Anatomy Exam 2

Multifidus insertion

Lateral surface of C2-L5

Anterior circumflex humeral

Origin is axillary artery. Smaller than posterior; supplies shoulder

Coracobrachialis blood supply

brachial artery

Dura mater blends with

epineurium

Anconeus insertion

lateral surface of olecranon and superior part of posterior surface of ulna.

rotators function

vertebral rotation and proprioception

Dura- arachnoid interface

(wrongly called subdural space) is not usual space. Bleeding into layer can create space where subdural hematoma forms

Secondary centers of vertebral column

1 spinous process, 2 transverse process, 2 epiphyseal ring

Spinal Veins drain to

12 anterior and posterior medullary and radicular veins

Thoracic vertebrae

12, articulate with ribs

First part of axillary artery

1st rib to medial border of pectorals minor. Has 1 branch, superior thoracic artery

Superficial sensory supply

2 dermatome, segmental progression, both are approximations

Xray

2D. White, black, and shades of gray. Inexpensive.

Veins

3 anterior and 3 posterior spinal veins in subarachnoid space

Central lymph nodes

3-4 nodes, receive lymph from pectoral, sub scapular, humeral nodes, mammry glands, some upper limb. Deep to pectorals minor and found in axillary arteries.

Coccyx

3-4 small coccygeal vertebra. Fused.

Pectoral (anterior) lymph node

3-5 nodes, receive lymph from anterior thoracic wall, include mammary gland. Important during breast exam

coccygeal vertebrae

3-5, fuse to form coccyx

Pectoralis Minor Proximal Attachment

3rd-5th ribs near their costal cartilages

Humeral (lateral; brachial) lymph nodes

4-6 nodes, receive lymph from upper limb, become inflamed during upper limb infections

Nerves of the Breast

4th - 6th intercostal nerves Rami communicans Sympathetic fibers

Growth and development of vertebral column

4th wk- 25 yrs. Primary centers: 1 centrum, 2 neural arch.

sacral vertebrae

5, fussed to form sacrum

Lumbar vertebrae

5, large bodies

Apical lymph nodes

6-12 nodes, receive lymph from all axillary nodes, mammry gland, vessels running with cephalic vein. Connection with deep cervical nodes resulting in spread of breast cancer to deep neck

Subscapular( posterior) lymph nodes

6-7 nodes, receive lymph from posterior aspect of thoracic wall and scapular region.

Cervical vertebrae

7 including axis and atlas, transverse foramen

Dislocated shoulder of Humerus at Glenohumeral Joint signs and symptoms may include:

A visibly deformed or out-of-place shoulder Swelling or bruising Intense pain Inability to move the joint

Abduction Muscles of arm

A-Deltoid Supraspinatus (1st 15 degrees)

Thorotrast

Absorbed by liver, spleen, and skeleton. Half-life of 22 years

Pectoralis Major Main Action

Adducts and medially rotates humerus; draws scapula anteriorly and inferiorly Acting alone, clavicular head flexes humerus and sternocostal head extends it from the flexed position

Breast Quadrants and Cancer

Anatomical location and description of tumors and cysts Carcinoma of the breast are usually adenocarcinomas- Malignant neoplasm of epithelial cells with a glandular or glandlike pattern Lactiferous ducts in the mammary gland lobules

Subclavius Main Action

Anchors and depresses clavicle

Serratus posterior superior innervation

Anterior rami T2-T5

Serratus posterior inferior innervation

Anterior rami T9-T12

3 longitudinal spinal cord arteries

Anterior spinal artery, 2 posterior spinal arteries.

Humeral nutrient artery

Arise from lateral aspect of brachial artery

Supraspinatus Clinical Muscle Test

Arm in scapular plane Same as deltoid otherwise

Teres major (lower subscapular nerve) Clinical Muscle Test

Arm is abducted Resistance to adduction Palpate in posterior axillary

Deltoid (axillary nerve) Clinical Muscle Test

Arm is abducted more than 15 degrees Apply resistance to abduction Middle section of deltoid can be palpated

Axilla

Armpit . No bones or muscles in this area

Blood supply to the breast

Arterial supply- Internal thoracic artery Lateral thoracic artery and thoracoacromial arteries Posterior intercostal arteries Venous drainage- Axillary vein Internal thoracic vein

Arachnoid mater

Avascular membrane. Elastic and fibrous tissue. Enclose CSF, held against dura mater by pressure from CSF, lumbar cistern

Base (Inferior boundary)

Axillary fossa bounded by anterior and posterior axillary folds. Formed by concave skin, subcutaneous tissue and axillary (deep) fascia

Brachial artery

Begins at inferior border of trees major. Ends in cubital fossa

MRI(magnetic resonance imagery)

Better tissue differentiation than CT scans. Body pulsed with radio waves. Strong magnetic field. H atoms provide basis. Axial, coronal. sagittal planes. Shades of gray.

Interspinales

Between adjacent spinous processes( on interspinous ligament)

Intertransversarii

Between adjacent transverse process

Symphyses

Between vertebral bodies. Limited motion,

Antebrachial fascia

Bicipital aponeurosis, interosseous membrane, palmar carpal ligament, flexor and extensor retinaculum. Cover forearm

Lateral wall

Bony wall formed by inter tuberclar sulcus of humerus

Biceps brachii blood supply

Brachial artery

Upper Limb Fasciae

Brachial fascia -Two intermuscular septa Antebrachial fascia- Bicipital aponeurosis Interosseous membrane Palmar carpal ligament Flexor and extensor retinaculum Hand fascia-Palmar aponeurosis

Floor of cubital fossa is formed by

Brachialis and supinator muscles of arm and forearm

Lymphovascular supply to breast

Breast cancer and lymphogenic metastasis Subareolar lymphatic plexus Axillary lymph nodes- Anterior or pectoral nodes Clavicular lymph nodes Subclavian lymphatic trunk Parasternal lymph nodes- Bronchomediastinal lymphatic trunk Right and left venous angles

T2 weighted images

Bright signal from fluid and an intermediate signal from fat.

