Exam 1

What happens to the spinal cord once you enter the lumbar region? Forms?

It tapers caudally and terminates in the Conus Medullaris

Posterior sternoclavicular ligament. Strength?

Strong- prevents dislocation posteriorly to protect the arteries/nerves in the neck.

Pec major has how many origins? Insertions?

3 heads of origin and 1 common insertion

Dysesthesia

"Phantom" pain

Musculocutaneous Nerve. Forms from? Nerve number? What does it do? How does it course? Can be?

(C5-C7). Innervates the 3 muscles of the anterior compartment of the arm and continues distal to the elbow as the lateral antebrachial cutaneous nerve (LABC). Passes through the coracobrachialis as it descends to the elbow. Can be impinged when passing through the muscle

How many neurons are between the CNS and sensory receptors innervated by GSA fibers?

1

How many neurons are between the CNS and skeletal muscle innervated by GSE fibers?

1

Generally speaking, the lower cervical and upper thoracic segments lie where in relation to their respective vertebral body?

1 level higher- C6 segment in line with C5 vertebral body

Rotatores. How many segments does it run? Why that size?

1-2. Small because most likely more involved in sending proprioceptive info to the brain vs contraction.

The true "shoulder" consists of how many joints? What are they?

1. AC joint 2. SC joint 3. Scapulothoracic joint 4. GH joint 5. Subacromial space

Sensory symptoms of destructive peripheral nerve injuries

1. Anesthesia 2. Hypesthesia 3. Neuralgia 4. Dysesthesia

5 ligaments of the spine. Which 2 are replaced in the c spine?

1. Anterior Longitudinal Ligament 2. Posterior Longitudinal Ligament 3. Ligamentum Flavum 4. Interspinous Ligament 5. Supraspinous Ligament Interspinous and Supraspinous Ligaments are found primary in the T and L spine and are replaced

Muscles of the anterior compartment of the arm and their main actions

1. Biceps brachii- elbow flexor and power supinator 2. Brachialis- "workhorse flexor" 3. Coracobrachialis- minor adductor and flexor of the arm at the GH joint

Why do we have arterial anastomoses in the elbow?

1. Colateral blood supply if the primary source is destroyed *2. Ensures adequate blood flow to the extremities no matter what position the limb is in or what position the joint is in.

Scalene Interval Syndrome/Thoracic Outlet Syndrome. Symptoms? Anomalous cause? If pinch GSA fibers? GSE fibers? One surgical procedure to eliminate this? Where are these motor symptoms experienced?

1. Cool, pale upper limb with a diminished pulse. 2. If pinch GSA- pain or paresthesia If pinch GSE- spasm/twitching. Cervical rib. Motor symptoms experienced in the distal extremity. Can amputate the first rib for relief to release pressure.

Roles of the upper trap

1. Elevate scapula 2. Extend head 3. Ipsilaterally laterally flex head

What are the joints of the elbow? Surrounded by?

1. Humeroradial- B/w the radial head (fovea) and the Capitulum of the Humerus 2. Humeroulnar- B/w the trochlear notch of the ulna and the trochlea of the humerus. 3. Proximal Radioulnar joint between the radial head and the radial notch of the ulna (on the coronoid process)

The mobility of the GH joint is a product of what 2 factors?

1. Incongruity of bony articular surfaces- round humeral head with the relatively flat glenoid fossa- minimal surface area of contact 2. A thin, lax articular capsule- fibrous capsule does little to restrict the movement b/w the humeral head and glenoid fossa.

Fracture of the clavicle. What are the 5 reasons why it is the most commonly fractured bone in the human body?

1. Its sinuous shape 2. The changing cross sectional area of the middle third 3. Its early ossification 4. The bone's role as a strut b/w the arm and axial skeleton 5. Its subcutaneous location- vulnerable.

4 main functions of the vertebral column?

1. Supports the weight of the head, upper limb, and thoracoabdominal viscera. 2. Transfers weight of the upper body to the lower limbs through the pelvis 3. Protects the spinal cord and nerve roots 4. Provides attachment site for muscles which resist the pull of gravity and move both the spine and limbs

Why is the axillary nerve vulnerable to destructive lesions? Causes?

1. Tearing as a result of fracture of the surgical neck of the humerus. 2. Stretching/tearing as a result of anterior GH dislocation. Can cause paralysis/paresis to the deltoid/teres minor and decreased sensation in the patch of skin controlled by its cutaneous distribution.

Name the 4 ligaments responsible for maintaining the integrity of the craniovertebral joints.

1. Tectorial Membrane 2. Cruciform ligament 3. Transverse ligament of the atlas 4. Alar ligaments

Main roles of the somatosensory fibers (main things they conduct)?

1. Touch, pain, pressure and temperature 2. Proprioception from muscles, tendons and joints

Results of CN XI lesion?

1. Trapezius paresis- ipsilateral "shoulder drop" 2. SCM paresis

What are the 2 end results of the brachial plexus (2 end types)? How many total?

11 collateral (preterminal branches) and 5 terminal branches. So 16 total nerves

How many thoracic vertebrae are there?

12

How many cranial nerves do we have?

12 pairs

Mammary gland. How many lobes? Opening? Duct? Common site for breast cancer? Important ligaments? Tail?

15-25 lobes opening separately onto the nipple through a lactiferous duct. The lactiferous duct. suspensory (Cooper's) ligaments. The tail of the breast extends toward the axillary region

Pulse points of the proximal upper limb?

1st is the subclavian and the first rib. Then the mid arm. Then the cubital fossa

What does the functional motion segment of the spine consist of? In a normal healthy spine? In an older one?

2 adjacent vertebral bodies and their intervertebral discs. True for a younger healthy spine. As we age, shifts back to the facet joints.

Dorsal surface of the scapula. What does it divide into? What are they?

2 fossae- Supraspinous fossa and the Infraspinous fossa (relatively flat)

Generally speaking, the middle thoracic segments lie where in relation to their respective vertebral body?

2 levels higher- T9 segment in line with T11 vertebral body

Biceps brachii. How many origins? Protects it? Insertions? Why again is it prone to damage with a labrum injury?

2 origins and a dual insertion. Origin is protected by the transverse tubercle ligament. Because it's origin is the supraglenoid tubercle

2 primary curves of the spine? 2 secondary?

2 primary are the thoracic and sacral. 2 secondary are the cervical and lumbar.

Divisions of the brachial plexus. How many? From a functional perspective, what will each do?

3 trunks split into 6 divisions (1 anterior and 1 posterior for each trunk). The anterior division somatomotor fibers will innervate muscles of the arm, forearm, and palmar hand in the anatomical position (flexors/pronators). The posterior division somatomotor fibers will innervate the posterior muscles of the arm and forearm (extensors).

The "elbow" includes how many joints?

3 within a synovial capsule

How many vertebrae are stacked to form the vertebral canal?

27

Scapula. Has 2 sets of 3 what? What are they? What runs along it? Terminates where?

3 borders and 3 angles. Superior border, superior angle, medial (vertebral) border, inferior angle, inferior border, lateral/axilary border (armpit), and lateral angle. Spine. Continues laterally and terminates at the acromion process

Cords of the brachial plexus. How many? Form from what? What are they?

3 cords form from the 6 divisions. Anterior division fibers from the superior and middle trunks form the lateral cord. Anterior division fibers from the inferior trunk form the medial cord. Posterior fibers from all 3 trunks converge to form the posterior cord.

How many coccygeal vertebrae are there?

3-5 fused

Trunks of the brachial plexus. How many? How many collateral branches? What are the segments? What does this segment give rise to? What forms next?

3. 2. Superior (upper) trunk arises from C5-C6. Middle trunk arises from C7. Inferior (lower) trunk arises from C8-T1. 2 collateral branches- Nerve to subclavius (C5, C6) which innervates the subclavius muscle (on the medial side). Suprascapular nerve (C5, C6) which innervates the supraspinatus and infraspinatus (on the lateral side). 3 trunks turns into 6 divisions (1 anterior and 1 posterior for each trunk)

How oblique are the articular facets of the C spine? Explains?

30-45 degrees. Explains why they have such great ROM

How many spinal nerves do we have?

31 pairs

How many vertebrae do we have? How many intervertebral discs?

33 vertebrae and 23 intervertebral discs

Roots of the brachial plexus. How many? How many collateral branches? What are the segments? What do they innervate? What forms next?

5. 2. Dorsal Scap arises from C5 and innervates the rhomboids and levator scap. Other is the Long Thoracic nerve (C5-C7) and innervates the serratus anterior. 5 roots give rise to 3 trunks.

Sacrum participates in how many joints during locomotion? What are they?

3: Lumbosacral joint (L5-S1) and the 2 sacroiliac joints between the sacrum and os coxa of the pelvis.

Frozen shoulder. Aka? What happens?

Adhesive capsulitis. Reduces both active and passive ROM

How many lumbar vertebrae are there?

5

How many sacral vertebrae are there?

5 fused

Generally speaking, the lumbar, sacral, and coccygeal segments lie where in relation to their respective vertebral body?

Adjacent to T11-L2

How many cervical vertebrae are there?

7

How many cervical spinal nerves are there?

8

When does the axillary artery become the brachial artery?

After passing the lower border of the teres major.

What do the C spine vertebra contain to aide the spinal nerves exiting?

A sulcus

Sacrum and coccyx. Anterior view. Sides? Holes? Rounded top?

Ala ("wings"). Anterior sacral foramina. Promontory

Why is the atlanto-occipital joint aka the "yes" joint?

Allows for flexion/extension in the sagittal plane

Eccentric contractions typically occur as the?

Braking force in opposition to either a concentric contraction or gravity

"Rami" means?

Branch

What does the clavicle act as? What happens when you don't have one/if you break it?

A bony strut providing the only connection between the UE and the axial skeleton. Arm will sag- tend to support the arm when injure it

What is CSF actually?

A clear, colorless liquid, low in protein and cellular contents which functions as a liquid cushion for the CNS within the bony confines of the skull and spine

Injury to the spinal cord above C4 will produce what?

A quadriplegic who cannot breathe independantly

Motor unit. Fiber locations

A single lower motor neuron (alpha motor neuron) and all the muscle fibers it supplies. Can be spread out- don't have to be close

Myotome

A specific muscle mass

Labrum. What does it do?

