TMJ, Cervical, Thoracic Flashcards

Question

Vertebrae with spinous process that is bifurcated?

Answer 1

Spinous process has 2 tubercles - -There is a large SP and it is bifurcated (unique to cervical spine) - -The bifurcation is usually palpable

Answer 2

TP has foramen for vertebral artery

Answer 3

1. Vertebral body is wider than high

Answer 4

Superior lateral surface of body raised for ucinate process --Uncoverterbal joints, joints of luschka --Uncinate process unique to cervical spine

Answer 5

Greatest degree of flexion and extension at C5-C6

Answer 6

In the cervical spine fair degree of movement, axis of movement at C5-C6

Answer 7

In the cervical spine fair degree of movement, axis of movement at C5-C6

Answer 8

Greatest degree of flexion and extension at C5-C6 because most likely to be injured there Whiplash etiology bc most movement of flexion and extension in that apex in the middle

Answer 9

Facet Joint alignment is unique in the cervical spine in that it is at 45 degrees

Answer 10

45 degrees

Answer 11

Cervical facet joint at an angle of 45 degrees in the frontal plane 1. This allows for a lot of movement patterns Thoracic is 60 degrees Lumbar is 90 degrees

Answer 12

1. Atypical Cervical Vertebrae: It is a transitional vertebrae ***C7 has the longest SP in the cervical spine 2. "Prominens" because it is the largest one - -> Otherwise it has regular cervical spine characteristics, has an uncinate process transverse foramen, but now has a costotrasnverse bar because it is transitional 3. Longest SP (in cervical spine)

Answer 13

Find C7 from T1 by extending the head: C7 dips in and T1 does not because T1 is attached to rib 1: which prevents T1 from sliding forward when you extend the neck C7 has the longest SP in the cervical spine

Answer 14

C7: It is called the Prominens because it is the largest one Otherwise it has regular cervical spine characteristics, has an uncinate process transverse foramen, but now has a costotrasnverse bar because it is transitional

Answer 15

The costotransverse joint is the joint formed between the facet of the tubercle of the rib and the adjacent transverse process of a thoracic vertebra. The costotransverse joint is a plane type synovial joint which, under physiological conditions, allows only gliding movement.

Answer 16

1. Transverse Processes is lateral 2. Spinous processes are bifid Bifurcations

Answer 17

1) Transverse Processes is lateral (gutter for NR-protect NR, issue if NR stuck in gutter or osteophyte) 2) Foramen for vertebral artery

Answer 18

Transverse Processes is lateral GOOD - --Have gutter like shape to protect the nerve root - --It protects the NR which is exposed as it exits, so this serves as protection which is unique to the cervical spine BAD ---Since the NR is in the gutter, if it gets stretched and gets stuck in the gutter then will get a problem with the nerve root ---Also issue if develop an osteophyte that develops in the gutter area that is sitting right on top of the nerve root

Answer 19

1. Posterior arch has superior and inferior articular facet favor flexion/extension 2. Aligned in sagittal plane at 45 degree angle 3. Also called: Zygapophyseal joints / Apophyseal joints 4. There is a space between these joints, there are uneven surfaces between the facet joints, the capsule has invaginations into the facet joints called meniscoids which are important because fatty and have a high degree of innervation. Therefore they get involved in entrapments in the cervical spin

Answer 20

dutton: The articular pillars and zygapophysial (facet) joints of vertebrae C2–7 are located approximately 1 inch lateral to the spinous processes. The articular pillar is formed by the superior and inferior articular processes of the zygapophysial joint, which bulge laterally at the pedicle–lamina junction. The articular facets on the superior articular process are concave and face superolaterally to articulate with the reciprocally curved and orientated facet on the inferior articular process of the vertebra above. The articular pillars bear a significant proportion of axial loading.

Answer 21

Posterior arch has superior and inferior articular facet, favor flexion/extension - ----There are articular facets on the posterior arch - ----Since on 45 degree angle flexion and extension are easy to do (note that the other movements are also easy to do) - ----All of the facets are aligned one on top of the other and in the cervical spine there is a line up that layer on top of each other called the articular pillar 1. This is the only part of the spine that when we do our mobilization treatments on the facet itself 2. We will access on the articular pillar (whereas on lumbar spine did SP, TP and not facet because facet joint was too deep) 3. Layering effect—it is designed to move

Answer 22

CONCAVE ON CONVEX Superior faces up, back, and medial Inferior faces down, forward and lateral Note: angulation progressively increases as you go down the cervical spine

Answer 23

up, back, and medial

Answer 24

down, forward and lateral

Answer 25

facet joint

Answer 26

facet joint

Answer 27

There is a space between facet joints, there are uneven surfaces between the facet joints, the capsule has invaginations into the facet joints called meniscoids which are important because fatty and have a high degree of innervation. Therefore they get involved in entrapments in the cervical spine.

Answer 28

-In degenerative diseases the meniscoids between facet joints start to atrophy and the meniscoids start to disappear as you get older --This causes decreased integrity in the joint and decreased stability of the facet joint --This increased mobility and decreased stability leads to osteophyte formation in the cervical spine More movement occurring in the facets and the constraint/ligaments and musculature

Answer 29

3 mechanically Linked Joints Atlanto Odontoid Joint and AA Joints

Answer 30

1. Atlanto-odontoid and A/A (C0-C1 and C1-C2) joints, No opening on Xray 2. C1-C2 held together by transverse ligament 3. Kept together by transverse ligament

Answer 31

There is no flexion/extension available at C1-C2 so the flexion and extension that takes place is C0-C1 NOTE C1-C2: 2 A/A joints and the AO joint in that complex have no openings on Xrays with flexion and extension: move together as a unit during flexion/extension -if there was it would indicate an instability between C1 and C2 because they are designed to rotate.

Answer 32

In C1-C2 there are three joints which are designed for rotation.. The two A/A joints and the AO joint in that complex have no openings on Xrays with flexion and extension-if there was it would indicate an instability between C1 and C2 because they are designed to rotate.

Answer 33

They move together as a unit during flexion/extension. The occiput slides on C1 and there is an opening at C2-C3 and further down but no opening at C1-C2 and if there is it is a ligament or bony issue.

