Human Structure Module 1: Back

Condition where stenotic vertebral foramen in one or more lumbar vertebrae may cause compression of one or more of the spinal nerve roots occupying the vertebral canal.

Lumbar spinal stenosis

Adult spinal cord ends at ___ Dural sac ends at ___ ___ attaches to dorsal coccyx

- L1/L2 intervertebral disc - S2 vertebral level - Filum terminale externum

Discuss the role played by the clavicle (and the sternoclavicular and acromioclavicular joints) in support of the upper limb.

Prevent unwanted movements by imposing a limitation on movement. (double check/read more)

Purpose of projections on bones

Projections on bones provide surface area for muscle attachment.

6 functions of skin

Protection Containment Prevention of dehydration Heat regulation (sweat, dilation of vessels) Sensation Synthesis and storage of vitamin D

Negative effects of scoliosis? More common in what sex?

Scoliosis can impede breathing; become more severe as person ages. More common in girls.

*Intermediate Back Muscles* Serratus posterior superior: -attachments (medial and lateral) -actions -innervation Serratus posterior inferior: -attachments (medial and lateral) -actions -innervation

Serratus posterior superior: -C7-T3 (medial), superior borders of ribs 2-5, lateral to angles. -elevates ribs 2-5 (inhalation) -anterior rami T2-T5 Serratus posterior inferior: (shown in picture) -T11-L2; Inferior border of ribs 9-12 (lateral to their angles) -depresses ribs 9-12 (exhalation) -anterior rami T9-T12

Keratinosis

The differentiation process that occurs as the cells (keratinocytes) migrate from the basal layer to the surface of the skin, resulting in keratinization

Epidural = ___ Subdural = ___

-outside of dura mater -inside the dura mater but outside of arachnoid

Kyphosis occurs in the ___ and ___ regions of the spine

thoracic and sacral kyphosis = vertebral collapse

scapulohumeral muscles: -connect __ to __ -main function

-connect scapula and humerus -rotation of arm

Pectoralis Minor: -medial and lateral attachments -actions -innervation

(around armpit, canfeel if elevate arm) -medial -- Ribs 3-5; lateral -- coracoid process of scapula -anteriorly tilts and depresses the scapula -medial pectoral nerve

Identify the normal curvatures of the vertebral column

(relative to posterior view --- looking at back) concave (lordosis) in cervical and lumbar convex (kyphosis) in thoracic

2 main parts of scapula

*acromion of scapula* - highest point; shoulder plade *spine of scapula* - wraps around posteriorly

Cauda equina -what it is, where it is, why it's important

*mnem: = horse's tail due to its appearance* -bundle of nerve roots that extend down after the spinal nerve ends. -spinal tap done here; contains CSF

Intermediate muscles (serratus posterior superior and inferior): -medial attachment(s) -lateral attachment(s) -actions -innervation

*serratus posterior superior* (image) -C7-T3 -superior borders of ribs 2-5, lateral to their angles -elevates ribs 2-5 in breathing inhalation -anterior rami t2-t5 *serratus posterior inferior* (lower down) -T11-L2 -inferior border of ribs 9-12, lateral to their angles -depresses ribs 9-12 in breathing exhalation -anterior rami t9-t12

In the adult, at what vertebral level would you expect to find the: - 5th sacral spinal cord segment - 12th thoracic spinal cord segment - lst cervical spinal cord segment What's the weird exception?

- below S5 - below T12, above L1 - above C1 vertebra -There are 8 cervical nerves, but only 7 cervical vertebrae. C1 nerve is above C1 vertabrae, and so on. For T, L, and S, there are the same number of each (11 Ts, 5 Ls, 5 Ss) and they go through and exit sort of under their respective vertebrae (e.g., T12 nerve is through and exits below T12 vertebra)

In the adult, at what vertebral level would you expect to find the: - 5th sacral spinal cord segment - 12th thoracic spinal cord segment - lst cervical spinal cord segment What's the weird exception?

