Segmental Stability of The Cervical Spine презентация

Cervical Spine Muscles

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

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

Longus colli and capitus

Longus colli and capitus

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

Superficial Neck Flexors

Scalenes

Lateral neck

Sternocleido-mastoid

Sternocleido-mastoid

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

The extensors

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

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

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

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

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!!!

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

Upper Trapezius and levator Scapulae

Trapezius

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

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

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

Work posture

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

Chin Poke

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

Forward Head Posture

Make best use of office space

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

Correcting neck posture

Upper cervical Flexors

Cervical flexion test-supine
Lead with chin…..dominant sterno-cleidomastoid
Over flexion upper cervical spine …overactive scalenes
Clenching of teeth…hyoid muscles

The Shoulder Complex

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

Typical synovial joint

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

Humerus

Glenoid fossa (scapula)

The shoulder

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

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

Acomioclavicular joint

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

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

Sternoclavicular Joint

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

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

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

Rotator cuff MRI

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

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

Bone spur

X-ray sub-acromial spur

Injections

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

Gleno-humeral dislocation

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

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

Fractured clavicle

Stabilisation for fractured clavicle

Fractured clavicle

Shoulder muscle stability

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

Trunk to Humerus
Latissimus Dorsi
Pectoralis Major

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

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

Latissimus Dorsi

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

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

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)

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

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

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)

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

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

Rotator Cuff
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

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

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

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

Biceps

Levator scapulae and upper trapezius

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

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

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

Scapulae Winging
Weakness of Serratus anterior
Long thoracis nerve palsy

Biceps Rupture

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