Functional Anatomy Lecture 2 Material - Examination of the Cervical Spine

This test is done by flicking the index finger and a positive response results in flexion/clawing of the hand which can be indicative of an UMN lesion

Hoffman Sign

What are classic cord symptoms

high impact injuries, high falls, car accidents, etc.

What plane are the facets oriented in in the upper cervical spine?

horizontal

What does degrees of freedom mean?

how you can move at a specific joint, what movement occurs there

What is the significance of the amount of rotation found at the atlantoaxial articulation?

if a pt. comes in with very limited rotation on one side, we know there must be some type of upper cervical involvement

When in our life are disc ruptures more common? why?

in our younger years because there is a lot of things inside the disc (fluid, water, gel) which means there is more to squeeze out of disc

These two deep cervical flexor muscles of the neck are often damaged in whiplash injuries

Longus colli and rectus capitis

Our head on our spine, with gravity is what type of force?

a compressive force

The atlanto-occipital articulation is a yes/no joint?

a yes joint

What are the 5 d's associated with a positive vertebral artery examination finding?

diplopia, dysarthria, dysphasia, dizziness, drop attack

What is the dermatome for C6

dorsal of the thumb

What is the dermatome for C7

dorsum of middle finger

What is the myotome for C7

elbow extension/wrist flexion

What is the myotome for C6

elbow flexion/wrist extension

If there is a capsular restriction or problem in the cervical spine, the pt. will have equal loss of what movements? What movement will the pt. have in tact?

equal loss of rotation and sidebending, pt. will still have full flexion

During protraction is the upper cervical spine extended or flexed?

extended

During retraction is the lower cervical spine extended or flexed?

extended

During flexion of C1 on C2 facets roll in what direction and glide in what direction?

facets roll anterior and glide posterior

What is the myotome for T1

finger ab/adduction

During protraction is the lower cervical spine extended or flexed?

flexed

During retraction is the upper cervical spine extended or flexed?

flexed

What are the three degrees of freedom at the mid/lower cervical spine?

flexion and extension, lateral flexion, and axial rotation

If a pt. is stenotic and has limited movement and nerve pressure would they "like" flexion or extension more?

flexion, because the space would be opening, giving them more room

What are the two degrees of freedom at C0-C1 articulation

flexion/extension sidebending (w/coupling in opposite directions)

When extension occurs at the C0-C1 articulation, how to the occipital condyles move in relation to the occiput

occipital condyles glide in the opposite direction of the movement of the occiput-the occipital condyles move anteriorly in extension

The upper cervical spine includes what area and vertebrae?

occiput-C2

In flexion of the mid/lower cervical spine, do the vertebrae open or close?

open

What is ridiculer pain?

pain that travels along the course of the nerve

Most disc problems occur where? Orientation?

posteriolaterally

This ligament is the widest in the cervical spine and checks the posterior migration of the nucleus

posterior longitudinal ligament

What is unique about the side-bending function happening at the C0-C1 articulation?

side-bending occurs with conjunct rotation to the opposite side so if I side bend to the right, the vertebrae are actually rotating to the left

Cervical intervertebral discs over time become less-gelatinous, less fluidity of movement. What does this mean? why?

spinal stenosis, more pressure on nerve because the space narrows

This feature of mid/lower cervical spine is like a bowl and is one of the joints at work when our vertebrae are stacked on one another

uncinate process

This feature of the mid/lower cervical spine prevents lateral shear, helps keep IVD stable

uncinate process

These joints extend from C3-T1 and there is usually a total of ten of these saddle-shaped joints. They are formed between the uncinate process and the interior lateral aspect of the superior vertebra

uncovertebral joints

How do we protect against disc herniation? (3 things)

uncovertebral joints posterior longitudinal ligament disc makeup

In flexion of the mid/lower cervical spine how do the facets of the upper vertebrae glide? (2 movements)

up and forward

A small chin nod is a great way to describe motion in this part of the spine

upper cervical spine

The c spine is divided into what three things?

upper cervical spine mid cervical spine lower cervical spine

What is the dermatome for C4

upper trapezius

These arteries may be occluded with extension and rotation of the cervical spine

vertebral

What type of bony congruency is present between C1 and C2?

very little

What is a junction referring to in the spine?