Adds depth to the socket of the glenoid fossa. Increases surface area of contact between the glenoid fossa and humeral head

Scoliosis. What is it? 2 causes? In what position is the patient placed in to examine for it? Why?

Abnormal lateral curvature of the spine. 1. Congenital vertebral deformity 2. Asymmetry of the paraspinal muscles- one side weaker than the other. Diagnosed by putting the patient in flexion- can see that the spinous processes are no longer straight.

Sacral Hiatus. If you put something up this, what would happen? On the anterior or posterior portion?

Access the inferior portion of the spinal cord. On the posterior portion.

Ventral surface of the scapula. What are the significant structures?

Acromion process, Coracoid process, scapular notch, Subscapular fossa (large concavity), and the Glenoid Fossa

Role of the Inferior GH Ligaments

Act as a hammock in which the humeral head rests, which stabilizes the head in abduction

Irritative Peripheral nerve injuries. Caused by? Can initiate impulses in?

Acue or chronic mechanical trauma or inflammation. May initiate impulses in sensory or motor fibers

Erb's point

An injection here will block the nerves of the cervical plexus

2 portions of the intervertebral disc?

Annulus fibrosis and nucleus pulposus

Subclavian artery

First pulse point for the blood supply to the UEs by compressing it up against the first rib. Located in the subclavian triangle.

Intervertebral discs. "Slipped disc"?

Fixed to rings of hyaline cartilage attached to the periphery of the vertebral bodies- no such thing

"Forearm" aka

Antebrachium

Scalene triangle. Formed by? Transmits?

Anterior and middle scalenes and the first rib. Transmits the Subclavian artery- major blood supply source to the UEs

2 compartments of the arm? Separated by?

Anterior and posterior. Lateral and medial intermuscular septa.

Prevertebral muscles. Attach to? Surrounded by? Innervation?

Anterior aspects of the cervical vertebrae. Prevertebral fascia. Ventral rami

Medial cord of the brachial plexus. Formed from?

Anterior division somatomotor fibers from the inferior trunk

Lateral cord of the brachial plexus. Formed from?

Anterior division somatomotor fibers of the superior and middle trunks

Rotator cuff. Anterior muscles? Posterior? Actions of each? Muscle reinforcements? Overall?

Anterior- Subscapularis (IR) Posterior- Supraspinatus (initiates abd), Infraspinatus (ER), Teres Minor (ER) Technically incomplete inferiorly because the muscles have no reinforcements. Maintain the integrity of the GH joint.

Coronal plane? What're the halves?

Anterior/ventral and Posterior/caudal

Cervical and lumbar spine have a_____ convexity of the spine? Thoracic and sacral have a_____ convexity of the spine?

Anterior/ventral. Posterior/caudal

How is the humeral condyle curved? Why?

Anteriorly- to provide more forward-facing articular surfaces which facilitate full range of elbow flexion

Typically, named peripheral nerves contain fibers from? Named for?

At least 2 adjacent ventral rami. Their peripheral distribution

Most named peripheral nerves arising from a spinal nerve plexus are formed by fibers from?

At least 2 subjacent spinal nerves

What is the widest vertebrae?

Atlas

C1 aka? C2 aka? C7 aka? C3-C6?

Atlas. Axis. Vertebra prominens. Normal C spine vertebrae

Somatotopic organization of ventral horns. Axial muscles vs limbs? Flexors vs extensors?

Axial muscles are medial to the motor neurons that supply the limbs. Flexors are dorsal to motor neurons that innervate extensor muscles.

What types of fibers do the dorsal and ventral rami contain?

Mixed- both afferent and efferent like the spinal nerve

What does damage to the lower motor neurons produce? Example of a disease that does this?

Flaccid, paralysis, atrophy of skeletal muscle. Polio

Coracoacromial Ligaments. Role? Process for it?

B/w the coracoid process and the distal end of the clavicle. Limits the upward displacement of the humeral head. On the medial inferior portion there is the impression for this ligament

Humeroradial joint

B/w the radial head (fovea) and the Capitulum of the Humerus

Humeroulnar joint

B/w the trochlear notch of the ulna and the trochlea of the humerus.

Axillary fossa. Base? Apex? Anterior wall? Posterior wall? Medial wall? Lateral wall?

Base- skin of the armpit Apex- interval between the clavicle and first rib Anterior wall- pec major and pec minor Posterior- subscap, trees major, and lat tendon Medial- serratus anterior and lateral rib cage Lateral- Intertrubecular (bicipital) sulcus

Vertebral arch

Basically the arch of the lamina

Cruciform Ligament

Behind the Tectorial membrane and has transverse and longitudinal ligaments

Costoclavicular ligament. Role?

Between the proximal clavicular head and rib 1. Also prevents posterior dislocation

Primary flexors of the elbow? Extensors?

Biceps brachii and Brachialis. Triceps brachii.

What is characteristic of the occipital condyles?

Biconvex- for biconcave superior articular facets of the atlas.

Why is it important that the veins of the Vertebral venous plexus have no valves? Is this a good or bad thing?

Blood can move in any direction according to pressure gradients- gravity, breathing, etc. Can be bad because it is a route for the spread of infection and metastases as well as emboli to the endocranium. The venous dural sinuses

Somatic Nervous system. Includes? Fiber types?

Body wall and extremities. Motor (efferent, GSE) and Sensory (afferent, GSA).

Cartilagenous joints

Bone joined by hyaline cartilage or fibrocartilage

Spondolophytes. Where can they grow?

Bone spurs. Either on the vertebral body or on the articular process.

What does the bifid process on the back of the C spine vertebrae provide?

Both posterior cervical muscles and the Ligamentum Nuchae.

"Arm" aka

Brachium

Divisions of the CNS

Brain and spinal cord

Facet angles in the 3 main types of vertebrae. Cervical? Thoracic? What shape articular surface? Lumbar? Shape?

C- 45 degree angle from the horizontal plane T- 20 degrees posterior of the horizontal plane and 80 degrees above it. Convex surface L- Basically perpendicular to the horizontal plane. Concave surface

What are all 4 muscles of the suboccipital region innervated by?

C1 dorsal ramus- however no cutaneous innervation at this point

Lesser Occipital Nerve. Part of? Number? Innervates?

C2 (only fibers from C2). Cutaneous nerves arising from the cervical plexus

Greater Auricular Nerve. Part of? Number? Innervates?

C2, C3. Part of the cutaneous nerves arising from the cervical plexus

Transverse Cervical Nerve. Part of? Number? Innervates?

C2, C3. Part of the cutaneous nerves arising from the cervical plexus

What nerve innervates the posterior scalp? Suboccipital region?

C2. C1

Supraclavicular Nerve. Part of? Number? Innervates?

C3, C4. Part of the cutaneous nerves arising from the cervical plexus

If you have a spinal cord injury above what level will produce a quadriplegic who cannot breathe independantly?

C4

Upper trunk lesions. Range from? What type of palsy? Major nerves involved? What position is the arm in? Forearm? Aka what position?

C5 to C6 roots. Major nerves are the Axillary, Suprascapular, and Musculocutaneous. Arm is stuck extended, adducted, and internally rotated. Forearm is extended and pronated. Waiter's tip position

Where are the largest ventral horns in the spinal cord located? Why?

C5-T1(for the brachial plexus of UEs) and L2-S3 (for the fibers that innervates the LEs)

Vertebra prominens. What vertebrae is it? Size?

C7. Provides extensive SA for the origin of multiple cervical muscles aka Nuchal muscles

The skin of the face and anterior scalp are innervated by which nerve?

CN 5, trigeminal nerve

Sternocleidomastoid (SCM) is innervated by? Same as? What does it divide?

CN XI- same as the trapezius. Divides each side of the anterolateral neck into 2 large triangles- the Posterior Cervical triangle and the Anterior cervical triangle

2 divisions of the nervous system (nerve wise)

CNS and PNS

A collection of nerve cell bodies in the CNS? PNS?

CNS- Nucleus PNS- Ganglion

A bundle of axons in the CNS? PNS?

CNS- Tract PNS- Nerve

In irritative peripheral nerve injuries, what happens when sensory fibers are stimulated?

Can cause pain or parasthesia

In irritative peripheral nerve injuries, what happens when motor fibers are stimulated?

Can cause spasm/twitching- uncontrolled involuntary muscle contraction

Posterior annulus and age? Force that can lead to issues? 2 possible results?

Can have degenerative changes. Tensile stress. Disc bulge or herniation

Trapezius paresis- "shoulder drop"

Caused by a lesion to CN XI. Ipsilateral. Weakness in the UT to help suspend the pectoral girdle

SCM Paresis

Caused by a lesion to CN XI. Weakness in contralateral rotation against resistance

2 main veins of the upper arm. What is the connection b/w them? Common site of?

Cephalic vein (middle of the bicep) more laterally and the Basilic vein more medially. Connected by the Median Cubital Vein- common site of venipuncture (blood drawing)

What are the 5 different regions of the spine?

Cervical, thoracic, lumbar, sacral, and coccygeal

Nursemaid's elbow. Are children or adults more likely to get this?

Children-if their hand is pulled too hard (radius articulates with the carpal bones)- pulls radial head right out of the joint. Angular ligament is not tea cup shaped to grasp the radial neck like it is in adults

What is the earliest postcranial bone to initiate ossification?

Clavicle

What is the most frequently fractured bone in the body?

Clavicle

What is the only bone connecting the UE to the axial skeleton?

Clavicle

When we elevate/depress the scap, what moves with it?

Clavicle

Clavicle. Aka? What is it? Sole? Development? Earliest?

Collar bone. Bony strut suspending the arm and allowing it to swing clear of the trunk. Only bony connection between the upper limb and axial skeleton (sternum). Develops early via intramembranous ossification. Earliest postcranial bone to initiate ossification

Spinal nerve. Combination of? Does it only have one type of fiber? Size? Splits into?

Combo of the doral and ventral roots- has mixed fibers (afferent and efferent). Most are very short- just big enough to exit the IV Foramen. Dorsal and ventral rami.

