Lecture 26 - Cervical and Thoracic Spine Flashcards
Cervical spine is composed of
7 cervical vertebrae divided into upper (C0-C2) and lower (C3-C7) cervical spine
C0-C1 is called
Occiput-Atlas
How does the occiput-atlas articulate
Articulates with condyles of occiput and superior facets of atlas
T or F: Atlas lacks a vertebral body and spinous process
T
3 movements of occiput-atlas
1) extension (10-15 deg)
2) Side bending (8 degree)
3) Minimal rotation
C1-C2 is also called
Atlantoaxial
How are the facets of the atlantoaxial aligned
Horizontally
What 4 movements is atlantoaxial responsible for
- 50% cervical rotation
- 10 degrees of flexion/extension
- 45 degrees of rotation
- Little to no side bending
What allows for increased mobility of C3-C7 compared to thoracic and lumber spine
Zygapophyseal (facet joints) are angulated at 45 degrees to the vertical in sagittal plane
What are the 4 movements of C3-C7
- Flexion (64 deg)
- Extension (24 deg)
3) Side bending (40 deg)
4) Rotation (40 deg)
T or F: The cervical spine (C3-C7) are not victims of wear and tear due to increased motion
F, they are
What joints make up the C3-C7 and their function
- 2 zygapophyseal (facet) joints for rotation and side bending
- 2 uncinate (Van Luschka/uncovertebral) joints that prevent posterior translation and some bending. Also acts as gliding mechanism for flexion and extension
What 3 components make up the intervertebral disc
- Annulus fibrosis
- Nucleus Pulposis
- End-plate
The cervical spine is reinforced by
Uncovertebral joints for posterior-lateral stability and protection against disc herniation
What is unique to the cervical spine in regards to the vertebral artery?
There is a foramen in C1-C6 to allow for passage of vertebral artery vertically
What does the vertebral artery arise from and turn into?
Arises from subclavian artery and turns into basilar artery
Where does the alar craniovertebral ligaments attach to?
The dens and occipital condyles of the cranium
What is the pathway of the alar craniovertebral ligaments (arise from and goes to)?
Arises from odontoid process and passes superiorly and laterally to inside of foramen magnum
What does the transverse craniovertebral ligament cover and attach to?
Covers dens and attaches horizontally to C1
T or F the transverse ligament forms part of the cruciform ligament
T
What 2 ligaments are important for keeping the dens in close approximation to C1 and away from the spinal cord
- Alar ligament
- Cruciform Ligament
Where does the ligamentum nuchae craniovertebral ligament extend to and from
Extends from spinous process of C7 to external occipital protuberance
What is the function of the ligamentum nuchae craniovertebral ligament?
Increases depth of cervical spinous process allowing for muscular attachment that helps limit cervical flexion
What are the 5 muscles that make up the posterior upper C-spine?
- Suboccipitals (cross 1-2 vertebrae levels)
- Rectus capitis posterior major
- Rectus capitis posterior minor
- Obliquus capitis inferior
- Obliquus capitis superior
What are the 3 muscles of the anterior upper c-spine
- Rectus capitis anterior
- Rectus capitis lateralis
- Longus colli cervicis
What are 8 muscles that make up the anterior lower cervical spine
- Sternocleidomastoideus (SCM)
- Long capitis
- Longus colli
- Anterior scalene
- Middle scalene
- Posterior scalene
- Splenius capitis
- Cervicis
Function of the longus capitis
Ventral flexor of c-spine and stabilizer
Function of longus colli
Stabilizer of mid c-spine and provides dynamic tension of anterior longitudinal ligament
What are the 9 muscles that make up the posterior lower cervical spine
- Splenius capitis
- Splenius cervicis
- Semispinalis capitis
- Semispinalis cervices
- Longissimus capitis
- Longissimus cervicis
- Levator scapulae
- Uppper trapezius
- Spinalis cervicis
Importance of superficial muscles of the neck in regards to biomechanics
Exert more torque by acting like large lever arms
Importance of deep muscles of the neck in regards to biomechanics
Segmentally arranged to guide and support cervical motion
Why does there need to be coordination between deep and superficial muscles of the neck?
Deep muscles cannot support the load of the head and the superficial segments cannot support cervical segments
What 2 muscles have the largest density of muscle spindles in the body
Suboccipital muscle and deep cervical muscles:
1. Multifidus
2. Longus colli
Occipital-Atlas Joint Shape
Simple, synovial, ellipsoid
Atlantoaxial joint complex shape
Made of 3 separate articulations (2 lateral and 1 median)
What are the 3 laws of fryettes laws of spinal motion (dont need to know)
Law 1 (Neutral Mechanics): When a spine is in neutral, sidebending to one side will be accompanied by horizontal rotation to opposite side (coupled relationship)
Law 2 (Non-Neutral Mechanics): When spine is flexed or extended, side-bending and rotation will occur on same side
Law 3: When motion is introduced in one plane it will reduce or modify motion in other planes of movements. (Sums up other 2 laws by stating that dysfunction in one plane will negatively affect all other planes of movement)
Describe the 3 principles of arthrokinematics of the C-spine (dont need to know)
1) Upper c-spine (neutral position) will side bend and rotate in opposite directions
2. Upper c-spine (flex or ext) will side bend and rotate in the same side
3. Lower c-spine will always side bend and rotate in the same direction
Vertebrae of the thoracic spine vary by region with superior segments sharing commonalities with the [blank] and inferior segments becoming more like [blank]
c-spine and l-spine
Vertebral bodies become..
larger and denser from superior to inferior to support increased body mass
Facet joints of the thoracic spine are
synovial and planar
What plane is the thoracic spine orientated in
Frontal plane (60 deg)
T or F: Thoracic discs are thicker compared to cervical and lumbar spine
F, thinner
What 2 factors contributes to lower mobility of thoracic spine
- Thin thoracic discs
- Attachment of thoracic spine to ribs
T or F: Transverse processes correlate to the same level as spinous processes
F, they do not
Do any ligaments arise from the thoracic spine
No, they only run through
What 3 ligaments attach thoracic vertebrae to ribs
- Superior costovertebral ligament
- Medial costovertebral ligament
- Lateral costovertebral ligament
What is the biggest function of the muscles in the thoracic spine?
Support segments from being exaggerated further into kyphotic predisposition
What 3 muscles attach t-spine to c-spine?
- Upper trap
- Splenius capitis
- Splenius cervicis
What 4 muscles attach t-spine to scapula?
- Rhomboid Major
- Rhomboid Minor
- Middle Trap
- Lower Trap
ROM of the thoracic spine is affected by
Rib cage and rib articulations
T or F: ROM is greater in the t-spine than the c and l-spine
F, it is less
Can the thoracic spine move independently of the rib cage
Yes they can, but the rib cage increases stability of the thoracic spine
Describe the clinical significance of end range of shoulder flexion coupled with end range thoracic extension
Patients with limited thoracic extension can contribute to shoulder elevation and shoulder abduction mobility impairments
Describe the 2 consensus that make up the arthrokinematics of the thoracic spine
- Side-bending of t-spine leads to approximation of ribs on ipsilateral side and separation of ribs on other side
- Rotation results in posterior rotation of rib on ipsilateral side and anterior rotation of rib on opposite side
What 2 motions does the arthrokinematics of rib motion undergo
- Pump-handle motion: anterior and superior migration of ribs at costovertebral and costotransverse joints
- Bucket Handle Motion: Lateral and superior migration of ribs
T or F: Neck pain is one of the most prevalent musculoskeletal conditions
T
