Helen's Practice Questions for Exam 2

What innervates the quadratus lumborum

Lumbar plexus T12, L1, L2, L3

What helps orient you to where the C7 spinous process is?

Most prominent vertebra on normal developing person

What special feature does C2 have?

Odontoid or dens

Distinguish between PROM, AROM, AAROM

PROM: when the joint is moved by an outside force such as a therapist • Generally a slightly higher number than AROM • Extra range from elasticity, protects joint because it allows extra "give" AROM when the joint is moved by muscles that act on that joint • If this value is grossly less than PROM, weakness is likely involved AAROM: outside force assists with motion of a joint

Superior angle of the scapula is in line with which spinous process

T2 (body type and muscular contraction could cause this to be inaccurate)

What are feeling limit movement for a soft end feel and name a joint which you would expect to have soft end feel

Adipose or muscle tissue • e.g. Knee flexion/elbow flexion

What muscles rotate the vertebral column?

All unilaterally: external oblique (opposite side) internal oblique (same side) multifidi (opposite side) rotatores (opposite side)

What does wrist abduction look like?

Also known as radial deviation of the radiocarpal joint

Name function, origin, insertion, and nerve for semispinalis capitis

F: extend the vertebral column and head O: transverse processes of C4- T5 I: between the superior and inferior nuchal lines of the occiput N: cervical

What do the palmar interossei do

Finger adduction

The lumbricals sprout from the sides of the tendons of ____________

Flexor digitorum profundus

What is tenodesis grasp?

Tenodesis grasp and release is a biomechanical occurrence that allows for some opening and closing of the fingers by movement of the wrist. The tendons of the forearm and fingers cross multiple joints and act as a complex pulley system. When the wrist is extended the tendons along the fingers shorten and pull the finger joints into flexion. Conversely, when the wrist is flexed the tendons along the finger joints lengthen and allow the finger joints to extend passively.

How do you test endfeel

Tested at end of AROM by performing PROM

How do you establish what is normal ROM for a patient

Testing uninvolved side to establish normal ROM for person tested

How do you palpate the multifidi

They are surprisingly think and directly accessible in the lumbar spine; only muscle fibers on the posterior surface of the sacrum p. 200 Trailguide

What is the function of the transverse foramen?

This is an opening on each of the transverse processes which gives passage to the vertebral artery and vein and a sympathetic nerve plexus.

What is the ligamentum nuchae

a fin-like sheet of connective tissue that runs along the sagittal plane form the external occipital protuberance to the spinous process of C7 in the neck; chief function is to help stabilize the head and neck. Attachment to superficial muscles of posterior neck p. 218 TG

What is significant about the T8 vertebra? Think about if it were to be fractured? What is nearby?

abdominal aorta, lungs; at risk for internal bleeding, punctured lung

What is a hiccup

an involuntary contraction of the diaphragm causing air to rush into the lungs and the vocal cords to snap shut

Levator Scapula is a/an ________________ to cervical flexion

antagonist

Palmaris longus is a/an ________ to extension of the wrist

antagonist

Both sternocleidomastoids are ______ to cervical extension

antagonists

Where do the scalenes insert

anterior and middle: 1st rib posterior: 2nd rib

Ribs are designed to move which directions

anterior, posterior, lateral, superior

Which vertebrae has a bifid process a. thoracic b. atlas c. axis d. lumbar

axis

Name some flexors of the neck

bilaterally: longus capitis, longus colli

When you're standing, the entire weight of your trunk/head/arms is transferred where?

bodies of vertebrae (lumbar vertebrae bear the brunt of this weight)

What structure is superficial to the SCM (could be tricky while palpating it) and what structure is deep to it?

carotid artery passes deep and medial to SCM external jugular vein lies superficial to it

the transverse fibers of the flexor retinaculum and the and carpal bones form the _____ _____

carpal tunnel

What is the insertion of the diagphragm

central tendon

Which vertebrae have transverse foramen?

cervical

The first rib is deep to which bone along the anterior axis

clavicle

What is the function of the transverse abdominis?

compress abdominal contents

Function of palmaris brevis

cup hand on medial side of hand

The transversospinalis group is ____________ to the erector spinae group

deep

What is the function of the serratus posterior inferior

depress ribs during inhalation

Synergists are internal intercostals (assists) and serratus posterior inferior; the antagonist is external intercostals (assists) What action is occurring

depression of the ribs

Abduction of phalanges 2-4 is performed by what muscle group

dorsal interossei

What is the function of the external intercostals

draw the ribs superiorly (increasing space in the thoracic cavity to assist with inhalation