Typical vertebra. Anterior portion: What type of bone is on the outside? Inside? What is in the middle of the posterior portion?

Compact. Spongy/trabecular. Vertebral foramen.

Anesthesia

Complete loss of sensation

Compression vs tension. Intervertebral discs better at handling which type of load placed on them?

Compression

Important features of the Radius.

Concave radial head with the fovea (head articulates with the Capitulum of the humerus and the radial process), neck of the radius, radial tuberosity, and the interosseous border

Spasmodic Torticollis (Wryneck). How do you see where you're going?

Condition of the SCM where the neck is constantly laterally flexed and contralaterally rotated. Caused by either an SCM pathology or disorder of CN XI. Have to keep the eyes rotated in

Anomalous cervical rib and Thoracic outlet syndrome

Congenital abnormality arising from the normally resorbed costal process of C7. Can also compress elements of brachial plexus as it passes through the scalene interval.

Interspinales. Where found? Action

Connect at the spinous processes of C spine. Extension

Transverse Ligament of the atlas. Why is it unusual? Forms? Size of this ligament? What happens if you were to rupture this ligament? Maintains?

Connects at both ends to the same bone (atlas). Forms a collar around the Dens maintaining the median atlantodental joint. Thin, but very strong. The Dens could injure the spinal cord. Maintains the vertebral foramen

Anterior sternoclavicular ligament. Strength?

Connects the anterior medial proximal clavicle to the sternum. Weak- most SC dislocations are usually directed anteriorly

Tectorial Membrane

Continuation of the PLL in the C spine connecting the atlas to the occipital bone along the anterior margin of the foramen magnum

The dura and arachnoid layer of the brain are continuous at? With?

Continuous at the foramen magnum with the dura and arachnoid covering the spinal cord as is the subarachnoid space

Lower motor neurons

Contraction of skeletal muscle is a direct result of these, located in the ventral horn of spinal gray

Phrenic nerve. Arise bilaterally from? What does it do? How does it travel?

Contributions from C3, C4, and C5 ventral rami. Innervates the diaphragm and adjacent membranes lining the thorax- pleura. Travels on the anterior scalene.

Cervical plexus arises from what sources? Located where?

Contributions of C1-C4 ventral rami of spinal nerves. Located in the occipital triangle

AC Joint. What are the important ligaments? Main purpose of these ligaments? Injury here?

Coracoclavicular Ligament, which is divided into the Trapezoid ligament (laterally) andConoid ligament (medially). And the AC Ligament is present. Maintain the integrity of this plane synovial joint and suspend the scapula from the clavicle. Shoulder separation

Important ligaments surrounding the Humeral head. Starting with the most superior and wrapping around from anterior to posterior. One other one?

Coracohumeral ligament, superior GH ligament, Middle GH ligament, and the inferior GH ligaments (anterior band, axillary recess, and posterior band). Transverse humeral ligament b/w the Greater and Lesser Tubercles.

Spinal lateral flexion occurs in what plane?

Coronal

Anterior Longitudinal Ligament (ALL). Extends to where? Principle responsibility?

Covers the anterior and lateral parts of the vertebral bodies and intervertebral discs. Principle responsibility is to limit the extension of the spine

Posterior Longitudinal Ligament (PLL). Principle responsibility? Relative strength compared to the ALL? Role with the annulus fibrosis?

Covers the posterior parts of the vertebral bodies and intervertebral discs. Limits flexion of the spine. Weaker than the ALL. PLL reinforces the posterior part of the annulus fibrosis which is why most herniations are posterolateral

When you reflect the Tectorial Membrane, what do you see?

Cruciform ligament

Skin and 2/3 of the back and posterior scalp are innervated by?

Cutaneous branches of the dorsal rami of spinal nerves

What does dissection of the occipital triangle reveal?

Cutaneous nerves of the cervical plexus

Exteroceptors. Each is sensitive to? When stimulated do what? What are the different types? Cell bodies located where?

Cutaneous receptors in the skin to the CNS. Transduces the physical energy from the stimulus into an action potential. Mechanoreceptors (deformation/displacement), Thermoreceptors (temperature), and Nociceptors (stimuli which damage tissue). In the DRG

What does the latissimus dorsi support? Why?

Deep back muscles- where is it located

Brachial plexus. Lies? Arises from? How can this be compressed- aka?

Deep in the neck. C5-T1 ventral rami. Subject to compression with hypertrophy or pathology of the scalenes- aka Scalene Interval Syndrome/Thoracic Outlet Syndrome

What does reflection of the Splenius muscles reveal

Deep neck and suboccipital muscles

Pia Mater

Deepest mening surrounding the spinal cord

What are bone spurs a result of? Technical term? Result of?

Degenerative pathology of the spine increasingly common in our longer-lived larger-bodied society. Spondolophytes. New growth of bone in areas of inflammation which can cause pain

Main portions of the posterior axillary fold?

Deltoid, subscapularis, the lat, and trees major

Fibrous joints. Connected by? Examples?

Dense CT. Skull sutures, teeth/gum (gomphosis), and tissue between the radius/ulna and the tibia/fibula- syndesmosis

When people say they "separated their shoulder", what is really going on?

Depending on Grade 1-Grade 3, couldv'e torn either the AC, Coracoclavicular, or Corachoacromial ligaments or all of them.

Roles of the lower trap

Depresses the scap against gravity

What does the spinal cord descend in?

Descends through the vertebral canal w/in a closed dural (thecal) sac

What joint is shoulder dislocation at? Shoulder separation?

Dislocation is at the GH joint, separation is at the AC joint

How may the posterior cervical triangle be subdivided further? Divided by? Into?

Divided by the belly of the Omohyoid muscle. Divided into the occipital triangle (superiorly) and the subclavian triangle (inferiorly).

How is the axillary artery divided? What is it divided by? How is it easy to remember?

Divided into 3 parts by the pec minor. Each part has as many branches as its number

Radian Nerve in the cubital fossa. What does it do? Divides?

Divides into superficial and deep branches- the deep branch of the radial nerve which is almost exclusively muscular and the superficial branch of the radial nerve which is completely cutaneous.

Midsagittal Plane

Divides the body into "equal" left and right halves

Posterolateral Herniation of a lumbar disc. Will compress nerves located where? What type of info sent? Can cause?

Does not compress nerve at that level- will usually compress the roots of the spinal nerve emerging through the next IV foramen down- sensory afferent info. Compression of the dorsal root may cause pain or parasthesia

CN XI. Where do the fibers arise? Axons run? Vulnerable to?

Dont arise from the brainstem- from ventral horn of C1-C5 and the axons run through the foramen magnum to exit through the jugular foramen. Run parallel to the spine. Vulnerable to lesion when removing cancers of the head/neck- crosses the occipital triangle to travel to the trap. The cancer can spread through chains of nodes along the posterior cervical triangle and CN XI can be lesioned when removing the tissue

Venous dural sinuses

Drain the brain and endocranium. CSF circulates along the length of the sub-arachnoid space before being absorbed into the network of these sinuses in the skull which drain.

Degenerative changes in the_____ are a major cause of chronic back pain? Which portion of the spine is particularly vulnerable?

Facet joints. Lumbar spine

What is the cause of the discrepancy b/w the length of the vertebral column and the spinal cord?

During development- 3 month old fetus cord segments are adjacent to vertebrae of same number and nerve roots are horizontal. However, in the 2nd and 3rd trimesters, the spine has grown in length more rapidly than the cord

A thin, lax articular capsule and the mobility of the GH joint. What is significant about this? What can happen to this with age?

Fibrous capsule does little to restrict the movement b/w the humeral head and glenoid fossa. Capsule can tighten up, leading to frozen shoulder

Why is the radial nerve vulnerable to compression? Where?

Either against the tendon of insertion of the lat or the proximal head of the humeral shaft. "Saturday night palsy; barstool neuropathy". Compressing this nerve between your arm and the barstool. Same with using crutches improperly

Scapulothoracic movements

Elevation (shrug), Depression, Protraction (punch), Retraction (row), and upward/downward rotation

What muscles elevate and depress the scap (anterior and posterior muscles)? Protraction and retraction? Upward (lateral) and Downward (medial) rotation?

Elevation- upper trap and levator scap Depression- lower trap, lat, and pec minor Protraction- Serratus anterior and pec minor Retraction- Rhomboid and middle trap Rotation- force couples

Synovial joints. Main feature? Forms a? Lined with? Articular surfaces covered with? Decreases?

Enclosed by a fibrous joint capsule which surrounds the articular surfaces and forms a closed articular cavity. Lined with synovial membrane which secretes synovial fluid . Articular surfaces covered with distortable hyaline cartilage laid over a thin layer of subchondral bone. Decreases friction

Where do the Radicular and Segmental Medullary arteries enter?

Enter the vertebral canal through the intervertebral foramina

What is found immediately beneath the vertebral canal? What is it for?

Epidural fat- cushioning/protection

The nerves of the cervical plexus may be blocked by an injection where? What will result occasionally? Why?

Erb's point. Occasionally a temporary "shoulder drop"- CN XI crosses the occipital triangle to reach the trapezius

Lordosis. Primary or secondary curve?

Exaggerated anterior curvature of the spine. Secondary

Kyphosis. Primary or secondary curve?

Exaggerated posterior curvature of the spine. Primary

suspensory (Cooper's) Ligaments. Extend from? Stage 4 and 5 cancer?

Extend from the pec major fascia through the mammary layer to the deep surface of the skin. With breast carcinoma, these ligaments get invaded causing their contracture, which can dimple the skin making it look like an orange/grapefruit peel. Stage 4 and 5 cancer can invade the pec major/pec minor

"Waiter's Tip position". What is the arm position result from lesion to what nerves? What muscles in the arm are paralyzed? Forearm?

Extended, adducted, and internally rotated. Lesion to the axillary, suprascapular, and musculocutaneous nerves. Deltoid, teres minor, supraspinatus and infraspinatus in the arm. Forearm is extended and pronated. Biceps brachii and brachialis.

Ligamentum Flavum. Extends b/w? Color? Helps maintain?

Extends b/w the laminae of adjacent vertebrae. It is elastic and yellow. Limits flexion and helps maintain normal vertebral curvatures, particularly in secondary curves

What are articular columns? Upside? Downside?