where a certain part of the spine meets with another part of the spine

These joints are also called facet joints and sit laterally on vertebrae. They are lined with articular cartilage

zygapophysial joints

What produces the convex surface at C1-C2?

articular cartilage

What provides the stability to upper cervical joints?

ligamentous and muscular structures

This structure bridges the space between adjacent lamina, is super elastic, prevents hyperflexion of the neck, and provides a smooth wall to vertebral canal

ligamentum flavum

What is the dermatome for T1

medial border of brachium

C3-C7 would be defined as what in reference to part of spine

mid/lower spine

The upper cervical spine allows for increased ___ and protects the ___ ___

mobility, medulla oblongata

What does a "yes" joint mean?

more flexion and extension occur here

The orientation of the facet joints dictate what two things

movement patterns and coupled movements

What two things produce considerable compressive forces on the neck?

muscle contraction and the weight of the head

What is the myotome for C2

neck extension

What is the myotome for C1

neck flexion

What is the myotome for C3

neck sidebending

Is the atlantoaxial articulation a yes/no joint?

no

What do we not want to do with pt.'s who have cord symptoms

no immobilization, manipulation, PROM

What is a unique feature about the space between C! and C2?

no vertebral discs

When flexion occurs at the C0-C1 articulation, how do the occipital condyles move in relation to the occiput

occipital condyles glide in the opposite direction of movement of the occiput--the occipital condyles move posteriorly in flexion

What is referred pain?

the source/area of the dysfunction may not really be where you feel the pain at

If a ligament is dysfunctional or compromised in the upper cervical joints, what is a big problem here?

the spinal cord would not have the ligaments protecting it from running into vertebrae or other things = dangerous

What is special about the number of nerve roots we have in the cervical spine and why does this happen?

there are eight nerve roots d/t the roots exiting above the corresponding vertebral level

In extension of the mid/lower cervical spine how do the facets of the upper vertebrae glide? (2 movements)

they glide down and back

In side-bending at C0-C1 articulation, how to the occipital condyles move

they move in and down when you go towards that side of direction of sideband

What is the purpose of the occipital condyles on the atlas?

this is where the skull sits

Upon having tight scalene muscles and compression of nearby structues/vessels/nerves, what syndrome can occur?

thoracic outlet syndrome

What is the line of force that motion goes through in side-bending of the cervical spine?

through the nose

What is the myotome for C8

thumb extension

This condition is a rare congenital mask disorder characterized by the unilateral shortening of the SCM

torticollis

This ligament attaches on either side of the atlas and courses posterior to the dens. It is the primary stabilizer preventing anterior translation of C1 on C2

transverse ligament

What is the DTR for C7

triceps

What is the dermatome for C8

ulnar border of hand

How many degrees of flexion and extension occur at C0-C1?

10 degrees of flexion 15-20 degrees of extension

How many degrees of freedom does the Atlanto-occipital articulation have?

2

How many degrees of freedom does the atlantoaxial joint have?

2

The IV discs make up what percentage of the superior-to-inferior height of the cervical spine?

25%

How many degrees of freedom occur at the mid/lower cervical spine?

3

How many degrees of rotation in one direction occurs at the atlantoaxial articulation?

40-45 degrees

The plane of facet joints average how many degrees from the horizontal?

45

How many discs are in the cervical spine?

5

What is the very top joint/articulation of the cervical spine?

C0-C1, occiput and C1 (atlas)

What vertebrae make up the atlantoaxial articulation?

C1-C2

What is the most common level of cervical nerve involvement?

C7

The CTJ junction comprises what vertebrae?

C7-T1

Why is the transverse ligament so important?

It prevents the dens from running into the spinal cord which could produce threatening cord symptoms

Whiplash associated injuries can affect this muscle that forms the medial border of the anterior/supraclavicular triangle

SCM

How are the cervical discs named?

after the vertebra above

This ligament has two portions: one attaches to the axis and the other to the occiput. It is the primary restraint for cervical flexion, lateral flexion, and axial rotation

alar ligament

Why is the pathology behind cervical IVD and lumbar IVD different?

at birth the lumbar nucleus makes up half of the disc while the cervical nucleus only makes up a quarter. Therefore, by our 40s and on in life, the cervical nucleus is primarily fibrocartilage and has no gelatinous component. So, later in life it is rare for cervical disc herniation.