Answer 34

Transverse ligament

Answer 35

It is to keep the odontoid in constant contact with the anterior arch of C1 **If you see movement in flexion on an xray between C1 and C2 it is either because a fx and displacement of the odontoid or a torn transverse ligament if odontoid displaced it can travel cranially or into cord. If instability between these two and get a gliding between C1-C2 and compress the cord: die

Answer 36

1) C1-C2 are planar flat joints from bony perspective 2) cartilage of both atlanto and axial part have convexity to them, there is a lot of literature that calls it a BICONVEX joint because of the cartilage on both surfaces and not because of the bone. 3) These two convexities not congruent so they are filled with meniscoids from the surrounding capsule to take up the space. Occiput motion: 1. Glide of occiput on C1 when go into flexion and extension. If you put your fingers on your occiputs and tuck your chin you will feel occiput slide posteriorly, if jut chin feel occiput roll anteriorly –feel glide of occiput on C1 when jut and nod 2. We look for this in the mobility in the C0-C1 joint * So the bone is flat but the cartilage makes it have the biconvex curvature * The transverse ligament goes across to keep the relationship of the anterior part of the odontoid with the posterior part of the arch close together –when flex they should not open up

Answer 37

1) Trochoid Joint between the odontoid , anterior arch of C1 and lateral masses ------In the subcranial area the rotation is a trochoid joint between the odontoid and the anterior arch (then it extends out to the lateral masses because all three of those joints are linked) 2) Odontoid stays in place and the osteo-ligamentous ring turns around the odontoid [For rotation, if the axis stays still and rotate around it—the movement occurs around the axis, If you initiate rotation it is your occiput moving first and then the ring of C1 moves around C2]

Answer 38

Trochoid Joint between the odontoid , anterior arch of C1 and lateral masses **subcranial area the rotation is a trochoid joint between the odontoid and the anterior arch **Then it extends out to the lateral masses because all three of those joints are linked

Answer 39

Odontoid stays in place and the osteoligamentous ring turns around the odontoid

Answer 40

If you initiate rotation it is your occiput moving first and then the ring of C1 moves around C2

Answer 41

1) 2 symmetrical joints, mechanically linked superior articular facets of lateral masses and occipital condyles 2) 3 degrees of freedom: Axial rotation, Flexion/Extension, Lateral Flexion 3) The cervical spine rule exception because in this joint sidebending and rotation are not coupled and they occur contralaterally:

Answer 42

3 degrees of freedom: Axial rotation, Flexion/Extension, Lateral Flexion

Answer 43

The cervical spine rule exception because in this joint sidebending and rotation are NOT coupled and they occur contralaterally: Different form lumbar spine: this occurs all the time regardless of whether in flexion or extension: they always occur in the opposite direction

Answer 44

Suboccipital mechanics: sidebending and rotation occur to opposite sides Different from rest of the cervical spine: sidebending and rotation coupled to the same direction

Answer 45

C0-C1, C1-C2: the subcranial section: sidebending and rotation always occur in the OPPOSITE direction (this is neutral mechanics)—it does not matter if the neck is in neutral or non-neutral position—they are always in the opposite direction only in the upper cervical spine In the rest of the cervical spine sidebending and rotation are always coupled to the same side –it doesn’t matter if it is neutral, flexion or extension

Answer 46

facet joints in the cervical spine are always considered to be engaged no matter what position they are in because of the angle of the facet joint (**Subcranial section is difference) Idling, always in the same direction, always does the same thing, different from the rest of the spine All cervical joints: C3-C7: couple in the same direction all the time: sidebend and rotation C0-C1-C2: the sub-occipital unitl: couple in opposite direction all the time: sidebend and rotation

Answer 47

All cervical joints: C3-C7: couple in the same direction all the time: sidebend and rotation C0-C1-C2: the sub-occipital unitl: couple in opposite direction all the time: sidebend and rotation

Answer 48

Extension of the PLL *within vertebral column: posterior body of axis over dense, covers cruciate ligament, inserts in foramen magnum Posterior neck near dura mater Big/thick/dense/ broad / strong

Answer 49

Tectorial Membrane

Answer 50

Anterior AO and AA Membranes

Answer 51

Posterior AO and AA Membranes

Answer 52

Ligamentum Nuchae

Answer 53

The continuation of the ALL.

Answer 54

the continuation of the ligamentum flavum. Goes between the two lamina.

Answer 55

external occipital protuberance/inion --> C7 (SP) thick posterior fascial band: suspends neck and critical for postural alignment instead of the supraspinous ligaments and intraspinous ligaments

Answer 56

external occipital protuberance

Answer 57

cross 1. Vertical: occiput --> posterior axis/C2 (anchors the transverse portion) 2. Transverse : portion keeps the dens in place on C1 - ->layer of articular cartilage on anterior surface-smooth articulation with dens

Answer 58

Transverse portion of the cruciform ligament KEEPS DENS IN PLACE on C1 STRONG trauma in hyperextension the dens will break before the ligament will tear --------------------------------------------- layer of articular cartilage on anterior surface: smooth articulation between dens and ligament Posterior dens articulates with anterior of this ligament

Answer 59

RA or Downs - ->instability at C1-C2 * **need to be very careful handling upper cervical spine in that population because can create a lot of damage if not careful

Answer 60

1. Apical Ligament | 2. Alar Ligament

Answer 61

Dentate Ligament Odontoid --> Basiput (Dens-->foramen magnum) small, maintains alignment, attach to peak of dens

Answer 62

2 Dentate Ligaments posterior-lateral odontoid --> occipital condyles (Dens--> occipital condyles) critical for cervical spine two posterlateral to the odontoid that goes to the occipital condyle to the need to be stable and symmetrical for the odontoid to stay center

Answer 63

1. Overlying vertebral body TILTS and SLIDES POSTERIORLY IV SPACE: compress posteriorly Anterior Fibers of Annulus: widens Limited by ALL and posterior arches Joint surfaces maximally congruent, maximal stability

Answer 64

overlying vertebral body tilts and slides posteriorly -->Vertebrae above slides down on the vertebrae below because they are stacked-backward glide of one facet joint over the other : -->The overlying vertebral body tilts and glides posteriorly

Answer 65

IV space compresses posteriorly because extension moment

Answer 66

They are widened

Answer 67

Limited by ALL and posterior arches **Limited by anterior structures: anterior AO and anterior longitudinal ligament will prevent the separation on the anterior portions **Posterior arches also will limit extension

Answer 68

CERVICAL EXTENSION Below C2, facets are always considered to be non-neutral and therefore they are considered to be controlling vertebral movement -->if they are non neutral this means they are engaged which means that there is contact Sidebending and rotation always occur to the SAME side ==>Since non-neutral they control the movement

Answer 69

Sidebending and rotation coupled , flexion and extension are uncoupled movements ALWAYS

Answer 70

Closed Packed Position: Flexion/Extension are uncoupled movements 70 DEGREES (magee) C0-C1 => 15 degrees are at the A/O (C0-C1) NONE AT C1-C2 The rest happens in the remainder of the cervical spine

Answer 71

1. upper vertebral body tilts and slides ANTERIORLY 2. Nucleous posterior 3. Stretch posterior annulus 4. limited by PLL, ligamentum nuchae, and ligamentum flavum 5. facets barely engaged

Answer 72

upper vertebral body tilts and slides ANTERIORLY Facet joint above slides and tilts anteriorly

Answer 73

Nucleus posterior Nucleus goes in the opposite direction from the movement

Answer 74

Stretch posterior annulus

Answer 75

imited by PLL, ligamentum nuchae, and ligamentum flavum

Answer 76

facets barely engaged It is the least stable position (more anterior-posterior shearing) They are engaged, but the least

Answer 77

extension stable flexion least stable

Answer 78

80-90 degrees

Answer 79

Right Facets Close Left Facets Open ***coupled with rotation below C2

Answer 80

20-45 degrees to each side

Answer 81

As sidebend facet slides up to allow for opening to sidebending—as slides because of the angle it also rotates As sidebend to the right which means rotating to the right, close on the right and open on the left: back and down on the right and up and forward on the left