What is the function of the serratus posterior superior

elevate ribs during inhalation

You want to discern the posterior scalene from the levator scapula...what could you have your client do?

elevate scapula

Bilaterally what do the scalenes do

elevate the ribs during inhalation anterior scalene also flexes the head and neck

All scalenes (bilateral) and serratus posterior superior work in synergy (with internal intercostals as an antagonist) to do what action

expansion of the ribs (inhalation)

Spinalis and iliocoastalis (bilaterally) are synergists and rectus abdominis is an antagonist. What movement is occurring

extension of the spine

When used bilaterally what do the 2 quadratus lumborum muscles do

fix the last rib during forced inhalation and exhalation

The carpal tunnel is a passageway for what?

flexor tendons and median nerve

Between bodies of vertebrae you find

intervertebral discs which cushion the shock. They are composed of tough outer layer, annular fibrosus, and a liquid center nuclear pulposus

Name distinguishing characteristics of the lumbar vertebrae

larger than the other vertebrae; Blunter spinous processes; 5 lumbar vertebrae;

Unilaterally what do the longus colli and longus capitis do?

laterally flex the head and neck to the same side rotate the head and neck to the same side

What is the action of the oblique capitis superior?

laterally flex the head to the same side

What actions does the QL do unilaterally?

laterally tilt (elevate) the pelvis laterally flex the vertebral column Assist to extend the vertebral column

Name some muscles that anchor to the thoracolumbar aponeurosis

latissimus dorsi and erector spinae group

Which spinalis would be an antagonist to right lateral flexion of the vertebral column

left spinalis

Passive rotation of the head and neck to the same side would _______ the SCM

lengthen

Name the curvature of the cervical spine

lordosis

What makes a strong muscle strong?

lots of sarcomeres

Insertion of longissimus

lower 9 ribs & transverse processes of thoracic vertebrae (thoracis) transverse processes of cervical vertebrae (cervicis) Mastoid process of temporal bone (capitis)

When bilateral external and internal obliques work in synergy, what motion happens (QL would be antagonist)

lumbar flexion

Name the muscles that are part of the transversospinalis group

multifidi rotatores semispinalis capitis

How many muscles go between ilium and sacrum?

none

What is in the posterior abdominal wall

o 5 lumbar vertebrae and associated discs o Muscles: psoas, quadratus lumborum, iliacus, transversus abdominis, and oblique muscles o Diaphragm o Fascia o Lumbar plexus o Fat, nerves, blood vessels,(aorta, IVC) and lymph nodes

All scalenes unilaterallly rotate head and neck to the ____ side

opposite

Which span of connective tissue is a continuation of the antebrachial fascia into the palm of the hand?

palmar aponeurosis

The fibers of the internal and external intercostals are ______ to each other

perpendicular

What nerve innervates the diaphragm

phrenic nerve (C3, C4, C5) Remember C5 keeps the diaphragm alive

Name this muscle Long, thick, fusiform muscle lateral to lumbar spine Comes from transverse processes of lumbar vertebrae, vertebral bodies and discs to lesser trochanter on femur Innervated by anterior rami of lumbar nerves L1-3 Flexes hip, laterally flexes trunk

psoas major

What muscles assists vertebral column extension

quadratus lumborum latissimus dorsi (assists when arm is fixed)

What are the flexors of the vertebral column?

rectus abdominis external oblique (bilaterally) internal oblique (bilaterally) psoas major (with insertion fixed) iliacus (with insertion fixed)

Which suboccipitals rotate the head to the same side?

rectus capitis posterior major, oblique capitis inferior

Which suboccipitals rock and tilt the head back into extension

rectus capitis posterior major, rectus capitis posterior minor, oblique capitis superior

Costal cartilage attachess ______ to the ______

ribs to the sternum

To access the first rib, you must palpate between the _____

scalenes

Passive rotation of the head and neck to the opposite side would ______ the scalenes

shorten

You want to feel the first rib move, what do you instruct your client to do

slow, deep breaths into upper chest

The lamina groove is located between which two bony landmarks of the vertebrae?

spinous and transverse processes

Upper arm articulates to trunk at what joint

sternoclavicular The shoulder girdle or pectoral girdle, composed of the clavicle and the scapula, connects the upper limb to the axial skeleton through the sternoclavicular joint (the only joint in the upper limb that directly articulates with the trunk).