- below S5 (very bottom of spinous nerves) - T12 - above C1 vertebra -There are 8 cervical nerves, but only 7 cervical vertebrae. C1 nerve is above C1 vertabrae, and so on. For T, L, and S, there are the same number of each (11 Ts, 5 Ls, 5 Ss) and they go through and exit sort of under their respective vertebrae (e.g., T12 nerve is through and exits below T12 vertebra)

Teres Major: -medial and lateral attachments -actions -innervation

- medial -- inferior angle of scapula; lateral -- medial lip of intertubercular sulcus of humerus - adducts and medially rotates humerus - lower subscapular nerve

Infraspinatus: -medial and lateral attachments -actions -innervation

- medial -- infraspinous fossa of scapula; lateral -- middle facet of greater tubercle of humerus - laterally rotates humerus (part of rotator cuff) - suprascapular nerve

Infraspinatus: -medial and lateral attachments -actions -innervation

- medial -- infraspinous fossa of scapula; lateral -- middle facet of greater tubercle of humerus - laterally rotates humerus (part of rotator cuff) - suprascapular nerve mnem: imagine it as similar looking to latissimus dorsi, but sharp point attaches to lateral side of humerus and pulls it towards ribs, making humerus/arm spin. mnem: infra -- screwdriver

Teres Minor: -medial and lateral attachments -actions -innervation

- medial -- lateral border of scapula; lateral -- inferior facet of the greater tubercle of humerus -laterally rotates the humerus -axillary nerve

Subclavius: -medial and lateral attachments -actions -innervation

- medial -- rib 1; lateral -- clavicle -depresses the clavicle and stabilizes the sternoclavicular joint -nerve to subclavius

Deltoid: -medial and lateral attachments -actions -innervation

- medial -- scapular spine, acromion, lateral 1/3rd of clavicle; lateral -- deltoid tuberosity of humerus -abducts, flexes, and extends the humerus -axillary nerve

Supraspinatus: -medial and lateral attachments -actions -innervation

- medial --supraspinous fossa of scapula; lateral -- superior face of the greater tubercle or humerus. - abducts humerus - suprascapular nerve mnem: imagine it sliding above the spine of the scapula to lift the arm

-What neural structure passes through a posterior (dorsal) sacral foramen? -What neural structure passes through a ventral (anterior) sacral foramen?

- posterior (dorsal) rami of the sacral nerves - anterior (ventral) rami of the sacral nerves

Describe the loss of function caused by a lesion of the following nerves: -Accessory n. (spinal accessory n.) -Dorsal scapular n. -Thoracodorsal n.

-Accessory n. innervates trapezius m. so pt would be unable to move scapula or neck (nodding and side to side neck/head stretch motions) -DSN provides motor innervation to the rhomboid muscles, which pull the scapula towards the spine and levator scapulae muscle, which elevates the scapula, so one would not be able to do those things. -.The latissimus dorsi is responsible for extension, adduction, transverse extension also known as horizontal abduction, flexion from an extended position, and (medial) internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine.

Describe collateral circulation in the arterial anastomes around the glenohumeral joint of shoulder. What is the significance of this. Include names of 3 main arteries involved.

-Collateral circulation = the alternate circulation around a blocked artery or vein via another path. -3 main arteries involved: suprascapilar, transverse vertical, and subscapular arteries. -If one of these are blocked off, blood can still flow through other two main arteries or through other vessels around upper arm. It can still function.

Breasts: -4 breast venous system components that supply blood to breasts -Suspensory ligaments attach to ___. -Role of lymphatic drainage system in breast cancer.

-Internal thoracic branches, Lat. thoracic a., Thoracoacromical branches, Post. Intercostal aa. -pectoral fascia (anteriorly lines pectoral muscles) -METASTASIS -- since lymph fluid goes all over breast and drains into large lymph vessels, cancerous cells can easily spread around and go to other parts of breast and body.

Rhomboid minor: -2 medial attachments -lateral attachment -actions -innervation

-Ligamentum nuchae, SP C7-T1 -Medial border of scapula *at* the spine --retracts and rotates the scapula to tilt the glenoid cavity inferiorly -dorsi scapular n.

anatomical position

-Palms and bottom of upper limbs point anteriorly. -head and eyes/gaze anterior -lower limbs close together with feet parallel and toes directed anteriorly.