Answer 82

If sidebend right facet slides up it also slides down as it closes on the opposite side: when right opens, facet on right slides up and forward and as it opens, other side closes and slides back and down—this creates the rotation with sidebending (the going forward)-because of the 45 degree angle it cannot go any other way

Answer 83

Facet on right slides up and anterior and as it opens the left side closes and slides posterior and inferior—the forward gliding creates rotation simultaneously with sidebending

Answer 84

If I open on one side the other side closes *the reason most motion at C5-C6 is that it is the apex of the curve—the center of the lordosis is C5 (at areas of transition: also in C7-T1 when go from lordosis to kyphosis, T7-T9 center of apex of kyphosis, T12 transition, and L3)

Answer 85

20-45 degrees

Answer 86

inferior glide of facet on the side to which it is rotating

Answer 87

1. inferior glide of facet on the side to which it is rotating 2. Largest range is C1-C2: 32-45 3. Degrees: 70-90 degrees to each side 4. Amount of rotation that occurs with sidebending decreases from C2 to C7

Answer 88

Left rotation of the head and neck 1) A/O sidebending right and slightly flexed 2) A/A in full left rotation 3) Lower cervical spine in combined movement of lateral flexion and slight extension **limited by ligament, annulus, and facets

Answer 89

Inferior glide of the facet on the side to which is is rotating Because it is the side sidebending towards which is side of extension, on other side get the opening of flexion ??? 2. Closing in the side you are rotating towards 3. Sidebend to right rotating to the right, close on the right and open on the left: slide posterior and inferior on the right, sueprior anterior on the left

Answer 90

inferior glide of facet on the side to which it is rotating Closing on the side you are rotating towards Sidebend to right rotating to the right, close on the right and open on the left: slide posterior and inferior on the right, superior anterior on the left

Answer 91

Largest range is C1-C2: 32-45 A/A 50% of rotation in the cervical spine is at C1-C2

Answer 92

Degrees: 70-90 degrees to each side

Answer 93

Amount of rotation that occurs with sidebending decreases from C2 to C7 Angle of facet joint changes causing less rotation as go down (and not so much rotation in thoracic spine, don’t rotate lumbar)

Answer 94

Flexion: 80-90 degrees Extension: 70 degrees (15 at A/O) Sidebending: 20-45 degrees Rotation: 70-90 degrees

Answer 95

LOWER: C-spine in combined movement of left lateral flexion and slight extension --->Combined movement: left lateral flexion with slight extension because of the lordosis A/A in full left rotation and slightly flexed --->Left rotation, but C0-C1 (AO) is going to be side-bent right and slightly flexed: in order to keep the eyes level: opposite direction of what happens in the lower cervical spine (the side bending and flexion) Limited by ligament, annulus and facets (these will all limit this) When lower neck is going one way, upper is going the other way to level your eyes

Answer 96

ucinate process have cartilage lined vertebral surfaces facing MEDIAL and SUPERIOR Capsule is continuous with annulus fibrosis of disc LIMITS LATERAL FLEXION

Answer 97

MEDIAL and SUPERIOR

Answer 98

ucinate process have cartilage lined vertebral surfaces facing

Answer 99

Capsule is continuous with annulus fibrosis of disc

Answer 100

LIMITS LATERAL FLEXION

Answer 101

Not born with uccinate processes, they develop during childhood and mature by second decade of life. Become fully articular by second or third decade in life and develop pseudo-synovial joint because not a true synovial joint. By the time they start functioning this way they are considered to be true articulations.

Answer 102

Capsule is continuous with the annulus fibrosis of the disc Important relationship with the disc which supports the neck

Answer 103

Limits lateral flexion | As you try to sidebend the neck they get in the way and limit the range of sidebending

Answer 104

1. Limits Side-bending of the neck 2. Becomes weight bearing with degeneration 3. Protects nerve root from being compressed by disc 4. Anterior wall of vertebral foramen 5. Supports dorsal and lateral annulus fibrosis

Answer 105

Limits lateral flexion | As you try to sidebend the neck they get in the way and limit the range of sidebending

Answer 106

As lose water in the disc and the vertical height or dimension of the neck diminishes, the uncovertebral joint becomes a weight bearing joint

Answer 107

protects the NR from being compressed by the disc, the uncovertebral joints prevent disc from going posterior-lateral due to the uccinate process being in the way, this protects the NR

Answer 108

It creates the anterior wall of the vertebral foramen—lateral recess foramen

Answer 109

Supports dorsal and lateral annulus fibrosis

Answer 110

EXTENSION: 70 Degrees FLEXION: 80-90 degrees (2 fingers from sternum) LATERAL FLEXION: 45 degrees to each side ROTATION: 80-90 degrees to each side

Answer 111

EXTENSION: 70 degrees FLEXION: 80-90 degrees A/O Extension: C0-C1: 15 Degrees Suboccipital Motion: 20-30 degrees Lower Cervical Spine: 100-110 degrees

Answer 112

LATERAL FLEXION: 45 degrees each side SUBOCCIPITAL: 8 degrees A/O: C0-C1: 3 degrees C1-C2: nothing C2-C3: 5 degrees

Answer 113

ROTATION: 80-90 A/O: C0-C1: 7 degrees AA: C1-C2: 50% of total ROM No lateral flexion, no sidebending, but a lot of rotation at C1-C2

Answer 114

1. 35% of the height of the cervical spine 2. gives the lordotic shape 3. outer 1/3 innervated by the vertebral nerves and sunnovertebral nerves 4. wide distribution of nocioceptors

Answer 115

Gives the lordotic shape **not completely level, more height anteriorly

Answer 116

Outer 1/3 innervated by the vertebral and sinoverterbral nerves Innervation to the capsule, nerve, and disc Painful with bulge because the sinnovertebral nerve which innervated multiple levels above and below gives pain when herniated disc

Answer 117

Painful with bulge because the sinnovertebral nerve which innervated multiple levels above and below gives pain when herniated disc

Answer 118

cervical spine has a wide distribution of nocireceptors which is why cervical discs are so painful for patients.

Answer 119

The cervical spine has a wide distribution of nocireceptors which is why cervical discs are so painful for patients.

Answer 120

1. Cervical spine does not have a good posterior annulus have fiber directions that are not criss crossed and instead they are CONCENTRIC and these converge on the posterior aspect, annulus comes around from the back but DOES NOT COMPLETE THE TOTAL BACK, since not total presence in back can have issues posteriorly due to the structure 2. Bagdook says the uccinate serve to protect the posterior instead 3. Integrity of posterior from 1. PLL 2. tectoral membrane, 3. ligamentum nuchae, thick posterior structures for posterior integrity of spine in cervical area

Answer 121

SUPERIOR : inferior pedicle above INFERIOR: superior pedicle below ANTERIOR: joints of von lushka/uncovertebral joints/uccinate process POSTERIOR: facet joint

Answer 122

Superior: inferior pedicle above

Answer 123

Inferior: superior pedicle below

Answer 124

Anterior: uncovertebral joints

Answer 125

Posterior: facet joint

Answer 126

thoracic and lumbar spine the disc creates this border, so anterior border of the foramen differs for the cervical spine =Anterior: uncovertebral joints

Answer 127

1/5-1/4 of the foramen *nerve surrounded by dural sleeve --->There is wiggle room around the nerve --->The issue is if the nerve root becomes inflamed and irritated, it becomes edemanus and starts taking up the whole space.

