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MSK > Session 6: Cervical and Thoracic Spine > Flashcards

Session 6: Cervical and Thoracic Spine Flashcards

1
Q

How are the seven cervical vertebrae classified?

A

Atypical cervical vertebrae

Typical cervical vertebrae

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2
Q

What are the atypical cervical vertebrae?

A

C1, C2 and C7

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3
Q

What are the typical cervical vertebrae?

A

C3-C6

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4
Q

Give the key features of typical cervical vertebrae.

A

Small body and broad from side to side
Large triangular vertebral foramen
Bifid spinous process (except for C7)
Transverse foramen in the transverse process.
Articular facets that are orientated in the coronal plane and at a 45 degree angle to the axial plane

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5
Q

What goes through the transverse foramina?

A

Vertebral artery and vein and sympathetic nerve plexus

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6
Q

Which is the widest cervical vertebra?

A

The atlas (C1)

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7
Q

What does the superior articular facets of the atlas (C1) articulate with? What is the joint called?

A

The occipital condyles of the skull. This is called the Atlanto-occipital joint.

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8
Q

What does the inferior articular facets of the atlas (C1) articulate with? What is the joint called?

A

The superior articular facets of the C2.

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9
Q

What movement does the Atlanto-occipital joint allow?

A

Permits nodding of head and contributes 50% of the total range of flexion and extension of the head and neck.

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10
Q

What movement does the Atlanto-axial joint allow?

A

Contributes to 50% of the total rotation of the head and neck.

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11
Q

What is the odontoid process?

A

Aka dens or odontoid peg.
Projects vertically upwards from the body of the axis. Vestigial remnant of the body of C1.

Held in place by the transverse ligament of the atlas and acts as a pivot joint. Key component to allow us to rotate our heads.

Apical ligament attaches between the odontoid process and the base of the skull superiorly.

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12
Q

What is the ligament called that is responsible for shaking your head?

A

The transverse ligament.

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13
Q

What is atlantoaxial instability?

A

Excessive movement between the C1 and C2 vertebrae.

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14
Q

What are the most common causes of atlantoaxial instability?

A

Acute trauma

Degenerative changes in rheumatoid arthritis.

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15
Q

Explain the features of C7.

A

It is also called vertebra prominens.
Longest spinous process.
Not bifid
Small transverse foramina

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16
Q

Why are the small transverse foramina relevant in C7?

A

Because they only transmit the accessory vertebral veins and not the vertebral arteries.

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17
Q

Where do the spinal nerves run?

A

Passes posterior to the vertebral artery which ascends through the foramina transversaria in C1-C6.

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18
Q

Does the C3 spinal nerve pass superior or inferior to the C3 vertebra?

A

Superior

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19
Q

What nerve root would be compressed in a disc prolapse in the cervical region?

A

Since there is no tranvsersing nerve root in the cervical spine the exiting nerve root would usually be compressed instead.

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20
Q

What is the ligamentum nuchae? What is it attached to?

A

A thickening of the supraspinous ligament.
External occipital protuberance
Spinous processes of all cervical vertebrae
Spinous process of C7

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21
Q

What are the roles of the ligamentum nuchae?

A

Maintain secondary curvature (lordosis) of the cervical spine.
Assist the cervical spine to support weight of the head
A major site of attachment of the muscles in the neck and trunk.

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22
Q

What is the function of anterior longitudinal ligament?

A

To prevent hyperextension of the vertebral column.

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23
Q

What is function of the posterior longitudinal ligament?

A

Prevents hyperflexion of the vertebral column

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24
Q

What is the main clinical relevance of the posterior longitudinal ligament?

A

That intervertebral disc prolapses tend to occur lateral to it.

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25
Q

What do the costal facets of the transverse processes of the thoracic vertebrae articulate with?
Are there any exceptions?

A

With the neck of the ribs

T11 and T12 don’t.

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26
Q

What is the orientation of the articular facets?

A

20 degrees in the coronal plane and 60 degrees in the axial plane.

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27
Q

Why does the thoracic spine have limited flexibility compared to cervical and lumbar region?

A

Because it is connected to the rib cage.

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28
Q

What do the superior costal facets articulate with?

A

The head of the ribs

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29
Q

What is a Demi-facet?

A

The superior and inferior costal facets are Demi-facets. This means that the superior Demi-facets articulate with the head of the adjacent rib and the inferior Demi-facet articulate with the head of the rib below that vertebra.

30
Q

What movements does the cervical spine permit?

A

Flexion and extension:
by atlanto-occipital joint and by the facet joints between the cervical vertebrae.

