Cervical Spine Anatomy and Kinematics

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Questions and Answers

How many cervical nerve roots are there compared to the number of cervical vertebrae?

  • There are 8 cervical nerve roots and 7 cervical vertebrae. (correct)
  • There are 8 cervical nerve roots and 8 cervical vertebrae.
  • There are 7 cervical nerve roots and 8 cervical vertebrae.
  • There are 7 cervical nerve roots and 7 cervical vertebrae.

Where does the C8 cervical nerve root exit in relation to the cervical vertebrae?

  • Below the C7 vertebra (correct)
  • Above the C8 vertebra
  • Below the C6 vertebra
  • Above the C7 vertebra

Which anatomical feature is unique to the axis (C2) vertebra?

  • Anterior tubercle
  • Posterior tubercle
  • Transverse foramen
  • Dens (odontoid process) (correct)

What is the primary orientation of the facet joints in the upper cervical spine (C1-C2)?

<p>Horizontal plane (A)</p> Signup and view all the answers

In which plane are the facet joints of the mid to lower cervical spine (C3-C7) oriented?

<p>Midway between horizontal and coronal (D)</p> Signup and view all the answers

Which of the following muscles is located in the posterior triangle of the neck?

<p>Scalene muscles (C)</p> Signup and view all the answers

The dorsal scapular nerve, which innervates the rhomboids and levator scapulae, originates from which cervical nerve root?

<p>C5 (B)</p> Signup and view all the answers

Which nerve from the cervical plexus is known to innervate the diaphragm?

<p>Phrenic nerve (B)</p> Signup and view all the answers

What is the approximate range of motion for cervical flexion, according to normative values?

<p>45 degrees (A)</p> Signup and view all the answers

Approximately what percentage of total cervical flexion and extension occurs at the atlanto-occipital (OA) joint?

<p>20% (C)</p> Signup and view all the answers

What is the approximate range of motion for lateral flexion in each direction in the cervical spine?

<p>45 degrees (C)</p> Signup and view all the answers

Roughly what percentage of cervical rotation occurs at the atlantoaxial (AA) joint (C1/2)?

<p>50% (C)</p> Signup and view all the answers

During cervical extension at the atlanto-occipital (OA) joint, what arthrokinematic motion occurs according to roll/glide mechanics?

<p>Occiput rolls anteriorly and glides posteriorly (B)</p> Signup and view all the answers

During cervical flexion at the OA joint, in which direction does the occiput roll and glide?

<p>Rolls anteriorly and glides posteriorly (A)</p> Signup and view all the answers

What arthrokinematic movement primarily occurs at the atlantoaxial (AA) joint?

<p>Pure rotation with minimal glide (A)</p> Signup and view all the answers

In the C2/3 to C7/T1 segments during cervical motion, what is the primary arthrokinematic movement at the facet joints?

<p>Sliding (B)</p> Signup and view all the answers

What happens to the facet joints on the side of lateral flexion in the C2/3 to C7/T1 segments?

<p>They close (A)</p> Signup and view all the answers

During cervical flexion in the C2-C7 region, in which direction do the inferior facets of the superior vertebra glide on the vertebra below?

<p>Anterior and superior (A)</p> Signup and view all the answers

In cervical lateral flexion, if you laterally flex to the right, what happens to the right facet joint in the C2-C7 region?

<p>Right facet closes (A)</p> Signup and view all the answers

During cervical rotation to the right in the C2-C7 region, what is the motion of the right superior facet?

<p>Glides posteriorly and inferiorly (B)</p> Signup and view all the answers

What is the coupled motion typically observed in the cervical spine (C2-C7)?

<p>Ipsilateral rotation and ipsilateral lateral flexion (B)</p> Signup and view all the answers

What compensatory motion occurs at the C1/2 segment during lateral flexion of the lower cervical spine to maintain horizontal gaze?

<p>Contralateral rotation (A)</p> Signup and view all the answers

Which of the following structures is typically palpated posteriorly in the midline of the neck?

<p>Spinous processes of C2-C7 (B)</p> Signup and view all the answers

Which muscle listed below is NOT typically palpated in the cervical region?

<p>Gluteus maximus (B)</p> Signup and view all the answers

To palpate the transverse processes of C1-C7, where would you typically locate them relative to the spinous processes?