Splenius cervicis: -attachments (INFERIOR and SUPERIOR) -actions (unilateral and bilateral) -innervation

-SP T3-T6; TP (transverse process) C1-C3 -unilateral (one side) ipsilaterally flexes and rotates head/neck to same side. Bilateral (both at one time) extends head and neck. -posterior rami of *middle cervical nerves* MNEM: when you see "cervices" think cervical vertebrae! attaches to the sides of those. It has 3 actions: *REF* (like a ref could use this muscle to look at the game) -- rotation (ipsilateral), extension, and flexion (ipsilateral) of cervical vert. Middle cervical nerve innervation because it crosses the back of the neck in the middle, diagonally.

Splenius cervicis: -attachments (INFERIOR and SUPERIOR) -actions (unilateral and bilateral) -innervation

-SP T3-T6; TP (transverse process) C1-C3 -unilateral (one side) laterally flexes and rotates head/neck to same side. Bilateral (both at one time) extends head and neck. -posterior rami of *middle cervical nerves*

Latissimus dorsi: -4 medial attachments -lateral attachment -actions -innervation

-SP T7-L5, thoracolumbar fascia, sacrum, iliac crest, ribs 10-12 -floor of the intertubercular sulcus of humerus (arms) -extends, adducts, and medially rotates the humerus -thoracodorsal nerve (i.e., middle subscalpular nerve)

- ___ is a congenital anomaly in which the laminae (posterior surfaces) of L5 and/or S1 fail to develop normally (separate) and fuse. The defect is often concealed by skin and indicated by tuft of hair. - ___ is an anomaly where one or more vertebral arches may almost completely fail to develop associated with herniation of the meninges and/or the spinal cord.

-Spina bifida occulta -Spina bifida cystica

Greater Tubercule What attaches to it?

-outer/lateral most surface of humerus. -first 3 muscles of rotator cuff -- supraspinous, infraspinous, and teres minor muscles

Rhomboid Major: -medial attachment -lateral attachment -actions -innervation

-T2-T5 -medial border of scapula *below* spine -retracts and rotates the scapula to tilt the glenoid cavity inferiorly -dorsi scapular n.

Levator scalpulae: -medial attachment -lateral attachment -actions -innervation

-TP C1-C4 -superior angle of scapula -elevates and rotates the scapula to tilt the glenoid cavity inferiorly -dorsal scapular nerve

- ___ and ___ spinal curvatures are primary curvatures present at birth - ___ and ___ curvatures are secondary curvatures which develop when the infant lifts its head and learns to walk. (both apply to normal spinal shape)

-Thoracic and sacral curvatures -Cervical and lumbar curvatures

What's on the deep (under) side of the latissimus dorsi m.?

-Thoracodorsal artery -Thoracordosal nerve from posterior cord of brachial plexus

What's on the deep (under) side of the trapezius m.?

-accessory nerve, CN XI -ventral rami of C3 and C4 -transverse cervical artery

-At which vertebral level would it be safe to do a lumbar spinal puncture? -Briefly describe process. -What is the supracristal line?

-below L4 (where SC ends) -Person must be in curled position. Extract from caudal equina in subarachnoid space. Avoid spinal cord because L4/L5 is below it. -upper most part of iliac crest, use it to find space below L4

Scoliosis types: - spine curves to right - spine curves to left

-dextroscoliosis -levoscoliosis

Semispinalis capitis: -attachments (INFERIOR and SUPERIOR) -actions (unilateral and bilateral) -innervation

-inferior -- transverse process of C7-T6/T7, anterior process of C4-C6; superior -- between superior and interior nuchal lines of occipital bone medially -Unilateral--extends and laterally rotates head to opposite side; Bilateral -- extends head. -Posterior rami of spinal nerves all the way down

Semispinalis cervicis: -attachments (INFERIOR and SUPERIOR) -actions (unilateral and bilateral) -innervation

-inferior -- transverse process of T1-T5/T6; superior -- spinal process of C2-C5 -Unilateral--extends and laterally rotates neck to opposite side; Bilateral -- extends neck. -Posterior rami of spinal nerves all the way down

Spinalis: -attachments (INFERIOR and SUPERIOR) -actions (unilateral and bilateral) -innervation

-inferior--median sacral crest, posterior surface sacrum, SP of Lumbar and lower Thoracic, medial part of iliac crest; superior--SP of T and C -unilateral--flexes VT laterally to same side, bilateral--extends VT and head -posterior rami of lower cervical nerves

Iliocostalis: -attachments (INFERIOR and SUPERIOR) -actions (unilateral and bilateral) -innervation