Facet joints of the C spine are stacked on each side. Allows great ROM, but z-joint dislocation is easier than in other segments of the spine

GH flexion occurs in what plane? Extension? Abd/add? IR/ER? Circumduction?

Flex/ext- sagittal plane Abd/add- coronal plane IR/ER- vertical axis Circumduction- Around all 3 cardinal axes

Deltoid. What are it's actions? Why are 2 of them unusual? Main role?

Flexion, extension, and abduction. Both flexes and extends- the direction that the fibers run in allow it to produce antagonistic movements. Anterior portion can produce flexion and the posterior portion can produce extension. Assumes responsibility for abduction past the first 20 degrees.

When is scapular rotation required? In order to?

For full flexion and abduction- scapula needs to rotate along the thoracic wall. In order to reposition the glenoid fossa

Inferior view of cranium. Big hole? Ridge shaped like a 3? Big bump you can feel? 2 bumps to the side of the big hole?

Foramen Magnum. Nuchal lines. External occipital protuberance. Occipital condyles

Direct posterior herniation of a lumbar disc. Can affect?

Forces the PLL to buckle- may compress multiple roots in the cauda equina

Cauda Equina. Why does it have this name?

Formed by the roots of the lower lumbar, sacral and coccygeal spinal nerves. Looks like a horse's tail

Denticulate Ligaments. From what meningeal layer?

Found between emerging nerves, they penetrate the arachnoid, and attach to the dura to help stabilize the cord. Essentially provide stability to the cord as it floats in a sea of CSF. Pia Mater

Investing layer of deep cervical fascia

Found under the skin, subcutaneous fat and Platysma layer. This splits around 2 pairs of large cervical muscles

What can lesion the ulnar nerve?

Fracture of the medial humeral epicondyle

What may lesion the median nerve?

Fracture of the supracondyles of the humerus- as it's heading down the arm to the cubital fossa

Hangman's Fracture?

Fracture through the pedicles of the axis b/w the superior and inferior articular facets

Ventral root. Originates/leads to? Rootlet fibers? Comprised of?

From the ventral horn (gray matter) to skeletal muscle. Rootlet fibers diverge. Comprised of somatic efferent fibers carrying info from the CNS to skeletal muscle.

Clavicle. Inferior view. Lateral end? Medial end?

Furthest lateral you see the Trapezoid line next to the conoid tubercle. Medial end you see an impressions for the costoclavicular ligament.

Why does the spinal cord get wider around certain regions?

Give rise to the spinal nerves contributing to the brachial and lumbosacral plexuses, innervating the upper and lower limbs respectively

Why do cyclists commonly fracture the clavicle?

Go over the handlebars and fall on a fully extended arm- force is transmitted right up to the clavicle

The Posterior cervical triangle. What are its contents?

Has few contents but they include major neuromuscular structures destined for the axillary fossa and UE. Originate and first course through the posterior triangle- go distally towards the UE.

Atlas. What does it lack? Articular facets? Lateral? Waist? Arches? Transverse Process?

Has no body or spinous process. Lateral mass joined by anterior and posterior arches- posterior arch is grooved superiorly for the vertebral arteries. Arches end in tubercles. It has biconcave superior articular facets (for biconvex occipital condyles). Also has articular facet for the Dens of the Axis. Longest transverse process- easy to feel

Proximal humerus (anterior view). Head? What is under then? 2 bumps? B/w?

Head. Connects to the anatomical neck. Greater Tubercle and Lesser Tubercle (laterally to medially). Surgical neck lies inferior to these tubercles. Intertrubecular (bicipital) surface- 1 of the 2 heads of the biceps brachii lies here.

Thoracic Vertebrae. Body shape? Articular facets? Costal facets? Spinous process? ROM?

Heart shaped bodies. Angled in the coronal plane which limit ROM and mainly allow lateral bending and rotation. Long obliquely oriented spinous process.

Trochlea. Found where? How does it span?

Humeral condyle- articulates with the ulnar trochlear notch. Obliquity of the groove of the trochlea causes the ulna, hence the entire forearm to laterally abduct as the elbow is extended

Axillary artery. Why is it important? Arises from? When does it get this name? What does it turn into? When?

It is the basis around which the cords of the brachial plexus are named. Arises from the subclavian artery as it enters the apex of the axilla by passing over the first rib. Turns into the brachial artery after passing the lower border of the teres major.

As soon as spinal nerves exit the intervertebral foramen, what do they split into?

Immediately upon exiting the foramen divide into large ventral primary rami and smaller dorsal primary rami

When does blood mix with CSF? Is it a good thing?

In a traumatic injury to the body/spine. Never- infectious agents can enter

Trapezoid Ligament. Process for it?

In between the Coracoacromial Ligament and the Conoid Ligament. Trapezoid shaped. Trapezoid line- most lateral marking on the inferior lateral end of the clavicle

Biceps in pronation? Supination?

In pronation, the biceps is lengthened when the radial tuberosity is rotated posteriorly and the tendon is wrapped around the neck. In supination, shortening contraction of the biceps will unwrap the neck and rotate the radial tuberosity anteriorly, particularly when the elbow is flexed

Multifidus. Well developed where? How many segments does it run?

In the lumbar spine. 2-4

In the middle arm, what happens to the ulnar nerve? 70-80% of individuals? After this?

In the middle arm, it pierces the inter muscular septum and descends in front of the triceps. In 70-80% of individuals it passes through the Arcade of Struthers (thin, aponeurotic band extending from the medial head of the triceps to the medial inter muscular septum. After this, it passes through the Cubital tunnel.

Where are the CNS vasculature and CSF found in the spinal cord?

In the subarachnoid space

Where is the first pulse point evaluating the blood supply to the UEs? What artery specifically? How do you physically determine the pulse?

In the subclavian triangle. Subclavian artery. Compress the artery against the first rib

Pre-plexus lesions. Type of effects?

Injuries to spinal cord segments, spinal nerves or ventral rami of C5-T1. Widespread effects

Post-plexus lesions

Injuries to terminal or collateral branches. More focused effects. Effects seen downstream

Plexus lesions

Injuries to trunks, divisions, or cords

Nucleus Pulposus . Centered? Allows for?

Inner semi-gelatinous hydrophilic region. Not centered- sits closer to the posterior portion. Movement and distortion of the motion segment by each disc and 2 subjacent vertebrae

Alpha motor neurons

Innervate extrafusal muscle fibers whose contraction generates tension and allows movement.

In addition to exteroreceptors, what other kinds of input enter the spinal cord via the DRG? Input segregated?

Input from proprioceptors located in muscles, tendons and joints. Segregated based on modality

Circumduction of the shoulder. What is it? What axis is it around?

Inscribing a cone in space (shoulder circles). Goes around all 3 principle axes

Brachialis. Regular curls vs reverse curls and this muscle?

Inserts on the ulnar tuberosity which means the muscle will flex the elbow no matter whether the forearm is pronated or supinated. Both regular curls and reverse curls shorten this muscle

Mobility of the GH joint comes at the price of_______. 2 types of injuries that can occur here?

Instability. Dislocation and subluxation

Deepest relatively minor C spine muscles other than the suboccipital muscles?

Intertrasnversii and Interspinales

What is the anterior boundary of the C spine intervertebral foramina? Size? Why does this pose a risk?

Intervertebral discs. The intervertebral foramina is small as it is, and any cervical spine herniation will impinge on these spinal nerves

Unilateral contraction of the SCM produces?

Ipsilateral lateral flexion of the head and contralateral rotation of the head

Palpation of the coracoid process. Where?

Is possible- intraclavicular fossa

What is unique about the transverse ligament of the atlas? What does it contain between it and the Dens?

It is attached at both ends to the same bone. Has a bursa sac

Atlanto-occipital joint. What surrounds articular facets? Joint aka? How can you fracture this?

Joint between the skull and atlas. Facets are surrounded by a fibrous capsule of the synovial joint. Known as the "yes" joint. Hit over the top of the head- Jefferson fracture

Lumbar Vetebrae. Body shape? Process they have that other parts don't? For? Articular facets? Permit? Transverse process? Spinous process? Why are these last 2 the size that they are?

Kidney bean shaped bodies. Mammilary Process- provide more SA. Angled in the sagittal plane to allow flexion/extension and lateral bending. Large transverse process and short broad spinous process. These 2 are very robust to allow for the paraspinals to attach resist gravity and keep up erect.

Is Lordosis or Kyphosis more common in older women? Why? Aka?

Kyphosis- more common in post-menopausal women with osteoporosis. Dowager's Hump

C spine total ROM. Lateral flexion? Flexion? Extension? Rotation?

L- 35 degrees F- 65 degrees E- 40 degrees R- 50 degrees

At what spinal level does the spinal cord taper off and the Conus Medullaris begin?

L1-L2

Spinal cord terminates at what level? Dural (thecal) sac extends to what level?

L1-L2. S2

Ventral Primary Ramus. Size? Innervates?

Large. Innervates the anterolateral body wall, hypo axial muscles and the upper and lower extremities.

Clavicle. Superior view. Lateral end? Medial End? In b/w?

Lateral end is broad and flat and articulates with the acromion. Medial end articulates with the manubrium of the sternum and is rounded. Then have the middle 1/3.

Sacrum and coccyx. Posterior view. Towards the edge? Middle? Holes? Runs up it?

Lateral sacral crest. Median sacral crest. Posterior sacral foramina. Sacral hiatus.

Distal humerus. Anterior view. What do you see on the sides?

Lateral supracondylar ridge, lateral epicondyle, medial supracondylar ridge, medial epicondyle, and the humeral condyle

Surgical neck of the humerus

Lies inferior to the greater and lesser tubercles.

Which spinal ligament is involved during a lumbar punch/spinal tap?

Ligamentum Flavum

What are the Interspinous and Supraspinous ligaments replaced by in the C spine?

Ligamentum Nuchae

Principle responsibility of the ALL?

Limit extension of the spine

Principle responsibility of the PLL?

Limit flexion of the spine

Main roles of the ligamentum flavum?

