CRANIO-VERTEBRAL JOINTS AND SUBOCCIPITAL REGION Lecture Powerpoint 2019.pdf · CRANIO-VERTEBRAL...
Transcript of CRANIO-VERTEBRAL JOINTS AND SUBOCCIPITAL REGION Lecture Powerpoint 2019.pdf · CRANIO-VERTEBRAL...
CRANIO-VERTEBRAL JOINTS AND SUBOCCIPITAL REGION
OUTLINE
I. CRANIOVERTEBRALJOINTSII. PREVERTEBRAL MUSCLESIII. SUB-OCCIPITAL REGION
Muscles ofback extendto neck
Specialized(Suboccipital) muscles atC1 and C2
Correlates:Hangman's fracturesResearch:Anatomy researchbased on imaging
HEADACHE
WORD OF THE DAY -SUBLUXATION =partial dislocation
BODY
VERTEBRAL ARCH
PEDICLE
TRANSVERSE PROCESS
LAMINA
SPINOUS PROCESS
BODY
ARTICULAR PROCESSES(FACETS)
PARS ARTICULARIS(INTERARTICULARIS)VERTEBRAE: ANATOMICAL,
CLINICAL TERMINOLOGY
PARS ARTICULARIS(INTERARTICULARIS) - IMPRECISE CLINICAL TERM (PARS) - part of a vertebra located between the inferior and superior articular processes of the facet joint (region between the lamina and pedicle).
SUBLUXATION -partial dislocationof vertebral body
BODYDISPLACED
CERVICAL VERTEBRA
ant.
post.
lat.view
NOSE
ARTICULAR FACETS -ANGLED SUPERIORLY AND MEDIALLY
- PERMIT -
1) FLEXION-EXTENSION 2) ROTATION
REVIEW:CERVICALVERTEBRA
MOVEMENTS OF HEAD AND NECK: body language
FLEXION - anterior EXTENSION - posterior
LATERAL FLEXION - head on shoulder, face forward
ROTATION - face turned,look over shoulder
YES
NOMAYBE
FIRST CERVICAL VERTEBRA = C1 (ATLAS)
SECOND CERVICAL VERTEBRA = C2 (AXIS)
DENS
Superior articular facets abut occipital condyles -Joint permits Flexion-Extension "yes" movement of head; Does not permit rotation
Ring of Atlas rotates on Dens of C2- C1-C2 Joint Permits Rotational movement of head "No"; Does not permit flex-extend
SUPERIORARTICULARFACET
1. ANTERIOR LONGITUDINAL LIGAMENT -Strong band on anterior side
C. LIGAMENTS
2. POSTERIOR LONGITUDINAL LIGAMENT-weaker, narrower band
3. LIGAMENTA FLAVA - yellow elastic bands connecting laminae
Review ligaments of back
Ligamenta Flava
Posterior Longitudinal Ligament
Anterior Longitudinal Ligament
LIGAMENTS OF SPINAL COLUMN
NOSE
ORIENT TO BISECTED HEAD
ATLAS C1
AXIS C2
NOSE
ATLAS C1
AXIS C2
ATLAS C1
AP view
Antero-posterior film of with mouth open
1. Transverse process of C22. Ramus of mandible3. Odontoid process (dens) of C2
DENS OFAXIS C2
ATLAS C1
1. ANT. ATLANTO-OCCIPITAL MEMBRANE (C1-OCCIP) = ANT. LONG. LIG.
3. POST.ATLANTO-OCCIPITALMEMBRANE(C1-OCCIP) =LIG.FLAVUM
2. MEMBRANA TECTORIA (C2-OCCIP) = POST. LONG. LIG.
B. LIGAMENTS OF CRANIO-VERTEBRAL JOINTS
Some are extensionsof ligaments of vertebral column
C2 FUNCTIONS:STABILIZE JOINTPROTECT MEDULLAPREVENT EXCESSMOVEMENT
NOSE
Note: Post. Atlanto-occipital membrane and Membrana tectoria fuse to DURA
DENS C1
C2
ORIENT TO VIEW STANDING INSIDE VERTEBRALCANAL LOOKING ANTERIOR
MEMBRANA TECTORIA
POST. LONG. LIG.
