Segmental Stability of The Cervical Spine

1.

Segmental Stability of
The Cervical Spine

2.

Cervical Spine
Muscles

3.

Neck Flexors
Superficial
• Sternocleidomastoid
• Scalenes
• Supra-hyoid muscles
• Infrahyoid musles
–
–
–
–
Deep
Longus Colli
Longus Capitus
Rectus Capitus
Anterior
Rectus Capitus
Lateralis

4.

Deep neck flexors
Deep
Attach directly to the vertebrae
Single segments
Close to axis of rotation
Tonic activity
Support the spinal curve

5.

Longus colli and
capitus

6.

Longus colli and
capitus
QuickTime™ and a
decompressor
are needed to see this picture.

7.

Superficial Neck
Flexors
Predominantly Mobilisers
Also lateral flexion and rotation
Hyoid muscles also control hyoid
movement (for speech and swallowing)
therefore only secondary cervical spine
mobilisers

8.

Superficial Neck
Flexors

9.

Scalenes
QuickTime™ and a
decompressor
are needed to see this picture.

10.

Lateral neck

11.

Sternocleido-mastoid

12.

Sternocleido-mastoid
QuickTime™ and a
decompressor
are needed to see this picture.

13.

14.

Neck
Extensors
Deep Extensors
Spinales
Semispinalis
Rotators
Intertransversarii
Interspinales
• Suboccipital
extensors
Multifidus
Superficial Extensors
• Upper trapezius
• Levator scapulae
• Splenius
• Longisimus

15.

The extensors

16.

Sub-Occipital
Extensors
(• upper
cervical
spine)
Rectus Capitus
posterior major
and minor
Occiput to C1 and C2
Obliquus capitus superior and inferior
Occiput to C1 and C1 to C2
Head on Neck Stabilisers

17.

Upper cervical
extensors
• Bilaterally upper cervical extension .
Mainly work to control excessive upper
cervical flexion.
Control excessive movement
• Eccentric activity
• Significant proprioceptive function

18.

Deep neck extensors
( mid to low cervical
spine)
Eccentric action to control movement
Proprioceptive role

19.

Deep neck extensors
Segmental control of extension mid to
lower cervical spine
Limit and control excessive cervical
flexion and shear /translation forces
Unilaterally controls rotation and lateral
flexion
Proprioceptive role

20.

Mobility
Muscles
• Splenius mastoid to C4-T3
Slenius cervicus TP C1-2 to Sp T4-6
Longissimus capitus Mastoid to TPC5-6
Iliocostalis cervicus TP C4-6 to ribs 3-6
Levator scapulae TP C1-4 to
superiormedial border of scapula
Lets just call them superficial extensors!!!

21.

Superficial Extensors
Upper and lower cervical extension
Not segmental
Ipsilateral rotation and lateral flexion
without segmental control

22.

Upper Trapezius and levator
Scapulae

23.

Trapezius
QuickTime™ and a
decompressor
are needed to see this picture.

24.

Levator Scapulae and
Upper
Trapezius
• Mainly
mobility of
scapula
Can also produce Neck extension and
lateral flexion but not their prime role
No segmental control
problematic if become short and stiff

25.

Ideal Neck Posture
Plane of neck and jaw should
be different not one continuous
line
Plumb line drawn down centre
of neck should be neutral or
within 10 degrees of forward
inclination
Plumb line from ear lobe
should fall just in front of
clavicle
Look for creases and
assymmetries

26.

Common Posture
types
Chin Poke ( upper cervical spine)
Forward head ( lower cervical spine)
Forward head with chin poke
Can also get a hinge or mid cervical
collapse

27.

Work posture

28.

Chin Poke
upper cervical spine
Short/overactive muscles
-Sterno cleido mastoid-suboccipital
extensors
Weak /lengthened muscles
-deep neck flexors

29.

Chin Poke

30.

Forward Head
lower cervical spine
Short overactive muscles
-scalenes
Weak/lengthened muscles
-Deep neck flexors
- Deep neck extensors

31.