-inferior--median sacral crest, posterior surface sacrum, SP of Lumbar and lower Thoracic, medial part of iliac crest; superior--angles of lower ribs and TP of Cervical vert. -unilateral--flexes VT laterally to same side, bilateral--extends VT and head -posterior rami of lower cervical nerves

Longissmus (Looong): -attachments (INFERIOR and SUPERIOR) -actions (unilateral and bilateral) -innervation

-inferior--median sacral crest, posterior surface sacrum, SP of Lumbar and lower Thoracic, medial part of iliac crest; superior--between tubercules and angles of ribs and TP of T and C -unilateral--flexes VT laterally to same side, bilateral--extends VT and head -posterior rami of lower cervical nerves

Splenius capitis: -attachments (INFERIOR and SUPERIOR) -actions (unilateral and bilateral) -innervation

-ligamentum nuchae (that stuff around spine) and C7-T4; mastoid process and lateral 1/3rd of superior nuchal line -unilateral (one side) laterally flexes and rotates head/neck to same side. Bilateral (both at one time) extends head and neck. -posterior rami of middle cervical nerves

Pectoralis major: -medial and lateral attachments -actions -innervation

-medial -- medial half of clavicle, sternum, costal cartilages 1-7; lateral -- lateral lips of intertubercular sulcus -medially rotates, flexes, and adducts the humerus -medial and lateral pectoral nerves

Terms to describe laterality: -bilateral -unilateral -ipsalateral -contralateral

-paired structures having right and left members (e.g., kidneys, brain hemispheres) -structures on one side only (e.g., spleen) -occurring on the same side of the body (e.g., right toes and right fingers are ipsalateral) -occurring on opposite sides of the body (e.g., the right hand is contralateral to the left hand)

Triceps Brachii: -proximal and distal attachments -actions -innervation

-proximal -- long head attached to infraglenoid tubercule of scapule, medial and lateral heads attached to posterior surface of humerus; distal -- olecranon process of ulna -extends the forearm; long head extends and adducts the arm -radial nerve

Serratus muscles -mnem and what they attach to

-serratus --> serrated --- very jagged (also as thin as paper; white a pearlescent up towards top of back, visualized best under rhomboid i believe) -attach to ribs, which is why they are so jagged

What is a meninx? Dural sac contains which two? Describe the extent of each meninx. What meninx anchors the spinal cord to the inner surface of the vertebral canal?

-singular form of meninges; the dura mater, arachnoid, and pia mater -dura mater and arachnoid -

Trapezius muscle: -4 medial attachments -3 lateral attachments -actions -innervation

-superior nuchal line, external occipital protuberance, ligamentum nuchae, and SP C7-T12 -lateral 1/3rd of the clavical and acomion and spine of scapula. -rotates, elevates (superior part), retracts (middle part), and depresses (inferior part) scapula --- think of a shrug. -Motor: spinal accessory nerve (CN XI); Proprioception: C3-C4

Explain how the suspensory ligaments of the breast cause dimpling in breast cancer. 5 signs of breast cancer from breast dissection/anatomy (mnemonic)

-suspensory ligaments basically maintain shape of breast and hold it in place (suspend); in breast cancer, mass can tugs on these ligaments and you often see little dimples all over breast. -*ROAD MAP* : *R*etraction of nipple and breast -- nipple and skin can pull inwards. *O*range peel appearance *A*ttachment -- of breast to anterior wall; less free movement of breast. *D*impling of skin. *MAP* - (forgot) but essentially an abnormal mammogram like a large mass. Axillary mass (enlarged lymph nodes in breast).

Distinguishing characteristics of: -cervical vertebrae -thoracic vertebrae -the five sacral vertebrae

-transverse foramen -costal facets -all five are fused together

The greater occipital nerve inserts into the ___ muscle, around 3cm inferolateral to the ___

-trapezius -greater occipital protuberance

Five superficial extrinsic back muscles Two intermediate extrinsic back muscles

-trapezius, latisimus dorsi, levator scapulae, and rhomboids (major and minor) (mnem: *T LRLR*) -serratus posterior inferior and serratus posterior superior

Extrinsic Back Muscles: -muscles in the *superficial layer*; these are in what direction? -muscles in the *Intermediate layer* Intrinsic Back Muscles: -muscles in the *Deep layer*

-trapezius, latissimus dorsi, rhomboid major, rhomboid minor, levator scapulae (direction: axioappenendicular) -serratus posterior superior, serratus posterior inferior -splenius, erector spinae, transversospinalis

Accessory nerve (CN XI) location and basic function What artery accompanies this?