Roots

Bundles of rootlets. Anterior and posterior

Medial Muscles of arm

C-Deltoid ( and flex) Subscapularis Teres Major

Innervation of splenius capitis

C3&C4

Supraclavicular nerve (1)

C3, C4

Multifidus origin

C3-C7, T1-T12, L1-L5, Sacrum, posterior superior iliac spine

Innervation of splenius cervicis

C5 & C6

Inferior lateral cutaneous nerve of arm

C5, C6

Posterior cutaneous nerve of arm

C5-C8, cutaneous branch of radial nerve

Cervical enlargement

C5-T1 . Brachial plexus arise for innervation of upper limb.

Radial nerve

C6-C8, back of hand

Median nerve

C6-C8, first 3 fingers

Levator costarum origin

C7-T11

Medial cutaneous nerve of forearm

C8-T1

Ulnar nerve

C8-T1, 5th and 4th digit

Medial cutaneous nerve of arm

C8-T2

Parasympathetic nerves arise

CN III, VII, IX, X, S2-S4

Lumbar puncture diagnosis

CNS disorder, detect virus, bacteria, proteins, blood

cervical vertebra

Can be bifid, uncinate process, transverse foramen, superior and inferior articular process, vertebral foramen. Short spinous process. Dens/odontoid process. No intervertebral disc between C1-C2.

Axillary vein is common site for

Central lines(IV)

Pectoralis Major Proximal Attachment

Clavicular head: anterior surface of medial half of clavicle Sternocostal head: anterior surface of sternum, superior six costal cartilages, aponeurosis of external oblique muscle

CSF

Clear, colorless, acellular fluid. Produced in choroid plexus.

Dislocation of Humerus at Glenohumeral Joint Treatment usually involves 3 steps

Closed Reduction Sling Rehab

Spinal cord

Continuation of medulla oblongata, conduction pathway , major reflex center, 42-45cm long, From foramen magnum to conus medullar is around L1-L2. Give rise to 31 pairs of spinal nerves

Brachialis distal attachment

Coronoid tuberosity, cover anterior elbow joint

Dural root sheath

Covers posterior an anterior nerve roots, blend with epineurium

Anterior segmental medullary arteries

Create anterior spinal nerve

Superior lateral cutaneous nerve of arm

Cutaneous branch of axillary nerve, C5 &C6

Myelomeningocele

Cystic dilation contains neural tissue

Triceps brachii blood supply

Deep brachial artery and posterior circumflex humeral artery

Clavipectoral fascia

Deep, cover pectorals minor and pectorals major

Arachnoid trabeculae

Delicate CT attaching arachnoid to Pia, look like spider webs

Posterior circumflex humeral artery of Blood Supply

Deltoid

Septa

Divide arm into posterior and superior part of arm

Levator scapulae muscle arterial supply

Dorsal scapular (subclavian origin)

Rhomboid muscle arterial supply

Dorsal scapular (subclavian origin)

Sometimes transverse doesn't exist. What will supply blood to where transverse would have if it were there?

Dorsal scapular artery

Levator scapulae, rhomboid minor, and rhomboid major innervation

Dorsal scapular nerve

Venous and Lymphatics of UL

Dorsal venous network- Cephalic vein and basilic vein Perforating veins- Connect deep and superficial together Cephalic vein- Clavipectoral triangle Costocoracoid membrane Basilic vein- Accompanying veins (L. venae comitantes)

Posterior roots

Dorsal, sensory (afferent) fibers, bring information from periphery to CNS

Teres minor Clinical Muscle Test

Elbow flex, arm 90 degrees in scapular plane Resistance to lateral rotation

levator costarum action

Elevate ribs for ventilation

Levator scapulae action

Elevates and rotates the scapula to tilt the glenoid cavity inferiorly

obliques capitis superior action

Extension of head and bends it to same side

Rectus capitis posterior major action

Extension of head, rotation of face to same side as muscle

Serratus Anterior Proximal Attachment

External surfaces of lateral parts of 1st-8th ribs

Classic Meningitis symptoms

Fever, headache, nuchal rigidity.

Subarachnoid space

Filled with CSF

Sentinel nodes

First node that lymph would drain to.

Superior and inferior articular process of thoracic vertebra

Flat and vertical

Infraspinatus Clinical Muscle Test

Flex elbow, adduct arm Resistance to lateral rotation Palpate muscle inferior to scapular spine

Medial wall

Formed by thoracis wall and serrates anterior

Axillary vein

Formed by union of brachial and basilica veins. Tributaries are abundant and highly variable. Cephalic vein joins with axillary vein close to where vein becomes subclavian vein

Posterior wall

Formed mainly by subscapularis and scapula. Posterior axillary fold is inferior most portion

Gadolinium

GBCA, enhance quality of MRI or MRA, Contain gadolinium ion and chelating molecule

What type of contrast causes still birth?