Answer 128

Rare to find prolapse posterior-laterally since the ucinate process protects the nerve root

Answer 129

lateral aspect if where the nerve root comes out, the foramen, lateral recess foramen, if there is an impingement and have the NR compressed it is a lateral recess stenosis

Answer 130

central stenosis would be abutting or impinging the cord in central canal

Answer 131

Rare to find prolapse posterior-laterally since ucinate process protects NR Rare to have a posterior lateral herniation in the neck because the ucinate process blocks disc there, so it protects the nerve The nerve still gets compressed in the cervical spine because start losing space in the lateral foramen because develop osteophytes

Answer 132

1. osteophytes at uncovertebral joints 2. swelling of facet capsule 3. venous congestion of dural sleeve 4. Nerve root ischemia

Answer 133

* Because the uncovertebral joint becomes WB as lose height in the disc, as develop DDD/ DJD in the neck the height decreases and have forces on joint and develop osteophytes at the uncovertebral joint-and the ucinate process and the joint itself forms the anterior border of the nerve root foramen—nerve will get stuck on the jagged pieces that develop off of the ucinate process * The nerve will get stuck on these pieces on the uccinate process

Answer 134

* The facet creates the posterior border of the nerve root foramen * Facet capsule can also become swollen and take up space-narrowing of the canal

Answer 135

*Inflammation and endemenous changes of the nerve root itself so the dura becomes more swollen, takes up more space and ultimate outcome is NR ischemia

Answer 136

*Inflammation and endemenous changes of the nerve root itself so the dura becomes more swollen, takes up more space and ultimate outcome is NR ischemia

Answer 137

Neutral/Resting: slightly extended Closed Packed: completely extended ``` Capsular Pattern: ie right facet: Left Lateral Bending Left rotation Forward Bending Deviates Right ```

Answer 138

slightly extended | The neutral resting position of the neck is lordosis

Answer 139

Closed Packed: completely extended [Maximal closure of the facet joints is being in total extension (looking up at the ceiling)]

Answer 140

Capsular Pattern: ie right facet: 1. Left Lateral Bending (b/c cannot open right facet) 2. Left rotation (b/c cannot open right facet) 3. Forward Bending Deviates Right (right because the left facet opens and the right doesn’t and will get a deviation to the right when go into forward bending) (when extending will be normal because it is already closed on the right and it is able to close normally on the left)

Answer 141

1. Head/neck posture 2. Relation to midline 3. Willingness to move head and neck

Answer 142

1. Dizziness, vertigo, drop attacks 2. Headache, RA, other inflammatory arthritis or treatment by steroids 3. Neurological involvement of the lower extremities

Answer 143

1. work and leisure activities 2. bifocals/progressives 3. swallowing 4. mouth breather 5. sleeping position 6. pillows 7. headaches

Answer 144

1. Neck Disability Index (NDI) | 2. Neck Pain and Disability Scale (NPAD)

Answer 145

1. Temperature 2. Moisture 3. Edema 4. Nodules 5. Spasm Alignment

Answer 146

Some patients will come in with something to support neck if in a lot of pain-head feels too heavy for neck-hold with hand, pillow, collar—and will describe head too heavy for neck and cannot support it

Answer 147

Relationship of head to midline, head should be in the midline, observe what is going on with that patient in midline

Answer 148

This is easy to see if they are turning their head Look at at the lordosis of the cervical spine. The earlobe should be in line with the acromion

Answer 149

1. Look at at the lordosis of the cervical spine. The earlobe should be in line with the acromion 2. the patient stand against the wall so that the apex of their thoracic is against the wall, and measure distance from apex of cervical lordosis to wall should be no more than 4-6 centimeters. This can give a sense of patient kyphosis as well 3. Tool to measure FHP called the craniovertebral angle: tragus (bump on ear) of ear to posterior aspect of C7: a diagonal line from tragus of ear to C7 and measure acute angle: the smaller the angle the more the FHP

Answer 150

As patient deteriorates and their thoracic kyphosis becomes more extensive and also don’t maintain lumbar posture so get a swayback and get a problem and cannot correct by saying stand up straight and pick up head because have to work from the base—interconnection between cervical thoracic and lumbar spine is important and will be doing abdominal stabilization for the patient to stabilize from the base and then elevate the thorax and straighten out the cervical spine. As patient position changes and habits change –cellphone posture, tablet, computer and slumped—in a “C” position taking away cervical lordosis due to this issue. The mouse –when people sit with computer on desktop with a bad chair and mouse way up so sitting with bad posture and killing their arm –really bad news. Spend time on education on using phone and texting and laptop ergonomics

Answer 151

Measure FHP Line 1: tragus (bump on ear) of ear to posterior aspect of C7: a diagonal line from tragus of ear to C7 Line 2: horizontal and measure acute angle: More acute angle = more FHP

Answer 152

***Dizziness and vertigo can also occur to middle ear issues-vestibular dysfunction * **Drop attack: patient just passes out and they don’t know why - -->Related to vertebral basular insufficiency: can occur due to inflammatory problem, due to predisposition to an issue in the upper cervical spine, can have a problem with RA (hypermobility at C1-C2 ie downs)

Answer 153

If someone takes steroids for a long period of time then they have a predisposition to have a loss of integrity of the ligament Prolonged steroid use can create issues in the upper cervical spine which can create issues in dizziness, vertigo, balance

Answer 154

If someone takes steroids for a long period of time then they have a predisposition to have a loss of integrity of the ligament Prolonged steroid use can create issues in the upper cervical spine which can create issues in dizziness, vertigo, balance

Answer 155

Looking at myelopathies: compression of upper cervical spine, look at if issues with coordination, weakness in the LEs and if it is bilateral it is cord involvement, all related to a cervical myelopathy

Answer 156

Looking at myelopathies: compression of upper cervical spine, look at if issues with coordination, weakness in the LEs and if it is bilateral it is cord involvement, all related to a cervical myelopathy * severe ->spasticity and paresis * gait issue if corticospinal tract or spinocerebellar tract abnormalities * if get worse--> UE involvement: bc lamina of the cord and get compression of the external portion of the cord

Answer 157

If someone has issues with gait and has not been to the neurologist, send them there If excess dizziness: send to ENT

Answer 158

1. Plumbers, electricians, aerialists etc who have positions in their jobs that have neck in hyperextension/other repetitive positions that are stressful for the neck. 2. Recreational soccer where bop ball on head a lot: compressive effect on their neck

Answer 159

1. For patients that are 40 and older and wear glasses that are bifocals: cervical radiculopathy because there is a small reading component on the bottom of the glasses and if they are not placed adequately the patient moves head to get focus in reading part and hyperextend to get over the bifocal part to read in the distance part: related to computer, book, newspaper: need to hold the paper and hyperextend neck to read the newspaper—create an issue 2. Walking downstairs with bifocals—need to look over the reading part to see the distance part to see the steps because the reading part distorts the distance 3. Suggest patient get separate glasses for reading so that you don’t have to change head posture, workspace glasses are only two zones-computer and reading without the distance 4. May want a distance lens for skiing -but then cannot read trail map…

Answer 160

anterior herniation in cervical spine *anterior herniation the impingement will be on the esophagus and the patient will say they feel like there is something in their throat and not swallowing well

Answer 161

In a position of extension when mouthbreath—snorers—this is a question also use for TMJ because mouth breathing also creates TMJ problems and sleep apnea problems and are snorers and have neck problems and it is all correlated.

