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DPT705: Biomechanics Kinesiology of the Spine > Week 1 - Upper Cervical Spine > Flashcards

Week 1 - Upper Cervical Spine Flashcards

1
Q

T/F: The vertebrae of the the cervical spine are the smallest and least mobile.

A

False: The vertebrae of the cervical spine are the smallest and MOST mobile. (allows you to move head around)

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2
Q

What is located in the transverse processes of cervical vertebrae?

A

Transverse foramina for vertebral artery.

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3
Q

Of the cervical vertebrae, which are considered Atypical? Typical?

A

Atypical: C1, C2, C7

Typical (near identical features): C3-C6

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4
Q

What two bones is the AO joint (OA joint) between?

A

Atlas and Occiput

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5
Q

What two bones is the AA joint between?

A

Atlas and Axis

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6
Q

What is the primary function of the atlas?

A

Hold up Cranium

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7
Q

What makes the Atlas different from a typical vertebrae? (4)

A

Has no:

  1. Body
  2. Pedicle
  3. Lamina
  4. Spinous Process
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8
Q

The Atlas has two large lateral masses that are joint by what?

A

anterior and posterior arches

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9
Q

What is located on the two large lateral masses of the Atlas?

A

Superior articular facets

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10
Q

Are the superior articular facets of the Atlas convex or concave?

A

concave

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11
Q

What do the superior articular facets of the Atlas articulate with?

A

Occiput

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12
Q

Are the inferior articular facets of the Atlas convex or concave?

A

Flat / slightly concave

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13
Q

Do the inferior articular facets of the Atlas face superiorly or inferiorly?

A

Faces inferiorly

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14
Q

Describe the orientation of the inferior articular facets of the Atlas.

A

Slopped downward at 20 degrees

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15
Q

In movement of C1 and C2, does C1 move on C2 or does C2 move on C1?

A

C1 is moving on C2

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16
Q

What do the inferior articular facets of the Atlas articulate with?

A

Superior facets of C2.

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17
Q

What is unique about the traverse processes of the Atlas (C1) that are different from the rest of the cervical vertebrae?

A

Largest transverse processes in the cervical region.

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18
Q

Why does the the Atlas have such large transverse processes?

A

Key attachment point for several small muscles to control fine movements.

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19
Q

What is unique about the Axis vertebrae that is different from the rest of the cervical vertebrae?

A

has a dens (odontoid process)

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20
Q

What is the purpose of the Anterior Facet of the dens on the Axis?

A

articulation with the anterior arch of C1 (Atlas)

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21
Q

Are the superior articular facets of the Axis convex or concave?

A

Slightly convex

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22
Q

Describe the orientation of the superior articular facets of the Axis

A

Oriented 20 degrees from the horizontal plane.

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23
Q

What do the superior articular facets of the Axis articulate with?

A

inferior facets of the atlas (c1)

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24
Q

Describe the convex/concave relationship of the AO joint.

A

Convex condyles of Occiput moving on Concave superior articular facet of Atlas

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25
Q

What is the primary movement of the AO joint?

A

Flexion/Extension (nodding)

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26
Q

At the AO joint, does the head move with the atlas, or atlas move with the head?

A

Atlas always moves with the head

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27
Q

Generally, how much translation occurs at the AO joint? Rotation? Lateral Flexion?

A

Very little translation, rotation, or lateral flexion.

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28
Q

What is the AROM at the AO Joint: Flexion

A

5 degrees +/-

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29
Q

What is the AROM at the AO joint: Extension

A

10 degrees +/-

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30
Q

What is the AROM at the AO joint: Total Flexion/Extension

A

15 degrees +/-

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31
Q

What is the AROM at the AO joint: Rotation

A

Negligible - 5 degrees

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32
Q

What is the AROM at the AO joint: Lateral Flexion

A

5 degrees +/-

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33
Q

Describe the convex/concave relationship of the AA joint.

A

slightly Concave inferior articular facet of Atlas and slightly convex superior articular facet of Axis

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34
Q

What is the primary movement at the AA joint?