Gadolinium

Filum terminale externum

Gains dural layer, attaches to coccyx, arcs as anchor for inferior portion of spinal cord and meningitis

Positron Emmission Tomography (PET)

Gamma ray emitting tracers in body that detect tissue with high metabolic activity. Used for physiological processes like rapidly growing tumor. Better understand where metabolic activity is occurring

why knee to chest position for spinal tap

Help spread the spinous processes and lamina of vertebrae so insertion of needle is easier

Dissection of axillary lymph nodes

Help staging and treatment of cancer. arrangement of nodes allows systemic order of removal for examination. Lymphedema(axillary nodes removed or radiated). Nerves at risk are long thoracic and thoracodorsal

Lateral radiographs, radiopaque letters (R or L)

Image take on the side

Superiorly boundary of triangular cubital fossa

Imaginary line connecting medial and lateral epicondyles

Embryological note of spinal cord

In embryos the spinal cord is entire length of vertebral column. Wk 8 the coccygeal portion atrophies. During fetal period column grows faster than spinal cord causing cord to ascend

Herniated disc

In lumbar and below, the herniation will affect the nerve of the spinal nerve below it .

Serratus posterior inferior lateral attachments

Inferior border of ribs 9-12, lateral to their angles

Subclavius Distal Attachment

Inferior surface of middle third of clavicle

Conus medularis

Inferior, tapering end of spinal cord

Lateral Muscles of arm

Infraspinatus Teres minor S-Deltoid (and extend)

Spinalis capitis

Inseparable from semispinalis capitis

scapular anastomosis

Involve branches from subclavian and axillary arteries.

Injuries of axillary vein

Involve damage to axillary vein. Proximal vein wound causes profuse bleeding, but also risk of producing air emboli

Subclavius Proximal Attachment

Junction of 1st rib and its costal cartilage

Transverse ligament of cruciate

Keep dens against anterior arch of atlas, pivot on axis. strong. Dens breaks before ligament tears. Prevent compression of spinal cord during flexion of head and neck

Root compression

L5 nerve root is largest and IV foramen is smallest. Increase risk of nerve compression id osteophytes(bony spurs) develop or IV disc herniations occur. lumbar spinal nerves increase, intervertebral foramen decrease.

Pectoralis Major Innervation

Lateral and Medial Pectoral nerves Clavicular head: C5, C6 Sternocostal head: C7, C8, T1

What are the boundaries of the triangle of auscultation?

Lateral border of trapezius, superior border of latissimus dorsi, medial border of scapula

Denticulate ligaments

Lateral extension of Pia, help anchor spinal cord, suspended CSF. Attach between posterior and anterior roots to dural sac

Pectoralis Major Distal Attachment

Lateral lip of intertubercular sulcus of humerus

Rhomboid minor medial attachments

Ligamentum nuchae, SP C7-T1

C&D dermatome

Limb development. Lateral outgrowths of trunk

Gray matter

Location of nerve cell bodies. Dorsal horn (sensory input), ventral horn (motor output).

Thoracic vertebra

Long and thin spinous process, heart or kidney bean shape, attach for rib of head. Transverse process attach for rib tubercle

Serratus Anterior Innervation

Long thoracic nerve (C5, C6, C7)

Clinical correlate: paralysis of the serratus anterior

Long thoracic nerve- Winged scapula Abduction above the horizontal position

Triceps brachii

Long, medial, and lateral heads. not affected by pronation and supination of forearm.

Cuada equina

Loose bundles of spinal nerves roots arising from inferior end of spinal cord

Where is CSF withdrawn for a lumbar puncture, aka spinal tap?

Lumbar cistern

meningitis diagnostic test

Lumbar puncture

Epidural

Lumbar, sacral, caudal. Affect nerve rotos of caudal equine as they exit dural sac. Loss of sensation inferior to injection site. Uses indwelling catheter in sacral canal

Mammography

Lumps- Fluid-filled cysts Masses with a jagged outline and irregular shape Calcifications (calcium deposits) are of two types- Macrocalcifications Microcalcifications Dense breast tissue- Almost entirely fatty breast tissue Scattered areas of dense glandular tissue and fibrous connective Heterogeneously dense breast tissue Extremely dense breast tissue

What imaging determines what's wrong in a macro sense?

MRI

What imaging is used for tissue differentiation?

MRI

What imaging works with hydrogen and radio waves?

MRI

Breast Tissues

Mammary glands Bed of the breast- Pectoral fascia Retromammary space Axillary tail Non-lactating breasts- Fat Glandular tissue and fibrous tissue Nipple and areola breast size and shape

Superior and inferior articular process of lumbar vertebra

Mammory bodies, concave (superior), convex (inferior)

Laterally boundary of triangular cubital fossa

Mass of extensor muscles of forearm arising from lateral epicondyle and supraepicondylar ridge; brachioradialis is most superficially

Medially boundary of triangular cubital fossa

Mass of flexor muscles of forearm, arise from common flexor attachment on medial epicondyle. pronator terms is most superficially

Insertion of splenius capitis

Mastoid process, lateral 1/3 of superior nuchal line

Pectoralis Minor Distal Attachment

Medial border and superior surface of coracoid process of scapula

Pectoralis Minor Innervation

Medial pectoral nerve (C8, T1)

Nerve

Mix of sensory of and motor nerve fibers d

Meningocele

Most common congenital neural tube defects. Dilation of meninges that have CSF but no neural tissue

Trapezius innervation

Motor: spinal accessory nerve. (CN XI). Proprioreception: C3-C4

Rotator Cuff Muscles

Musculotendinous cuff Protective Supportive

Other meningitis complaints

Nausea, vomiting, photophobia

Rami

Nerve splits to head posteriorly or anteriorly and further splits will happen to form the named nerves. Mixed fibers but can be motor or sensory nerve based on majority of fibers

