for what reason?
To allow for movement at the cervical spine
52
Lower cervical facet joints are approximately __ degrees off the frontal and transverse planes.
45
53
What motions (osteokinematics) can be performed at the cervical spine?
- flexion/extension
- lateral flexion
- rotation
- protraction/retraction
54
What occurs in the cervical spine with protraction? Retraction?
Protraction has the upper cervical in extension and the lower cervical in flexion.
Retraction has the upper cervical in flexion and the lower cervical in extension.
55
What occurs at the atlanto-occipital joint arthrokinematically?
The convex occipital condyles on the concave articular facets of C1 cause a opposite roll/glide at the joint in the sagittal and frontal plane.
56
What is the primary motion that occurs at the atlanto-occipital joint?
Nodding
57
When nodding (flexion) the occipital condyles roll _______ and glide __________.
- anteriorly
| - posteriorly
58
When nodding (extension) the occipital condyles roll ______ and glide _________.
- posteriorly
| - anteriorly
59
What occurs at the antlanto-axial joint arthrokinematically?
Sagittal Plane
-tilt of atlas on axis
Transverse Plane
- On the ipsilateral side of rotation, the superior facet slides posteriorly on the inferior facet.
- On the contralateral side of rotation, the superior facet slides anteriorly on the inferior facet.
Frontal Plane
-negligible
60
What is the primary motion that occurs at the atlanto-axial joint?
Rotation
61
What ligament limits rotation at the atlanto-axial joint?
Alar ligament
62
What ligament limits tilting of axis at the atlanto-axial joint with flexion?
Transverse ligament
63
What coupling motions occur with lateral flexion and rotation at the cervical spine?
-lateral flexion and rotation coupled in the same direction (lateral flexion to the R occurs with rotation to the R)
64
If either lateral flexion or rotation were to be done in isolation what would occur?
They would come in contact with another blocking motion
65
What occurs at the facet joints of C3-C7 arthrokinematically with each of the osteokinematic motions?
Sagittal Plane
- Flexion-inferior facet glides anteriorly and superior
- Extension- inferior facet glides posterior and inferior
Transverse Plane
- Same side as rotation- inferior facet glides posterior and slightly inferior
- Opposite side as rotation- inferior facet glides anterior and slightly superior
Frontal Plane
- Same side as lateral flexion- inferior facet glides inferior and slightly posteriorly
- Opposite side of lateral flexion- inferior facet glides superior and slightly anterior
66
Describe the arthrokinematics of R rotation at C4-C5
- R (ipsilateral) C4 facet glides ________ and slightly ________ on C5 facet
- L (contralateral) C4 facet glides _________ and slightly _________ on C5 facet
- posterior, inferior
| - anterior, superior
67
What is the overall function of the cervical spine?
- stability and protection (vertebral canal and transverse foramen)
- C-spine demonstrates most flexibility
- stability is especially important (AA and AO joints)
68
What muscles act on the cervical spine and what are their actions?
Antero-Lateral
- SCM
- Scalenes
- Longus colli and capitis
- Rectus capitis anterior and lateralis
Posterior
- Splenius cervicis and capitis
- Suboccipital muscles
Muscles of Thorax that act on neck
- Erector Spinae
- Semispinalis cervicis and capitis
- Rotatores
- Multifidi
- Interspinalis
- Intertransversarius
69
What are the concerns with muscular imbalances and poor posture?
- With a bad posture, some muscles may be working overtime to help and try and maintain posture, this can cause pain, headaches, TMJ issues.
- Can also cause facet joint irritation by closing down the joints.
70
What are the reasons for muscular imbalance?
- Excessive or violent hyperextension movement strain SCM, longus colli, and anterior scalenes causing chronic spasm/guarding
- Inhibition, pain, weakness or fatigability of deep flexors (longus colli/capitis) resulting in SCM and anterior scalene becoming more dominant
- Ergonomics: protracting to improve visual contact with computer screen or poor sitting posture
71
TEMPOROMANDIBULAR JOINT
TEMPOROMANDIBULAR JOINT
72
What bones make up the TMJ?
- mandible
| - temporal bone
73
What is the purpose of the articular disc at the TMJ?
- seperates into upper and lower articulations to cushin the large, repetitive force of mastication
- allows convex surfaces to remain congruent throughout ROM, increase stability, minimize loss of mobility, reduce friction, and reduce biomechanical stress on TMJ
74
What type of joint is the TMJ?
synovial
75
The articular eminence and mandibular condyle are both _______ resulting in an incongruent joint. This is why the articular disc is present.
convex
76
What type of cartilage is the TMJ covered in? Why?
- fibrocartilage
| - fibrocartilage is usually present to withstand repeated and high-level stress
77
The inferior TMJ functions as a __________ joint.
| The superior TMJ functions as a _________ joint.
- simple hinge
| - gliding
78
What attaches to the articular disc?
- medial and lateral poles of condyle
- joint capsule and lateral pterygoid anteriorly
- bilaminar retrodiscal pad posteriorly
79
The attachment at the medial and lateral poles of the condyle allows the condyle to rotate freely on the disc in an ________ and _________ direction.
anterior and posterior
80
The attachment of the articular disc to the joint capsule and lateral pterygoid anteriorly restricts __________ translation of the disc.
posterior
81
- The superior lamina of the bilaminar pad assists the disc in translating _________ with mandible depression.
