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Applied anatomy
Upper cervical applied anatomy
Question | Answer |
---|---|
Features of atlas | 1. no spinous process 2. widest of all C vertebrae 3. posterior arch=spinous process 4. lateral masses=body 5. 2 superior biconcave facets and 2 inferior biconvex |
Features of Axis | 1. Strongest vertebra 2. Odontoid process 3. Axis for rotation of head and C1 (most in C spine) 4. 2 superior biconvex facets |
Craniovertebral joints | two atlantooccipital joints, convex on concave and 4 atlanto axial: 2 biconvex and 2 pivot synovial |
A/O joint | 1. biconvex condyles of occiput on biconcave facets of C1 2. Extension of 25 degrees and flexion of 10 degrees and SB of 5 degrees 3. connected by anterior and posterior atlantooccipital membranes |
Anterior A/O membrane | anterior arch of C1 to anterior rim of foramen magnum |
posterior A/O membrane | Posterior arch of C1 to posterior rim of foramen magnum |
Median A/A joint | Dens of C2 to ant. arch of C1 connected by transverse ligament posteriorly and alar ligaments on the sides |
Alar ligaments | tension with ext or flexion combined with rotation. Restricts rotation and SB to contralateral side |
ADI | Atlanto Dental Interval. Anterior: shift of 3.5mm of C1 on C2 means transverse ligament injury and >5mm includes alar ligament too Posterior: <14mm there is a chance of cord compression |
Ideal posture for C spine | Muscle balance between posteior semispinalis capitis and levator scapulae and anterior SCM and scalenus anterior |
Foreward head | stress on spleneus capitis and levator. Rectus capitis posteior major contracts to keep extension. increased scalene tension elevates ribs. there is a flexion torque on c spine. cause could be TOS, headache, midcervical instability, TMD, disc derangement |
Suboccipital triangle | 1. Suboccipital nerve--> rim of foramen magnum and posterior arch of C1. motor innervation to occipital muscles Vertebral A. Greater occipital N--> between posterior arch of atlas and lamina of C2. Sensory to scalp and susceptible to compression |
Deep anterior neck flexors | rectus capitis anterior, rectus capitus lateralis, longus capitus |
sinuvertebral nerve | sensory nerve that branches from ventral aspect of spinal nerves and turns back into IV canal. Innervates PLL, ant. dura mater and facet capusule, and vascular structures |
Segments of vertebral artery | 1. Proximal: Subclavian A to C6 TP 2. Transverse:C6-C2 TP 3. Suboccipital: C2 to foramen magnum 4. within the skull from foramen magnum |
VBI | Suboccipital 4 curves: 1. within transverse forament of C2 2. between C2 and C1 3. within C1 transverse foramen 4. between posterior arch of atals and foramen magnum |
should a person who has no history of VBI ever be tested for it? | yes, any time the treatment of choice is traction, mobilization, or manipulation it is a good idea to do sustained extension, rotation, simulated manipulation position, and ask a thorough history about diziness |