In order to achieve cervical stability, what balance is required?

balance between flexors and extensors

What is the dermatome for C2

behind the ear

Where is the first disc located in the cervical spine?

between C2 and C3

What is the DTR for C5

biceps

What is the DTR for C6?

brachioradialis

The IVD height to body ration is greatest in this part of the spine. Why?

cervical spine, because the bodies are so small

How do cervical vertebrae compare to thoracic and lumbar vertebrae in relation to the vertebral bodies?

cervical vertebrae are significantly smaller than thoracic and lumber vertebral bodies

What does the CTJ junction stand for?

cervicothoracic junction

What is unique to C1-C2 regarding movement?

convex surface on convex surface, like a ball sitting on a ball

What is unique about coupled movements of the mid/lower c spine compared to the coupled movements of the upper c spine?

coupling occurs to the same side, aka rotation and side-bending occur to the same side

This articulates with the posterior surface of the anterior arch of the atlas to prevent from it running into the spinal cord

dens

The inferior articular surfaces of the vertebrae above face (superior/inferior) and (anterior/posterior)

inferior, anterior

D/t the bi-convex articulation at C0-C1, what happens to joint height?

it decreases vertically

What does articular cartilage mean?

it means cartilage on the bone itself as opposed to cartilage between bones (like meniscus)

What is a "no" joint?

it means rotation is the biggest motion occurring here

What is the dermatome for C3

lateral neck

What is the dermatome for C5

lateral shoulder

What are the three possible views for a cervical spine x-ray?

lateral, A/P, odontoid

The CTJ is an important area because of what?

postural dysfunction

Shortening of the suboccipital muscles effects what?

posture

In the cervical spine, the mid-position or neutral position between flexion and extension is the same as what position?

resting position

Upon right rotation at the atlantoaxial joint, the right facet of C1 glides in what direction? and the left facet?

right facet glides posteriorly and the left facet glides anteriorly

In extension at C1-C2, the roll is in what direction and the glide?

roll is posterior, glide is anterior

What are the two degrees of freedom at the atlantoaxial joint?

rotation and flexion/extension

What is the coupled motion of the upper cervical spine?

rotation and side-bending to opposite sides

What two movements are unique to the cervical spine because they work together in movements?

rotation and sidebending

These muscles are important to accessory breathing

scalenes

If there is tension in this muscle, the greater occipital nerve that pierces it may be subject to entrapment

semispinalis capitis

These two muscles are active during upright postures and stabilize the lower cervical spine

semispinalis capitis and cervicis

In regards to load-bearing, what is the mid/lower cervical vertebrae's roll?

serve as load-bearing structure for compressive forces

What is the myotome for C5

shoulder abduction

What is the myotome for C4

shoulder elevation

The lower cervical spine compromises ___ to allow for increased ___

stability, mobility

Since the joints in cervical spine are many and all stacked on top of each other, what happens if you do not move them?

stiffness

How is anterior annulus fibrosis typically damaged? (3)

strains or tears of anterior annulus fibrosis hyperextension trauma strain of lateral portions of the posterior longitudinal ligament when stretched by bulging disc

The superior articular surfaces of the vertebrae below face (superior/inferior) and (anterior/posterior)

superior, posterior

These two ligaments serve as inter muscular septa and are taught with extreme neck flexion

supraspinous ligament and ligament nuchal

What kinds of joints are present within the upper cervical spine?

synovial joints

This is the continuation of the posterior longitudinal ligament that attaches to the foramen magnum

tectorial membrane

How many degrees of combined flexion/extension occur at the atlantoaxial articulation?

ten degrees

If the scalene muscles are tight, what can they compress in the area?

the brachial plexus and subclavian artery

In the case of a heart attack, the referred pain would be?

the left arm

Posteriorly on the cervical discs, the annulus fibrosis does not have any oblique fibers-only vertical fibers. What does this mean?

the majority of our disc problems are posterior

Where do the nerve roots exit with corresponding vertebral level in the cervical spine?

the nerve roots exit above the vertebral level

In right rotation of the mid/lower cervical spine how does the right facet glide? How does the left facet glide?

the right facet glides down and back while the left facet glides up and forward

In right side-bending of the mid/lower cervical spine how does the right facet glide? How does the left facet glide?

the right facet glides down and back while the left facet glides up and forward