- The inferior lamina limits forward ___________.
- anteriorly
| - translation
82
What is the make up of the joint capsule of the TMJ?
?
83
Where is the TMJ joint capsule strong?
capsule is firm medial and laterally
84
Where is the TMJ joint capsule weak?
capsule is thin and loose anterior and posterior
85
How does the joint capsule strengths and weaknesses influence dislocations?
-more dislocations will have anteriorly and posteriorly due to the thin and loose structure
86
What are the ligaments of the TMJ and what purpose do they serve?
Lateral TMJ Ligament
-stabilizes lateral portion of the capsule
-helps guide movement during opening
Stylomandibular Ligament
-weakest of 3 ligaments with questionable function
Sphenomandibular Ligament
-swinging hinge that suspends the mandible
87
What is the normal resting position of the TMJ?
lips closed and teeth several millimeters apart
88
What are the different movements of the TMJ osteokinematically?
- depression/elevation
- protrusion/retrusion
- left and right lateral excursion
89
The articular disc of the TMJ functionally seperates the TMJ into upper and lower joint cavities. 50% of motion occurs as ________ in the lower joint and the other 50% of motion occurs in the upper joint as _______.
- rolling
| - gliding
90
How and at which part of the joint does the first part of mouth opening occur?
posterior rolling at the lower joint
91
How and at which part of the joint does the second part of mouth opening occur?
anterior glide in the upper joint
92
How and at which part of the joint does the first part of mouth closing occur?
glide posterior in the upper joint
93
How and at which part of the joint does the second part of mouth closing occur?
anterior rolling at the lower joint
94
What happens with the articular disc during opening and closing?
sliding anteriorly and posteriorly between the joint
95
How and at which part of the joint does protraction and retraction occur?
- we will see anterior and posterior gliding
| - occuring in the upper joint
96
What happens with the articular disc during protraction and retraction?
moving anterior and posterior to keep joint congruency
97
Does rotation occur with protrusion and retrusion?
No
98
Lateral excursion involves primary ___________ translation of condyle and disc within the fossa.
side-to-side
99
What occurs on the ipsilateral side during lateral excursion?
posterior glide
100
What occurs on the contralateral side during lateral excursion?
anterior glide
101
What muscles and forces act on the TMJ during opening? Closing? Protrusion? Retrusion? Lateral Excursion?
```
Opening
-primarily gravity
-digastric
-suprahyoids
-inf. lateral pterygoid
Closing
-temporalis
-masseter
-medial pterygoids
-control of disc via sup. lateral pterygoids
Protrusion
-sup. masseters
-medial pterygoids
-lateral pterygoids
Retrusion
-post. fibers of temporalis
-deep fibers of masseter
-ant. digastric (some help)
Lateral Excursion
-contralateral med/lat pterygoid (pull condyle forward)
-ipsilateral temporalis (pull condyle posterior)
```
102
What are the normal ROM for different motions of the TMJ?
- opening
- lateral deviation
- protrusion
- retrusion
- opening= 35-50mm (25-35mm needed for everyday activity)
- 2 knuckles= functional
- 3 knuckles= normal
- lateral deviation= 10-15mm
- protrusion= 3-9mm
- retrusion= about 3mm
103
What is TMD?
- Temporomandibular Disorders
- broad/vague term used to describe dysfunctions associated with TMJ
- includes pain, popping, reduced bite force, reduced ROM, etc.
104
What are the factors associated with TMD?
- stress/emotional disturbance
- daily oral parafunctional habits
- asymmetric muscle activity
- sleep bruxism
- chronic forward head posture
- C-spine pathology
- sensitization of the CNS
105
_________ and ____________ both may be observed with osteokinematic movement of the mandible and may result from differently shaped mandibular condyle heads or may indicate a pathology.
Deviations and deflections
106
Deviation is motion that produces an "_" curve with depression or protrusion.
S
107
Deflection is motion that produces a "_" curve with depression or protrusion.
C
108
Deviation is more indicative of a _______ imbalance, or a joint obstruction "walking around the obstruction".
muscle
109
Deflection is usually more indicative of a anterior ______ displacement, blocking your ability to glide forward.
disc
110
Describe what is occurring during mouth opening/closing when there is a disc displacement with reduction? Why is there a click? What is a reciprocal click?
- disc is sitting anteriorly
- the click is us sliding back underneath the articular disc like we want it to usually be
- the reciprocal click is what happens when we slide back off of the disc
111
Describe what is occurring during mouth opening/closing when there is a disc displacement without reduction? Why is there no click?
- disc is not relocating and blocks translation and limits motion
- there is no click because the disc never slides into the right place
112
An anterior disc displacement that does NOT reduce is called a _____ lock, why?
- closed
| - limits the ability to open the mouth, disc stops movement
113
The anterior disc displacement that does NOT reduce limits what movement at what joint?
-anterior glide at upper joint
114
How does posture and the cervical spine impact the TMJ?
-head and neck position may affect tension in cervical muscles which can influence the function of the mandible