Subclavius Innervation

Nerve to subclavius (C5, C6)

Atlas

No spinous process, facet for dens, transverse foramen, lamina. No vertebral disc

Ulnar nerve branches

None in arm, supplies articular branches to elbow joint

Median nerve branches

None in axilla or arm, does supply articular branches to elbow joint

Origin of splenius capitis

Nuchal ligament, SP C7-T4

Imaging uses barium

Nuclear medicine

SPECT or PET

Nuclear medicine imaging

Rectus capitis posterior major insertion

Occipital bone below inferior nuchal line

Obliques captis superior insertion

Occipital bone between superior and inferior nuchal lines

Rootlets

Often omitted form diagrams for simplicity anterior and posterior

Thoracic-acromial artery

Origin is axillary artery. 4 branches: acromial, deltoid, pectoral, clavicular

Subscapular artery

Origin is axillary artery. Branch of axillary that is greatest in diameter and shortest in length. Give rise to circumflex scapular and thoracodorsal

Posterior circumflex humeral

Origin is axillary artery. Larger than anterior; supplies glenohumeral joint, deltoid, tires major, tires minor, long head triceps. Pass through quadrangular space with axillary nerve

Lateral thoracic artery

Origin is axillary artery. Supply pectoral, serrates anterior and intercostal muscles; axillary lymph nodes; lateral aspect of breast. Highly variable origin. Travel down thoracic region

Superior thoracic artery

Origin is axillary artery. Supply subclavius, muscles in 1st and 2nd intercostal space, superior portion of serratus anterior, pectoral muscles

Throacodorsal artery

Origin is subscapular artery. Unnamed branches to latissimus dorsi; anastomoses around scapula

Circumflex scapular artery

Origin is subscapular artery. Unnamed branches to teres major, teres minor, infraspinatus. Anastomose with supra scapular and dorsal scapular

Clinical Correlate: heart attack referred pain

Pain perceived at a location of the painful stimulus Angina pectoris -Pain in the chest (site of injury) Spinal level that receives visceral sensation from the heart simultaneously receive cutaneous sensation from parts of the skin on the shoulder

Hand fascia

Palmar aponeurosis

Ulnar nerve

Pass distally from axilla anterior to insertion of trees major and long head of triceps, on medial side of brachial artery

Sympathetic ganglion

Path for sympathetic autonomic nerves. Enter through white rami communicans. Exit through gray rami communicans, doesn't synapse and exit splanchnic nerve

Pectoral Girdle

Pectoral region covers anterior thoracic wall and part of the lateral thoracic wall Breasts are tissues overlying the chest muscles - Mammary glands Pectoral muscles

Deep fascia

Pectoral, axillary, clavipectoral (gliding, protection, support)

Pectoral region muscles attachments, nerves, and function

Pectoralis major Pectoralis minor Subclavius Serratus anterior

Anterior wall

Pectoralismajor and minor with fascia, anterior axillary fold is inferiormost portion

Filum terminale internum

Pial part, still within dural sac

Clinical correlate: Absence of the pectoral muscles

Poland syndrome Congenital- 1 in 10,000 to 100,000 Cause- Six-week mark Blood flow Genetic markers Reconstructive surgery- TRAM flap

Lateral cutaneous nerve of forearm

Posterior and anterior branch

Serratus posterior superior/anterior muscle arterial supply

Posterior intercostal arteries (branches of aorta)

Innervation of Superficial, erector spinae, transversospinalis, segmental

Posterior ramus

Subarachnoid hemorrhage

Pressure often elevated appearance clear to bloody, Xanthochromia often present, RBC> 50mm, WBC slightly increased, Normal glucose, protein elevated, normal gram stain

Bacterial meningitis

Pressure often elevated, clear to turbid, negative Xanthochromia, RBC <5mm, WBC elevated and many PMNs, Low glucose, elevated protein, Gram stain organisms

Viral meningitis

Pressure often elevated, often look clear, negative xanthochromia, RBC <5mm, WBC elevated and many lymphocytes, Glucose normal, Protein elevated, normal gram stain

Meningitis

Progress rapidly in hours or progress over days.

3 Functions of CSF

Protect brain and spinal cord from trauma, supply nutrients to nervous tissue, remove waste products

Serratus Anterior Main Action

Protracts scapula and holds it against thoracic wall; rotates scapula

What nerves supply the hand

Radial nerve, superficial branch, median nerve, ulnar nerve

Great anterior segmental medullary artery

Reinforce circulation to 2/3 spinal cord including lumbosacral enlargement. Only on left side. In 65% of people. Arise form left posterior intercostal artery.

Levator costarum

Resemble lateral continuations of rotators

Ligamentum flava

Resist separation of lamina in flexion. Run between posteriro surface of lamina on vert below to anterior surface of vert above

Spinal nerve C8

Responsible for sensation from skin of 5th digit and proximal past wrist. Innervation of digit flexors

Rhomboid major and rhomboid minor action

Retracts and rotates the scapula to tilt the glenoid cavity inferiorly

Nuclear medicine imaging

Reveal radioactive substances. Rates of metabolism and or abnormal chemical activities. Diagnose many cancers, heart disease, GI, endocrine, and neurological disorders.

Iliocostalis cervicis origin

Ribs 3-6

Trapezius actions

Rotates scapula to tilt the glenoid cavity superiorly, elevates (superior part), retracts (middle part), and depresses (inferior part) scapula

obliques capitis inferior action

Rotation of face to same side

Dura mater

Run from foramen magnum to sacral hiatus, lateral rot IV foramen. Ends around S2, separated from bone by extradural (epidural) space.

