MT-01 Anatomy and biomechanics of cervical spine-102024 [Autosaved].pptx

Anatomy of cervical

1. 10/30/24 Presentation Title | Presented By: MR 1 DPT 6 TH SEMESTER MUJEEB UR RAHMAN ASSISTANT PROFESSOR IPM&R KMU

2. Objectives 10/30/24 Presentation Title | Presented By: Name 2 CERVICAL SPINE • Functional anatomy and movement • Notes on evaluation and treatment • Cervical tests and mobilizations

3. 30/10/2024 3 Vertebral column

4. 30/10/2024 4 ARTICULATIONS & FUNCTIONAL ANATOMY OF THE CERVICAL SPINE

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7. 30/10/2024 16 For examination and treatment purposes cervical spine (SP) can be divided into upper cervical, mid cervical and lower cervical. The cervical spine is the most mobile section of the whole spinal column and also the most vulnerable. Richest in afferent proprioceptive nerves, which exercise an effect on the entire locomotor system. DIVISION OF CERVICAL SPINE

8. Cervical spine division & Related Disorders: 30/10/2024 17 High cervical spine (UCS): Occiput - C2 No disc between occiput-C1 & C1-C2. Disorders of the upper cervical spine frequently result in cervicogenic headaches from arthritic joints Mid cervical spine (MCS): C3-C5 Disorders in this region are most commonly of synovial joint type disorders & may refer symptoms upwards or downwards. (Facet sprain/strain)

9. 30/10/2024 18 Lower cervical spine (LCS): C5-C7 Disorders are mostly due to: Prolapsed intervertebral discs Degenerative discs and joints Nerve root entrapment

10. Atlas 30/10/2024 19 Lacks a vertebral body and is replaced by a superior projection from the second vertebra - the dens (odontoid process). Resembles a washer sitting on a peg between the occiput and the axis. Bony regions - anterior arch, lateral masses and posterior arch.

11. Axis: 30/10/2024 20 The second cervical vertebra. A pivot on which the combined occiput and atlas rotate. The dens is located on the superior aspect of the vertebra body. Dens articulates with the anterior arch of the atlas. Apical ligament attaches the tip of the dens to the occiput.

12. Upper Cervical Joints 30/10/2024 21 Many of synovial joints are present with these small bones; Between the condyles of the occiput and the atlas. Between the lateral masses of the atlas and axis. Between the dens and the anterior arch. There is no intervertebral disc between occiput & C1 or between C1 & C2

13. Movements 30/10/2024 22 The upper cervical spine is responsible for approximately 50% of the motion that occurs throughout the entire cervical spine. Motions at the O-A and A-A joints occur relatively independently, while below C2, normal motion is a combination of motion at other levels.

14. 30/10/2024 23 Flexion and extension Cervical spine flexion/ extension= 50°).Occurs at both (Atlanto-occip) C0-1 and (Atlanto-axial) C1-2 regions. C0-1 has slightly more flexion/extension than C1-2. (C0-C1=25°, C1-C2=20°). Rotation Small amount of rotation occurs at C0-C1 Approximately 40°-50 degrees of rotation occur at C1-2.Nearly 60% of cervical rotation occurs at the upper cervical spine. (Total cervical rotation=80°). Lateral Flexion Cervical Lat Flexion= 40-50°.To achieve these movements, thoracic spine till T4 should move freely. Independent movement in each segment in each direction. Loss of independent movement in any segment will effect functional range .

15. Coupled movements 30/10/2024 24 Coupling of movement at each motion segment. Essential for normal functional capacity. Upper cervical spine (Occiput-C2) Lateral flexion accompanied by rotation in the opposite direction. Mid and Lower Cervical spine In C2-C3 & Onwards Lateral Flexion accompanied by rotation in the same direction.

16. Mid & Lower Cervical Spine (Vertebral Bodies) 30/10/2024 25 Wider transversely as compared to antero-posterior direction. Significantly smaller than either the thoracic or lumbar vertebral bodies. Serves as a load-bearing structure for compressive forces.

17. Unciform Processes 30/10/2024 26 Found on the superior posterolateral rim of the vertebral bodies. Unciform process consists of a ridge that runs antero-posteriorly.Converts the superior planar surface to a concave surface. The inferior aspect of the vertebra above is reciprocally shaped. This articulation (vertebra above and unciform processes) is referred to as the uncovertebral joints or the joints of Luschka .

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19. Pedicles 30/10/2024 28 Project posterolaterally from the vertebral bodies. Making spinal canal relatively large and triangular rather than round. The anterior wall of the spinal canal is relatively straight.

20. Transverse processes 30/10/2024 29 Anterior and posterior components united by a small strut of bone. The whole arrangement is referred to as the transverse process. The space in the middle is called the transverse foramen. The vertebral artery courses through this foramen. Cervical nerve roots exit and lie in the groove of the transverse process.

