Lectures cervical and thoracic spine Flashcards Preview

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Flashcards in Lectures cervical and thoracic spine Deck (66)
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occiput-atlas articulation

- occiput is a convex surface
-atlas is a concave surface
-primary motion is "nodding" 15-20 deg
-side flexion about 10 deg
- no real rotation


Atlas C1

-no body or spinous process
-it develops into ondontoid process of C2
-transverse processes are large


atlas -axis articulation ROM

- primary motion is rotation 50 deg
-flex / ext 10 deg
- side flex 5 deg


transverse cruciate ligament

-holds dens of the axis against the ant. arch of C1


alar ligament

-arise from either side of odontoid and attach to medial aspect of occiput


C3-c6 typical vertebrae

-standard body
-posterior arch
-transver process
- spinous process
-width of body incr as it bears more weight


C7 transitional vertebra variation

-largest spinous process in C/S
-not bifid SP like the other above
- Prime attachment fro ligamanetum nuchae, traps, rhombus minor etc.


zygoapophyseal joint

-superior facets face upward, backward, and medially
-inferior facets face downward, forward and laterally
-angle in cervical 45 deg


Cloward's areas

C3-4 above scap by level of clavicle
C4-5 medial border top of scapular triangle
C5-6 medial border bottom of scap triangle
C6-7 inf border of scap


intervertebral foramen

-transmits nerve roots to and from the spinal canal to extremities
-nerve roots usually pinched by disc of same level
- also contains dural root sleeve, lymphatic channels, small arteries and veins and recurrent meningeal nerve


cervical nerve roots

-more nerve roots than vertebral levels
-C1 nerve roots passes above C1 vertebrae
-thus each nerve root below this is named for the vertebrae above it
-C8 exits b/w C7- T1


nerve root vulnerability

1. epineurium is poorly developed with less collagen and more fragile collagen
2. perineurium, which acts as diffusion barrier is absent at nerve root level
3. fasciculi do not branch , thus more fragil and less flexible


open pack of cervical spine

slight extension


close pack cervical spin

-full extension


capsular pattern of C/S

side flexion and rotation equally limited, extension


Cervical SPine ROM

flexion 440 deg
extension 75
sidebending 35-45
rotation 80-90


uncinated joints

-saddle shape
-limits side flexion if C/S
- uncis is on the superior part f cervical vertebrae
-joint seems to form as the annulus degenerates
-not really fully developed until about 18 yo
-effectively converts a planar joint to more of a concave and beveled surface


vertebral artery

-first branch of subclavian artery
-enters the foramen at C6
-torturous oath, transversing up to the occiput at C2


3 common sites of distortion

-skeletal muscles and fascial bands at or near C6 where artery first enters
-osteophytes around C4-5 and C5-6
-sliding motion of AA articulation


vertebral artery compromise

-rotation of head >50 deg may lead to contra kinking of vertebral artery
- VBI test to be done before quadrant


intervertebral disc

- no disc b/w O-C1 or C-2
-annulus fibrosus has proprioceptors and free nerve endings that are pain sensitive
-there is virtually no nucleus left after 45 years of age
-as disc decr in size, uncinated process grows


what biomechanics rule does
O-C1 follow

O-C1 - convex on concave rule

C2- T1 follows concave on convex rule


Canadian C Spine dangerous mechanisms

-fall from elevation >/= 3 feet/ 5 stairs
-axial load to head
-MVC high speed >100 km/hr, rollover, ejection
-motorized recreational vehicles
-bicycle struck or collision
*** simple reared MVC excludes


cSpine rule not applicable if

-non-trauma case
-GCS <15
-unstable vital signs
-age <16
-acute paralysis
-known vertebral disease
-previous c-spine surgery


acute radiculopathies are associated with...

disc herniation


chronic radiculopathies are associated with ...



contraindications to manual therapy

-cervical instability esp cranioverterbral region
-presence of cancer in C/S
- fracture
- sublaxation
-advanced neurologic signs
-surgical fusion


Thoracic vertebrae facet facing...

inferior facet face down , forward and slightly medially
-oriented about 60 deg from horizontal


Rule of 3's

T1-3 same level as TP
T4-6 SP at a level 1/2 way in b/w its own TP and the TP of the vertebrae below
T7-9 is at the level of the TP of the vertebrae below it
T10 same as T9
T11 same as T6
T12 same as T3


intercostalbrachial nerve

-lateral cutaneous branch of the secondintercostal nerve
-supplies floor of axilla
-joins with medial branch brachial cutaneous n (medial side of arms to dital elbow)