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Musculo-skeletal System > MSK Session 9 - Cervical and Thoracic Spine > Flashcards

MSK Session 9 - Cervical and Thoracic Spine Flashcards

1
Q

Describe the structure of the thoracic and cervical spine.

A
  • Vertebrae: 7 cervical, 12 thoracic
  • Discrete Single Vertebrae

I. 19 separable vertebrae

II. All capable of individual movement

  • Cervical Spine: Mobile
  • Thoracic Spine: Immobile
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2
Q

Describe the characteristics of a typical cervical vertebrae.

A
  • Smallest of the discrete vertebrae
  • Form skeleton of the neck
  • Bifid Spinous Process (except C7)
  • Transverse foramen in transverse process

I. Foramen transversarium

II. Conduit for vertebral artery and vein (except C7)

iii. C7 foramen transmits the accessory vertebral vein
- Large triangular vertebral (neural) foramen
- Body is small and broad from side to side.
- Superior articular facet faces upward and backward while inferior articular facet faces downward and forward.

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3
Q

Describe the properties of the first cervical vertebrae: Atlas

A
  • Articulates with:

I. Occiput of skull superiorly (atlanto- occipital joint → 50% of Total flexion and extension – “nodding”)

II. Axis (C2) inferiorly – atlanto-axial joint → 50% Total rotation – shaking the head)

  • No vertebral body (Body is fused with axis to form dens or odontoid process)
  • No spinous process
  • Widest cervical vertebra
  • Vertebral arches are thick and strong to form a powerful lateral mass
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4
Q

Describe the properties of the second cervical vertebrae: Axis

A
  • Strongest cervical vertebra
  • Characterised by 3 main features:

I. The Odontoid Process or Dens

II. Rugged lateral mass

III. Large spinous process

  • Dens and transverse ligament prevent horizontal displacement of atlas as well as the independent movement of C1 on to C2 which could give rise to neurological problems.
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5
Q

Describe the properties of the seventh cervical vertebrae.

A
  • Vertebra prominens.
  • Longest spinous process
  • Spinous process is not bifid.
  • The transverse process is large, but the foramen transversarium is small and only transmits the accessory vertebral veins.
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6
Q

Have an understanding of the bony and neural structures of the spinal vertebrae.

A
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7
Q

Outline the structure of the ligamentum nuchae.

A
  • Nuchal ligament
  • Thickening of the Supraspinous Ligament
  • Attached to:

I. External occipital protruberance

II.. Spinous processes of all cervical vertebrae

III. Spinous process of C7

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8
Q

Outline the functions of the ligamentum nuchae.

A
  • Maintains secondary curvature of cervical spine
  • Helps the cervical spine support the head
  • Major site of attachment of neck and trunk muscles (e.g. Trapezius, Rhomboids)
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9
Q

Identify and describe the structure of the ligaments of the vertebral column.

A
  • Provide stability
  • Major ligaments: anterior longitudinal and posterior longitudinal ligament (anterior and posterior to vertebral bodies)
  • Anterior is stronger than posterior
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10
Q

Outline the movements of the cervical spine.

A
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11
Q

Describe the structure of the thoracic vertebrae.

A
  • Demi-facets on sides of body for articulation with head of rib (T2-T8); whole facets T9-10
  • Costal facets on transverse processes for articulation with tubercle of rib (except T11 and T12)
  • Vertebral foramen is small and circular
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12
Q

Have an understanding of the articulating surfaces of the thoracic spine.

A
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13
Q

Describe the neuroanatomy of the anterior and posterior cord.

A
  • Anterior Cord – Sensory and Motor Light Touch, Pinprick and Pain
  • Posterior Cord (Dorsal Columns)– Vibration and Proprioception
  • More central tracts move the arms and more lateral tracts move the legs
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14
Q

Describe the pathophysiology of Anterior Cord Syndrome.

A
  • Sensory problems
  • Motor problems depending on the level (part of spine affected)
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15
Q

Describe the pathophysiology of Central Cord Syndrome.

A

Arm problems more so than leg problems (inverted paraplegia)

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16
Q

Describe the pathophysiology of Posterior Cord Syndrome.

A
  • Loss of proprioception
  • Loss of co-ordination
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17
Q

Have a detailed understanding of the dermatomes of the upper limbs.

A
18
Q

Have a detailed understanding of the dermatomes of the lower limbs.

A
19
Q

Most muscles in the upper and lower limbs receive innervation from more than one spinal nerve root. They are therefore comprised of multiple myotomes.

Outline the myotomes for the main body movements.

A

The list below details which movement is most strongly associated with each myotome:

  • C1/C2: Neck flexion/extension
  • C3: Neck lateral flexion
  • C4: Shoulder elevation
  • C5: shoulder abduction and lateral rotation plus weak contribution to elbow flexion
  • C6: Elbow flexion/wrist extension/supination /medial rotation of shoulder
  • C7: Elbow extension/wrist flexion/pronation / weak contribution to finger flexion and extension
  • C8: finger flexion / finger extension / thumb extension / wrist ulnar deviation
  • T1: finger abduction and adduction
  • L2: hip flexion
  • L3: knee extension and hip adduction
  • L4: ankle dorsiflexion
  • L5: great toe extension /ankle inversion / hip abduction
  • S1: ankle plantar-flexion/ankle eversion/ hip extension (or L5)
  • S2: knee flexion /great toe flexion
  • S3-S4: anal wink
20
Q

What is a neural level?