Limits flexion and helps maintain normal vertebral curvatures, particularly in secondary curves

Interspinous Ligaments. Where located? Main role?

Located between spinous processes. Limits separation of vertebral bodies as in flexion

Triceps. Action of the long head vs medial and lateral heads? Primary action?

Long head has minor shoulder extending and adducting functions- attaches to the infraglenoid tubercle. Primary action is elbow extension

Vertebral Prominens. Main difference b/w it and C3-C6? Palpating it?

Long spinous process. First bump you feel when you move down your neck

Serratus anterior innervated by? Engineering? What happens if cut? When could this happen?

Long thoracic nerve- bad engineering because just superficial to muscle. Destructive lesion- can result in paralysis or paresis. Could be cut during a mastectomy or from trauma to the thorax

"Manubrium" of the sternum

Looks like the handle of a serrated knife

Contraction of skeletal muscle is a direct result of stimulus by_______ located in either the brain or spinal cord

Lower motor neurons

Which muscle stabilizes the axis of rotation in upward (lateral) rotation of the scapula?

Lower trap

What are the purpose of ligaments? Either?

Maintain integrity of the joints. Either tense or slack

What lies immediately superficial to the pec major?

Mammary gland

T1 dermatome

Medial aspect of the forearm, elbow and lower arm

T2 dermatome

Medial aspect of the upper arm

Median Nerve. Forms from? Nerve number? What does it do?

Median nerve (C6-T1) via contributions from lateral and medial cords. Controls 5 intrinsic hand muscles including thenar (grip muscles) at the base of the thumb and the skin of the median palm and lateral 3.5 digits.

What portion of the clavicle is the site for fracture?

Middle 1/3

C7 dermatome

Middle finger and middle hand

Arachnoid Mater. Subarachnoid space in life? In cadaver?

Middle layer between the dura mater and pia mater. In life, the pressure of the CSF in the subarachnoid space keeps the dura and arachnoid apposed- in a cadaver they are easily separable.

Most muscles are innervated by a peripheral nerve arising from a spinal nerve plexus and containing somatic efferents from? Why is this?

More than 1 spinal cord segment- there is overlap. Because virtually every muscle below the head is formed by the fusion of myoblasts derived from multiple adjacent somites. So, each muscle can have efferent info from at least 2 or more adjacent somites.

Conoid Ligament. Process for it?

Most medial AC joint ligament. Conoid tubercle- on the inferior lateral end of the clavicle (just medial to the Trapezoid line).

Dura Mater. How does it project?

Most superficial layer surrounding the spinal cord. Projects laterally to each intervertebral level to encompass the roots of the spinal nerves

Where are motor symptoms of Scalene Interval Syndrome/Thoracic Outlet Syndrome experienced?

Motor symptoms experienced in the distal extremity.

Intertransversarii. Where found? Action?

Muscles on the lateral end of the C spine transverse processes. For lateral flexion

Lateral cord terminal branches. What are the 2? What do they innervate?

Musculocutaneous nerve (C5-C7). Innervates the 3 muscles of the anterior compartment of the arm and continues distal to the elbow as the lateral antebrachial cutaneous nerve (LABC). Passes through the coracobrachialis as it descends to the elbow. Median nerve (C6-T1) via contributions from lateral and medial cords. Controls 5 intrinsic hand muscles including thenar (grip muscles) at the base of the thumb and the skin of the median palm and lateral 3.5 digits.

What happens to a dermatome when there is a loss of 1 spinal nerve or dorsal root?

NOTHING! Dermatomes overlap, so the person would not perceive a patch of skin devoid of sensation

Dermatome

Nerve and the piece of skin it innervates

Neuralgia

Nerve pain

What comes out of the actual spinal cord itself?

Nerve roots.

Vertebral venous plexus? What is different about the veins of this network vs typical veins? What does the plexus freely communicate with?

Network of valveless veins running the length of the trunk- from the pelvis up to the head and neck. These veins have no valves. The veins of the body wall and the venous dural sinuses.

Is the brachial plexus inside everyone exactly the same?

No, there is some variation. If the C4 ventral rami fibers participate, it is known as a prefixed plexus. If the fibers from T2 contribute, it is referred to as a postfixed plexus

Is the AC ligament strong?

No, weak

Is the body's line of gravity perfectly symmetrical? What happens as a result?

No- it lies in the anterior of the spine. The deep back muscles, particularly those of the lumbar spine must counteract this, which can lead to muscle strain and low back pain.

Is anyone truly perfectly symmetrical?

No- right vs left handed people, more developed on one side

Is the spinal cord the same circumference all the way down?

No- the are cervical and lumbosacral enlargements.

Monosynaptic reflex arc. What type of receptors cause this?

Nociceptors- synapse right with the motor neuron to stimulate an action aka a reflex

Dislocation. Normally? What shoulder joint? Subluxation?

Normally anteriorly- when the head of the humerus is forcibly removed from its socket in the glenoid fossa. GH joint. Partial dislocation (not completely out of the socket)

Cervical plexus. Where is it found? Nerves involved? Innervate?

Occipital triangle. Lesser occipital nerve, Greater auricular nerve, Transverse cervical nerves, and the Supraclavicular nerves. Cutaneous innervations

Posterior Ulna. What do you see/feel? What is covering it?

Olecranon (part you can palpate). There is a bursa b/w it and the wenis. Bursitis can lead to "student's elbow"

Important features of the Ulna

Olecranon at the very top (beak shaped projection forward and is the palpable portion of the elbow under the wenis), trochlear notch, coronoid process with the radial process on the lateral side, ulnar tuberosity, and the interosseous border

Posterior distal humerus. What do you see? Process receives?

Olecranon fossa which is filled by the olecranon process of the ulna. Can also see the medial epicondyle- insertion point for the triceps brachii. There is also an ulnar groove for the ulnar nerve between the medial epicondyle and the olecranon fossa.

Supraspinous Ligaments. Where located? Main role?

On the tips of the spinous processes. Limits separation of the spinous processes as in flexion

Carrying/valgus angle. Visible only when? Men vs women? Stressors that increase the angle? Decrease the angle? Why might it be bigger in one gender? Angle lost?

Only in the anatomical position. Women have a greater angle. Valgus stressors. Varus stressors. Could be bigger in women to help the arm swing clear of their broader pelvic girdle. Lost in flexion

Osteofascial compartments of the muscles of the arm. Organized into? What are these formed by?

Organized into functional groups/compartments. Within each compartment, muscles tend to share innervation and blood supply. Formed by: 1. Deep fascia surrounding each limb segment 2. Intermuscular septa projecting from deep fascia to bone 3. Bone 4. Interosseous membranes where applicable. All 4 provide surface area for muscle attachment.

Origin vs insertion in muscle contraction

Origin normally remains fixed, but the insertion is mobile

Filum Terminale

Projection of the pia mater that descends from the tip of the Conus Medullaris thru the sacral hiatus to the coccyx.

Why is it possible to fracture the clavicle during child birth?

Ossifies early via intramembranous ossification and sometimes the baby may be pulled out of the birth canal by the arm

Motor symptoms of destructive peripheral nerve injuries?

Paralysis (nerve totally cut) or paresis (nerve partially cut)

Cubital tunnel and full elbow flexion. Symptoms if irritated? Example cause?

Paresthesias over small finger and ulnar 4th finger and ulnar dorsum of hand. Paresis (if it occurs) could effect multiple functions of the hand including finger abduction, thumb adduction, and pinching of the thumb and forefinger. Excessive cell phone use or sleeping on a flexed arm.

Lateral Thoracic artery

Part 2 of the axillary artery division. Runs parallel to the Long Thoracic nerve.

Scapular artery

Part 3 of the axillary artery division. Splits into the circumflex scapular artery which exits the triangular space and the Thoracodorsal artery which runs parallel with the nerve and supplies the lat.

What is important about the Rectus Capitis Posterior Minor?

Part of it actually attaches to the Dura Mater- if it goes into spasm, it is a potential explanation for migraine headaches.

Hypesthesia

Partial loss of sensation-numbness

Radial Nerve. How does it descend the arm? Vs. the Ulnar nerve? Median nerve?

Passes through the lateral intermuscular septum to reach the Cubital Fossa. The ulnar nerve passes through the medial intermuscular septum en route to the anterior and posterior compartment of the arm. Median nerve also descends along the arm to the cubital fossa which crosses anterior to the brachial artery en route to the fossa (not involved in innervation of the upper arm).

Anterior Thoracoappendicular Muscles

Pec major, pec minor, and serratus anterior

Evolution of the pectoral girdle vs the pelvis girdle

Pectoral girdle has evolved to maximize mobility of the upper limb in contrast to the pelvic girdle which has evolved to maximize the stability in weight bearing of the lower limbs

What forms the anterior axillary folds?

Pectoral muscles and overlying skin

Parts of the typical vertebra and function. To the left and right directly posterior of the compact bone? Processes that project left and right? Perpendicular processes to those? Part you can feel? Fuses to lead into the part you can feel?

Pedicles- protect the spinal cord Transverse processes- Muscle attachment/movement Articular processes- facilitate and guide movement Spinous process Lamina

Annulus Fibrosis. Thinnest where? Age?

Peripheral portion composed on concentrically arranged rings of fibrocartilage. Posteriorly. Vulnerable to degenerative change

Scapulothoracic joint. What is it? What motions does it participate in?

Permits the scapula to glide along the thorax on a curved surface of loose connective tissue. Protraction/retraction

Dorsal Root Ganglia (DRG). Collections of? Located where? Are there synapses here?

Pesudounipolar sensory neuron cell bodies. Located on the dorsal root in the IV foramen just proximal to the mixed spinal nerve. No synapses here- central processes of the neurons continue to the dorsal root horn of the spina gray

Meninges of the spinal cord starting with the cord itself and going to the superficial level? Directly around it? Next layer? Outer most? Around that?

Pia mater, Arachnoid mater, and Dura mater. Epidural fat

Parasthesia

Pins and needles

Reflection of the skin and superficial fascia of the anterolateral neck will reveal what?

Platysma- a muscle of facial expression

Nuchal muscles. Aka? Main role generally?

Posterior C spine muscles. Maintain the head in an upright position against gravity.

