Week 1 - Upper Cervical Spine Flashcards
T/F: The vertebrae of the the cervical spine are the smallest and least mobile.
False: The vertebrae of the cervical spine are the smallest and MOST mobile. (allows you to move head around)
What is located in the transverse processes of cervical vertebrae?
Transverse foramina for vertebral artery.
Of the cervical vertebrae, which are considered Atypical? Typical?
Atypical: C1, C2, C7
Typical (near identical features): C3-C6
What two bones is the AO joint (OA joint) between?
Atlas and Occiput
What two bones is the AA joint between?
Atlas and Axis
What is the primary function of the atlas?
Hold up Cranium
What makes the Atlas different from a typical vertebrae? (4)
Has no:
- Body
- Pedicle
- Lamina
- Spinous Process
The Atlas has two large lateral masses that are joint by what?
anterior and posterior arches
What is located on the two large lateral masses of the Atlas?
Superior articular facets
Are the superior articular facets of the Atlas convex or concave?
concave
What do the superior articular facets of the Atlas articulate with?
Occiput
Are the inferior articular facets of the Atlas convex or concave?
Flat / slightly concave
Do the inferior articular facets of the Atlas face superiorly or inferiorly?
Faces inferiorly
Describe the orientation of the inferior articular facets of the Atlas.
Slopped downward at 20 degrees
In movement of C1 and C2, does C1 move on C2 or does C2 move on C1?
C1 is moving on C2
What do the inferior articular facets of the Atlas articulate with?
Superior facets of C2.
What is unique about the traverse processes of the Atlas (C1) that are different from the rest of the cervical vertebrae?
Largest transverse processes in the cervical region.
Why does the the Atlas have such large transverse processes?
Key attachment point for several small muscles to control fine movements.
What is unique about the Axis vertebrae that is different from the rest of the cervical vertebrae?
has a dens (odontoid process)
What is the purpose of the Anterior Facet of the dens on the Axis?
articulation with the anterior arch of C1 (Atlas)
Are the superior articular facets of the Axis convex or concave?
Slightly convex
Describe the orientation of the superior articular facets of the Axis
Oriented 20 degrees from the horizontal plane.
What do the superior articular facets of the Axis articulate with?
inferior facets of the atlas (c1)
Describe the convex/concave relationship of the AO joint.
Convex condyles of Occiput moving on Concave superior articular facet of Atlas
What is the primary movement of the AO joint?
Flexion/Extension (nodding)
At the AO joint, does the head move with the atlas, or atlas move with the head?
Atlas always moves with the head
Generally, how much translation occurs at the AO joint? Rotation? Lateral Flexion?
Very little translation, rotation, or lateral flexion.
What is the AROM at the AO Joint: Flexion
5 degrees +/-
What is the AROM at the AO joint: Extension
10 degrees +/-
What is the AROM at the AO joint: Total Flexion/Extension
15 degrees +/-
What is the AROM at the AO joint: Rotation
Negligible - 5 degrees
What is the AROM at the AO joint: Lateral Flexion
5 degrees +/-
Describe the convex/concave relationship of the AA joint.
slightly Concave inferior articular facet of Atlas and slightly convex superior articular facet of Axis
What is the primary movement at the AA joint?
Rotation
Where is the Median Joint located?
Between the Anterior arch of the Atlas and Dens of the Axis
What purpose does the Dens serve in the AA joint?
Vertical axis for rotation
What is the AROM at the AA joint: Flexion
5 degrees +/-
What is the AROM at the AA joint: Extension
10 degrees +/-
What is the AROM at the AA joint: Total Flexion/Extension
15 degrees +/-
What is the AROM at the AA joint: Axial Rotation
35 degrees - 40 degrees
What is the AROM at the AA joint: Lateral Flexion
Negligible - 5 degrees
Describe the Arthrokinematics of Cervical Flexion at the AO joint.
Convex occipital condyles roll forward on Concave superior articular facet of Atlas. Simultaneous slide in opposite direction posteriorly.
Describe the Arthrokinematics of Cervical Flexion at the AA joint.
Flat to slightly concave inferior articular facets of the Atlas tilt foward on Flat to slightly convex superior articular facets of the Axis.
Describe the Arthrokinematics of Cervical Extension of the AO joint.
Convex occipital condyles roll posteriorly on Concave superior articular facets of Atlas. Simultaneous slide in opposite direction anteriorly.
Describe the Arthrokinematics of Cervical Extension of the AA joint.
Flat to slightly concave inferior articular facets of the Atlas tilt backwards on Flat to slightly convex superior articular facets of the Axis.
Why is Cervical Rotation at the AO joint restricted?
Restricted motion due to orientation of the bony architecture of the lateral facets.
Why is Cervical Rotation at the AA joint ideal?
Ideal for rotation because of the 20 degree from the horizontal facet orientation.
Describe Arthrokinematics of Cervical Lateral Flexion at the AO joint.
Convex occipital condyles slightly roll on Concave superior articular facets of Atlas. Slide in opposite direction of the roll.
Define coupling.
