LECOM-SH OPP Exam 3

LECTURE 18 - CERVICAL SPINE/NECK!!!!!!!!!!!!!!!!!!!!!!!!!

What are the superior boundaries of the anterior neck?

Mandible

What are the superior boundaries of the posterior neck?

Mastoid process

superior nuchal line

What are the superior margins of the inferior base of the neck?

Manubrium

Clavicle

Acromion

What are the posterior boundaries of the the inferior base of the neck?

1st rib

Junction of C-VII / T1

What are the boundaries of the anterior neck triangle?

Anterior midline, mandible, SCM

What are the boundaries of the posterior neck triangle?

Middle 1/3rd of clavicle, Trapezius, SCM

What are the non-bony anterior neck structures? (there are 6)

1) hyoid bone

2) thyroid notch

3) Laryngeal prominence

4) Median cricothyroid ligament

5) arch of cricoid

6) thyroid gland (left, Isthmus, right lobes)

What are the bony structures of the anterior neck? (only 1)

Hyoid bone (it "floats")

What are the bony structures of the posterior neck?

C0 - Occiput

C1-C7

What is the facial significance of the hyoid bone?

pretracheal fascia begins (superiorly) at hyoid bone

What is shape of the hyoid bone?

U-shaped and contains lesser and greater horns

What is the surrounding superior structural attachments of the hyoid bone?

Floor of the oral cavity

What is the surrounding Inferior structural attachments of the hyoid bone?

Larynx

What is the surrounding Posterior structural attachments of the hyoid bone?

Pharynx

What side of an intervertebral disc is the thickest?

thickest anteriorly

What are the typical characteristics of cervical vertebrae (C3-C6)

- Vertebral body

- specialized transverse processes

- Vertebral foramen

- Facet joints

- Bifid spinous process

What direction of the cervical Facets facing?

B.U.M.

backwards/upwards/medially

What are the characteristics of atypical cervical: C1?

- No body

- Posterior arch is shorter / straighter than anterior arch

- AND - provides

- An articulating surface for the - dens of C2

- Relatively prominent TP

- Superior articular facets are concave and kidney-shaped

- Inferior articular facets are circular and almost flat

What are the characteristc of atypical axis: C2

Dens: upward projection of the body of C2 that articulates with C1 in such a way that it is situated where one would expect the body of C1 to be

What's another term for "dens"?

First palpable spinous process

What is found at Vertebral level CIII/IV?

upper margin of the thyroid cartilage/bifurcation of common carotid

What is found at vertebral level CVI?

Arch of cricoid cartilage,

Superior end of esophagus, superior end of trachea

Rotation: movement in a ___________ plane about a __________ axis

Transverse

vertical

Sidebending: movement in a __________ plane about an _____________ axis.

coronal plane

A-P axis

uFlexion: movement ___________ in a ___________ plane about a ____________ axis.

Forward,

Sagittal,

Transverse

Extension: movement ___________ in a ___________ plane about a ______________ axis.

Backwards

Sagittal

Transverse

How do you assess the Static assessment?

Posture

Anterior inspection for symmetry

Posterior inspection for symmetry

Lateral inspection

Cervical lordosis

How do you assess a dynamic assessment?

- Range of motion (rotation/side bending/Flexion/Extension)

- Global ROM (active ROM)

- Segmental ROM (passive ROM)

Rotation occurs in ____________ plane about a __________ axis

Transverse plane and vertical axis

Sidebending occurs in a ___________ plane about __________ axis

coronal plane and A-P axis

Flexion/Extension occurs in a _________ plane about ____________ axis

Sagittal plane and transverse axis

AGAINNNNNN REVIEW FRYETTES MOTHER F*CKIN PRINCIPLES, 1, 2, and 3

1) in the neutral side bending and rotation are coupled in opposite directions

2) In sufficient flexion or extension, side bending and rotation are coupled in the same direction

3) Initiating movement of a vertebral segment in any plane or motion will modify the movement of that segment in other planes of motion

Classic spinal Mechanics of the Occiput on C-1:

What type does it exhibit?

Exhibits type 1-like mechanics (NO MATTER WHAT) - side bending and rotation are ALWAYS OPPOSITE, regardless of flexion, extension or neutral

Classic spinal Mechanics of the C1-C2 (important info)

C1 on C2 pretty much only rotates and by the C1 motion

Classic spinal Mechanics of the C2-C6:

What type does it exhibit?

Exhibits type II-like mechanics - Sid bending and Rotation are always coupled to the same side, REGARDLESS of flexed, extension, and neutral

Classic spinal Mechanics of C7:

What type does it exhibit?

C7 has inferior facet joints and tend to follow Fayette mechanisms

How are motion patterns in the cervical spine determined by?

the shape of facet joints (independent of discs, ligaments, and musculature

What are the 2 layers of the cranial dura mater?

Outermost: periosteal dura mater layer

Innermost: Meningeal dura mater layer (close contact with arachnoid mater)

What are the 3 dural partitions?

Falx cerebri, Tentorium cerebelli, and Falx cerebelli

What layer is the Falx cerebri apart of?

crescent-shaped downward projection of MENINGEAL DURA MATER

What layer is the Tentorium cerebelli apart of?

Horizontal projection of the MENINGEAL DURA MATER

What layer is the Falx cerebelli apart of?

Small midline projection of the MENINGEAL DURA MATER

What are the major muscle groups of the neck?

- muscles of the pharynx

- muscles of the larynx

- strap muscles

- muscles of the outer cervical collar

- postural muscles in the muscular compartment of the neck

What 3 muscles are in the superficial posterior portion of the neck AND attach to the cervical spine?