Inferior longitudinal ligament

Run from transverse ligament to body of C2

Superior longitudinal ligament

Run from transverse ligament to foramen magnum. Hold transverse ligament in place and limit extension

Transverse cervical artery

Runs towards back

Serratus posterior superior medial attachments

SP C7-T3

Serratus posterior inferior medial attachments

SP T11-L2

Rhomboid major medial attachments

SP T2-T5

Latissimus dorsi medial attachments

SP T7-L5, thoracolumbar fascia, sacrum, iliac crest, ribs 10-12

sacrum and coccyx

Sacral base, 5 fused elements (transverse lines), anterior sacral foramen, anterior sacral facets, sacral canal (continuation of spinal cord)

Subscapularis Clinical Muscle Test

Same as infraspinatus Resistance to medial rotation

Lumbar vertebra

Short spinous process, large body, short transverse process, widely spaced lamina.

Lumbar puncture

Spinal tap. Withdrawal of CSF, Lateral decubitus, Knee-chest position. Pressure, proteins, microbes. Insert between L3/4 or L4/5

spinalis cervicis insertion

Spinous process C2-C5

Obliquus captis inferior origin

Spinous process of axis (C2)

Pectoralis Minor Main Action

Stabilizes scapula by drawing it inferiorly and anteriorly against thoracic wall

Hypoechoic

Structures that reflect some sound (liver cells)

Anechoic

Structures that transmit all sound waves without reflection. (blood vessels or air).

Origin of axillary artery

Subclavian artery

Fascial components

Subcutaneous tissue- (superficial fascia) Named deep fasciae- Pectoral fascia Axillary fascia Clavipectoral fascia- Gliding, protection, and support

Subscapular and lateral thoracic of Blood Supply

Subscapularis

Whiplash

Sudden and forceful hyperextension and hyper flexion of neck. Lead to damage of anterior and posterior longitudinal ligament, herniated intervertebral disks.

Anterior spinal artery

Sulcal arteries. Form from union of 2 vertebral arteries, posterior from either vertebral or posteroinferior arteries.

Trapezius muscle arterial supply

Superficial branch of the transverse cervical artery

Lymphatic drainage

Superficial lymphatic vessels- Lymphatic plexuses Cubital lymph nodes Humeral (lateral) axillary lymph nodes Apical and axillary lymph nodes and deltopectoral lymph nodes Deep lymphatic vessels- Humeral (lateral) axillary lymph nodes

Serratus posterior superior lateral attachments

Superior borders of ribs 2-5, lateral to their angles

Roots of spinal nerves

Supplied by radicular arteries (arise from same arteries as segmental medullary)

Suprascapular of Blood Supply

Supraspinatus Infraspinatus

Meninges

Surround, support, and protect spinal cord and spinal nerve roots

Sympathetic nerves arise from

T1-L2/3. White rami also found. Gray rami are at all levels

Lumbosacral enlargement

T11- S1, anterior rami give rise to lumbar and sacral plexuses, innervates lower limbs

Does T1 or T2 specifically look for fluid?

T2

Intercostobrachial nerve

T2

Levator scapulae medial attachments

TP C1-C4

superior part of humerus provide attachments for

Tendons of shoulder muscles

Adduction Muscles of arm

Teres Major

Circumflex scapular of Blood Supply

Teres Major Teres Minor

What should you always remember about images?

They are always in reverse

Pia mater

Thin and transparent, vascular layer of CT. Cover brain, spinal cord, nerve roots, spinal blood vessels. From conus medullaris to film terminale internal

Latissimus dorsi muscle arterial supply

Thoracodorsal artery (branch of axillary)

Latissimus dorsi innervation

Thoracodorsal nerve (middle sub scapular nerve)

White matter

Tracts and fascicle

Longissimus cervicis insertion

Transverse process C2-C6

Longissimus capitis origin

Transverse process C4-T4

Longissimus cervicis origin

Transverse process T1-T6

Obliquus captis superior origin

Transverse process of atlas (C1)

Superficial Sensory Supply

Two dermatome maps- Clinical findings (A & B) Limb development (C & D) Segmental progression Both are approximations

Brachial fascia

Two inter muscular septa

Computed Tomography(CT)

Use Xrays to create transverse anatomical images, table moves through gantry, generator circles, transform info into "slice" images. Uses Ionization radiation.

Barium

Used in GI, mixed in slurry and ingested. Risks are allergic, stomach cramps, GI problems.

Ultrasound

Uses high-frequency soundwaves

Spondylolisthesis

Vertebral body slip anteriorly with or without fracture to the pars interacrticularis. Due to pars interarticular defects or fracture. Most common in L4 & L5. cause back pain.

Filum terminale

Vestigial remnant of coccygeal portion of cord. Internal and externum.

Dermatome map

Visualize area that will be affected from different levels of anesthetic injections

Lateral cutaneous nerve of forearm

When musculocutaneous nerve emerges lateral to biceps

What is important about cervical and lumbosacral regions?