Vertebral arteries course through what entrance to the Foramen Magnum? How is this compromised in the elderly?

Posterior atlanto-occipital membrane. Uncinate processes may form creating bony tunnels which may reduce flow through the arteries.

Posterior cord of the brachial plexus. Formed from?

Posterior division fibers arising from all 3 trunks

B/l contraction of the SCM produces? If the head and C spine are fixed?

Posterior fibers- extension of the head at the atlanto-occipital joint Anterior fibers- Flex the head and c spine, particularly against resistance (from the supine position). Pull on the inferior attachments to raise the clavicle and pectoral girdle- shrug for assistance in deep inspiration

Uncinate Processes can form superiorly but what directions can they also grow in and interfere with? Aka?

Posteriorly and impinge on the spinal cord in the vertebral canal. Aka spinal stenosis. Can grow laterally and impinge on spinal nerves in the intervertebral foramen or arteries in the transverse foramen.

3 categories of brachial plexus injuries

Pre-plexus lesions, plexus lesions, and post-plexus lesions

Subdeltoid/Subacromial Bursa. What can happen with age?

Prevents friction b/w the acromion and the tendons of the deltoid and supraspinatus. Vulnerable to deterioration/inflammation which can lead to subacromial bursitis

Disc herniation. Involves? Results in? What spinal position most likely to cause this and why?

Protrusion of the nucleus pulposus through a posterolateral bulge or tear in the annulus resulting in compression of spinal nerves and can lead to radiculopathy. Spinal flexion- the posterior portion of the annulus is the weakest part

Sympheseal Joints

Provide a mechanism of shock absorption and load bearing for vertebrae.

Glenoid Fossa. What is it? What contributes to its deepening?

Provides a shallow, oval articular surface, deepened somewhat by a cartilaginous labrum for receipt of the humeral head.

Brachial plexus. Travels from? What are the segments? What is the acronym for it?

Proximal to distal. Roots, trunks, divisions, cords, and terminal branches. "Real Texans drink cold beer"

What is the Brachial plexus gradient generally? Each segment?

Proximal-distal gradient of innervation by the somatic motor fibers in the brachial plexus. C5-C6 fibers should innervate the proximal (shoulder muscles) C7 and some C8 innervate the elbow/wrist (intermediate rami) C8 and T1 innervate the distal hand muscles

Sternoclavicular joint (SC). Strength? Permits? What is present? Ligaments?

Quite strong. Permits clavicular motion at this joint. Articulating disc dividing the joint space into synovial compartments. Anterior sternoclavicular ligament, posterior sternoclavicular ligament, and costoclavicular ligament.

Proximal humerus (posterior view). What is important here?

Radial (spiral) groove- radial nerve travels through here. Deltoid tuberosity

What does the Brachial artery divide into? At what level? Heading where? Anastomoses?

Radial and Ulnar arteries. Heading toward the wrist. At the level of the radial neck. Anastomoses among these around the elbow

What is the only nerve of the 16 nerves of the brachial plexus that has input from C5-T1?

Radial nerve

Radial (spiral) groove. Where found?

Radial nerve travels through here. Posterior proximal humerus

Suboccipital region. What are the 4 main muscles going around the loop?

Rectus capitis posterior minor more or less parallel to the spine ,the starts the triangle with the Rectus capitis posterior major on a 45 degree angle from the spine, then the Obliquus capitis superior more or less parallel to the spine, and finally is the Obliquus Capitis Inferior completing the triangle.

Anterior group of the Prevertebral muscles. What are they? Their action?

Rectus capitus anterior (b/w atlas and skull base), Longus capitus (sternum-skull base), and the Longus coli (length of upper T and C spine). These initiate flexion of the head and c spine against resistance (gravity or an active force). SCM will complete flexion

Lateral group of the Prevertebral muscles. What are they? Their action? If the head and spine are fixed?

Rectus capitus lateralis (b/w atlas and skull base) and the 3 scalenes (anterior, middle, and posterior). Anteriorly and laterally flex the head and neck and assist in contralateral rotation. Scalene will elevate the rib cage to assist in inspiration

Foraminal Stenosis

Reduction in the size of the intervertebral foramina by uncinate processes growing laterally

What is a "plane synovial joint"?

Relatively flat surfaces gliding past each other.

Laminectomy

Removal of the contents of the vertebral canal by cutting through the laminae

Posterior cervical/Nuchal musculature. Resists? Respond to? Key here?

Resist flexion of the head against gravity. Respond to stimuli- seeing something cool, hearing something cool, etc. Need to be rapid- we are always quickly reacting the stimuli

Role of the Rhomboids?

Retraction

Roles of the middle trap

Retraction

Reflection of the trapezius reveals what 3 muscles? (bottom to top). Innervated by?

Rhomboid major, Rhomboid minor and Levator scapulae. C5 ventral rami: Dorsal scapular nerve- from brachial plexus.

Downward (medial) rotation of the scap. What are the force vectors?

Rhomboids pulling from the median border, levator scap pulling from the superior angle, and the lat and pec minor pulling on the lateral (axillary border)

Synovial joints. Innervation?

Richly innervated with sensory nerve endings that transmit pain and proprioception

Cubital Fossa. What are the boundaries? Roof and floor too? Contains?

Roof is the aponeurosis of the biceps. Line bisecting the tips of the humeral epicondyles is superior, pronator teres is medial and the brachioradialis is lateral. Floor is the brachialis. Contains the median nerve, the brachial artery, and the Radial nerve.

Where are the roots and trunks of the brachial plexus located? Divisions and cords?

Roots and trunks are supraclavicular and the divisions and cords are infraclavicular

Which portions of the brachial plexus are located supraclavicularly? Infraclavicularly?

Roots and trunks. Divisions and cords

In terms of the spine, are the roots located inside or outside the spine? Rami?

Roots are inside, spinal nerves just big enough to exit, and the rami are outside the spine

Brachial plexus. What are the segments and how many of each?

Roots- 5 Trunks- 3 Divisions- 6 Cords- 3 Terminal branches- 5

Muscles and tendons of the______ help maintain the integrity of the GH joint and provide stability during all movements of the arm

Rotator cuff

Mobility of the GH joint and the incongruity of the bony articular surfaces. What is significant about this?

Round humeral head with the relatively flat glenoid fossa- minimal surface area of contact

Omohyoid Muscle. Runs b/w? What does it do?

Runs b/w the scap and the hyoid bone. Inferior belly divides the posterior cervical triangle into the occipital triangle and the subclavian triangle.

Intervertebral Foramina bounds. Superiorly? Inferiorly? Anteriorly? Posteriorly? Transmit? Split into?

S/I- Pedicles of adjacent vertebrae A- Vertebral bodies P- Facet joints Transmit short/mixed spinal nerves that immediately upon exiting the foramen divide into large ventral primary rami and smaller dorsal primary rami

What level does the dural (thecal) sac extend caudally to?

S2 level

Erector Spinae. Aka? What are the 3 (in order from medial to lateral)? Contract bilaterally? Unilaterally?

Sacrospinals. Spinalis, Longissimus, Iliocostalis. Bilaterally, the erector spinae extend the vertebral column. Unilaterally they ipsilaterally laterally flex the spine.

Spinal flexion/extension occurs in what plane?

Sagittal

Part 3 of the axillary artery division. What does it branch into?

Scapular artery, Anterior circumflex humeral artery, and the posterior circumflex humeral artery (passes through the quadrangular space).

Synovial membrane

Secretes synovial fluid

Semispinalis. Segments? Under what muscle in the C spine? How many segments does it run?

Semispinales Capitis and Semispinales Cervicis. Under the Splenius muscles. 4-6

Greater Occipital nerve. Passes through? Innervates?

Semispinales capitus. C2- innervates the skin of the posterior scalp. (C1 innervates the suboccipital muscles but has no cutaneous involvement)

Medial intermuscular septum

Separates the biceps brachii and coracobrachialis from the long head of the triceps

Lateral intermuscular septum

Separates the brachialis from the lateral head of the triceps

Intermediate Muscles of the back

Serratus Posterior Superior and Inferior

Upward (lateral rotation) of the scapula. What are the force vectors?

Serratus anterior pulling from the inferior border, Upper trap pulling the superior border, and the lower trap pulling the medial border downward

Intermediate Back Muscles. When reflecting the Rhomboid Minor/Major you should see? When reflecting the latissimus dorsi you should see?

Serratus posterior superior. Serratus posterior inferior.

Scapula. Aka? Glides? Where does it articulate?

Shoulder blade. Glides freely on the posterior thoracic wall, moving the pectoral girdle and upper limb. Articulates with the clavicle at the acromioclavicular joint (AC joint) and the proximal humerus at the Glenohumeral joint

If you have an issue with your diaphragm, where will you present with pain? Why?

Shoulder pad area- Sends an impulse to C4 dorsal root, which refers pain to the C4 dermatome

What are the actions of the Iliocostalis cervicis, Longissimus cervicis, and spinalis cervicis similar to?

Similar to the splenius- resist both flexion and contralateral lateral bending

Anular Ligament. Similar to what ligament? Shape as a child vs adult? What are kids prone to as a result?

Similar to the transverse ligament of the atlas- it attaches at both ends to the same bone (the ulna). Serves as a joint surface for pronation/supination. Changes with age- as a kid it is cylindrical and surrounds the radial head. As an adult, it becomes teacup shaped (wider circumference at the top than bottom). This resists subluxation and dislocation of the radial head as it grasps the radial neck. In children, they can get nursemaid's elbow if their hand is pulled too hard (radius articulates with the carpal bones)- pulls radial head right out of the joint

Deltoid tuberosity. Where found?

Site of deltoid insertion. Found on the posterior proximal humerus

Dorsal rami innervate?

Skin and 2/3 of the back and posterior scalp, deep intrinsic back muscles, posterior ligaments of the spine, and the facet joints

Transverse cut of the neck and all layers. Most superficial to deep?

Skin, subcutaneous fat, Platysma found embedded in the subcutaneous fat, the investing layer of deep cervical fascia, and the prevertebral layer of fascia

Cervical Vertebrae. Body size? Why? Transverse processes? Articular facets? Vertebral Foramina? Size? Why? Part they have that other segments don't? Around the body? Spinous Process? ROM?