-underside of trapezius muscle is where you'll likely find it but it originates in CN XI, where it provides proprioception. -transverse cervical artery

Accessory nerve (CN XI) location and basic function What artery accompanies this?

-underside of trapezius muscle is where you'll likely find it but it originates in CN XI, where it provides proprioception. -transverse cervical artery *mnem:* remember transverse cervical artery innervates it because that's exactly the direction the accessory nerve goes -- across (down) the cervical vertebrae.

Muscle origins and insertions in the *scapula*: 1) Rhomboid major insertion 2) Rhomboid minor insertion 3) Latissimus dorsi origin 4) Supraspinatus origin 5) Supraspinatus insertion 6) Trapezius insertion

...of scapula: 1) medial border 2) where the scapular spine and medial border meet 3) inferior angle (tip of downward pointing part) 4) supraspinous fossa 5) around the anteriolateral surface of the greater tubercule and head of humerus (which is attached to scapula under acromion) 6) along superior (top) surface of scapular spine and clavical

Identify and demonstrate the parts of the breast. Encapsulated or not?

15-20 lobes: each is separate; have drainage thru duct system in direction of nipple; similar to sweat gland; *IT IS NOT ENCAPSULATED* - like other stuff had barriers between it and other stuff; breasts don't have anything separating them from thoracic wall, which is why suspensory ligaments can span thru breasts. Lactiferous ducts; open up into sinuses - note difference between ducts and sinuses in cadaver

There are _#_ spinal vertebrae and each one gives rise to _#_ nerves

31 2

symphysis joint

A symphysis is a fibrocartilaginous fusion between two bones. It is a type of cartilaginous joint, specifically a secondary cartilaginous joint. A symphysis is an amphiarthrosis, a slightly movable joint. A growing together of parts or structures.

Abduction vs. Adduction

Abduction - movement of limb *away* from midline Adduction - movement of limb *towards* midline.

Reduced blood supply to brain stem is a condition called ___.

Arteriosclerosis

How would you assess if the accessory nerve (CN XI) is working?

Assess the trapezius nerve. Ask the pt to shrug his/her shoulders. Can pt move scapula? (damage to accessory nerve is most commonly iatrogenic from surgery)

Which cranial vertebra does NOT contain the carotid artery?

C7 (makes sense...it's the bottom one and carotid is in neck)

proximal

Closer to the origin of the body part or the point of attachment of a limb to the body trunk (e.g., elbow is proximal to the wrist and the proximal part of an artery is its beginning)

Beginning with the skin, name in correct sequence all structures penetrated when doing a lumbar spinal puncture (a) in the midline and (b) slightly lateral to the midline by passing through the ligamentum flavum.

DOUBLE CHECK needle passes thru skin, fat, supraspinous ligament, through flavum, into subarachnoid space. you can take advantage of that anatomy clinically by knowing where dura and dural sack is to remove fluids or insert agents into it

Deep Muscles of the Back: -Deep - more superficial (2) -Deep - more intermediate (1 group, 3 muscles) (mnem) -Deep - deepest (1 group, 3 muscles)

Deep Muscles: -Splenius Capitis and Splenius Cervicis -Erector Spinae (iliocostalis, longissimus and spinalis) (mnem: I Love Spines -- because it moves the spine) -(not 100% sure if need to know) Transversospinales (semispinalis, multifidus and rotatores)

Aging of vertebrae and intervertebral discs.

During middle and older age, there is an overall decrease in bone density and strength, particularly centrally within the vertebral body, that results in superior and inferior surfaces of the vertebrae becoming increasingly concave. The nuclei pulposi dehydrate and lose elastin and proteoglycans while gaining collagen. As a result, the IV discs lose their turgor, become stiffer and more resistant to deformation.

Explain the concept of anatomical variation and discuss how it can impact patient care.

Essentially, there is a general anatomy that we study, but there are so many exceptions. Bones can be different sizes, muscles can vary in size or appearance, etc. Doctors should be able to recognize this concept and still be able to locate structures, usually by using bones, etc as points of reference in palpation, radiographic images, surgery, etc.