Many of the cervical transverse processes are deep to which neck muscle?

sternocleidomastoid

What innervates the subclavius

subclavian nerve

What nerve innervates the suboccipital muscles?

suboccipital p. 205 Trail guide

What are deepest muscles of the upper posterior neck?

suboccipitals (8 small muscles):

What structures are near the abdominal aorta

Lies on anterior surface of vertebrae Deep to small intestines Lateral to the aorta is the psoas major

Describe how you would palpate the diaphragm

1. Partner in supine, with knees bolstered. Locate the inferior edge of the rib cage, lateral to the xiphoid process. 2. Lay your thumbpads just inferior to the ribs on the abdomen and ask your partner to take slow, deep breaths. 3. Moving only as your partner exhale, slowly press and curl your thumbpads underneath the edge of the ribs. During inhalation, you may not feel the tissue of the diaphragm, but your will most likely feel its contraction as it pushes other tissues into your thumbpads.

Which rib attaches to the sternum at the level of the sternal angle

2nd

Name some characteristics of the abdominal region

Abdomen connects pelvis and thorax Houses vital organs of alimentary and urogenital systems Bound superiorly by diaphragm and inferiorly by pelvis Can adjust pressure based on voluntary or reflexive contractions to expire air or release fluid or feces

What is the blood flow from the abdominal aorta

Abdominal aorta: ◦Common iliac arteries (right and left) ◦Internal iliac arteries (then enters pelvis) ◦External iliac arteries (gives off 2 branches: deep circumflex iliac and inferior epigastric) ◦Femoral arteries Abdominal aorta divides into right and left common iliac arteries; each of those divide into an internal and external iliac artery; external iliac artery turns into femoral artery once it passes inguinal ligament

What is another name for C1

Atlas

What is another name for the C2 vertebra?

Axis

What limits movement for a firm end feel? Name an example of firm end feel

Capsule or ligament or tendon • e.g. Shoulder external rotation

Name the primary muscle of respiration

Diaphragm

Distal ______ is based on proximal _______

Distal mobility is based on proximal stability

What innervates the rhomboids?

Dorsal scapular nerve (C4, C5)

What is the function of the internal intercostals?

Draw the ribs inferiorly (decreasing space in thoracic cavity) to assist with exhalation

Name that muscle Large triangular mm lateral to psoas major Comes from superior 2/3 of iliac fossa, ala of sacrum, and anterior sacro-iliac ligaments to lesser trochanter of femur and shaft of femur Innervated by femoral nerve L2-4 Flexes and stabilizes hip joint

Iliacus

Lumbar Plexus (describe)

Ilioinguinal and iliohypogastric nerves (L1) Supply the abdominal muscles and skin of the inguinal and pubic areas Femoral nerve L2-L4 To the anterior thigh and supplies the flexors of the hip and extensors of the knee. Obturator nerve L2-L4 Innervates the iliacus; supplies the adductor muscles Lumbosacral trunk L4-L5 Participates in the formation of the sacral plexus with the anterior rami of S1-S4 Genitofemoral nerve (L1,L2) Pierces psoas major, divides lateral to common and external iliac arteries into femoral and genital branches Lateral cutaneous nerve of the thigh (L2-3) Supplies skin on anterolateral surface of thigh Accessory obturator nerve (L3-4)

How does the diaphragm help with inspiration

Its muscle fibers contract and pull the central tendon inferiorly. Because the central tendon is attached to the connective tissue that surrounds the lungs, a vacuum is created in the upper thoracic cavity, pulling air into the lungs (increases volume of thoracic cavity during inhalation)

Name some contraindications to ROM testing

Joint dislocation • Post surgery • Fracture • Myositis ossificans • Ectopic ossification

Top of the iliac crest should be in line with which spinous process

L4

Origin and insertion of iliocostalis

O: common tendon (lumborum), posterior surface of ribs 1-12 (thoracis & cervicis) I: transverse processes of lumbar vertebrae 1-3 and posterior surface of ribs 6-12 (lumborum), posterior surface of ribs 1-6 (thoracis), transverse processes of lower cervicals

Origin and insertion of diaphragm

O: costal attachment (inner surface of lower 6 ribs) Lumbar attachment: upper 2 to 3 lumbar vertebrae sternal attachment: inner part of xiphoid process I: central tendon

Name origin and insertion of external oblique

O: external surfaces of 5th through 12th ribs I: Anterior part of the iliac crest, abdominal aponeurosis to linea alba

