Upper Cervical

Question 1

Unique structures of cervical spine:

Answer 1

• transverse foramina for vertebral artery

- C1, C2 and C7 are all atypical vertebrae

Question 2

Atypical cervical vertebrae

Answer 2

C1, C2 and C7

Question 3

Primary function of the atlas

Answer 3

hold the head on the neck

Question 4

Structure of the atlas

Answer 4

• no body, pedicle, lamina or SP
• 2 large lateral masses joined by anterior and posterior arches
• concave superior articular facet to articulate with occiput
• inferior articular facet: flat and slightly concaved, faces inferiorly and is sloped down 20 degrees

Question 5

inferior articular facet of the atlas

Answer 5

• flat and slightly concave
• facets inferiorly sloped down at a 20 degree angle
• articulates with superior facet of C2

Question 6

T/F the atlas has the largest transverse process in the cervical region

Answer 6

True- due to key attachment point of multiple small muscles to control fine movements

Question 7

the superior articular facet of the axis (C2) is convex or concave?

Answer 7

convex to articulate with the atlas

Question 8

OA joint

Answer 8

• convex on concave
• primary motion is flexion/extension (nodding)
• always moves with the head
• ROM fo flexion/ext is about 15 total degress (5 flexion, 10 extension)

Question 9

Primary motion of OA joint

Answer 9

flexion/extension (nodding)

Question 10

ROM for flexion/extension at OA joint

Answer 10

15 degrees total

• 5 from flexion
• 10 from extension

Question 11

ROM values for OA

Answer 11

• axial rotation is negligible
• lateral flexion +/- 5 degrees
• flexion/ext- 15 degrees

Question 12

AA joint primary motion

Answer 12

-rotation

Question 13

orientation of the AA joint is closer to the __________ plane

Answer 13

horizontal

Question 14

Median joint of the AA joint

Answer 14

anterior arch of the atlas and the dens of the axis

Question 15

Dens

Answer 15

vertical axis for rotation

Question 16

ROM at AA joint

Answer 16

• +/- 5 degrees flexion
• +/- 10 degrees extension
• 25-40 degrees of axial rotation
• about 5 degrees of lateral flexion

Question 17

Flexion of OA

Answer 17

• convex on concave

- occipital condyle roll anteriorly and simultaneously slide posteriorly with flexion (opp. with extension)

Question 18

Flexion of the AA joint

Answer 18

flat to slightly concave

atlas tilts forward with cervical flexion

Question 19

Extension of OA

Answer 19

• rolls back and slightly forward

Question 20

Extension of AA

Answer 20

atlas tilts backward

Question 21

cervical rotation at AA

Answer 21

ideal for rotation (OA has restricted motion0

Question 22

Cervical Lateral rotation (OA)

Answer 22

small amount of rolling occurs

slide is in the opposite direction of the roll

Question 23

Lateral rotation AA

Answer 23

spinal coupling

frontal and horizontal planes

Question 24

spinale coupling

Answer 24

one motion around one plane is associated with another around a different plane

Question 25

role of OA and AA joints in spinal coupling

Answer 25

- lateral flexion is coupled with contralateral rotation | - rotation is coupled with contralateral lateral flexion

Question 26

longus capitis and longus colli form the...

Answer 26

anterior longitudinal ligament

Question 27

suboccipital muscles function to

Answer 27

exert fine control of OA and AA joints (position the eyes, ears and nose)

Question 28

Alar ligament

Answer 28

- attaches laterally on dens and medial on occipital condyles - limits contralateral head rotation and contralateral lateral flexion

Question 29

Transverse ligament

Answer 29

connects the atlas to the axis and holds the dens in place on the posterior side

Question 30

Cruciform ligament

Answer 30

contains the transverse ligament and suprior-inferior bands of the transverse ligament

Question 31

Tectorial membrane

Answer 31

- cranial continuation of the posterior longitudinal ligament - limits flexion of Up cervical spine and provides multidirectional stability

Question 32

the tectorial membrane is injured with what type of injury?

Answer 32

forced flexion injuries

Question 33

QQ: what happens at the OA joint during flexion?

Answer 33

the occipital condyles slide posteriorly

Question 34

QQ: what does a positive finding on the sharp purser test indicate?

Answer 34

compromise in the integrity of the transverse ligament

Question 35

4 signs and symptoms of damage to tectorial membrane

Answer 35

- nausea - dizziness - light headedness - nystagmus

Question 36

Sharp purser test assesses the integrity of the

Answer 36

transverse ligament

Question 37

the tectorial membrane restricts

Answer 37

OA flexion

Question 38

signs of a positive tectorial membrane test

Answer 38

- nystagmus - facial paraesthesis - profuse sweating - nausea and vomiting - difficulty swallowing

Question 39

The alar ligament restricts

Answer 39

side-bending and rotation of the axis to the opposite side

Question 40

positive alar ligament test

Answer 40

if the C2 does NOT move with cervical movement this is a positive test - look for spasm of muscles in presence of a tear

Question 41

alar ligament test: when you passively rotate the head to the right the C2 spinous process should come into contact with your finger on what side?

Answer 41

the left side - this is indicative of a LEFT intact alar ligament - should have 15-20 degrees of motion

Question 42

normal motion with alar ligament test

Answer 42

15-20 degrees

Question 43

transverse cruciate ligament does what?

Answer 43

- provides stability in the sagittal plane - restricts anterior glide of the atlas in flexion of C1 on C2 - holds dens in place - if torn dens will move posteriorly on spinal cord

Question 44

with AA rotation what type of end-feel is normal?

Answer 44

firm

Question 45

QQ: what spinal coupled motion occurs with right rotation at C1 and C2

Answer 45

left lateral flexion

Question 46

QQ: which structure of the upper cervical region is a continuation of the posterior longitudinal ligament

Answer 46

Tectorial membrane

Question 47

QQ: T/F Longus Colli and Longus capitis function together as a dynamic posterior longitudinal ligament

Answer 47

FALSE - they work together as the dynamic anterior longitudinal ligament

Question 48

QQ: what does a positive sharp purser test indicate?

Answer 48

compromise in integrity of the transverse cruciate ligament

Question 49

QQ: when testing passive flexion combined with right side-bending at the OA joint, you are assessing...

Answer 49

maximum posterior glide of the left condyle