Lordosis: -def/characteristics -excessive curvature in the lower back is called ___ -what tends to cause and/or worsen lordosis?

Excessive Lordosis: Excessive curvature of the lower back is known as *lumbar hyperlordosis*, commonly called hollowback or saddle back. Lordosis by increased belly fat or pregnancy (so heavy anterior weight).

seborrheic keratosis stain -- histologic characteristics

Histologic characteristics: Basaloid cells mixed with squamous cells. Keratin-filled invaginations of the epithelium. Intraepidermal horn cysts, brown globule-like structures composed of melanocytes found at the dermoepidermal junction

What's a ramus?

In anatomy, a branch, such as a branch of a blood vessel or nerve. For our purposes, generally synonymous with *nerves that go out to muscles*

-Manubrium and Sternum -the structure that joins them is called the ___ and is located on the _#_ ribs.

In picture, manubrium is blue and sternum is the longer structure under it. Angle of Lewis -located at the 2nd ribs

Locating rhomboid major vs minor in terms of scapula.

Major is large portion below spine of scapula. Attaches to the medial border of the scapula, between the scapula spine and inferior angle. Minor is small portion that angles up starting (laterally) from the medial border of the spine of the scapula.

Identify the 4 rotator cuff muscles and explain how the rotator cuff supports the glenohumeral joint

Mnem: *SITS* Supraspinatus m. Infraspinatus m. Teres Minor m. Subscapularis m. (In order of rotation around shoulder)

Briefly outline blood flow (veins and arteries) of anterior wall (chest region) include the name of structures that drain blood from veins to major arteries.

More lateral/peripheral veins drain to larger veins as you go towards center/medial. *Tributaries* collect blood from veins and drain into major arteries.

Function of muscles for bones

Muscles manipulate, hold in place, and move around bones otherwise bones would just be floating in space

Don't memorize tables or groups; no one will ask what superficial muscles of back are. Many questions on stuff like what's on top of what, so take a note if someone says x is under y, etc.

N/A

Veins and nerves tend to be found together and when looking for one, can likely find it close to other. They intertwine to form ___.

Neurovascular bundles (think about it..makes sense)

The ___ mater surrounds the spine like a sock.

Pia Mater Cannot be removed from spine.

Fractures, dislocations and fracture-dislocations may interfere with the blood supply to the spinal cord from the spinal and medullary arteries resulting in ___ that affects its function leading to muscle weakness and paralysis.

Spinal *ischemia*

Splenius -literal definition of word (helpful sorta) -2 parts -location (starts where, goes where, ends where) -origin and insertion -action -extension vs rotation functions

Splenius = bandage -2 parts are capitis and cervices -comes up across back and neck and to mastoid region underneath ear -origin - both originate at ligamentum nuchae and spines C7-T6 -attachment - capitis: mastoid process & superior nuchal line laterally; cervicis: posterior tubercles of C1-C3 vertebrae -action: helps to extend or rotate the neck laterally -extension- would pull on both of them so they work synergistically with that -rotation: flex just right side, you'd make the head/neck rotate laterally to the right.

Superficial - associated with movements of the ___. Intermediate - associated with movements of the ___. Deep - associated with movements of the ___.

Superficial - associated with movements of the shoulder. Intermediate - associated with movements of the thoracic area. Deep - associated with movements of the vertebral column.

Intrinsic vs Extrinsic muscles and which groups of back muscles are in each; in terms of what nerves innervate (generally); functions.

The *deep* muscles develop embryologically in the back, and are thus described as intrinsic muscles. Connect upper limbs to trunk. They are the superficial back muscles. Dr. Davies defines it by what nerves innervate the muscles; deep/intrinsic muscles innervated by posterior rami of spinal nerves and act to maintain posture and control movements of the vertebral column. The *superficial and intermediate* muscles do not develop in the back but rather start somewhere else, and are classified as extrinsic muscles. Extrinsic muscles innervated by anterior rami of cervical nerves and act on the upper limb.

Superficial muscles are axioappendicular, meaning ___ (trapezius, lat. dorsi, rhomboids, levator scapulae)

The Axioappendicular muscles are the muscles that extend between the axial and appendicular skeletons (like limbs). e.g., muscles that attach to spine (axio) and clavicle or scapula or etc. (appendicular skeleton)

Describe the structure and range of motion of the acromioclavicular joint

The acromioclavicular joint provides the ability to raise the arms above the head.