32.

Forward Head Posture

33.

34.

35.

Make best use of office space

36.

Occupational therapy for patients can be used
creatively to ease the A&C shortages

37.

Correcting neck
posture

38.

Upper cervical Flexors

39.

40.

Cervical flexion testsupine
Lead with chin…..dominant sternocleidomastoid
Over flexion upper cervical spine
…overactive scalenes
Clenching of teeth…hyoid muscles

41.

42.

The Shoulder Complex

43.

4 joints
• The glenohumeral joint
• The acromioclavicular joint
• The Sternoclavicular joint
• The Scapulothoracic articulation

44.

45.

46.

Typical synovial joint

47.

The glenohumeral joint
Ball and socket synovial joint
Large humeral head
Small glenoid fossa
Stability sacrificed for mobility

48.

Humerus

49.

Glenoid fossa
(scapula)

50.

The shoulder

51.

Gleno-humeral movement
• Flexion
• Extension
• Internal (medial) Rotation
• External (lateral) Rotation
• Abduction
• Adduction

52.

The Acromioclavicular joint
Small plane joint
The lateral end of the clavicle and the
acromion process of the scapula
Joins the scapula to the clavicle
Small gliding movements through
shoulder elevation
Rotation of scapular around clavicle

53.

Acomioclavicular joint

54.

Acromioclavicular joint sprain
Fall onto point of shoulder.
Sprain or disruption of the acromioclavicular ligaments
Grade 1 to 3
Step deformity with grade 3

55.

The Sternoclavicular joint
• Small fibrous plane joint
• Between the medial end of the clavicle
and the sternum
This attaches the shoulder complex to
the trunk
Gliding Movements and rotation of the
clavicle on the sternum
Allows end range elevation

56.

Sternoclavicular Joint

57.

The Scapulothoracic articulation
Not a true synovial joint
Allows the scapula to glide around the
thoracic wall
Keeps the glenoid in contact with the
humerus
Supported only by muscles

58.

59.

Scapulohumeral
rhythm
During 180 degrees of arm elevation
2:1 ratio of humeral to scapula movement
-120 degrees glenohumeral
- 60 degrees scapulothoracic
Occurs in 3 phases

60.

Phase 1
abduction
- 30 degrees GH
Scapulohumeral
- minimal scapula
movement rhythm
Phase 2 and 3
- 90 degrees of GH
abduction
- 60 degrees of scapula
rotation
Phase 3
the scapula
rotation of the
clavicle
- mainly elevation of
and posterior

61.

62.

63.

Rotator cuff MRI

64.

Impingement
Syndrome
Structures between the humerus and the
acromion can become compressed and
pinched during elevation of the arm. The
space is at its narrowest between 70 and
120 degrees.
• Supraspinatus tendon
• Long head of biceps
• Sub-acromial bursa

65.

66.

Biomechanical risk factors
Internal rotation of the shoulder during
elevation
Secondary impingement due to reversed
scapulohumeral rhythm
Short 2 joint muscles

67.

Bone spur

68.

X-ray sub-acromial
spur

69.

70.

Injections

71.

Glenohumeral
Excessive translation
of the large humeral head on
Instability
the relatively small glenoid due to
- Damaged ligaments
- Poor muscle control
Unidirectional (anterior or posterior)
Multidirectional (global)
Instability tests
Need to improve dynamic control

72.

Gleno-humeral
dislocation

73.

Frozen Shoulder
Frozen shoulder is characterised by
progressive pain and stiffness in the
glenohumeral joint
Can be idiopathic or following injury
3 stages all lasting about 6 months

74.

Frozen Shoulder
stages
• Stage 1 Progressive and severe pain. Little
stiffness
• Stage 11 Plateau in pain and increasing
stiffness
• Stage 111 Little pain. Shoulder very stiff

75.

Fractured clavicle

76.

Stabilisation for
fractured clavicle

77.

Fractured clavicle

78.