A

Rotation

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35
Q

Where is the Median Joint located?

A

Between the Anterior arch of the Atlas and Dens of the Axis

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36
Q

What purpose does the Dens serve in the AA joint?

A

Vertical axis for rotation

37
Q

What is the AROM at the AA joint: Flexion

A

5 degrees +/-

38
Q

What is the AROM at the AA joint: Extension

A

10 degrees +/-

39
Q

What is the AROM at the AA joint: Total Flexion/Extension

A

15 degrees +/-

40
Q

What is the AROM at the AA joint: Axial Rotation

A

35 degrees - 40 degrees

41
Q

What is the AROM at the AA joint: Lateral Flexion

A

Negligible - 5 degrees

42
Q

Describe the Arthrokinematics of Cervical Flexion at the AO joint.

A

Convex occipital condyles roll forward on Concave superior articular facet of Atlas. Simultaneous slide in opposite direction posteriorly.

43
Q

Describe the Arthrokinematics of Cervical Flexion at the AA joint.

A

Flat to slightly concave inferior articular facets of the Atlas tilt foward on Flat to slightly convex superior articular facets of the Axis.

44
Q

Describe the Arthrokinematics of Cervical Extension of the AO joint.

A

Convex occipital condyles roll posteriorly on Concave superior articular facets of Atlas. Simultaneous slide in opposite direction anteriorly.

45
Q

Describe the Arthrokinematics of Cervical Extension of the AA joint.

A

Flat to slightly concave inferior articular facets of the Atlas tilt backwards on Flat to slightly convex superior articular facets of the Axis.

46
Q

Why is Cervical Rotation at the AO joint restricted?

A

Restricted motion due to orientation of the bony architecture of the lateral facets.

47
Q

Why is Cervical Rotation at the AA joint ideal?

A

Ideal for rotation because of the 20 degree from the horizontal facet orientation.

48
Q

Describe Arthrokinematics of Cervical Lateral Flexion at the AO joint.

A

Convex occipital condyles slightly roll on Concave superior articular facets of Atlas. Slide in opposite direction of the roll.

49
Q

Define coupling.

A

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

50
Q

What two motions does spinal coupling happen around?

A

Lateral Flexion and Rotation

51
Q

Does spinal coupling happen at all cervical spine joints?

A

No, differs from upper c/spine (AO and AA joints) versus mid c/spine joints.

52
Q

AO and AA Joints spinal coupling: Lateral Flexion is coupled with ____.

A

contralateral rotation

53
Q

AO and AA Joints spinal coupling: Rotation is coupled with ____.

A

contralateral flexion

54
Q

Between the AO and AA joints, Flexion/Extension is greatest at which?

A

AO joint

55
Q

What percent of rotation occurring at the cervical spine happens at the AA joint?

A

~50%

56
Q

T/F: coupled motion occurs in opposite directions.

A

True: Left Lateral Flexion and Right Rotation.

57
Q

What are the 6 muscles of the Cervical Musculature?

A
  1. Longus Capitis
  2. Longus Colli

Suboccipitals

  1. Rectus Capitis Posterior Minor
  2. Rectus Capitis Posterior Major
  3. Oblique Capitis Superior
  4. Oblique Capitis Inferior
58
Q

What is the Origin of: Longus Capitis

A
  1. anterior tubercles of Transverse Procesess of C3-C6
59
Q

What is the Insertion of: Longus Capitis

A
  1. inferior surfaces of Occiput
60
Q

What is the Action of: Longus Capitis

A

Unilaterally
1. Flexion/Extension

Ipsilateral
2. Lateral Rotation

Bilaterally
3. Nodding

61
Q

What is the Innervation of: Longus Capitis

A

Ventral Rami C1-C4

62
Q

What is the Origin of: Longus Colli

A 
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
63
Q

What is the Insertion of: Longus Colli

A
  1. Tubercle on C1
  2. anterior tubercles of transverse processes of C5-C6
  3. anterior surface of C2-C4
64
Q

What is the Action of: Longus Colli

A
  1. Nodding

2. Support of cervical lordosis

65
Q

What is the Innervation of: Longus Colli

A

Vertral Rami C1-8

66
Q

What two purposes do the Longus Capitis and Longus Colli serve?