One motion around one plane is associated with another motion around a different plane.
What two motions does spinal coupling happen around?
Lateral Flexion and Rotation
Does spinal coupling happen at all cervical spine joints?
No, differs from upper c/spine (AO and AA joints) versus mid c/spine joints.
AO and AA Joints spinal coupling: Lateral Flexion is coupled with ____.
contralateral rotation
AO and AA Joints spinal coupling: Rotation is coupled with ____.
contralateral flexion
Between the AO and AA joints, Flexion/Extension is greatest at which?
AO joint
What percent of rotation occurring at the cervical spine happens at the AA joint?
~50%
T/F: coupled motion occurs in opposite directions.
True: Left Lateral Flexion and Right Rotation.
What are the 6 muscles of the Cervical Musculature?
- Longus Capitis
- Longus Colli
Suboccipitals
- Rectus Capitis Posterior Minor
- Rectus Capitis Posterior Major
- Oblique Capitis Superior
- Oblique Capitis Inferior
What is the Origin of: Longus Capitis
- anterior tubercles of Transverse Procesess of C3-C6
What is the Insertion of: Longus Capitis
- inferior surfaces of Occiput
What is the Action of: Longus Capitis
Unilaterally
1. Flexion/Extension
Ipsilateral
2. Lateral Rotation
Bilaterally
3. Nodding
What is the Innervation of: Longus Capitis
Ventral Rami C1-C4
What is the Origin of: Longus Colli
Superior Oblique Portion -anterior tubercles of transverse processes of C3-C5 Inferior Oblique Portion -anterior surface of bodies of C1-C3 Vertical Portion -anterior surface of C5-T3
What is the Insertion of: Longus Colli
- Tubercle on C1
- anterior tubercles of transverse processes of C5-C6
- anterior surface of C2-C4
What is the Action of: Longus Colli
- Nodding
2. Support of cervical lordosis
What is the Innervation of: Longus Colli
Vertral Rami C1-8
What two purposes do the Longus Capitis and Longus Colli serve?
- “Dynamic” anterior longitudinal ligament
2. Vertical Stability
Are the Suboccipital muscles difficult or easy to palpate?
Difficult
Where do the suboccipital muscles lie in relation to Upper Trapezius, Splenius group, and semispinalis capitas muscles?
Deep
What action do the Suboccipital Muscles provide?
Fine control over the AO and AA joints
-position eye, ears, nose
T/F: The Alar Ligament is considered fibrous.
True
What are the two attachments of the Alar Ligament?
- Lateral side of the Apex of the dens
2. Medial side of the occipital condyles
What is the function of the Alar Ligament?
- Limits contralateral head rotation
2. and contralateral lateral flexion
What does the Transverse Ligament connect?
Atlas to Axis
What is the function of the Transverse Ligament?
holds Dens in place on the posterior side of the dens
What does the Cruciform Ligament contain?
“atlantal cruciform” ligament contains the
- transverse ligament
- superior and
- inferior bands of the transverse ligament
What would happen if the Cruciform Ligament is comprimised?
Anterior subluxation of the atlas and impinge spinal cord.
The Tectorial Membrane is a cranial continuation of ____.
posterior longitudinal ligament
Where does the Tectorial Membrane run?
C2 body ascends to the Occipital Bone
What is the function of the Tectorial Membrane?
Limits flexion of upper cervical spine and provides multidirectional stability.
How is the Tectorial Membrane injured?
Forced flexion injuries.
What does the Tectorial Membrane cover?
Covers the cruciate and the alar ligaments
What happens when injury occurs from MVA?
Whiplash occurs with hyperextension exceeding cervical flexion resulting in the anterior structures of the cervical region more prone to injury.
What are the 4 components of whiplash injury?
- Acceleration-deceleration mechanism to the neck
- Prognosis varies
- Symptoms not just limited to head and neck
- Outcome tools
What does the Sharp-Purser test assess and in what plane?
Test assesses the integrity of the transverse ligament. Sagittal Plane Stability.
The Tectorial Membrane test assess what?
Longitudinal Stability
When its the Tectorial Membrane Test positive? (5)
if cardinal signes or symptoms of spinal cord compression are produced:
- Nystagmus
- Facial Paraesthesias
- Profuse Sweating
- Nausea, Vomiting
- Difficulty Swallowing
The Alar Ligament test assess what?
Axial Rotation (horizontal plane) and side bending (frontal plane)
The Transverse Cruciate Ligament test assess what?
Stability in the Sagittal Plane
- Describe what clinical tests would you use with a patient whom you suspect has instability in the upper cervical spine? (7)
- Sub-Occipital Active ROM Assessment
- Foward and backward nodding (OA nodding)
- AA Rotation - Sharp-Purser Test (transverse ligament)
- Tectorial Membrane
- Alar Ligament
- Transverse Cruciate Ligament
- Sub-Occipital Passive ROM
- Sub-occipital nodding (mostly OA)
- AA Rotation - Passive Combined Motions
- OA (Flexion with Side-bending)
- OA (Extension with Side-bending)