Levator Scapulae: -attachments -innervation -actions

The levator scapulae is a small strap-like muscle. It begins in the neck, and descends to attach to the scapula. Attachments: Originates from the transverse processes of the C1-C4 vertebrae and attaches to the medial border of the scapula. Innervation: Dorsal scapular nerve. Actions: Elevates the scapula.

Describe the structure and range of motion of the sternoclavicular joint.

The sternoclavicular joint allows movement of the clavicle in three planes, predominantly in the anteroposterior and vertical planes, although some rotation also occurs. A description of movement would be elevation and depression.

What veins are valveless and what does this allow?

The veins around the spinal cord; usually muscles push blood a certain direction in veins, but around spinal cord, the valveless natures allows blood to flow either direction.

Deep Fascia

dense connective tissue on the surface of muscles

What forms a *vertebral canal*?

Two or more vertebral foramina stacked together make a vertebral canal. (houses spinal cord)

Lumbar triangle is and area of no muscle that is surrounded by what 3 structures?

latissimus dorsi, external oblique muscle, and the iliac crest

What 3 superficial muscles are innervated by the Dorsal scapular nerve (DSN)?

all but the first two we learned; the ones that are under trapezius and lat. dorsi. levator scapulae and the two rhomboids.

What 3 superficial muscles are innervated by the Dorsal scapular nerve (DSN)?

all but the first two we learned; the ones that are under trapezius and lat. dorsi. levator scapulae and the two rhomboids. The rhomboids work collectively with the levator scapulae muscles to elevate the medial border of the scapula, downwardly rotating the scapula with respect to the glenohumeral joint. mnem: imagine dorsal scapular nerve as a sports bra strap going around back of scapula and attaching to spine of scapula, letting those three muscles pull the scapula back away from glenohumeral joint

Benefit of spine having multiple vertebrae

allows for more flexibility (as opposed to if the spine was solid)

Describe how a spinal nerve is formed from spinal nerve roots.

anterior and posterior rami (=roots) join to form spinal nerve

___ muscles erect hairs

arrector muscles

deep

away from the surface of the body (e.g., the humerus is deep to the arm muscles)

intermediate

between 2 structures; specifically between a superficial and deep structure. (e.g., the biceps muscle is intermediate between the skin and humerus bone)

medial

closer to the middle of the body; more centered (e.g., pinky finger is on medial side of the hand)

the bottom portion of the spinal cord is called the ___

conus medullaris

dorsal (posterior) vs ventral (anterior) rami of spinal nerves

dorsal/posterior nerves generally carry sensory information to brain ventral/anterior rami/nerves generally carry motor info to muscles. Mnem: *ventromotor* and *shivers up spine* -- spine is posterior/dorsal and shivers are sensations and they go up spine.

3 dermis layers before you reach adipose tissue

epidermis, dermis, hypodermis (in that order) hypodermis also called superficial fascia or subcutaneous tissue; thin layer that binds upper levels of dermis to the underlying layers (adipose). made of loose tissue and fat dermis houses hair follicles, sweat glands, etc.

Anesthetics injected into ___ (spine)

epidural fat (anesthetics are lipid-soluble)

The internal vertebral plexus is in the ___ and is embedded in the ___

epidural space epidural fat

The posterior (dorsal) ramus of spinal nerve innervates the ___ back muscles

erector spinae

distal

farther from the origin of a body part or the point of attachment of a limb to the body trunk (e.g., the wrist is distal to the elbow which is distal to the shoulder)

nerve and artery at back of neck these are located in what layer of skin

greater occipital nerve (C2) -- image occipital artery superficial fascia

transverse planes

horizontal planes passing through the body at right angles to the median and frontal planes, dividing the body into superior (upper) and inferior (lower) parts

term meaning nearer to feet and closer to middle of body (e.g., the anterior parts of the ribs run this way)

inferomedial

The vertebrae articulate with each other via ___, ___, and ___.

intervertebral discs, ligaments and joint capsules

Of what clinical significance is the vertebral venous plexus? What is it?

it's the vein system around the spine; it's valveless which lets blood flow in any direction to carry nutrients. Has multiple blood supply sources at each vertebra like an elevator shaft. Glucose, oxygen, etc can go in. The internal vertebral venous plexus provides an alternate route of venous return when the jugular veins of the neck are compressed, when the flow through the inferior vena cava is obstructed, and when intrathoracic or intraabdominal pressures are increased.