Where limbs and nerves arise

C1 to C7 nerves exit _______ the corresponding vertebrae, C8 nerves exit _____

above, below C7

Deep veins

accompany arteries

semipro position

active only against resistance for pronated forearm and biceps flexor

Rank the different tissues that are visible in X-rays (water and most tissues, spongy bone, fat, compact bone, air) from least radio dense to most radiodense

air, fat, water and most tissues, spongy bone, compact bone

Rank the different tissues that are visible in X-rays(water and most tissues, spongy bone, fat, compact bone, air) from most radiolucent to least radiolucent

air, fat, water and most tissues, spongy bone, compact bone

Musculocutaneous nerve supplies

all 3 muscles of anterior arm

Superficial and deep veins

anastomose freely with each other. Have valves (more numerous in deep veins), venae comitantes

Vasocorona pal anastomosis of

anterior and posterior spinal arteries, supplies most of whit matter. Could be tested in terms of blood clot

Serratus Anterior Distal Attachment

anterior surface of medial border of scapula

Rotatores origin

anterior surface of transverse process

Dural sac ends

around S2, so cannot extract CSF this low

sacral cornu of sacrum and coccyx

articulates with coccygeal Cornu

Spinal dysraphism/ spina bifida occulta

asymptomatic

Boundaries of axilla lateral view shows

axillary boundaries and contents. Artery, nerves, vein, lymph, and fat

rotatores insertion

base of spinous process

Superior articular process of atlas

bean shaped

Axillary artery

begin at lateral border of 1st rib and ends at inferior border of trees major. 3 parts

Musculocutaneous nerve

begins opposite inferior border of pectorals minor, pierces coracobrachialis, continues distally between biceps and brachialis

Thoracic, lumbar, sacral, and coccygeal nerves exit

below vertebrae with same name

Pars interarticularis fracture

between superior and inferior articular surfaces. Vertebral body can slip and compress vertebral cancel.

Semispinalis capitis Insertion

between superior and inferior nuchal lines

Synovial

between superior vertebra's inferior articular process and inferior vertebra's superior articular process

Roof of cubital fossa is formed by

brachial and ante brachial(deep) fascia reinforced by bicipital aponeurosis, subcutaneous tissue, and skin

Origin of axillary vein

brachial and basilic vein. veins origin is one step away from heart.

Brachialis blood supply

brachial artery and radial recurrent artery

Workhorse of elbow flexors

brachialis

Levator costarum insertion

brevis dorsal of rib 1 inferior, Longus dorsal of rib 2 inferior

Aneurysm of axillary artery

can form in first part of axillary artery. May compress trunks of brachial plexus

X-radiation exposure

carcinogen, cause very few cancers. Mutagen, so radiation to testes or ovaries is problematic. Harmful to fetuses.

Enlargement of axillary lymph nodes

caused by lymphangitis due to infection in upper limb affecting humeral nodes first. Infection in pectoral, breast or superior abdomen can produce enlargement of pectoral nodes first.

Pectoral, sub scapular, and humeral lymph nodes pass to

central nodes, the apical nodes, then supraclavicular.

two enlargements of the spinal cord

cervical and lumbosacral

Apex (superior border)

cervico-axillary canal, bound by 1st rib, clavicle, superior edge of scapula

Common uses of X-rays

chest X-rays, initial image of skeletal system

Two dermatome maps

clinical findings (A&B), limb development( C&D)

Sacral hiatus of sacrum and coccyx

closed by sacroccygeal ligament

Scapular anastomosis

collateral circulation. Needed due to legation of lacerated subclavian or axillary artery or vascular stenosis.

Herniation

common cause of back pain. Can cause upper and lower limb pain.

Iiocostalis thoracis lumborum origin

common tendon

Longissimus thoracis origin

common tendon, lumbar transverse process

Join internal vertebral (epidural) plexus

communicate with dural sinuses and veins in cranium

Enlargement of apical nodes may

compress cephalic vein

Alar ligaments

connect dens to medial surface of occipital condyles. help prevent excessive rotation of head and atlas.

Axillary fascia

continuation of the pectoral fascia, forms the floor of the axilla

Coracobrachialis proximal attachment

coracoid process

Pectoral fascia

covers pectorals major, becomes axillary fascia

Long head of triceps brachii

cross glenohumeral joint to attach to infraglenoid tubercle. Aid in extension and adduction of arm.

Median nerve descends into

cubital fossa, lies deep to bicipital; aponeurosis and median cubital vein

Superficial branch of radial nerve

cutaneous in distribution, supply sensation to dorsal of hand and fingers

Arteries that arise from medial aspect of brachial artery

deep artery(profunda brachii artery), superior and inferior ulnar collateral arteries

Anconeus blood supply

deep brachial artery and recurrent interosseous artery

Radial nerve travels with

deep brachial artery, pass through humeral shaft in radial groove

Transversospinalis

deep to erector spinae. From transverse to spinous process

Rotatores

deepest transversospinalis muscle

Serratus posterior inferior actions

depresses ribs 9-12

Cubital fossa

depression on anterior aspect of elbow. Boundaries of triangular cubital fossa are Superiorly, medially, and laterally

lumbar lordosis

develop when infant begins walking

What is ultrasounds useful in examining?

developing fetus, abdominal and pelvic organs, muscles and tendons, heart and blood vessels

Major use for central venous catheters

difficult peripheral venous access, delivery of certain medications or fluids, prolonged intravenous therapies, specialized treatment

Erector spinae inferior attachment

dorsal surface of sacrum, iliac crest, and spinous processes of lumbar vertebrae

main action of arm muscles is at

elbow joint

What is the ultrasound process?

electric current, piezoelectric crystals vibrate rapidly, ultrasound beam, echoes(reflected sound waves), gray-scale images

Serratus posterior superior actions

elevates ribs 2-5

Lumbar cistern

enlargement of subarachnoid space caudal to conus medullaris. CSF and caudal equine, From L2-S2

Radial nerve

enter posterior to brachial artery, medial to humerus, anterior to long head of triceps, gives branches to long and medial heads of triceps

What is CT's used for?

evaluate lung parenchyma. Soft tissues of neck, chest, and abdomen, and pelvis.