4. CRUCIATE (CROSS) LIGAMENT-parts
1) Transverse Ligament of Atlas
2) Superior Band to Occipital Bone
3) Inferior Band to Body of C2
C. LIGAMENTS OF CRANIO-VERTEBRAL JOINTS
INFERIORBAND
SUPERIORBAND
TRANSVERSE LIGAMENT OF ATLAS - attaches to inner side of atlas (C1); Holds Dens (C2) Anteriorly
LIGAMENTS OF CRANIO-VERTEBRAL JOINTS
C1
C2
Henry VIII – Executed 72,000 people
Medulla
F/E= Flex-ExtendR=Rotate
Knot
Joint C1-C2 Only Rotates, No Flex-Ext; All Other Joints Flex-Ext
Knot Post. to C1-C2 Flexes Joint ; Sudden Drop Breaks Vertebrae and Ligaments,Vertebrae can penetrate CNS – Instantaneous death ; Knot anywhere else just flexes neck; Death by strangulation -with prolonged Agony
DEATH BY HANGINGFLEXNECK
F/ER
T1 - MRI - BONES,FLUID DARK
F/EF/EF/EF/E
CT OF HANGMAN'S FRACTURE
AXIS C2
ATLAS C1
FRACTURE
ANATOMICALLY,FRACTURES OCCURWITH FLEXION OR EXTENSION OF C1-C2 JOINT; AUTO WRECKS, FALLS IN ELDERLY MOSTLYHYPEREXTENSION
**
CLASSIFYFRACTURESC2
C2
C1
C3
- Fractures of spine occur in 14% of hospital admissions following automobile accidents (cervical 6%)- Reduction by use of both seat belts and air bagsWang, J. Neurosurg. Spine 10: 86-92, 2009
Alar Ligament
5. Alar “Check”Ligaments -From Dens to Occipital Bone- PreventsExcessive Rotation of Head
C. LIGAMENTS OF CRANIO-VERTEBRAL JOINTS
PrevertebralMuscles -Located anterior to Cervical vertebrae
II. PREVERTEBRAL MUSCLES
Lab Prosections:Disarticulate C1 – occipital bone separate in Retropharyngeal Space
Head, structures of ant. and lat.neck can be displaced forward
PREVERTEBRAL MUSCLES
ACT - FLEX NECK/HEADINN - CERVICAL VENTRAL RAMI
2. Longus capitisO - Trans processes C3-C6I - Occipital bone
1. Longus colliO- Trans processes Lowercervical vertebraeI - Bodies upper cervicalvertebrae
Colli = neck in Latin
4. Rectus Capitis Lateralis O - Atlas (Trans process)I - Occip. Bone
PREVERTEBRAL MUSCLES
3. Rectus Capitis Anterior O - Atlas I - Occip. Bone
TRAPEZIUS
Recall: Dissection Back
SUBOCCIPITAL REGION
SPLENIUS CAPITIS AND SPLENIUS CERVICIS-located deep to trapezius
1. Rectus Capitis Post. MinorC1 to Occipital bone
2. Rectus Capitis Post. MajorC2 to Occipital bone
3. Obliquus Capitis SuperiorC1 to Occipital bone
4. Obliquus Capitis InferiorC2 to C1
Rectus Capitis Post. Minor
Rectus Capitis Post. Major
Obliquus Capitis Superior
Obliquus Capitis Inferior
SUBOCCIPITAL MUSCLES
All innervated by -Suboccipital N. (dorsal ramus C1)
Semi-spinalisreflected
SUBOCCIPITAL MUSCLES - actions deduced from origin/insertion and location
1. Rectus Capitis Posterior Minor-Extend2. Rectus Capitis Posterior Major-Extend/rotate3. Obliquus Capitis Superior-Extend4. Obliquus Capitis Inferior-Rotate
SUBOCCIPITAL TRIANGLE = Rectus Capitis Posterior Major, Obliquus Capitis Inferior, Obliquus Capitis Superior
flex-extend
rotate
OCCIPITALBONE
C1 - ATLAS
C2 - AXIS
Rectus CapitisPosteriorMinor
Rectus CapitisPosteriorMajor
Obliquus CapitisInferior
Obliquus CapitisSuperior
NOTE: OBLIQUUS CAPITIS INFERIOR - PRODUCES ONLYROTATION OF HEAD **
SUBOCCIPITAL TRIANGLE - ARTERIES/NERVES
A. NERVES
1) Suboccipital Nerve- Dorsal ramus C1 -Motor to SuboccipitalMuscles2) Greater Occipital Nerve - Dorsal ramus C2 - Sensory to skin
B. ARTERIES
1) Vertebral Artery2) Occipital Artery
C2
C1
Vertebral A.
Occipital A. Suboccipital Nerve
Greater Occipital Nerve
Bifurcation
CommonCarotidArtery
VertebralArtery
InternalCarotidArtery
External Carotid Artery
Lingual Artery
Facial Artery
Maxillary Artery
Occipital Artery
Left side onlyHighMag
VERTEBRALARTERYTURNS ABOVE C1
I
II
III
IVV
VIVII+VIII
IX, X+XI XII
V1V2V3
PITUITARYSTALK INTERNAL CAROTID A.
VERTEBRAL A.
MIDDLE MENINGEAL A.
SEE VERTEBRALARTERY INSIDECRANIAL CAVITY
ANATOMY OF HEADACHE - Headache = pain in any region of the head- Complex because diverse causes: ex. vascular, meningeal, muscular- Structures sensitive to pain: scalp, air sinuses, meninges, arteries and veins- Neural tissue is Insensitive: brain parenchyma (nerve cells, glia; except small part of midbrain)
Sensory Innervation of Dura: from recurrent branches of nerves that enter cranial cavity
- Trigeminal: branches of V1, V2 and V3 (ex. nervous spinosus);- Also: (Vagus X), Upper cervical spinal nerves
V1
V2
V3 branchesex.NervusSpinosus
Sensory branchesof C1 and C2,Vagus (X)
SENSORY INNERVATION OF DURA
TENSION HEADACHE: POSSIBLE ROLE OF SUBOCCIPITAL MUSCLES
DETECT HEAD ROTATION:MUSCLE SPINDLES IN SUBOCCIPITAL MUSCLES
Can contribute to reflexes
ANATOMICAL RESEARCH LIVES!
Rectus Capitis Post. Minor Inserts to Post. Atlanto-Occipital membrane and Dura
RectusCapitisPost minor
Dura
Post. Atlanto-Occip. Membrane = LIG. FLAVA
Cranial dura is innervated; possible cause of headache
OCCIP.BONE
C1
RECTUS CAPITIS POSTERIOR MINOR ATTACHES TO DURA