Answer 162

1. Worst position to sleep in for neck is prone—if neck issue get them out of sleeping in prone 2. Can impinge nerve root the entire night and give cervical radiculopathy

Answer 163

for normal alignment Don’t want to sleep on acromion because don’t want to cause impingement in the shoulder so want a bit rotated, but also don’t want too much rotation in trunk because will have problems: can protract the shoulder you are resting on and then accommodate for the space between the ear and the bed so fill the space

Answer 164

Common that neck patients get headaches: C1 position if rotated or sidebent and stuck will give a bad headache (hair washing sinks at the hairdresser sit at occiput at C1-hyperextend you into the sink and if have an occluded neck this is very bad and there are documented CVAs) Cervical spine and TMJ patients get a lot of headaches

Answer 165

1. Related to pain and disability 2. Self scored, give to patient in waiting room to do 3. 20 categories, 5 things to assess problems related to neck injuries 4. Used more than the NPAD

Answer 166

Measurements with neck movements, neck pain intensity, pain emotion and cognition and how it interferes with life function

Answer 167

C3 First piece you find in neck under chin as come down, in a horseshoe shape sitting in front of C3, if flex neck a little bit place a pincer grasp around hyoid and glide it medially and laterally-it does not feel so nice-should have a certain amount of mobility that is normal from medial to lateral

Answer 168

C4-C5 (adams apple) 1. Under a gland which is a softer material and feel for osseous formation underneath, when swallow can feel it move 2. Should have some mobility 3. Feel for the size of it-some have goiter that is there. ***Sometimes will find enlarged so refer to doctor especially if lethargic, hair loss, weight gain are sx of thyroid disease.

Answer 169

C6 - --Indentation under the thyroid - --Uncomfortable to be palpated ***This is where you put a tracheostomy because it is cartilage, easy to get in there, and under the glands

Answer 170

Inion/external occipital protuberance Back of the neck, protrudes in back middle of head

Answer 171

Place your fingers directly under the patient’s earlobes and you will feel a rounded prominence on each side under your fingers. These are the mastoid processes (Figure 4.8).

Answer 172

Place your finger on the inion and move inferiorly into an indentation (posterior arch of C1). As you continue to move inferiorly, the rounded prominence that you feel is the spinous process of C2

Answer 173

C7 is the prominens and is long and slender and almost feels like T1 does longest cervical SP Extend the head slightly. The C6 vertebra will drop off slightly at the beginning of the movement, followed by C7 with a slight increase in extension, and T1 will not drop off at all.

Answer 174

Come off the side of the SP and feel a bamobo like structure that goes down on both sides, must do in prone and supine when muscles are relaxed

Answer 175

BRACHIAL PLEXUS IN POSTERIOR TRIANGLE Borders: Anterior: SCM Posterior: Upper Trapezius Inferior /base: Clavicle ***plexus is sitting underneath clavicle in the posterior part of it in the posterior triangle

Answer 176

Anterior: Midline of neck Posterior: SCM is the back Top: Angle of jaw is top of the triangle

Answer 177

between mastoid and inferior angle at the mandible: Between the angle of the angle of jaw and mastoid underneath the earlobe If push too hard it will be tender, if maligned will be tender, if maligned will not be symmetrical If very side bent one of the transverse processes will be disappear under the mastoid and will not be able to find it on that side and will be very prominent on the contralateral side

Answer 178

Thyroid = Adam's Apple

Answer 179

Thyroid = Adam's Apple

Answer 180

Cricoid --be careful not to gag the patient

Answer 181

external occipital protuberance

Answer 182

Between mastoid and inferior angle of the mandible

Answer 183

anterior: SCM posterior: upper traps base: clavicle

Answer 184

1) Swallowing 2) Look up at Ceiling 3) Look down at shoes 4) Check Shoulder 5) Tuck Chin In 6) Poke Chin Out

Answer 185

Tests: 1. lips 2. jaw 3. pharynx 4. larynx 5. suprahyoid 6. infrahyoid * *Submandibular and suprahyoid muscles are funcitoning * *make sure lips, jaw, pharynx, larynx, suprahyoid, infrahyoid are functioning **check the soft tissue anterior cervical spine / movement anteriorly when injure, especially deceleration / acceleration : head whipped back and forth, anterior muscles get strained and get anterior swelling and that becomes dysfunctional for the patient as well. Make sure things are moving ok.

Answer 186

quick sense of what is going on

Answer 187

Upper Cervical: FLEXION Lower Cervical: EXTENSION

Answer 188

Upper Cervical: EXTENSION Lower Cervical: FLEXION

Answer 189

1. Against the wall by putting the apex of their thoracic kyphosis against the wall and measuring to the apex of the lordosis 2. Drop a plumbline, earlobe to acromion 3. Cervical cranial alignment measure from the tragus of ear to C7—measuring acute angle to look at his alignment

Answer 190

upper cervical flexion, lower extension *opposing abilities of the upper and lower cervical spine to coordinate things

Answer 191

upper cervical extension, lower flexion

Answer 192

nose as midpoint THE SIDE THE NOSE DEVIATES TOWARDS, IS THE SIDE OF THE RESTRICTION INDICATES A C0-C1 PROBLEM Nod: condyle into flexion with a posterior glide Jut: opposite, anterior glide issue

Answer 193

INDICATES A C0-C1 PROBLEM Nod: condyle into flexion with a posterior glide Jut: opposite, anterior glide issue

Answer 194

Nod/Tuck: condyle into flexion with a posterior glide (upper cervical flexion, lower extension) Jut: opposite, anterior glide issue (upper cervical extension, lower flexion)

Answer 195

1) Observe patient from all angles 2) Patient is sitting or standing 3) Make sure patient maintains appropriate lordosis and posture

Answer 196

Use nose and midline as reference Check for lateral deviation to the side with Nod/Jut Restriction is on the side to which it deviates

Answer 197

50% of the ROM Isolate A/A: Fully flex the neck to lock the cervical spine then ROTATE [to only get C1 on C2 pivot] ***Takes out the flexion that is available at the lower part of the cervical spine and then allow C1 to rotate around C2 with fully flexed neck C3 and down look at facets sliding and gliding whereas at C1-C2 it is a pivot joint. Take up the slack below: only allowing for the pivoting rotation available at C1-C2.

