VI. Upper cervical biomechanics (C0-C1-C2) Flashcards
What is the most complex, specialized and unique area of the spine?
upper cervical
What is the dichotomous function of the upper cervical spine?
mobility and stability
What type of headache is often associated with dysfunction in the upper cervical spine?
cervicogenic headache
The upper cervical area is the emphasis of many chiropractic techniques including……
-Grostic -Nucca -Hole in one -Palmer Specific -Atlas Orthogonal -Blair -Kale
Are the condyles of the occiput concave or convex?
convex (steeper anteriorly)
What direction do the articular surfaces of the occipital condyles face?
laterally and inferiorly
The articular surfaces of the occipital condyles are widest _____ and narrowest _____.
posteriorly : anteriorly
Are the superior articular facets of the atlas concave or convex?
concave (compliment condyles of occiput)
What direction do the articular surfaces of the superior articular facets of Atlas face?
medially and superiorly
The superior articular surfaces of atlas are slightly wider ______
posteriorly
Both the condyles of the occiput and the superior facets of atlas converge ______
anteriorly
What is the combined (flexion/extension) segmental range of motion for the C0-C1 joint?
25º
Which flexion/extension segmental range of motion is greatest in the cervical spine?
C0-C1 with 25 degrees
Where is the IAR for flexion and extension of the C0-C1 joint?
just above the odontoid
What is the kinematic pattern of motion for flexion and extension in the C0-C1 joint?
predominantly in the sagittal plane with insignificant coupling
During cervical flexion, a large percentage of the population will extend at C0-C1 at the end renge of cervical flexion. This is called_____.
paradoxical movement of the occiput
It is hypothesized that paradoxical movement of the occiput results from what?
the tension in the posterior cervical muscles and possibly the nuchal ligaments
During flexion, the posterior joint surface of C0 glides ____ (up/down) the articular surface of C1 as the anterior surface glides ____ (up/down) and the gap ____ (widens/narrows) between the occiput and the posterior arch of the atlas.
up : down : widens
During extension, the posterior joint surface of C0 glides ____ (up/down) the articular surface of C1 as the anterior surface glides ____ (up/down) and the gap ____ (widens/narrows) between the occiput and the posterior arch of the atlas.
down : up : narrows
During flexion, the occiput rolls ____ (anteriorly/posteriorly) and slides ____ (anteriorly/posteriorly)
anteriorly : posteriorly
During extension, the occiput rolls ____ (anteriorly/posteriorly) and slides ____ (anteriorly/posteriorly)
posteriorly : anteriorly
What is the segmental range of motion for lateral flexion of the C0-C1 joint?
5º to each side
What limits range of lateral flexion of the C0-C1 joint?
alar ligaments
What is the IAR for lateral flexion of the C0-C1 joint?
midway between ondontoid tip and EOP
What is the kinematic pattern of motion for lateral flexion of the C0-C1 joint?
predominantly a movement in the coronal plane with contralateral coupled rotation
On the side of lateral flexion, the articular surface of C0 is gliding ____ (up/down) the articular surface of C1 as the side opposite the lateral flexion is gliding ____ (up/down).
down : up
What is the segemental range of motion for rotation at the C0-C1 joint?
5º the each side
What limits the segmental range of motion for rotation of the C0-C1 joint?
articular anatomy and connections of the alar ligament
Which segment of the cervical spine has the most range of motion for rotation?
C1-C2
What is the IAR for rotation of the C0-C1 joint?
it has not been experimentally determined
What is the kinematic pattern of motion for rotation of the C0-C1 joint?
descriptions of movement are limited
On the side of rotation, the C0 articular surface slides ____ (anterior/posterior) and ____ (superior/inferior) on the articular surface of C1 while on the side opposite the rotation it slides ____ and ____.
posterior : superior
anterior : superior
Describe the inferior facets of C1
circular in shape, convex, directly below superior facets
face inferiorly and medially
Describe the superior facets of C2
oval shape, slightly convex
face superiorly and laterally
The gutter at the posterior ondontoid, where the transverse ligament lies, is lined with what?
fibrocartilage
The odontoid/atlas joint is imbedded in _____ tissue and lacks a _____
adipose : capsule
What is the segmental range of motion for combined flexion and extension of the C1-C2 joint?