Smaller- don't have to support much weight. Short-terminate into anterior and posterior tubercles. Angles slightly oblique to the transverse plane- give this region the greatest mobility. Large vertebral foramina which is large because it is right by the medulla oblangata and inverted the UEs. Lot of fine motor movement/sensation. Transverse Foramina- vertebral arteries/veins. Go up through the foramen magnum to supply the brain. Uncinate process- lipped lateral edges of the superior aspect of the vertebral body. Prone to degeneration. Short, bifid (forked). Greatest ROM of all the spine

Zygapophyseal (facet) joints formed by? Facet joints are an example of? Permit?

Smooth facets and the articular processes of 2 vertebrae. Synovial joints which permit relatively free motion

GSA fibers. Other names? What do they do?

Somatic afferent fibers aka somatosensory fibers. For touch, pain, pressure and temperature. Also for proprioception from muscles, tendons and joints

2 divisions of the nervous system (parts wise)

Somatic and Visceral

GSE fibers. Other names? What do they do?

Somatic efferent fibers aka somatomotor fibers. Stimulate voluntary and reflex contraction of skeletal muscle

In what arrangement are the motor neurons of the ventral horns?

Somatotopica

What is a condition of the SCM where the neck is constantly laterally flexed and contralaterally rotated? Caused by?

Spasmodic Torticollis (Wryneck). Either from SCM pathology or from a disorder/lesion of CN XI.

Dermatome

Specific area of the body wall

Doral root. Originates/leads to? Rootlet fibers? Comprised of? Slight swelling?

Specific muscle and travels to the ventral horn (gray matter). Rootlet fibers converge. Somatic afferent fibers carrying info from the periphery to the CNS. Swelling is the dorsal root ganglia

What happens when the lamina do not fuse together properly during development?

Spina bifida

Spondylosis

Spinal degeneration usually as a result of osteoarthritis

Divisions of the PNS

Spinal nerves and cranial nerves

What is arguably the most adapted part of the body over the last 7 million years? Why?

Spine- evolved from quadrupedal to bipedal

Rectus Capitus Posterior Major. Attaches? Action?

Spinous process of C2 to lateral inferior nuchal line. Extension and ipsilateral rotation

Obliquus Capitis Inferior. Attaches? Action? Crosses?

Spinous process of C2 to transverse process of C1. Ipsilateral rotation. Atlantoaxial joint "no"

Splenius muscles. What are the 2? When they contract bilaterally? Unilaterally?

Splenius Capitis (superior muscle) and the Splenium Cervicis. Bilaterally they extend the head and C spine. Unilaterally they rotate and flex the cervical spine ipsilaterally.

What is the floor of the occipital triangle formed by?

Splenius capitus (most superior), the Levator scap (middle), and the 3 scalene muscles

After giving rise to the collateral nerves, each cord of the brachial plexus terminates by?

Splitting into 2 terminal branches

Osteoporosis. Affects what part of the bone? What is the mechanism behind it?

Spongy/trabecular. There is increased resorption of the spongy bone caused by a greater osteoclast activity than osteoblast.

Supraspinatus and Deltoid regarding abduction

Spurt contraction of the supraspinatus initiates abduction to the first 20 degrees. The deltoid is responsible for abd past the first 20 degrees

Why do track and field runners put their hands behind their head?

Stabilize the coracoid. Contraction of the pec minor elevates the rib cage to assist in deep inspiration

Lateral/Radial Collateral Ligament (RCL). Stabilizes against? What are its parts? What do they do?

Stabilizes the joint against varus stress- application of force from the medial side. Attaches inferiorly to the Anular ligament surrounding the radial head.

SCM. Where do its heads attach?

Sternal head attaches from the manubrium of the sternum to the lateral half of the superior nuchal line of the occipital bone. Clavicular head runs from the medial third of the clavicle to the mastoid process of the temporal bone

If a female is going on the treadmill or walking up stairs in the clinic and all of a sudden gets jaw pain what do you do? Signs of?

Stop immediately- can be referred pain from an unwell heart and may be signs of a heat attack- from the Greater Auricular Nerve

Spinal cord is supplied and drained by blood vessels which course through what layer? What are the names of these vessels? Where do these arteries arise from?

Subarachnoid space. 1. Anterior (single) and Posterior (paired) spinal arteries 2. Radicular and Segmental Medullary arteries which enter the vertebral canal through the intervertebral foramina Arise from the vertebral arteries

Lumbar puncture/"spinal tap"/"spinal anesthesia. Where is it introduced? Compared to caudal anesthesia? Typically done for what reason? What position is the patient placed in before administration? Why is it done in this region

Subarachnoid space. More powerful. To remove CSF. Placed so that the spine is tightly flexed to move spinous processes apart. Done here because the cord stops at L1-L2, so easy access to the subarachnoid space

Intrinsic muscles of the posterior cervical spine. Superficial layer? Intermediate layer? Deep layer?

Superficial- Splenius capitis and cervicis Intermediate- Iliocostalis cervicis, Longissimus cervicis, and spinalis cervicis. Deep- Semispinal cervicis and capitis.

SLAP tears. What does it stand for? May result from? Often accompanied by?

Superior Labrum Anterior Posterior. May result from poor throwing mechanics or from a fall on or blow to the shoulder. Often accompanied by an injury to 1 of the 2 biceps brachii.

Lateral view of a lumbar vertebrae. Very top? Dips down to form? On the bottom portion? Very bottom?

Superior articular process. Superior vertebral notch. Inferior vertebral notch. Inferior articular process.

Role of the Serratus Posterior Muscles? Innervated by?

Superior- elevation of the ribs Inferior- depression of the ribs Ventral rami, not dorsal

Transverse plane? What're the halves?

Superior/cranial and Inferior/caudal

Dorsal Primary Ramus. Size? Innervates?

Supplies the skin of the back and posterior scalp, facet joints, posterior ligaments of the spine, and epaxial (intrinsic back) muscles- erector spinae, transversospinales, splenius, suboccipital region.

What is the purpose of the vertebral body?

Support body weight from UE-LE.

What is seen when you reflect the Supraspinatus and Infraspinatus? Why is it vulnerable?

Suprascapular nerve and artery. Suprascapular nerve innervates the supraspinatus and infraspinatus. The nerve is vulnerable to entrapment because it courses through the scapular notch

Most commonly injured portion of the rotator cuff in non-throwing athletes? What can bursitis of this tendon lead to?

Supraspinatus. Can lead to calcification of the tendon

Medial epicondyle. What is it generally for?

Surface area for attachment of the anterior (flexor) forearm musculature.

Lateral epicondyle. What is it generally for?

Surface area for attachment of the posterior forearm (extensor) muscles

Prevertebral fascia. Covers?

Surrounds the cervical spine and both the anterior and posterior muscles which attach to it

Synarthroses vs. Diarthroses

Syn- bony articulations linked by solid tissues Di- synovial joints

Humeroradial and humeroulnar joints form a? What limits flexion? Extension (exception)?

Synovial hinge joint. Muscle mass of the anterior arm and forearm. Olecranon process limits the extension of the forearm as it fills the olecranon fossa (ladies may be able to hyperextend as they have an olecranon foramen instead of a fossa)

What type of joint is the median atlantoaxial joint?

Synovial pivot joint

Proximal Radioulnar joint. Joint type? For?

Synovial pivot joint (like median atlantoaxial joint). Pronation/supination of the radius around the ulna

T12 nerves pass b/w?

T12 and L1

Where does referred heart attack pain in males refer?

T2 dermatome- medial aspect of the upper arm

Root of the scapular spine is at what T spine level? Inferior angle?

T3. T7

Why in PT do we strengthen the core when someone comes in with back pain? Anatomically?

Take some load off the back muscles. The anterolateral abdominal muscles, lat muscles, and the deep back muscles are all in close proximity

How can a myotactic reflex be demonstrated via the biceps?

Tap the biceps tendon and it demonstrates the integrity of C5 and come C6 afferent/efferent cord segments of the spinal cord

Triceps myotactic reflex?

Tapping the tendon will demonstrate the integrity of C7 spinal cord segments

When you perform a laminectomy around the atlanto-occipital joint, what ligament do you see?

Tectorial membrane

Aponeuroses

Tendons in a flat sheet shape

Triangular Space. What are the borders? What nerve/artery is found there? What happens if this innervation is damaged?

Teres Minor, Long head of the triceps brachii, and Teres Major. The radial nerve (in radial groove) and circumflex scapular artery. If damaged, will get "drop wrist"- wrist is permanently flexed, unable to extend it.

Quadrangular Space. What are the borders? What nerve/artery is found there? Why are these vulnerable?

Teres minor (superior), medial humeral shaft (laterally), Teres Major (inferior), Long head of the triceps (medially). Axillary nerve and posterior humeral circumflex artery. Nerve is vulnerable to lesion with a fracture of the surgical neck of the humerus.

Basilar artery

The 2 vertebral arteries form this single artery at the level of the junction between the pons and medulla.

What does the subarachnoid space contain?

The CNS vasculature as well as CSF

What is directly inferior to the Conus Medullaris?

The Cauda Equina

Alar ligaments. Connect? What type of injury could tear these? Example?

The Dens to the Occipital condyles. A hyperflexion injury- in football, tackling with the head down

Dens. What is it? Anterior articular facet? Posterior articular facet?

The Dens- odontoid like process. Projects through the vertebral foramen of the atlas. Makes the axis the strongest cervical vertebrae due to the compact bone of the Dens. Anterior articular facet on the Dens helps form the Median atlantoaxial joint. Posterior articular facet of the Dens contacts the transverse ligament of the atlas.

Axis (C2). What projects from it? Contributes to? Superior articular facets help form? Anterior articular facet on the Dens helps form? Posterior articular facet on the Dens contacts?

The Dens- odontoid like process. Projects through the vertebral foramen of the atlas. Makes the axis the strongest cervical vertebrae due to the compact bone of the Dens. Superior articular facets are horizontal and help form the 2 lateral atlantoaxial joints. Anterior articular facet on the Dens helps form the Median atlantoaxial joint. Posterior articular facet of the Dens contacts the transverse ligament of the atlas.