Name origin and insertion of transverse abdominis

O: lateral inquinal ligament, iliac crest, thoracolumbar fascia, and internal surface of lower 6 ribs I: abdominal aponeurosis to linea alba

Name the origin and insertion of the quadratus lumborum

O: posterior iliac crest I: last rib and transverse processes of the 1-4 lumbar vertebrae

Name origin and insertion of the rectus abdominis

O: pubic crest, pubic symphysis I: cartilage of the 5th, 6th, 7th ribs and xiphoid process

Multifidi origin and insertion

O: sacrum and transverse processes of lumbar and through sacral veretbrae I: spinous processes of lumbar vertebrae through C2 (span 2-4 vertebrae at a time)

Name origin and insertion of spinalis

O: spinous process of the upper and lower Thoracic vertebrae (thoracis), ligamentum nuchae, spinous process of C-7 (cervicis) I: spinous process of upper thoracic (thoracis), spinous processes of cervicals except C1 (cervicis)

Origin and insertion of SCM

O: sternal head: top of manubrium clavicular head: medial one-third of clavicle I: mastoid process of temporal bone and the lateral portion of superior nuchal line of occiput

Origin and insertion of rotatores

O: transverse process of lumbar through cervical vertebrae I: spinous processes of lumbar vertebrae through C2 (span 1-2 vertebrae)

Name the muscles of vertebral column extension?

Pg. 194 Trail guide (aka antagoinists of flexion) longissimus (bilaterally) iliocostalis(bilaterally) multifidi (bilaterally) semispinalis capitis spinalis (bilaterally) interspinalsis intertransversarii (bilaterally)

The following are ______ to ROM testing Inflammation/infection • Medication that mask pain or muscle relaxants • Hemophilia • OP, Hypermobility, subluxation • Hematoma • Bony ankyloses • Carcinoma, fragile bone condition • Post prolonged immobilization

Precautions

Costal facets articulate with what?

Ribs

External and internal obliques are working in synergy for rotation of the spinal column. Left external oblique is contracting and right internal oblique. Which way is the person rotating?

Right

What goes through the vertebral foramen

Spinal cord

12th rib is in line with which spinous process

T12

Nerves of the anterolateral abdominal wall

Thoraco-abdominal nerves: anterior rami of inferior 6 thoracic spinal nerves (T7-11); former inferior intercostal nerves distal to the costal margin •Runs between IAO and TA to supply abdominal skin and mms Lateral (thoracic) cutaneous branches: thoracic spinal nerves T7-9 (or sometimes T10) Subcostal nerve: large anterior ramus of spinal nerve T12 Iliohypogastric and ilio-inguinal nerves: terminal branches of anterior ramus of spinal nerve L1

What patient might benefit form the tenodesis grasp?

Typically we use our finger flexor and extensor muscles to open and close our fingers and the extension of the wrist allows us to have greater force for pinching and grasping. After a spinal cord injury at the C6 level, a person might be able to send a signal to the muscles controlling the wrist, but not the fingers. We can use the passive mechanical advantage of tenodesis to assist in picking up objects and increase independence in activities such as eating meals and brushing teeth.

What are the actions of the splenius capitis and splenius cervicis?

Unilaterally: Rotate head and neck to the same side Laterally flex the head and neck to the same side Bilaterally: Extend the head and neck

Function of sternoclediomastoid

Unilaterally: laterally flex the head and neck (same side) Rotate head and neck to the opposite side Bilaterally: flex the neck assist to elevate rib cage during inhalation

The palmar interossei are difficult to assess because they are deep to what?

the lumbricals They are also situated between the metacarpals

What happens to the diaphragm during exhalation?

the muscle fibers of the diaphragm relax, releasing the central tendon and allowing the lungs to deflate

What is the deepest muscle of the abdomen

the quadratus lumborum

The diaphragm is the barrier for what 2 cavities

thoracic and abdominal

What are the primary curvatures of the spine

thoracic and sacrococcygeal (retained from original fetal curvature)

What is the deepest of the 4 abdominal muscles

transverse abdominis

C1 does not have a spinous process true or false

true

C1 has no body true or false

true

The hypothear is on the ____ side of the palm

ulnar

What muscles do lateral flexion of the vertebral column

unilaterally to the same side: iliocostalis external oblique internal oblique longissimus quadratus lumborum psoas major (assists) intertransversarii spinalis latissimus dorsi (assists)

What limits motion for a hard end feel? What motion should produce a hard end feel

• Hard/bony • Joint surfaces • e.g. Elbow extension/ knee extension