- trapezius

- erector spinae group

- Levator scapulae

What 2 muscles are in the intermediate posterior portion of the neck?

- splenius cervicis

- splenius capitis

What 6 muscles are in the deep posterior portion of the neck?

- Iliocostalis cervicis

- Longissimus cervicis and capitis

- Spinalis cervicis

- Semispinalis capitis and cervicis

What are the 6 groups of anterior neck muscles?

- Platysma

- SCM

- Hyoid muscles

- Strap muscles

- Scalenes

- Prevertebral muscles

Do cervical spinal nerves exit at, below, or above the corresponding vertebra?

ABOVE their numbered vertebrae (exception is C8 and it exits below C7)

What is the Muscle strength test for C5?

Biceps - elbow flexion

What is the Muscle strength test for C6?

Extensor carpi radialis - wrist extension

What is the Muscle strength test for C7?

Triceps - elbow extension

What is the Muscle strength test for C8?

flexor digitorum profundus - 3rd digit flexion distally

What is the Muscle strength test for T1?

ABDuctor digiti minimi - finger abduction

What is the Deep Tendon Reflex (DTR) for C5?

Biceps Tendon

What is the Deep Tendon Reflex (DTR) for C6?

Bracioradialis

What is the Deep Tendon Reflex (DTR) for C7?

Triceps Tendon

Where does the vertebral artery arise from?

1st part of the subclavian artery

What levels of vertebrae does the vertebral artery pass through? what is the foramen called?

through 6-1 cervical vertebrae and through the transverse foramen

LECTURE 19 HEENT - !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

OOOOOOoooooOOOOOO list the osteopathic Tenets whoop whoop!!

Whats 1?

Whats 2?

Whats 3?

Whats 4?

1) The body is a unit - MIND, BODY, AND SPIRIT! (Biopsychosocial approach to ALL patients)

2) Self-regulation, self-healing, and health maintenance

3) Structure and function are reciprocally interrelated

4) Rational treatment is based upon the above tenets

How many bones in the adult skull?

29

What are the bones in the cranial group? (6 total)

ØOcciput

ØSphenoid

ØEthmoid

ØFrontal

ØTemporal (2)

ØParietals (2)

What are the bones in the facial group?

ØVomer

ØMandible

ØMaxillae (2)

ØPalatines (2)

ØZygomatics (2)

ØLacrimals (2)

ØNasals (2)

ØInferior conchae (2)

Which 2 bones function as paired bones?

Frontal and mandible

What bones combine to form the pterion suture? IMPORTANT

1. Frontal

2. Parietal

3. Sphenoid

4. Temporal

What bones combine to form the Asterion suture? (IMPORTANT)

1. Parietal

2. Temporals

3. Occiput

What bones combine to form the Lambda? (IMPORTANT)

1. Parietals

2. Occiput

What forms the coronal suture?

frontal and parietal bone

What forms the bregma landmark?

Intersection of Coronal & Sagittal Sutures

What forms the lambdoid suture?

parietal bone and occipital bone

What forms the sagittal suture?

both parietal bones

What passes through the optical canal?

optic nerve and opthalmic artery (everything else eye-wise passes through the superior orrbital fissure)

WWHHOOOOOO Said "The cerebro-spinal fluid is the highest known element in the human body...."

our man :) A.T. Still

WWHHOOOOOO Said " All nerves drink from the waters of the brain"

our man :) A.T. Still

Who came up with the cranial rhythmic impulse (CRI)?

William Garner Sutherland

Who came up with Primary respiratory mechanism (PRM)

William Garner Sutherland

Who said, "The human brain is a motor; the breath of life is a spark of ignition to the motor, something that is not material, that we cannot see."

William Garner Sutherland

What is the first cranial concept?

1.Inherent motility of the brain and spinal cord

What is the second cranial concept?

2.Fluctuation of the cerebrospinal fluid

What is the third cranial concept?

3.Mobility of the intracranial and intraspinal membranes

What is the fourth cranial concept?

4.Articular mobility of the cranial bones

What is the fifth cranial concept?

5.Involuntary mobility of the sacrum between the ilia

what is the sphenobasilar synchondrosis (SBS)

- Articulation of the sphenoid with the occipital

What does the angle of the SBS define?

flexion phase and extension phase

What type of joint is the Temporomandibular joint (TMJ)?

Ellipsoid, Synovial joint

What are the motions of the TMJ?

depression, elevation, protraction/retraction, lateral glide

What happens when you depress the TMJ?

mouth opens, ad mandibular head glides anteriorly

What happens when you elevate the TMJ?

mouth closes and mandibular head glides posterioly

What are the muscles of the TMJ?

temporalis, masseter, lateral pterygoid, medial pterygoid

What is the action of the temporalis?

elevates and retracts mandible

What is the action of the Masseter?

Elevation, protraction, ipsilateral lateral glide

What is the action of the lateral pterygoid?

Depression, protraction, contralateral lateral glide

What is the action of the medial pterygoid?

Elevation, protraction, contralateral lateral glide

Review head and neck musculature and vasculature if you'd like :))

Review Cranial nerves!!! Slide 27 & 28 of lecture 19 PPT

Example/symptoms of nerve entrapment of CN V?

Headache, Trigeminal neuralgia

Example/symptoms of nerve entrapment of CN VII?

Altered taste, Bell's palsy

Example/symptoms of nerve entrapment of CN VIII?

Vertigo, tinnitus

Example/symptoms of nerve entrapment of CN IX and X?

Poor suckling, FTT

Example/symptoms of nerve entrapment of CN III, IV, VI

Blurred vision, diplopia, eye fatigue, headache