Latissimus dorsi actions

extends, adducts, and medially rotates humerus

semispinalis capitis function

extension and lateral flexion of head

semispinalis thoracis and cervicis function

extension and lateral flexion of vertebrae

rectus capitis posterior minor action

extension of head

All back muscles are

extension of neck region or back region

paired action of splenius cervicis and splenius capitis

extension of the neck

Motions of spine

extension, flexion, lateral flexion, lateral extension, rotation of head and neck, rotation of upper trunk

Spina bifida

failure of vertebral arches to fuse together. Occur in lumbosacral juncture. Can cause issues with walking, bladder issues, and neurological defects. Folic acid helps prevent.

when elbow is close to 90 degrees and forearm is supinated, biceps is most efficient in producing

flexion

Solo action of splenius capitis

flexion and rotation of neck to same side

Solo action of splenius cervicis

flexion and rotation of neck to same side

movements of cervical spine

flexion, extension lateral flexion, rotation. Highest range of motion

arm movements

flexion-extension, pronation-supination

when elbow extended

flexor of forearm

Latissimus dorsi lateral attachment

floor of intertubercular sulcus of humerus

Superior and inferior ulnar ollateral arteries

form periarticular anastomosis of elbow region

Third part of axillary artery

from lateral border of pectorals minor to inferior border of teres major. 3 branches: sub scapular, anterior circumflex humeral and posterior circumflex humeral.

nucleus pulposus

gelatinous. Absorbs compression forces between verts

Iodinated compounds

general IV but can be put in abdomen. Harmless, but can cause infection, allergic reaction, etc.

some arm muscles also act at the

glenohumeral joint

lordosis

help bring our center of gravity into a vertical line and balance our body weight on vertebral column allowing bipedal movement

Coracobrachialis action

help flex and adduct arm, stabilize glenohumeral joint. Resist downward dislocation of humeral head when carrying something

Anconeus

help triceps extend to forarm. Tenses of capsule of elbow joint, prevent it from being pinched during extension.

Erector spinae muscles

iliocostalis, longissimus, spinalis

T1 weighted images

images show dark fluid and bright fat

Herniated disc between C7-T1

impinges spinal nerve C8 .

Parasympathetic synapse

in ganglia near or in wall of organ they supply

Supraclavicular nodes

inferior deep cervical nodes that drain into veinous system

What does scapular anastomosis often result in?

insufficient supply to arm, forearm and hand. Not developed enough for surgical ligation of axillary between sub scapular and profound brachia.

Thoracic aorta

intercostal arteries

Extradural (epidura) space

internal venous plexus embedded in fatty matrix

Spinal nerve passes through

intervertebral foramen

Thoracolumbar fascia

investing fascia surrounding quadrates lumborum. Continue as nuchal fascia and gluteal fascia.

Trapezius lateral attachments

lateral 1/3 of clavicle, acromion, and spine of scapula

Median nerve orginates

lateral and medial cords

Anconeus origin

lateral epicondyle

Unilateral contraction of erector spinae

lateral flexion of neck or trunk, rotation of head, side of contracting muscle

After reaching lateral border of humerus, radial nerve pierces

lateral inter muscular septum in cubital fossa. Divides into deep branch and superficial branch

Musculocutaneous nerve emerges

lateral to biceps as lateral cutaneous nerve of forearm

Biceps brachii proximal attachments

long head to supraglenoid tubercle and short head to coracoid process

What is the advantages of ultrasounds?

low cost, portable, real-time images

Lumbar and sacral plexuses innervate

lower limbs

Herniated disc

lumbar region can result in caudex equine syndrome. Result in numbness and tingling and pain in lower limbs or loss of bowel or bladder function

Brachialis

main flexor of forearm, the only pure flexor, product greatest flexion force, flexes forearm in all positions, Not affected by pronation and supination

Sulcal artery supplies

majority of gray matter

Longissimus capitis insertion

mastoid process

Rhomboid minor lateral attachment

medial border of scapula at spine

Rhomboid major lateral attachment

medial border of scapula below spine

Ulnar nerve pass posterior to

medial epicondyle and medial to olecranon to enter forearm, posterior to medial epicondyle

Ulnar nerve pierces

medial intermuscular septum with superior ulnar collateral artery, descend between septum and medial head of triceps

Rectus capitis posterior minor insertion

medial portion of occipital bone below inferior nuchal line

Dura mater innervation

meningeal nerves that branch off after nerve is formed, before rami split

Mammillary processes of lumbar vertebra is attachment for what muscles?

multifidus and longissimus

Deep branch of radial nerve

muscular an articular in distribution

Biceps brachii, brachialis, and coracobrachialis innervation

musculocutaneous nerve

Cancer metastasize to apical nodes

nodes may adhere to axillary vein

Multiphase CT

non-contrast scan taken then a contrast scan is taken. Look for cryptic bleeding/hemorrhaging . Not routine because of high radiation dose

Scottie dog sign fracture

normal appearance of lumbar spine in oblique radiograph. "Collar"

what are some limitations of ultrasounds?

not effective at imaging body parts that have gas or are hidden by bone

Lateral, medial, and long head of briceps brachii converge inferiorly to attachment to (distal attachment)

olecranon of ulna

Brachial artery end in cubital fossa

opposite neck of radius, under bicipital aponeurosis. Divides into ulnar and radial artery

Anulus fibrosus

outer ring of collagen surrounding fibrocartilage arranged in lamellar configuration. Limit rotation between vertebra.

