Session 6: Cervical and Thoracic Spine

Question 1

How are the seven cervical vertebrae classified?

Answer 1

Atypical cervical vertebrae

Typical cervical vertebrae

Question 2

What are the atypical cervical vertebrae?

Answer 2

C1, C2 and C7

Question 3

What are the typical cervical vertebrae?

Answer 3

C3-C6

Question 4

Give the key features of typical cervical vertebrae.

Answer 4

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

Question 5

What goes through the transverse foramina?

Answer 5

Vertebral artery and vein and sympathetic nerve plexus

Question 6

Which is the widest cervical vertebra?

Answer 6

The atlas (C1)

Question 7

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

Answer 7

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

Question 8

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

Answer 8

The superior articular facets of the C2.

Question 9

What movement does the Atlanto-occipital joint allow?

Answer 9

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

Question 10

What movement does the Atlanto-axial joint allow?

Answer 10

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

Question 11

What is the odontoid process?

Answer 11

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.

Question 12

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

Answer 12

The transverse ligament.

Question 13

What is atlantoaxial instability?

Answer 13

Excessive movement between the C1 and C2 vertebrae.

Question 14

What are the most common causes of atlantoaxial instability?

Answer 14

Acute trauma

Degenerative changes in rheumatoid arthritis.

Question 15

Explain the features of C7.

Answer 15

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

Question 16

Why are the small transverse foramina relevant in C7?

Answer 16

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

Question 17

Where do the spinal nerves run?

Answer 17

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

Question 18

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

Answer 18

Superior

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

What are the roles of the ligamentum nuchae?

Answer 21

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.

Question 22

What is the function of anterior longitudinal ligament?

Answer 22

To prevent hyperextension of the vertebral column.

Question 23

What is function of the posterior longitudinal ligament?

Answer 23

Prevents hyperflexion of the vertebral column

Question 24

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

Answer 24

That intervertebral disc prolapses tend to occur lateral to it.

Question 25

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

Answer 25

With the neck of the ribs | T11 and T12 don't.

Question 26

What is the orientation of the articular facets?

Answer 26

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

Question 27

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

Answer 27

Because it is connected to the rib cage.

Question 28

What do the superior costal facets articulate with?

Answer 28

The head of the ribs

Question 29

What is a Demi-facet?

Answer 29

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.

Question 30

What movements does the cervical spine permit?

Answer 30

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

Question 31

What does the superior Demi-facet articulates with?

Answer 31

The head of the adjacent rib.

Question 32

What does does the inferior Demi-facet articulates with?

Answer 32

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

Question 33

What does the transverse processes with costal facets articulate with?

Answer 33

The tubercle of the rib of the adjacent rib.

Question 34

How does T1 differ from the other thoracic vertebrae?

Answer 34

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

Question 35

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

Answer 35

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

Question 36

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

Answer 36

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

Question 37

Muscle action of: C5

Answer 37

Shoulder abduction, external rotation and elbow flexion

Question 38

Muscle action of: C6

Answer 38

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

Question 39

Muscle action of: C7

Answer 39

Elbow extension Wrist flexion Pronation Finger flexion and extension

Question 40

Muscle action of C8:

Answer 40

Finger flexion Finger extension Thumb extension Wrist ulnar deviation

Question 41

Muscle action of: T1

Answer 41

Finger abduction | Finger adduction

Question 42

Role of transverse ligament between C1 and C2.

Answer 42

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

Question 43

What spinal nerves does the brachial plexus consist of?

Answer 43

Anterior rami of the C5-T1 spinal nerves.

Question 44

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

Answer 44

Starts in neck | Ends in axilla

Question 45

Brachial plexus is divided into five parts. Which?

Answer 45

``` Randy Tom Ditches Cool Boys Roots Trunks Division Cords Branches ```

Question 46

What are the roots of the brachial plexus formed by?

Answer 46

The anterior rami of spinal nerves C5 to T1.

Question 47

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

Answer 47

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

Question 48

Root value of superior brachial trunk.

Answer 48

C5 and C6

Question 49

Root value of middle brachial trunk.

Answer 49

Direct continuation of C7

Question 50

Root value of inferior brachial trunk.

Answer 50

C8 and T1.

Question 51

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?

Answer 51

The axilla

Question 52

What happens to the divisions once in the axilla?

Answer 52

Converge to form three cords.

Question 53

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

Answer 53

The axillary artery.

Question 54

What are the three cords?

Answer 54

Lateral cord Posterior cord Medial cord

Question 55

What is the lateral cord formed by?

Answer 55

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

Question 56

What is the posterior cord formed by?

Answer 56

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

Question 57

What is the medial cord formed by?

Answer 57

M1: | Continuation of anterior division of the inferior trunk

Question 58

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

Answer 58

``` ARMUM: Axillary nerve Radial nerve Median nerve Ulnar nerve Musculocutaneous nerve ```

Question 59

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

Answer 59

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

Question 60

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

Answer 60

Ulnar, median and musculocutaneous nerves | Supply the flexor (anterior compartments)

Question 61

Root value of: Musculocutaneous nerve.

Answer 61

C5-C7

Question 62

Root value of: Median nerve.

Answer 62

C6-T1 (Sometimes C5-T1)

Question 63

Root value of: Ulnar nerve.

Answer 63

C8-T1

Question 64

Root value of: Axillary nerve.

Answer 64

C5,C6

Question 65

Root value of: Radial nerve.

Answer 65

C5-T1

Question 66

Root value of: Long thoracic nerve.

Answer 66

C5-C7

Question 67

Root value of: Medial pectoral nerve.

Answer 67

C8-T1

Question 68

Root value of: Lateral pectoral nerve.

Answer 68

C5-C7

Question 69

What is the brachial plexus divided into?

Answer 69

``` Five parts. Roots Trunks Division Cords Branches ```

Question 70

What are the 'roots' of the brachial plexus formed by?

Answer 70

The anterior rami of the spinal nerves C5-T1