Answer 198

nod first, chin should reach chest with mouth closed, 2 finger widths are acceptable stabilize sternum, tuck chin and drop head OVERPRESSURE on the top: only taking up the slack

Answer 199

forehead in the horizontal

Answer 200

bilaterally One hand over head to ear, and push to sidebend, and stabilize on shoulder. Make sure to direct my hand in the direction of the pull. OVERPRESSURE

Answer 201

Bilaterally-chin almost to shoulder Rotate: I can place my elbow to create a force couple with forehead and opposite side of occiput with my elbow on the shoulder (of the hand that is at the occiput) One hand around forehead, one hand around occiput, stabilize with elbow Or take hand around and stabilize and create the rotation by putting them in the cradle of my arm OVERPRESSURE

Answer 202

hand over top of patient -----Overpressure, if pain free all directions except extension -----We do not overpressure into extension, it closes down spinal foramen too much, too much force -----Can overpressure flexion, SB and rotation Be careful about amount of force, neck is highly irritable-just take up that last little bit of slack and makes sure asymptomatic

Answer 203

Flexion: nod first, chin should reach chest, 2 finger width acceptable Extension: forehead to horizontal Lateral flexion bilaterally Rotation: bilaterally, chin almost to shoulder **overpressure if pain free except for extension

Answer 204

Measure ROM, worn on the head and has three inclinometers Side for flexion/extension Top for rotation Front for sidebending **Do not use if have pacemaker because of the magnet can deactivate pacemaker (to zero out the inclinometers)

Answer 205

Palpation of ROM, location, and endfeel tested in sitting hold the patient's head and direct the movement as in AROM

Answer 206

-----Two handed: create a coupled movement -----Coordinate both hands simultaneously in opposite directions -----One hand on frontal bone and other hand on occiput -----Move head in flexion, extension, rotation and sidebend -----Other option is the arm wrapped around the patient head -----Other option is fingers through the patient’s hair—issue if no hair or sheitel/toupe /scarves-wont have something to grab onto

Answer 207

Secure Handhold: Frontal bone, occiput Stand to side of patient Have patient sit up straight Flexion: Initiate movement from the occiput hand, front hand is receptacle receiving at the frontal bone ---Feel the endfeel and then bring back to neutral before doing next movement. Extension: hold and support under occiput move from frontal but do not compress frontal bone will give headache. Fully support the occiput by creating a cradle Sidebending: take to end, back to middle, and same handhold for sidebend to opposite side Rotation: work more from occiput than from frontal bone

Answer 208

Need to have full control of patient head and support it-accept all weight of head Flexion: lift from under occiput and control direction—off end of table—support her need her to relax Extension: Sidebend: support head Rotation: support head: hand across give place to rest, lift up from occiput and take around, carrying weight of head the whole time –I liked having her head roll on my forearm to support it

Answer 209

Cervical Compression Cervical Distraction

Answer 210

Patient seated in good posture Handhold: interlinked fingers or hand over hand on the crown of the patient’s head (my elbows down towards her shoulders but not pushing down on the shoulders) Direction of force: directly down through the head through the neck: down straight -Feel until the end, finished once take up all the slack + = reproduction of sx =Disc flattened and go to side and if sx of impingement on NR, they will increase the symptoms

Answer 211

Patient seated with good posture PT: Hands under the occiput, mastoid into interthenar space into hands, force is a lift: Lean back towards me, I WS back in the lunge to create the distraction Relieve symptoms because open foramen EXCEPTION: 1. NR is adhered because dural sheath doesn’t slide: pull and create a traction effect the nerve gets pulled because it is attached and the symptoms will increase with the distraction component 2. Nerve glitched by osteophytes (if the osteophyte is putting pressure onto the nerve the distraction can relieve that pressure and feels better, if it is caught on the osteophyte and pull on it -pain)

Answer 212

2 fingers of resistance Have patient sit nice and straight: “don’t let me move you” or “meet the resistance of my fingers” Isometric resistance in midrange to FLEXION: two fingers front EXTENSION: two fingers under occiput/external occipital protuberance LATERAL FLEXION: two fingers parietal bone ROTATION: two fingers side of frontal bone

Answer 213

neck rotation/ flexion just 1 isometric test (easy to flare up c-spine) hands on front of forehead and back of occiput

Answer 214

shoulder shrugging C2, C3, C4

Answer 215

shoulder abduction

Answer 216

elbow flexion C5, C6

Answer 217

wrist extension

Answer 218

elbow extension, wrist flexion

Answer 219

thumb extension, finger flexion

Answer 220

finger abduction, adduction

Answer 221

C2, C3, C4

Answer 222

Jaw line/ neck

Answer 223

Supraclavicular fossa

Answer 224

lateral brachium (side of the arm)

Answer 225

lateral base of thumb

Answer 226

distal phalanx digit #3

Answer 227

ulnar border of digit #5

Answer 228

medial border forearm

Answer 229

BICEPS BRACHIORADIALIS

Answer 230

decreased/hyporeflexive

Answer 231

hyperreflexive

Answer 232

i. Start at plantar calcaneus and drag it up laterally and at MTP go medially, the toes should normally flex (Negative) ii. POSITIVE: toes fanning out- especially of big toe iii. normal in babies: normal in infant to 6 months-2 years old we expect it to be integrated, if it still exists then that is reason for concern and referral to doctor

Answer 233

a. stabilize at lower leg and give a quick stretch into dorsiflexion at plantar foot: if there is clonus patient will kick back at you i. Spasticity document how many beats

Answer 234

i. Stabilize their hand but leave their fingertips free ii. Hold their hand and flick their 3rd digit into extension, look for clawing (flexing) iii. (+) = clawing thumb & first finger

Answer 235

send to neurologist into dx of cervical myelopathy

Answer 236

dermatome = crown of head myotome = rotation (cervical mucles)

Answer 237

dermatome = pics: side of beck -> face, shoulder/neck area myotome = elevation (shoulders)

Answer 238

dermatome: lateral brachium (side of the arm) myotome = biceps DTR – bicep, if have + biceps do test a corresponding C5 muscle

Answer 239

dermatome = thumb myotome = wrist extensors DTR – brachioradialis

Answer 240

myotome = triceps dermatome = digit 3 DTR – triceps

Answer 241

myotome – intrincis (ie thumb) & ulnar deviation | dermatome – ulnar border

Answer 242

myotome- palmar/dorsal interosseous – ab/adduction dermatome – ulnar on the forearm (ulna area)

Answer 243

C5 vs. axillary (shoulder pain) check biceps

Answer 244

radial/median n check thumb peripheral nerves change at the wrist

Answer 245

C7 includes 2nd and 3rd digits Posterior only digit 3 this does median compare to thumb to distinguish C6/C7 vs. median

Answer 246

C8 dermatome extends proximal Peripheral Ulnar Nerve doe not extend proximally far past wrist

Answer 247

T1 extends to cubital fossa med-antebrachial doesn’t extend there , medial-antebrachial covers larger area

Answer 248

We do not need to put the patient through this test if patient has adverse reaction to active/passive range of motion testing, if someone has symptoms on active/passive extension and rotation, do not need to do the vertebral artery test, already know it is positive and do not need to put the patient in the position again to jeopardize their blood flow

Answer 249

About C6 with the longus colli creating a contraction Area in upper cervical spine around C1 and C2 that is notable for areas of compression