A
  • Last functioning (sensory and motor function) level of a neuron
  • Remember level of the nipples is the junction between C4 and T4
21
Q

Describe the neuroanatomy of the nerve roots.

A
  • The nerve roots exit more horizontally in the cervical spine
  • Nerve Roots in cervical spine exit above their vertebral body until the C7/T1 junction
22
Q

X Rays are good at observing bony landmarks and any associated pathology.

Be able to identify structures on an X-ray of the cervical spine.

A
23
Q

MRI’s are good at observing soft tissue and any associated problems. However they are not very good at observing bony land marks.

A
24
Q

Outline cervical spondylosis.

A
  • Degenerative osteoarthritis of intervertebral joints in cervical spine
  • Pressure on nerve roots leads to radiculopathy:

I. Dermatomal sensory symptoms: paraesthesia, pain

II. Myotomal motor weakness

  • Pressure on the cord leads to myelopathy (less common):

I. Global weakness

II.Gait dysfunction

III. Loss of balance

IV. Loss of bladder and bowel control

25
Q

Outline the pathophysiology of a Hangman’s fracture.

A
  • Hyperextension of head on neck
  • Axis fractures through the pars interarticularis
  • Unstable fracture
  • Forward displacement of C1 and body of C2 on C3
26
Q

Outline the pathophysiology of a Peg fracture.

A
  • Aka Odontoid Fracture
  • Occurs where there is a fracture through the odontoid process of C2.
  • The mechanism of injury is variable, and can occur both during flexion or extension with or without compression 5.
  • Blow to back of head e.g. falling against a wall when balance is compromised
  • ‘Open mouth’ AP X-ray = ‘peg view’ or MRI cervical spine
27
Q

Outline the pathophysiology of a Jefferson’s fracture.

A
  • Fracture of anterior and posterior arches of atlas
  • Axial load e.g. diving into shallow water, impact against the roof of a vehicle, falls from playground equipment
  • Typically causes pain but no neurological signs
  • May damage arteries at base of skull with secondary neurological sequelae e.g. ataxia, Horner’s syndrome
28
Q

What is whiplash injury?

A
  • High mobility
  • Low stability
  • Prone to ‘whiplash injury’ – hyperextension and hyperflexion
  • No identifiable injured structures
29
Q

What anatomy changes are associated with a cervical prolapsed intervertebral disc?

A
  • Tear of the annulus fibrosis
  • Nucleus Pulposus – migrates through into the spinal canal
  • Wake-up with pain
30
Q

What will a patient complain of with a left sided C5/6 prolapsed intervertebral disc?

Which nerve is affected?

A
  • C6 nerve
  • Pain: Biceps into thumb and index finger
  • Sensory deficit: numbness/ P&Ns thumb and index finger
  • Motor weakness (deficit): Biceps and Wrist Extension
31
Q

What will a patient complain of with a left sided C7/T1 prolapsed intervertebral disc?

Which nerve is affected?

A
  • C8 nerve
  • Pain: Down to Little and Ring Fingers
  • Sensory deficit: Numbness/ P&Ns Little and Ring fingers
  • Motor weakness (deficit): Long Finger Flexors
32
Q

What anatomy changes are associated with a cervical myelopathy?

A
  • Osteoarthritis of the cervical spine
  • Osteophytes
  • Thickening Ligamentum Flavum
  • Signal Change in the Spinal Cord
33
Q

What will a patient complain of with a cervical myelopathy at C3/4?

A
  • Pain: Neck Pain
  • Motor weakness: Shoulder Abduction
  • Sensory deficit: Numbness/P&Ns from shoulder down and feet
34
Q

What will a patient complain of with a cervical myelopathy at C5/6?

A
  • Pain: Neck Pain
  • Motor weakness: Elbow Flexion, Wrist Movements and Finger Movements
  • Sensory deficit: Numbness/P&Ns from shoulder down and feet
35
Q

What is the clinical presentation of cervical myelopathy?

A
  • Progressive Disorder
  • Clumsiness
  • Loss Fine motor movements
  • Gait/ Balance disturbance
  • Positive Hoffmanns and Babinski reflex
  • Clonus
  • Dysdiadhokokinesis
36
Q

What are the anatomy changes of thoracic cord compression?

A
  • Fracture of the vertebra giving bony fragments in the canal or tumour developing in the canal compressing the spinal cord
  • Commonest Surgical Cause of Thoracic Cord Compression is Fractures and Tumours
  • Pain:Thoracic Pain
  • Motor weakness: Weakness of all muscles in the legs
  • Sensory: Numbness/ P&Ns from umbilicus down and loss of Sphincter Control
37
Q

If the tumour was at T5 how would the presentation change?

A
  • Pain: High Thoracic Pain
  • Motor weakness: Weakness of all muscles in the legs and INTERCOSTALS
  • Sensory: Numbness/ P&Ns just below the nipples and loss of Sphincter Control
38
Q

How can one test the function of the myotomes?

A
39
Q

How does one test the dermatomes anteriorly?

A
40
Q

How does one test the dermatomes posteriorly?

A

Musculo-skeletal System (10 decks)

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