Rotation:
by atlanto-axial joint (odontoid process acting as a pivot) and by the facet joints between the vertebrae.

Lateral flexion:
45 degrees occurring at the facet joints

31
Q

What does the superior Demi-facet articulates with?

A

The head of the adjacent rib.

32
Q

What does does the inferior Demi-facet articulates with?

A

The head of the adjacent rib below. This means that T3 articulates with rib 3 and rib 4.

33
Q

What does the transverse processes with costal facets articulate with?

A

The tubercle of the rib of the adjacent rib.

34
Q

How does T1 differ from the other thoracic vertebrae?

A

The superior facet is not a Demi-facet. Only vertebra to articular with the first rib.

35
Q

How do T9 and T10 differ from the other thoracic vertebrae?

A

Single pair of whole facets is present.
Articulates with the ninth and 10th respectively.
Located across both the vertebral body and the pedicle.

36
Q

How do T11 and T12 differ from the other thoracic vertebrae?

A

Have single pair of whole costal facets, located on their pedicles.

37
Q

Muscle action of: C5

A

Shoulder abduction, external rotation and elbow flexion

38
Q

Muscle action of: C6

A

Elbow flexion/wrist extension/supination/internal rotation of the shoulder

39
Q

Muscle action of: C7

A

Elbow extension
Wrist flexion
Pronation
Finger flexion and extension

40
Q

Muscle action of C8:

A

Finger flexion
Finger extension
Thumb extension
Wrist ulnar deviation

41
Q

Muscle action of: T1

A

Finger abduction

Finger adduction

42
Q

Role of transverse ligament between C1 and C2.

A

Lies over the odontoid process and prevents horizontal displacement of the atlas.

43
Q

What spinal nerves does the brachial plexus consist of?

A

Anterior rami of the C5-T1 spinal nerves.

44
Q

Where does the brachial plexus start and where does it end?

A

Starts in neck

Ends in axilla

45
Q

Brachial plexus is divided into five parts. Which?

A 
Randy Tom Ditches Cool Boys
Roots
Trunks
Division
Cords
Branches
46
Q

What are the roots of the brachial plexus formed by?

A

The anterior rami of spinal nerves C5 to T1.

47
Q

After the roots form into the brachial plexus, where do they pass through?

A

Between scalenus anterior and scalenus medium to enter the posterior triangle of the neck.

48
Q

Root value of superior brachial trunk.

49
Q

Root value of middle brachial trunk.

A

Direct continuation of C7

50
Q

Root value of inferior brachial trunk.

A

C8 and T1.

51
Q

The superior, middle and inferior trunks divide into divisions which are situated posterior or anterior. There are three anterior and three posterior. They leave the posterior triangle of the neck and enter what?

A

The axilla

52
Q

What happens to the divisions once in the axilla?

A

Converge to form three cords.

53
Q

The three cords are classed based on their position relative to what?

A

The axillary artery.

54
Q

What are the three cords?

A

Lateral cord
Posterior cord
Medial cord

55
Q

What is the lateral cord formed by?

A

LAdos:
Anterior division of the superior trunk
Anterior division of the middle trunk

56
Q

What is the posterior cord formed by?

A

P3:
Posterior division of the superior trunk
Posterior division of the middle trunk
Posterior division of the inferior trunk

57
Q

What is the medial cord formed by?

A

M1:

Continuation of anterior division of the inferior trunk

58
Q

What are the five major terminal branches of the brachial plexus?

A 
ARMUM:
Axillary nerve
Radial nerve
Median nerve
Ulnar nerve
Musculocutaneous nerve
59
Q

What are the terminal branches of posterior cord of the brachial plexus and what compartments do they supply?

A

Axillary and radial nerves. Supply the extensor (posterior compartment)

60
Q

What are the terminal branches of anterior divisions (medial and lateral cords) of the brachial plexus and what compartments do they supply?

A

Ulnar, median and musculocutaneous nerves

Supply the flexor (anterior compartments)

61
Q

Root value of: Musculocutaneous nerve.

62
Q

Root value of: Median nerve.

A

C6-T1 (Sometimes C5-T1)

63
Q

Root value of: Ulnar nerve.

64
Q

Root value of: Axillary nerve.

65
Q

Root value of: Radial nerve.

66
Q

Root value of: Long thoracic nerve.

67
Q

Root value of: Medial pectoral nerve.

68
Q

Root value of: Lateral pectoral nerve.

69
Q

What is the brachial plexus divided into?

A 
Five parts.
Roots
Trunks
Division
Cords
Branches
70
Q

What are the ‘roots’ of the brachial plexus formed by?

A

The anterior rami of the spinal nerves C5-T1

MSK (28 decks)

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