Axillary artery runs behind

pectoralis minor

Arachnoid and pia blend with

perineurium

A&B dermatome

popular in neurology, sensory and motor in skin. More usefully clinically

Radial nerve supplies all muscles in

posterior compartment of arm and forearm

rectus capitis posterior major/ minor and obliques capitis superior/ inferior nnervation

posterior ramus of C1

Rectus capitis posterior minor origin

posterior tubercle of atlas (C1)

Bilateral contraction of erector spinae

primary extensor of vertebral column and neck

Subtendinous olecranon bursa

proximal to distal attachment of 3 heads of triceps brachii. Friction-reducing. Between triceps tendon and olecranon

Branch to lateral head of triceps arise within

radial groove

Triceps brachii and anconeus innervation

radial nerve

Biceps tendon forms distally and attaches to

radial tuberosity

Hyperechoic

reflect most sound waves

Echogenicity or brightness depends on

reflected signal

MRI risks

remain motionless for long periods, bad for pediatrics, claustrophobia, metallic implants, low-quality ferrous tattoo ink can cause burns

Multifidus

resembles continuation of semispinalis

iliocostalis thoracis insertion

ribs 1-6

Iliocostalis thoracis lumborum insertion

ribs 6-12

iliocostalis thoracis origin

ribs 6-12

Inferior articular process of atlas

round and flat

Median nerve

run distally in arm on lateral side of brachial artery until it reaches middle of arm. Cross to medial side and contact brachialis

Anterior longitudinal ligament

runs from base of skull to anterior surface of sacrum.

second part of axillary artery

runs posterior to pectorals minor. has 2 branches, thoracoacromial and lateral thoracic arteries

Intervertebral foramen

same number of spinal nerves as number of vertebras in that region. Except cervical region has 8 because C1 exit between occipital and atlas

Axillary artery clinical application

scapular anastomosis, compression of axillary artery, aneurysm of axillary artery

Spinal injection

similar to lumbar puncture without stylet attached. Anesthetic heavier than CSF, it don't travel upward when pt inclined. Travel superiorly when pt lays flat. Difficult to re-administer if it wears off. Experience sever headaches

How does scapular anastomosis develop?

slow occlusion, sub scapular artery receives blood sue to anastomosis with several arteries . Sudden occlusion doesn't allow enough time for collateral circulation to develop.

Rotatores brevis

spans one intervertebral joint

Rotatores longus

spans two joints

Semispinalis cervicis insertion

spinous process C1-C5

spinalis cervicis origin

spinous process C5-T2

Semispinalis thoracis insertion

spinous process C6-T4

Spinalis thoracis origin

spinous process T10-L3

Spinalis thoracis insertion

spinous process T2-T8

Origin of splenius cervicis

spinous process T3-T6

Rectus capitis posterior major origin

spinous process of axis (CII)

3 boney attachments of thoracolumbar fascia

spinous process, transverse process, angle of rib

Intertransversarii action

stabilize and adjust intervertebral joint

Lateral head of triceps brachii

strongest, activated to work against resistance

Isoechoic

structures that reflect sound waves similar to surrounding structures (diaphragm)

Fascial components

subcutaneous tissue(superficial fascia), deep fascia

Superficial veins are in

subcutaneous tissue. 2 main are cephalic and basilica veins

Levator Scapulae lateral attachments

superior angle of scapula

Trapezius medial attachments

superior nuchal line, external occipital protuberance, ligamentum nuchae, SP C7-T12

Elbow anastomosis

superior ulnar collateral a., inferior ulnar collateral a., radial collateral a., middle collateral a., radial recurrent a., recurrent interosseous a., anterior ulnar recurrent a., posterior ulnar recurrent a.

When forearm is pronated, biceps is primary(most powerful) ____ of the forearm

supinator

Caudal epidurals are useful in pediatric populations for

surgery in groin, pelvis or lower extremities

what should you always do when taking images?

take multiple vies.

Posterior longitudinal ligament

tectorial membrane. Upper part of ligament connecting C11 ro intracranial aspect of skull base

Aponeurosis

thick and tough to get through. Thickened bands. Tendons fusing with fascia

longissimus thoracis insertion

thoracic transverse processes, ribs 2-12

Scapular anastomosis allows blood flow to circumvent in what arteries?

transverse cervical artery, dorsal scapular artery(anastomosing branch of transverse cervical), suprascapular artery, branches of sub scapular artery, branches of thoracic aorta

Lateral crest of sacrum and coccyx

transverse process

Insertion of splenius cervicis

transverse process C1-C3

Iliocostalis cervicis insertion

transverse process C4-C6

semispinalis cervicis origin

transverse process of T1-T6

Obliquus captifs inferior insertion

transverse process of atlas (C1)

Semispinalis capitis origin

transverse processes T6-C7, articular process C4-C6

Semispinalis thoracis origin

transverse processes T6-T10

Veins in the plexuses are

valveless (flow bidirectional). Allow pelvic cancers to metastasize to spinal cord

Anterior roots

ventral, motor( efferent) fibers, bring information from CNS to periphery

Multifidus function

vertebral stabilization

Cervical lordosis

when an infant begins to lift their head

Compression of axillary artery

when injury results in profuse bleeding. 3rd part can be compressed against humerus. Origin compressed with downward pressure in angle between clavicle and inferior attachment of sternocleidomastoid

Medial head of triceps brachii

workhorse of forearm extension. Active at all speeds in presence or absence of resistance