<p>Lateral to the spinous processes (D)</p> Signup and view all the answers

The suboccipital muscles are located in which region?

<p>Posterior base of the skull (A)</p> Signup and view all the answers

Which muscle is a prominent palpable structure in the anterior lateral neck, running diagonally?

<p>Sternocleidomastoid (C)</p> Signup and view all the answers

Which of the following muscles is primarily involved in mastication and can be palpated in the face?

<p>Masseter (A)</p> Signup and view all the answers

Along with the masseter, which other muscle of mastication can be palpated on the lateral aspect of the skull?

<p>Temporalis (B)</p> Signup and view all the answers

The alar ligaments primarily limit which motion at the atlantoaxial joint?

<p>Rotation (D)</p> Signup and view all the answers

The transverse ligament of the atlas plays a critical role in preventing which motion or instability?

<p>Anterior translation of the atlas on the axis (C)</p> Signup and view all the answers

Which cervical nerve roots primarily contribute to the suprascapular nerve?

<p>C5 and C6 (D)</p> Signup and view all the answers

The long thoracic nerve, known to innervate serratus anterior, originates from which cervical nerve roots?

<p>C5, C6, C7 (B)</p> Signup and view all the answers

Which nerve root primarily contributes to the axillary nerve, which innervates the deltoid and teres minor muscles?

<p>C5 (A)</p> Signup and view all the answers

The musculocutaneous nerve, innervating muscles in the anterior compartment of the arm, is formed from which cord of the brachial plexus?

<p>Lateral cord (D)</p> Signup and view all the answers

Which cord of the brachial plexus gives rise to the radial nerve, which innervates posterior arm and forearm muscles?

<p>Posterior cord (A)</p> Signup and view all the answers

The ulnar nerve, innervating intrinsic hand muscles and some forearm flexors, is a continuation of which cord of the brachial plexus?

<p>Medial cord (D)</p> Signup and view all the answers

Flashcards

How many cervical vertebrae are there?

There are seven cervical vertebrae in the neck.

How many cervical nerve roots are there?

There are eight cervical nerve roots.

Where do C1-C7 nerves exit?

C1-C7 nerves exit above their respective vertebrae.

Where does the C8 nerve exit?

C8 nerve exits below C7 vertebra.

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What is the orientation of the upper C-spine facet?

The orientation of the upper cervical facet is horizontal.

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What is the orientation of the mid/lower C-spine facet?

The mid/lower C-spine facet is midway between horizontal and coronal.

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What is cervical flexion?

Forward bending movement of the neck.

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What is cervical extension?

Backward bending movement of the neck.

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What is lateral cervical flexion?

Sideways bending movement of the neck.

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What is cervical rotation?

Turning movement of the neck.

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Atlanto-occipital (OA) joint function

Approximately 20% of total flexion and extension happens here.

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Atlantoaxial (AA) joint function

50% cervical rotation occurs here.

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What do C3-C7 joints do?

C3-7 facet and intervertebral joints supply the rest of cervical motion.

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How does the OA joint move?

OA joint follows roll and glide rules.

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How does the AA joint move?

AA joint allows rotation with minimal gliding.

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How do C2/3-C7/T1 joints move?

C2/3 through C7/T1 joints involve sliding and tilting at the facet and intervertebral joints.

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Cervical extension arthrokinematics

During extension, the facets glide inferiorly and close.

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Cervical flexion arthrokinematics

During flexion, the facets glide superiorly and open.

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Lateral flexion arthrokinematics

With lateral flexion, the superior facet glides inferior and posterior

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Cervical rotation arthrokinematics

With rotation, the superior facet glides posterior and inferior.

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Compensatory counter-rotation

Motion where eyes stay pointed forward.

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Key cervical structures to palpate

Palpate the occiput, spinous processes C2-7, and transverse processes C1-7.

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Muscles to palpate in the neck

Palpate the suboccipital muscles, upper trapezius, and levator scapulae.