20 degrees
What is the IAR for flexion/extension of the C1-C2 joint?
in the middle third of the dens
What is the kinematic pattern of motion of the C1-C2 joint in flexion/extension?
angular sagittal plane motion coupled with slight sagittal plane translation
Flexion = +θ x with slight +z
Extension = -θ x with slight -z
In flexion of the C1-C2 joint, the posterior joint surfaes and posterior arches _____ (separate/approximate) as the atlas articular surfaces slide (posteriorly/anteriorly)
separate : posteriorly
In extension of the C1-C2 joint, the posterior joint surfaes and posterior arches _____ (separate/approximate) as the atlas articular surfaces slide (posteriorly/anteriorly)
approximate : anteriorly
What is the segemental range of motion for lateral flexion of the C1-C2 joint?
averages 5 degrees to each side
What is the IAR for lateral flexion of the C1-C2 joint?
undetermined
What is the kinematic pattern of motion for lateral flexion of the C1-C2 joint?
coronal plane angular movement with translation in the coronal plane toward the side of lateral flexion
C1 articular surfaces translate on the C2 articular surfaces ____ (toward/away from) the side of lateral flexion with slight tilting between the joint surfaces.
toward
What is the segmental range of motion for rotation of the C1-C2 joint?
average of 40 degrees to each side
The first how degrees of cervical rotation occur exclusively at C1-C2?
25 degrees
Approximately how much of cervical rotation occurs at the C1-C2 joint?
half
What is the IAR for rotation of the C1-C2 joint?
vertical axis in center of the dens
What is the kinematic pattern of motion for rotation of the C1-C2 joint?
Atlas rotates around the dens in the horizontal plane with coupled vertical translation
During rotation of the C1-C2 joint, the C1 articular surface slides ____ (anterior/posterior) on the side of rotation and ____ (anterior/posterior) on the side opposite rotation.
posterior : anterior
What anterior muscles are invovled in kinetics of the upper cervicals?
rectus capitis anterior
longus capitis
What posterior muscles are invovled in kinetics of the upper cervicals?
rectus capitis posterior major
rectus capitis posterior minor
obliquus capitis superior
obliquus capitis inferior
What lateral muscles are involved in kinetics of the upper cervicals?
rectus capitis lateralis
What muscles initiate flexion of the upper cervical spine?
bilateral anterior concentric activity of rectus capitis anterior and longus capitis
What muscle guide flexion of the upper cervical spine?
bilateral posterior eccentric conctraction of subocciptals
Flexion of the upper cervical spine is limited by?
eccentric activity of suboccipital muscles
joint capsule
PLL
nuchal ligaments
cruciate ligaments
chin hitting sternum
What muscle initiate extension of the upper cervical spine?
bilateral concentric activity of suboccipitals
What muscles guide extension of the upper cervical spine?
bilateral eccentric activity of rectus capitis anterior and longus capitis
Extension of the upper cervical spine is limited by?
eccentric activity of anterior musculature
ALL
anterior atlanto-occipital membrane
capsular ligaments
cruciate ligaments
impact of occiput on posterior C1
impact of posterior arch of C1 on SP of C2
What muscles initiate lateral flexion of the upper cervical spine?
concentric contraction of ipsilateral rectus capitis lateralis
What muscles guide lateral flexion of the upper cervical spine?
eccentric contraction of contralateral rectus capitis lateralis
Lateral flexion of the upper cervical spine is limited by?
eccentric activity or lengthening of contralateral rectus capitis lateralis
capsular ligaments
lateral atlanto-occipital and occipital ligaments
alar ligaments
What initiates and guides rotation of the upper cervical spine?
movement is a combination of concentric activity on the side of rotation balanced by eccentric activity on the side opposite of rotation
Rotation of the upper cervical spine is limited by?
contralateral eccentric muscle activity
apical and alar ligaments at C0-C1
cruciate ligaments at C1-C2
articular design of C0-C1
What are the possible views to obtain by X-ray of the upper cervical spine?
AP open mouth
lateral cervical
