Upper Cervical Flashcards
Unique structures of cervical spine:
- transverse foramina for vertebral artery
- C1, C2 and C7 are all atypical vertebrae
Atypical cervical vertebrae
C1, C2 and C7
Primary function of the atlas
hold the head on the neck
Structure of the atlas
- 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
inferior articular facet of the atlas
- flat and slightly concave
- facets inferiorly sloped down at a 20 degree angle
- articulates with superior facet of C2
T/F the atlas has the largest transverse process in the cervical region
True- due to key attachment point of multiple small muscles to control fine movements
the superior articular facet of the axis (C2) is convex or concave?
convex to articulate with the atlas
OA joint
- 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)
Primary motion of OA joint
flexion/extension (nodding)
ROM for flexion/extension at OA joint
15 degrees total
- 5 from flexion
- 10 from extension
ROM values for OA
- axial rotation is negligible
- lateral flexion +/- 5 degrees
- flexion/ext- 15 degrees
AA joint primary motion
-rotation
orientation of the AA joint is closer to the __________ plane
horizontal
Median joint of the AA joint
anterior arch of the atlas and the dens of the axis
Dens
vertical axis for rotation
ROM at AA joint
- +/- 5 degrees flexion
- +/- 10 degrees extension
- 25-40 degrees of axial rotation
- about 5 degrees of lateral flexion
Flexion of OA
- convex on concave
- occipital condyle roll anteriorly and simultaneously slide posteriorly with flexion (opp. with extension)
Flexion of the AA joint
flat to slightly concave
atlas tilts forward with cervical flexion
Extension of OA
- rolls back and slightly forward
Extension of AA
atlas tilts backward
cervical rotation at AA
ideal for rotation (OA has restricted motion0
Cervical Lateral rotation (OA)
small amount of rolling occurs
slide is in the opposite direction of the roll
Lateral rotation AA
spinal coupling
frontal and horizontal planes
spinale coupling
one motion around one plane is associated with another around a different plane
role of OA and AA joints in spinal coupling
- lateral flexion is coupled with contralateral rotation
- rotation is coupled with contralateral lateral flexion
longus capitis and longus colli form the…
anterior longitudinal ligament
suboccipital muscles function to
exert fine control of OA and AA joints (position the eyes, ears and nose)
Alar ligament
- attaches laterally on dens and medial on occipital condyles
- limits contralateral head rotation and contralateral lateral flexion
Transverse ligament
connects the atlas to the axis and holds the dens in place on the posterior side
Cruciform ligament
contains the transverse ligament and suprior-inferior bands of the transverse ligament
Tectorial membrane
- cranial continuation of the posterior longitudinal ligament
- limits flexion of Up cervical spine and provides multidirectional stability
the tectorial membrane is injured with what type of injury?
forced flexion injuries
QQ: what happens at the OA joint during flexion?
the occipital condyles slide posteriorly
QQ: what does a positive finding on the sharp purser test indicate?
compromise in the integrity of the transverse ligament
4 signs and symptoms of damage to tectorial membrane
- nausea
- dizziness
- light headedness
- nystagmus
Sharp purser test assesses the integrity of the
transverse ligament
the tectorial membrane restricts
OA flexion
signs of a positive tectorial membrane test
- nystagmus
- facial paraesthesis
- profuse sweating
- nausea and vomiting
- difficulty swallowing
The alar ligament restricts
side-bending and rotation of the axis to the opposite side
positive alar ligament test
if the C2 does NOT move with cervical movement this is a positive test
- look for spasm of muscles in presence of a tear
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?
the left side - this is indicative of a LEFT intact alar ligament
- should have 15-20 degrees of motion
normal motion with alar ligament test
15-20 degrees
transverse cruciate ligament does what?
- 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
with AA rotation what type of end-feel is normal?
firm
QQ: what spinal coupled motion occurs with right rotation at C1 and C2
left lateral flexion
QQ: which structure of the upper cervical region is a continuation of the posterior longitudinal ligament
Tectorial membrane
QQ: T/F Longus Colli and Longus capitis function together as a dynamic posterior longitudinal ligament
FALSE
- they work together as the dynamic anterior longitudinal ligament
QQ: what does a positive sharp purser test indicate?
compromise in integrity of the transverse cruciate ligament
QQ: when testing passive flexion combined with right side-bending at the OA joint, you are assessing…
maximum posterior glide of the left condyle