Answer 250

posterior brain

Answer 251

Always tested prior to cervical manipulation **ESPECIALLY PATIENTS OVER 30 YEARS OLD (Degenerative changes occur in the neck after age 25-30 years old so if plan to do an end range mobilization, a manipulation, we need to do this test first)

Answer 252

Patient in supine Have patient extend, laterally flex, and rotate to each side (Note that lateral flexion and rotation occur to the same side) Hold 15-30 seconds if positive *****ONLY TREAT THESE PATIENTS IN THE MIDRANGE Positive signs: 1. Blurring of vision 2. Vertigo 3. Nystagmus: watch patient eyes 4. Dizziness 5. Headache 6. Pain 7. Tinnitus, noise in ear

Answer 253

* **interview the patient for signs and symptoms * **coordinate this with PMH, signs, and Sx * **Special questions: patient says dizzy, tinnitus, headaches—elevate suspicion-doesn’t mean it is this but if know this in the hx to begin with, correlate it with the patient current situation 2. Test: see if get sx actively SUPINE or SITTING full range of motion in ROTATION, hold for 10 seconds Return head to NEUTRAL for 10 seconds End range ROTATION to the opposite side and hold 10 seconds ALTERNATIVE: “Body on Head Rotation Test” if vestibular issues to eliminate the vestibular component ***If get sx on the head on body rotation but not on the trunk on head rotation test the referral is not to the neurologist but to the ENT ***If patient is dizzy with head rotation and get nystagmus, and when head still not dizzy when trunk, suspect vestibular. If the reverse suspect the neck.

Answer 254

If the patient exhibits any of the positive signs, MOBILIZATION of the upper cervical spine is contraindicated!!! do not perform end range upper cervical maneuvers, TREAT IN MIDRANGE

Answer 255

****treat these patients in midrange, can do compression and distraction in the midrange, do not take them to the end of the range****

Answer 256

Extension, side-bending and rotation to one side +Magee compresses and saunders distracts FOR COMPRESSION OF NEUROFORAMINA also for NR impingement and disc pathology (it is the vertebral artery test) Extend head, then rotate and sidebend off to the side and then place hands on top and do the compression on the vertex of the skull and it goes down the neck-hold a couple of seconds and ease off. Take them back to neutral. Then repeat that to the opposite side. Watch the patient.

Answer 257

Long sitting Passive flex head and one hip together (flex head and leg) *SHARP PAIN INDICATES MENINGEAL or DURAL IRRITATION (prefers slump test or kerning test which produces same symptoms) Soto Hall: if patient actively flexes head to chest

Answer 258

Long sitting Pt actively flex head to chest and one hip together *SHARP PAIN INDICATES MENINGEAL or DURAL IRRITATION

Answer 259

(relief test) for patient with C4-C5 NR, their position of comfort is to put their hand over their head-they will come in and tell you that this is the only position that eases their pain/gives them relief because it is their relief sign = bakody sign. This is due to the fact that the nerve root travels down from mid-cervical spine into the plexus-when bring the arm up it takes the stretch off of the NR as it traverses down the arm. Ask patient to actively do this for you and see if it relieves their symptoms/they will report to you that this helps. TEST: Patient seated Passively or actively elevates arm through abduction so hand rests on top of head (+)Decrease or relief of symptoms indicates cervical extradural compression ie disc NR C4-C5

Answer 260

increase sx: indicative of space occupying lesion | ask patient in history if coughing, sneezing, bearing down causes pressure or increases their symptoms

Answer 261

test for the presence of radicular symptoms, especially those involving the C4 or C5 nerve roots. The patient is positioned sitting or supine and is asked to elevate the arm through abduction, so that the hand or forearm rests on top of the head. If this position relieves or decreases the patient’s symptoms, a cervical extradural compression problem, such as a herniated disk, or nerve root compression should be suspected. The specific segmental level can be determined by the dermatome distribution of the symptoms. If the symptoms are increased with this maneuver, the implication is that pressure is increasing in the interscalene triangle.

Answer 262

modified hinge joint *synovial articulation = compound modified ovoid bicondylar joint tubercle of mandible only RESTS into mandibular glenoid fossa the ARTICULATION is the articular eminence on the zygoma anterior to the condyle

Answer 263

the ARTICULATION is the articular eminence on the zygoma anterior to the condyle (tubercle of mandible only RESTS into mandibular glenoid fossa )

Answer 264

NO tubercle of mandible only RESTS into mandibular glenoid fossa the ARTICULATION is the articular eminence on the zygoma of the temporal bone anterior to the condyle

Answer 265

the condyle of the mandible the trabeculae portion of the condyle is the articular portion of the TM that will connect with the articular eminence

Answer 266

the mandible

Answer 267

accommodates the lower teeth = 16 mandibular teeth in the lower part of the jaw

Answer 268

1. the body of the mandible 2. the two perpendicular postions = the ramus = the mandibular angle 3. 2 processes = the coronoid and condylar

Answer 269

1. coronoid process | 2. condylar process

Answer 270

the head | the neck *the lateral pterygoid muscle attaches onto the anterior neck of the condyle in the pterygoid fossa

Answer 271

the lateral pterygoid attaches to the anterior neck of the condyle in the pterygoid fossa

Answer 272

The mental protuberance

Answer 273

the midline of the chin

Answer 274

= glenoid fossa inferior aspect CONCAVE

Answer 275

NO: condylar process of the mandible is convex Resting place: the temporal fossa is concave Articulation: the anterior portion of the articular eminence is convex THE TWO PORTIONS OF THE JOINT AS THEY MEET EACHOTHER ARE CONVEX ON CONVEX The two convex surfaces are separated by a biconcave disc

Answer 276

The two convex surfaces are separated by a biconcave disc THE TWO PORTIONS OF THE JOINT AS THEY MEET EACHOTHER ARE CONVEX ON CONVEX

Answer 277

the posterior articular eminence on the zygoma of the temporal bone and the anterior condyle process of the mandible

Answer 278

yes at rest

Answer 279

apex of the styloid process of the temporal bone --> angle and posterior border of the angle of the mandible

Answer 280

it is right next to the condyle of the mandible --if it is not well aligned get ear pain this is why patients may go to the ENT for TMJ problem

Answer 281

FIBROCARTILAGE - -it is most durable for repeated forces - -it can remodel and repair - multidirectional to allow gliding (at the bone it is perpindicular)

Answer 282

no fibrocartilage

Answer 283

it is a synovial joint -a lot of innervation and vascular --lead to a hot joint when inflamed *also has propriocepters that tell you what the joint is doing

Answer 284

surrounds the synovium when joint gets inflamed get synovitis on the side

Answer 285

Lateral: stronger --we do not see many issues on lateral aspect THIN and LOOSE = anterior, medial, posterior --> predisposes the disc to dislocate anteriorly

Answer 286

ANTERIORLY

Answer 287

margin or articular area of the TEMPORAL BONE neck of the MANDIBLE

Answer 288

Superior synovial membrane: lines fibrous capsule superior to the articular disc Inferior synovial capsule: lines the capsule inferior to the disc BOTH ARE HIGHLY VASCULARIZED