79.

Shoulder muscle
stability

80.

Role of The Scapula
Provides base for muscle attachment
Allows the glenoid to upwardly rotate therefore
allowing a greater range of shoulder movement
Elevation/depression
Abduction/adduction
Upward and downward rotation

81.

Trunk to Humerus
Latissimus Dorsi
Pectoralis Major

82.

Latissimus Dorsi
O- spinous processes of T6-12;
iliac crest; 3 lower ribs and interdigitates with external oblique
I- Interbercular groove humerus
A- GH internal rotation; depression ; extension

83.

Pectoralis Major
O- sternal end of clavicle;
strenum; external oblique;rib cartilages 2-6
I- greater tubercle of humerus
A- Adducts the abducted arm :
internal rotation ; forward adduction across chest

84.

Latissimus Dorsi

85.

Trunk to Shoulder Complex
Pectoralis Minor
Trapezius
Levator Scapula
Rhomboids
Serratus Anterior

86.

Pectoralis Minor
O- Ribs 3-5
I- Coracoid process of scapular
A- Downward rotation scapula; depresses shoulder;
moves inferior angle backwards ( pseudo-winging)

87.

Trapezius
Upper; Middle ;Lower.
O- Occiput; spinous processes C7-12
I- lateral 1/3 of clavicle; acromion; spine of scapula
A- Scapular retraction; upward rotation;
( upper traps -scapular elevation; lower traps- depression)

88.

89.

90.

Levator Scapulae
O- C1-4
I- vertebral border of scapula
A- scapular elevation; scapular elevation

91.

Rhomboids
Major and Minor
O- spinous processes C7 to T5
I- root of spine of scapula
A- Downward rotation of scapula;
retraction of scapula

92.

Serratus Anterior
O- Fleshy digitations from upper 9 ribs
I- Medial border of scapula (interdigitates with external oblique)
A- Protraction of scapula;
Force couple with traps -upward rotation of scapula
(interdigitates with external oblique)

93.

• Supraspinatus
Scapula to Humerus
• Infraspinatus
• Teres Minor
• Subscapularis
• Deltoid
• Coracobrachialis
• Teres Major
• Biceps (long head)
• Triceps(long head)

94.

Teres Major
O- post surface of inferior angle of scapular
I- lesser tubercle of humerus
A - GH extension (particularly from a raised position)
internal rotation

95.

Rotator Cuff
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

96.

Supraspinatus
O- supraspinous fossa of scapula
I- Greater tubercle of humerus
A- GH Abduction
prevents superior movement of humeral head

97.

Infraspinatus and Teres
Minor
O- infraspinous fossa scapula
I- greater tubercle of humerus
A- GH external rotation
prevents posterior glide

98.

Subscapularis
O- Subscapular fossa
I- lesser tubercle of humerus
A-GH internal rotation
prevents anterior translation

99.

100.

101.

Biceps

102.

Levator scapulae and upper
trapezius

103.

Scapular stabilisers
Serratus anterior
protracts the scapula
upward rotation of the glenoid
Trapezius
Upper and Middle fibres retract and upwardly
rotate
Lower fibres upward rotation of glenoid and
counterbalance lateral pull of serratus anterior

104.

Scapula Mobility
• Levator Scapulae
-scapula elevation
Muscles
-glenoid downward rotation
Pectoralis minor -glenoid downward
rotation
-pseudo winging
Rhomboids -scapula elevation and
retraction
-glenoid downward rotation

105.

Glenohumeral Stability
Supraspinatus - abduction
- resists anterior translation
Infraspinatus and Teres Minor
- external rotation
- resist posterior translation
Subscapularis
-medial rotation
resists anterior translation
-

106.

Scapulae Winging
Weakness of Serratus anterior
Long thoracis nerve palsy

107.

Biceps Rupture

108.

109.

110.

111.

112.

113.

114.

115.

116.

The to do list gets longer

117.

And at some point we’ve all had
enough – pity it’s 9am on Monday!