21. In the lower cervical region the SP are relatively short with bifid tips. Increase in length between the 3rd cervical spine and the 2nd thoracic spine. If Spinous processes are too long then range of extension is compromised. The bifid tips decrease this impaction to some extent. 30/10/2024 30 Spinous Processes (SP)

22. Apophyseal Joints 30/10/2024 31 Each vertebra in the lower cervical spine has two superior articular processes and two inferior articular processes. These articular processes have articular facets and combined they form the articular pillar.

23. Articular Facets 30/10/2024 32 Mean inclination is 45 degrees to the frontal plane. Superior facets face posterior and superior. Inferior facets face anterior and inferior. Joints are surrounded by a joint capsule.

24. Inter-vertebral discs 30/10/2024 33 The IVDs of the vertebral column lie between the adjacent superior and inferior surfaces of the vertebral bodies from C2 to S1 and are similar in shape to the bodies The IVD forms a symphysis or amphiarthrosis between two adjacent vertebrae and represents the largest avascular structure in the body. Each disk is composed of an inner nucleus pulposus (NP), an outer annulus fibrosus (AF), and limiting cartilage end plates. The annulus and end plates anchor the IVD to the vertebral body.

25. 30/10/2024 34 The IVDs contribute 20–25% of the length of the vertebral column In cervical and lumbar regions, the IVDs are thicker anteriorly and this contributes to the normal lordosis . In the thoracic region, each of the IVDs is of uniform thickness. The major stresses that must be withstood by the IVD are axial compression, shearing, bending, and twisting

26. 30/10/2024 35 In the upper cranio -vertebral region (occiput to C2), there is comparatively little flexion–extension, whereas the mid to lower cervical spine permits increasing flexion–extension movements from approximately 10° at the C2–3 level to about 20° at C5–6 and C6–7. Axial rotation in the upper cervical spine is 30–40° in each direction, whereas it is 5–6° in the lower cervical spine. Zygapophyseal joints of the spine are capable of only two major motions: gliding upward and gliding downward

27. 30/10/2024 36 BIOMECHANICS

28. 30/10/2024 37 The motions that occur at the cervical spine correspond to motions of the head It is estimated that the osseoligamentous system contributes 20% to the mechanical stability of the cervical spine while 80% is provided by the surrounding neck musculature The role of the ligaments in stabilization occurs mainly at end of range postures while the muscles supply dynamic support in activities around neutral- and mid-range postures

29. 30/10/2024 38 At the zygapophyseal joints, there is a sagittal range of 50–80 degrees in each direction of flexion and extension The only significant arthrokinematic motions available to the zygapophyseal joint are an inferior, medial glide of the inferior articular process of the superior facet during extension and a superior, lateral glide during flexion Segmental side bending is, therefore, extension of the ipsilateral joint and flexion of the contralateral joint. Rotation, coupled with ipsilateral side bending, also involves extension of the ipsilateral joint and flexion of the contralateral

30. Flexion 30/10/2024 39 Flexion may be divided into three sequential phases The initial phase begins in the lower cervical spine (C4–7) where C6–7 makes its maximum contribution followed by the C5–6 segment and then by C4–5. Motion in the second phase occurs initially at C0–2 followed by C2–3 and C3–4. The first phase of motion occurs again at the lower cervical spine (C4–7) initially, with the C4–5segment followed by C5–6 then the C6–7 segment

31. 30/10/2024 40 At the segmental level, flexion is described as an anterior osteokinematic rock tilt of the superior vertebra in the sagittal plane, a superoanterior glide of both superior facets of the zygapophyseal joints, and an anterior translation slide of the superior vertebra on the IVD. This produces an anterior (ventral) compression and a posterior (dorsal) distraction of the cervical disk Consequently, the main arthrokinematic motion that seems likely to be occurring here is an anterior spin (or very near spin).

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33. Extension 30/10/2024 42 Extension is described as a posterior osteokinematic sagittal rock, an inferoposterior glide and approximation of the superior facets of the zygapophyseal joints, and a posterior translation of the vertebra on the disk The uncovertebral joint undergoes a posterior arthrokinematic spin.

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35. Lateral flexion 30/10/2024 44 Side bending (lateral flexion) is an ipsilateral osteokinematic rock, a superoanterior glide of the contralateral superior facet, and a posteroinferior glide of the ipsilateral facet In addition, there is a contralateral translation of the vertebra on the disk, an inferomedial glide of the ipsilateral uncovertebral joint, and a superolateral glide of the contralateral uncovertebral joint.

36. 30/10/2024 45 A composite curved translation results. This curve is formed by the superoinferior linear glides of the zygapophyseal joints, the oblique inferomedial and superomedial glides of the uncovertebral joints, and the linear translation across the disk.

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38. Rotation 30/10/2024 47 Rotation is chiefly an osteokinematic motion of the vertebra about a vertical axis that is coupled with ipsilateral side bending Presumably, the translation follows the side bending (i.e., contralateral ), resulting in the same uncovertebral and zygapophyseal arthrokinematic motions as does side bending.

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40. 10/30/24 Presentation Title | Presented By: Name 49 Tuck Chin In This action produces upper cervical flexion with lower cervical extension Poke Chin Out This action produces upper cervical extension with lower cervical flexion

41. Subjective and objective examination next >>>>