Answer 289

Superior synovial membrane: lines fibrous capsule superior to the articular disc superior joint is anything above the disc highly vascularized: blood supply and nutrition to the disc and feeds the fibrocartilage = disc health

Answer 290

Inferior synovial capsule: lines the capsule inferior to the disc Inferior joint is anything below the disc highly vascularized: blood supply and nutrition to the disc and feeds the fibrocartilage = disc health

Answer 291

temporomandibular ligament

Answer 292

intrinsic thick part of the articular capsule

Answer 293

1. Outer oblique temporomandibular ligament: attaches to neck of condyle strengthens the TMJ laterally 2. Inner oblique temporomandibular ligament: attaches to the lateral pole of the condyle, the posterior disc, + with the postglenoid tubercle acts to prevent posterior dislocation of the joint

Answer 294

attaches to neck of condyle 1. strengthens the TMJ --LATERALLY 2. suspend the mandible with MODERATE opening –suspensory ligament, suspends moderate opening of the joint 3. resist the amount of ROTATION in the joint 4. resist POSTERIOR displacement of the mandible

Answer 295

attaches to the 1. lateral pole of the condyle, 2. the posterior disc 3. with the postglenoid tubercle acts to prevent POSTERIOR dislocation of the joint

Answer 296

The outer oblique TM ligament

Answer 297

the Inner oblique TM ligament

Answer 298

The outer oblique TM ligament

Answer 299

Outer oblique temporomandibular ligament

Answer 300

the inner oblique TM ligament

Answer 301

they attach the mandible to the cranium Stylomandibular ligament: styloid process of temporal bone -> angle of mandible Sphenomandibular ligament spine of sphenoid --> lingual of mandible

Answer 302

extrinsic ligament of the TMJ 1. *it is thickening of the fibrous capsule of the porotid gland and deep cervical fasica 2. styloid process of temporal bone -> angle of mandible * inserts between the masseter and medial pterygoid 3. TAUT: keeps the articulation together during opening = guides mandible and keeps the mandible + disc + temporal bone opposed: STOPGAP: at the end of extreme opening: stops you at the end of the range of opening

Answer 303

TAUT: keeps the articulation together during OPENING = guides mandible and keeps the mandible + disc + temporal bone opposed: STOPGAP: at the end of EXTREME opening: stops you at the end of the range of opening

Answer 304

the stylomandibular ligament

Answer 305

spine of the sphenoid --> lingual of the mandible *primary support of the mandible (a suspensory ligament) Serves as a swinging hinge for the mandible: taut with MODERATE opening of the jaw

Answer 306

the spehnomandibular ligament

Answer 307

the stylomandibular ligament

Answer 308

When the TM ligament relaxes --> sphenomandibular ligament takes over in the moderate opening *they work in conjunction together in moderate opening

Answer 309

First TM becomes taut, and as that relaxes the spehomandibular ligament becomes taut, and then at the end of the range the stylomandibualr ligament becomes taut

Answer 310

When the temporomandibular ligament relaxes --> sphenomandibular ligament takes over in the moderate opening *they work in conjunction together in moderate opening

Answer 311

This is the ligament people complain about if mouth kept open a long time-ie dentist with mouth partially open for a long time

Answer 312

First temporomandibular ligament becomes taut, (suspend the mandible with MODERATE opening ) and as that relaxes the spehomandibular ligament becomes taut, (taut with MODERATE opening of the jaw) and then at the end of the range the stylomandibular ligament becomes taut (STOPGAP: at the end of EXTREME opening:)

Answer 313

First temporomandibular ligament becomes taut, (suspend the mandible with MODERATE opening ) and as that relaxes the spehomandibular ligament becomes taut, (taut with MODERATE opening of the jaw) and then at the end of the range the stylomandibular ligament becomes taut (STOPGAP: at the end of EXTREME opening:)

Answer 314

First temporomandibular ligament becomes taut, (suspend the mandible with MODERATE opening )

Answer 315

spehomandibular ligament

Answer 316

stylomandibular ligament

Answer 317

1. FIBROCARTILAGENOUS 2. BICONCAVE-allow for better congruency - -divide the joint into 2 separate compartments 3. Innervation and vascularization found in outer aspect of the disc 4. Varies in thickness 2mm anteriorly to 3mm posteriorly--allows the disc to adapt to bony surfaces

Answer 318

FIBROCARTILAGENOUS

Answer 319

BICONCAVE-allow for better congruency | --divide the joint into 2 separate compartments

Answer 320

Varies in thickness 2mm anteriorly to 3mm posteriorly--allows the disc to adapt to bony surfaces

Answer 321

Innervation and vascularization found in outer aspect of the disc

Answer 322

Innervation and vascularization found in outer aspect of the disc the central portion is avascular and aneural inner portion not have blood supply or innervation the outer aspect of disc has innervation and vascularization

Answer 323

Innervation and vascularization found in outer aspect of the disc the central portion is avascular and aneural inner portion not have blood supply or innervation the outer aspect of disc has innervation and vascularization

Answer 324

If disc issue, pain based on where the condyle is in contact with the disc: if condyle center in disc wont hurt, if disc displaces and sit on the back part of the disc (because anterior displace disc)—which is vascular and innervated and pain for the patient

Answer 325

Varies in thickness 2mm anteriorly to 3mm posteriorly. Allows the disc to adapt to bony surfaces. =Thicker on back than it is on the front Contours to the shape between articular eminence and glenoid fossa-a self centering mechanism: allows the condyle of the mandible to sit in the center of the disc -->Disc cannot repair itself—if tear the disc will have an issue and patient will need some type of an intervention Don’t commonly see tears but do see displacements

Answer 326

Disc cannot repair itself—if tear the disc will have an issue and patient will need some type of an intervention Don’t commonly see tears but do see displacements

Answer 327

HINGE JOINT mandibulomeniscal = Bordered by mandibular condyle and inferior aspect of disc Condyle and disc firmly attached: medial + lateral Condyle rotates anteriorly on the disc: the firm medial and lateral attachment of the disc on the condyle causes forward translation OPENING: mandible rotate anterior -->condyle of mandible is rotating forward on the disc.

Answer 328

GLIDING JOINT meniscotemporal = Bordered by mandibular fossa and superior surface of the disc Loose attachment allows the join to glide forward

Answer 329

HINGE JOINT Condyle rotates anteriorly on the disc

Answer 330

mandibulomeniscal = Bordered by mandibular condyle and inferior aspect of disc

Answer 331

meniscotemporal = Bordered by mandibular fossa and superior surface of the disc

Answer 332

Loose attachment allows the join to glide forward

Answer 333

Condyle and disc firmly attached: medial + lateral Condyle rotates anteriorly on the disc: the firm medial and lateral attachment of the disc on the condyle causes forward translation

Answer 334

MEDIAL AND LATERAL Collateral discal ligaments = medial and lateral aspect of the disc --> medial and lateral poles of the condyles *** permits anterior and posterior rotation on the condyle ANTERIOR Anteriorly disc attached to capsule and tendon of the lateral pterygoid POSTERIOR Fibroelastic tissue on posterior disc--> posterior mandibular fossa CIRCUMFERENCE Joint capsule attaches to circumference

Answer 335