A
  1. “Dynamic” anterior longitudinal ligament

2. Vertical Stability

67
Q

Are the Suboccipital muscles difficult or easy to palpate?

A

Difficult

68
Q

Where do the suboccipital muscles lie in relation to Upper Trapezius, Splenius group, and semispinalis capitas muscles?

A

Deep

69
Q

What action do the Suboccipital Muscles provide?

A

Fine control over the AO and AA joints

-position eye, ears, nose

70
Q

T/F: The Alar Ligament is considered fibrous.

A

True

71
Q

What are the two attachments of the Alar Ligament?

A
  1. Lateral side of the Apex of the dens

2. Medial side of the occipital condyles

72
Q

What is the function of the Alar Ligament?

A
  1. Limits contralateral head rotation

2. and contralateral lateral flexion

73
Q

What does the Transverse Ligament connect?

A

Atlas to Axis

74
Q

What is the function of the Transverse Ligament?

A

holds Dens in place on the posterior side of the dens

75
Q

What does the Cruciform Ligament contain?

A

“atlantal cruciform” ligament contains the

  1. transverse ligament
  2. superior and
  3. inferior bands of the transverse ligament
76
Q

What would happen if the Cruciform Ligament is comprimised?

A

Anterior subluxation of the atlas and impinge spinal cord.

77
Q

The Tectorial Membrane is a cranial continuation of ____.

A

posterior longitudinal ligament

78
Q

Where does the Tectorial Membrane run?

A

C2 body ascends to the Occipital Bone

79
Q

What is the function of the Tectorial Membrane?

A

Limits flexion of upper cervical spine and provides multidirectional stability.

80
Q

How is the Tectorial Membrane injured?

A

Forced flexion injuries.

81
Q

What does the Tectorial Membrane cover?

A

Covers the cruciate and the alar ligaments

82
Q

What happens when injury occurs from MVA?

A

Whiplash occurs with hyperextension exceeding cervical flexion resulting in the anterior structures of the cervical region more prone to injury.

83
Q

What are the 4 components of whiplash injury?

A
  1. Acceleration-deceleration mechanism to the neck
  2. Prognosis varies
  3. Symptoms not just limited to head and neck
  4. Outcome tools
84
Q

What does the Sharp-Purser test assess and in what plane?

A

Test assesses the integrity of the transverse ligament. Sagittal Plane Stability.

85
Q

The Tectorial Membrane test assess what?

A

Longitudinal Stability

86
Q

When its the Tectorial Membrane Test positive? (5)

A

if cardinal signes or symptoms of spinal cord compression are produced:

  1. Nystagmus
  2. Facial Paraesthesias
  3. Profuse Sweating
  4. Nausea, Vomiting
  5. Difficulty Swallowing
87
Q

The Alar Ligament test assess what?

A

Axial Rotation (horizontal plane) and side bending (frontal plane)

88
Q

The Transverse Cruciate Ligament test assess what?

A

Stability in the Sagittal Plane

89
Q
  1. Describe what clinical tests would you use with a patient whom you suspect has instability in the upper cervical spine? (7)
A
  1. Sub-Occipital Active ROM Assessment
    - Foward and backward nodding (OA nodding)
    - AA Rotation
  2. Sharp-Purser Test (transverse ligament)
  3. Tectorial Membrane
  4. Alar Ligament
  5. Transverse Cruciate Ligament
  6. Sub-Occipital Passive ROM
    - Sub-occipital nodding (mostly OA)
    - AA Rotation
  7. Passive Combined Motions
    - OA (Flexion with Side-bending)
    - OA (Extension with Side-bending)

DPT705: Biomechanics Kinesiology of the Spine (5 decks)

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