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