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Anterior neck muscles to palpate

Palpate the sternocleidomastoid, masseter and temporalis muscles

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Study Notes

  • The presentation is about the anatomy and kinematics of the cervical spine
  • The objectives are to understand cervical anatomy (bones, joints, muscles, nerves, connective tissues) and the normal osteokinematic and arthrokinematic motions of the cervical spine

Cervical Anatomy

  • There are 7 cervical vertebrae
  • There are 8 cervical nerve roots
  • The C1-7 nerves exit above their respective vertebrae
  • The C8 nerve exits below the C7 vertebra
  • Cervical facet (zygapophyseal joint) orientation includes:
  • Upper C-spine with horizontal plane
  • Mid/Lower C-spine midway between horizontal and coronal
  • Muscles of the neck include:
    • Semispinalis capitis
    • Splenius capitis
    • Sternocleidomastoid
    • Levator scapulae
    • Splenius cervicis
    • Serratus posterior superior
    • Rhomboideus minor (cut)
    • Rhomboideus major (cut)
  • Muscles of the neck
  • Digastric muscle
  • Mylohyoid muscle
  • Stylohyoid muscle
  • External Carotid artery
  • Hyoid bone
  • Thyroid Cartillage
  • Scalene Muscles
  • Clavicle
  • Pectoralis major muscle
  • Sternocleidomastoid muscle
  • Sternothyroid muscle
  • Manubrium of sternum
  • Components of the brachial plexus
  • Dorsal scapular nerve (C5)
  • Phrenic nerve
  • Musculocutaneous nerve (C5, 6, 7)
  • Axillary nerve (C5, 6)
  • Radial nerve (C5, 6, 7, 8, T1)
  • Median nerve (C5, 6, 7, 8, T1)
  • Ulnar nerve (C7, 8, T1)
  • Lateral pectoral nerve (C5, 6, 7)
  • Long thoracic nerve (C5, 6, 7)
  • Upper subscapular nerve (C5, 6)
  • Thoracodorsal (middle subscapular) nerve (C6, 7, 8)
  • Lower subscapular nerve (C5, 6)
  • Medial pectoral nerve (C8, T1)
  • Medial brachial cutaneous nerve (C8, T1) -Contribution from T2
  • The Cerivcal Plexus Consists of:
  • Great auricular nerve
  • Lesser occipital nerve
  • Greater auricular nerve
  • Transverse cervical nerve
  • Supraclavicular nerve

Cervical Osteokinematics

  • Flexion: 45 degrees
  • Extension: 45 degrees
  • Lateral flexion: 45 degrees each side
  • Rotation: 60 degrees each side
  • Approximately 20% of total flexion and extension happens at the atlanto-occipital (OA) joint
  • 5-6 degrees of lateral flexion can occur
  • 50% of rotation occurs at the atlantoaxial (AA) joint (C1/2)
  • C3-7 facet and intervertebral joints supply the rest of the motion

Cervical Arthrokinematics

  • OA joint follows roll/glide rules
  • AA joint is only rotation with minimal to no glide
  • C2/3 through C7/T1 involves:
  • Sliding at facet joints
  • Sliding and tilting at intervertebral joints
  • Results of movement are "opening" and "closing" of facet joints
  • Opening: distance between facet surfaces increases
  • Closing: distance between facet surfaces decreases
  • Cervical Arthrokinematics - Extension
  • OA Roll/ Glide
  • C1/2: Posterior Tilt
  • C2-7: Facets glide inferior and there is closing
  • Cervical Arthrokinematics - Flexion
  • OA: Roll/glide
  • C1/2: Anterior Tilt
  • C2-7: Facets glide superior, and there is opening of facets
  • Cervical Arthrokinematics – Lateral Flexion
  • Superior facet glides inferior and slightly posterior
  • Closing on side of movement, opening on opposite
  • Example: right lateral flexion = right facet closing and left opening
  • OA: Roll and glid according to convex/concave rules
  • Cervical Arthrokinematics - Rotation
    • OA: Almost no rotation
    • AA joint: Glide with pure rotation
    • C2-7: Superior facet glides posterior and slightly inferior
  • Coupled motions
    • Orientation of the facets at C2-7
    • Coupled ipsilateral rotation and lateral flexion
    • Compensatory counter-rotation at C1/2 during lateral flexion
    • Keeps eyes pointed forward
  • Palpation involves palpating:
    • Occiput
    • Spinous processes C2-7
    • Transverse processes C1-7
    • Suboccipital muscles
    • Upper trapezius
    • Levator Scapulae
    • Sternocleidomastoid
    • Masseter
    • Temporalis

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