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side-bending at C1-2?
NONE! the dens blocks it
where is the most sup SP
external occipital protuberance
holes in cervical vertebrae?
- one for the spinal cord
- one in each TP, the transverse foramen, for the vertebral arteries
3 places where atlas interacts with axis
- 2 AA joints (facet joints)
- 1 AO joint between atlas and the ondontoid (the posterior aspect of the ant part of atlas has a litle articular facet for the dens)
which are the "typical cervical vertebrae?"
in the typical c-vert, where is the most flex/ext?
uncinate processes - where? joints are called __ or __
- typical verts
- joints of Van Lushka or uncovertebral joints
facets in c-spine -- what plane?
~45 degrees up from horiz
how to be sure you're palpating it
nickname for C7 bc it has the longest SP
put a finger on it and extend the neck. C7 should stay still bc it's blocked by the ribs, while if you're finger's on C6 it'll disappear
characteristic of the TPs in typical vert
they have a gutter to protect the nerve root, and run pretty much in the X axis under the nerve
special char of SPs in axis and in typical vert
cervical facet joints are in the sagital plane at __ angle,
curve of them?
face which way?
- concave on convex
- inf faces down, forward, lat
- sup faces up, post, med
what kind of joint is it between the ondontoid, ant arch of C1, and lat masses?
motions at C1-2?
rotation only! no flex/ext, no SB
how many degrees of freedom at A/O joint?
paired motions at C0-C1 and C1-C2
SB and rot in opp dir, always!
C2-C3, and in the C-spine below, how do SB and rot interact?
always to the same side
(C0-C2 they're in opp dir)
the two sections
- upside-down cross
- transverse connects two sides of the atlas and keeps the dens in place
- vertical runs from C2 to occiput
dentate ligament, its two components run where?
- apical - dens to basiocciput (straight up the Y axis)
- alar - postero-lat dens to occipital condyles (45 up superolat) -- keeps dens centered. in SB, the ipsilat lig gets slack while contral goes tight
when are the joint surfaces of the lower C-spine maximally congruent, maximally stable?
in max ext
coupled motions with c-spine flex and ext?
none. They're indep, unlike SB and rot
how much ext happens at the A/O jt?
total c-spine ext?
roughly 70, though dancers can get to 90
15 happens at AO
lig nuchae runs where?
inion to C7 along the SPs
ligamentum flavum connects what? limits what
how much flexion in c-spine?
- about 80-90 (though oatis says 35-70)
- flexion is more unstable than ext
SB is ipsi/contralat with rot where?
- above C2 it's contralat rot
- below it's paired with ipsilat rot
how much SB in c-spine?
20-45 degrees to each side (just think of it as 45 degrees though)
how many degrees of rot at C1-C2?
total c-spine rot?
- 32-45 degrees to each side
how does the facet glide on side to which you're rotating?
amount of rot with SB changes how as you go from C2-7?
the rot decreases as you get lower
in L rotation of head and neck, what's happening in upper and in lower c-spine?
- upper -- AO is SB R and slightly flexed
- lower -- SB L and slight ext
where is the cartilage lined surface in an uncinate process?
facing med and sup
capsule of uncovert jts is continuous with what?
annulus fibrosis of the disc
uncovert jt limits what?
when do uncinate processes develop? what type of joint?
- 2nd and 3rd decade -- by the time you're in your 40's it's a fully wt bearing jt bc by then you've had degen of disc
role of uncovertebral joints
- limit SB of neck
- protect nerve from being compressed by disc
total flex/ext in c-spine, and flex/ext separately
- 150-160 degrees
- flex - 80-90
- ext 70
subocciptal (AO) flex/ext
- 20-30 -- total?
- 15 degrees ext
"Lower cervical 100-110 degrees" -- total flex/ext??
lat flex at C0-C1, C1-2, C2-C3 and total in rest of c-spine?
- 45 degrees to each side below
post annulus in c-spine?
there's none - the ring ends at the uncinate process and then there are dense posterior ligaments taking over the role of post annulus
rot at AO, AA, and total ROM
- 7 degrees
- 50% of total
- 80-90 total
IV discs make up what percent of c-spine ht? do what to the shape of the neck
what innervates the outer 1/3 of the IV disc
vertebral and sinuvertebral nerves
nociceptors in IV discs?
borders for nerve root foramen
- sup -inf pedicle
- inf - sup pedicle
- ant - joints of von luschka
- post - facet jt
nerve occupies what % of intervertebral foramen? surrounded by what?
why do we rarely find discs in C-spine prolapsing posterolaterally?
- bc of uncinate process protecting the nerve.
- but that leaves space for ant motion, which is common
4 risks for c-spine nerves
- osteophytes at uncovertebral joints
- swelling of facet capsule
- venous congestion of dural sleeve
- nerve ischemia