Name three abnormal curvatures of the vertebral column.

kyphosis (hunchback), lordosis (obese, pregnant; sounds like lard), scoliosis

procedure done to relieve pressure on the spinal cord or nerve roots, commonly caused by a tumor or herniated IV disc.

laminectomy (removing one or more portions of the spine)

What superficial muscle is innervated by the Thoracodorsal nerve?

latissimus dorsi

The triangle of auscultation is an area of no muscles surrounded by what 3 muscles

latissimus dorsi, trapezius, and the rhomboid major muscles Surrounded by *TIL* -- trapezius, infraspinatus, and latissimus dorsi (this is where you place a stethoscope to listen to lung sounds)

What do the levator scapulae muscles do?

levator = to lift, scapulae = scapula lifts the scapula mnem: what do levator scapulae do? [shrug]

Back strains and sprains result from trauma, often over time. What muscles are likely to be affected in back strains and sprains?

lumbar IV joints, especially the erector spinae. (makes sense since it would hurt to stand or straighten spine)

Dr. davies messed something up on 8/14/18; said afferent and efferent w/ respect to rami, but meant inferior and superior (dbl check that)

n/a

superior / cranial

nearer to the head; up (e.g., the heart is superior to the stomach)

superficial

nearer to the surface of the body (e.g., the skin is the most superficial part of the back; muscles are superficial to bones in general)

Describe the way in which cutaneous nerves arise from deep nerves, pass through the superficial fascia and enter the skin.

nerves and blood supply for muscles tend to come from deep and go through superficial fascia and finally the skin. e.g., Deep Side of Trapezius m. has: Accessory nerve, CN XI Ventral rami of C3 and C4 Transverse cervical artery these start deeper down and can be found on the bottom of muscles; otherwise, a simple cut could paralyze you (if nerves were on outside of muscles)

Skin Ligaments

numerous small fibrous bands, extend through the subcutaneous tissue and attach the deep surface of the dermis to the underlying deep fascia

On what bone is the superior nuchal line found?

occipital bone (picture is of back of head)

lateral

off to the side; further from the median plane (e.g., cheeks are lateral to nose, thumb is on lateral side of hand)

In a lab practical, if there's a pin anywhere around the spinal cord and it asks what mater it's made of, the answer will always be ___

pia mater

Intervertebral discs

separate the 33 vertebrae in the vertebral column (spine)

spinal cord in adults ends at ___ ___ fills rest of dural sack white vs gray matter

spinal cord ends at L1/L2 intervert. Disc. Cauda equina fills rest of dural sac. Spinal cord blends into brainstem. No sharp demarcation. White matter = axons from spinal cord to brain(stem) & vice versa. Gray = neuronal cell bodies Note spinal cord level does not equal vert. level. Two different things & have to be careful to designate what you are referring to.

term meaning nearer to the head and farther from the median plane

superolateral

what happens to intervertebral discs as we age?

the int. vert. disc shrinks & nucleus pulposus become less fluid; discs more likely to pop out (herniate)

If the thoracodorsal nerve were injured, what deficit would the patient present with?

thoracodorsal nerve innervates the latissimus dorsi muscle. Therefore, damage to this would impair the pt's *ability to extend and rotate arms and rotate lower trunk*.

anterior / ventral

toward or closer to the front of the body; in front of (e.g., the toes are anterior to the ankle)

posterior / dorsal

towards the back; nearer to back than front. (e.g., the heel is posterior to the toes; the occipital lobe is posterior to the frontal lobe)

inferior / caudal

towards the feet; below (e.g., stomach is inferior to the heart)

Median (median sagittal) plane

vertical plane passing longitudinally through the center of the body, dividing it into *right and left halves*

Frontal (coronal) planes

vertical planes passing through the body at right angles to the median plane, dividing the body into anterior (front) and posterior (back) parts

sagittal planes

vertical planes passing through the body parallel to the median plane; helpful to have a point of reference, such as starting at middle of clavicle.