Posterolateral herniation of the L4/L5 disc will compress which nerve?

The L5 nerve b/w L5 and S1- leaves the L4 nerve in tact

What forms the "M" of the terminal branches of the lateral and medial cords of the brachial plexus?

The Musculocutaneous Nerve (Lateral cord), the Median nerve (contributions from the lateral and medial nerves), and the Ulnar nerve (Medial cord).

Why are most disc herniations posterolateral in nature?

The PLL reinforces the annulus fibrosis posteriorly, so it slips out to the side

Because the tendons of the supraspinatus and deltoid are right up against bone what is there to prevent friction?

The Subdeltoid and Subacromial Bursa.

Part 1 of the axillary artery division. What does it branch into?

The Superior Thoracic Artery

Posterior cervical triangle. What are the borders? Also the roof?

The anterior border of the trap (posteriorly), posterior border of the SCM (anteriorly), and the middle 1/3 of the clavicle. Roof is formed by the investing layer of deep cervical fascia.

Medial cord of the brachial plexus. Formed by? How many collateral branches? What is it? Innervates?

The anterior division somatomotor fibers from the inferior trunk. 3 collateral branches- Median pectoral nerve (C8-T1). Innervates both pectoral muscles. Median Brachial Cutaneous Nerve (MBC) (C8-T1). Skin of the upper arm. Median Antebrachial Cutaneous Nerve (MABC) (C8-T1). Skin of the forearm. In this nerve order from proximal to distal.

Lateral cord of the brachial plexus. Formed by? How many collateral branches? What is it? Innervates?

The anterior division somatomotor fibers of the superior and middle trunks. Just 1 collateral branch. Lateral pectoral nerve (C5-C7). Innervates the pec major only.

Anterior division of the brachial plexus. What do they control?

The anterior division somatomotor fibers will innervate anterior muscles of the arm, forearm, and palmar hand in the anatomical position (flexors/pronators).

Reflection of the pectoral musculature exposes the contents of? Contains? Embedded?

The axillary fossa- very large and pyramidal in shape. Axillary vessels, brachial plexus, and the axillary lymph nodes. All embedded in the axillary fat

Posterior Cord terminal branches. What are the 2? What do they innervate?

The axillary nerve (C5, C6) which splits off to head toward the deltoid/teres minor. Also innervates the patch of skin covering the lateral arm and the GH joint itself (important for pitchers). Exits the quadrangular space. The radial nerve (C5-T1). Only branch of the brachial plexus to have input from all 5 segments. Innervates all muscles of the posterior arm (triceps brachii) and forearm and has an extensive cutaneous distribution to the posterior arm, forearm and most of the dorsum of the hand when pronated. Exits the triangular space.

Mammary glands and lymphatic drainage? Why can excision of the lymph nodes be hazardous?

The breast lymph is directed primarily toward the axillary nodes, and if they need to be excised, run the risk of damaging the brachial plexus.

Elbow joint capsule. Anterior/posteriorly? Laterally/medially? What are the main ones?

The capsule is weak and loose anteriorly/posteriorly but it is reinforced medially and laterally by collateral ligaments. Lateral (radial) collateral ligament and the Medial (ulnar) collateral ligament

Where is CSF formed? Where does it circulate?

The choroid plexus within the ventricles (hollow portion) of the brain. Circulates the length of the subarachnoid space- through the brain and spinal cord- before being absorbed into the network of venous dural sinuses in the skull

What happens to the inferior end of the spinal column and vertebrae?

The cord grows away from the vertebrae

The roots/trunks of the brachial plexus along with the subclavian artery pass b/w what?

The scalene interval- anterior and middle scalene and the first rib

Dural (thecal) sac

The spinal cord descends through the vertebral canal within this

Medial/Ulnar Collateral Ligament (UCL). Stabilizes against? What are its parts?

The elbow's strongest ligament that stabilizes the joint against valgus stress resulting from an application of force from the lateral side. The anterior band- tight in extension (primary resistant to varus stress). Posterior band is tight in flexion. Oblique band deepens the trochlear notch and is the floor of the cubital tunnel that the ulnar nerve passes through.

Caudal anesthesia. Where is it commonly applied? What does it do?

The epidural space. Numbs the nerves of the cauda equina

When the lumbar spine is put into flexion, are the erector spinae flexing or extending? The abdominal muscles?

The erector spinae are extending. Abdominal muscles are flexing.

When the lumbar spine is put into extension, are the erector spinae flexing or extending? The abdominal muscles?

The erector spinae are flexing to pull the spine into extension and the abdominal muscles are extending

Glenohumeral joint. What is articulating? Type of joint?

The head of the humerus and the glenoid fossa

Serratus Anterior. How is like the holster on a policeman's belt?

The holster is like the scapula and the serratus anterior is like the leather belt- holds the scap onto the thorax

What forms the intervertebral foramen of 2 lumbar vertebrae? B/w? What is the purpose of this foramen?

The inferior and superior vertebral notches b/w adjacent pedicles. Spinal nerves exit.

With the exception of C8, the cervical spinal nerves are numbered according to?

The inferior margin of the IV foramen thru which they emerge

Ligamentum Nuchae. Replaces? Extends from where to where?

The interspinous and supraspinous ligaments in the c spine. Extends from the external occipital protuberance of the skull to the spinous process of the vertebra prominens (C7)

What are the 3 atlantoaxial articulations?

The left and right lateral atlantoaxial joints and the synovial median joint between the Dens and the atlas.

Latissimus Dorsi arises from? Via? Contributes to?

The lower thoracic and lumbar spine via a flat tendon called a aponeurosis. Contributes to a complex of tissues enclosing the deep back muscles called the thoracolumbar fascia

Why are the atlantoaxial joints known as the "No" joints?

The median joint is a synovial pivot joint- the head and atlas rotate around the axis as a unit shaking the head like saying "no"

Thoracic, lumbar and sacral spinal nerves are numbered according to?

The number of the overlying vertebra

Reflection of the pec major reveals?

The pec minor

Where do the vertebral arteries course through to enter the Foramen Magnum?

The posterior atlanto-occipital joint

Posterior cord of the brachial plexus. Formed by? How many collateral branches? What is it? Innervates?

The posterior division somatomotor fibers from all 3 trunks. 3 collateral branches- Upper subscapular nerve (C5, C6). Innervates the subscapularis. No cutaneous distribution. Thoracodorsal nerve (C6-C8) which innervates the lat. The Lower subscapular nerve (C5, C6) which innervates the subscapularis and the teres major. In that order from proximal to distal.

Posterior division of the brachial plexus. What do they control?

The posterior division somatomotor fibers will innervate the posterior muscles of the arm and forearm (extensors).

Which bone moves in pronation/supination? Hand? Why? Ligament that supports this?

The radius only- only the distal radius articulates directly with the bones of the carpus, so the hand moves with the radius. Anular Ligament

What passes through the scalene interval?

The roots/trunks of the brachial plexus along with the subclavian artery.

Conus Medullaris

The spinal cord tapers caudally and terminates into this at the L1-L2 level

What portions of the scapula are palpable?

The spine, acromion process, and the coracoid process.

What layer do you need to access in order to take a sample of CSF?

The subarachnoid space

In addition to the dural sac, what also extends to the S2 level? Clinical significance? More commonly applied where?

The subarachnoid space- can introduce things here (anesthesia for example).

Why is edema not a symptom of thoracic outlet syndrome?

The subclavian vein does not pass through the scalene interval- superficial to the scalene muscles

What does reflection of the Splenius and Semispinalis reveal?

The suboccipital region

What forms the facet joint between 2 lumbar vertebrae? Between? Each defines?

The superior and inferior articular processes of 2 vertebrae. Plane synovial joints. Range of free gliding motion between the adjacent vertebrae.

"Winged" scapula. Can result from?

The trap and rhomboids are no longer opposed by the serratus anterior- destructive lesion of the Long thoracic nerve

Which cervical vertebrae transmit the vertebral arteries?

The upper 6 cervical vertebrae

What is found in the spinal gray? What makes it gray?

The ventral and dorsal horns- spinal nerve roots arise from here. Concentration of neuron cell bodies

Where do the spinal arteries arise from?

The vertebral arteries

Cords of the brachial plexus are named on the basis of?

Their anatomical relationship to the axillary artery when the upper limb is in the anatomical position- lateral cord is lateral to the artery, medial cord is medial, and the posterior cord sits behind the artery

What happens to the relative position of the spinal cord segments as we travel inferiorly in terms of their relation to the IV foramen in which they exit?

There is a discrepancy- spinal nerve roots get longer and more vertical

Because the spinal cord and vertebral column are unequal in length, how does this affect the nerve roots?

There is variation in the length and orientation of the nerve roots- cervical spine has short, transversely oriented roots, but as you move inferiorly, the nerve roots become longer and more vertical.

Uncovertebral joints. Restrict? Can they cause pain?

They can expand superiorly and form uncovetebral joints- degenerative clefts in the lateral parts of the cervical discs. Restrict lateral flexion. Can interfere with intervertebral foramen so yes

Uncinate Processes (other than one on C spine body). What can happen as early as 20 years of age? What type of joint can form? Primarily restrict what movement? Can they cause pain?

They can form as discs lose moisture, shrink or come into contact with other processes causing inflammation. They can expand superiorly and form uncovetebral joints- degenerative clefts in the lateral parts of the cervical discs. Restrict lateral flexion. Can interfere with intervertebral foramen so yes

"Anastomosis". How is it significant to the spinal arteries? Lack? Why are these beneficial? Located where? Does every body part have this?

This is where spinal vessels can "hook up"- free and open communication. Also lack valves. If you cut one of these vessels, it is not the end of the world. Example of having "collateral" supply- if the primary blood source is cut off, have a back up. Located in the subarachnoid space. No

Part 2 of the axillary artery division. What does it branch into?

Thoracoacromial artery and the Lateral Thoracic artery (parallel to the Long Thoracic Nerve)

What does "caudal" mean?

Toward the tail

Transversospinales. Where do they attach? Bilateral contraction produces? Unilateral?

Transverse and spinous processes. Bilateral produces extension, unilateral produces contralateral rotation

Deep muscles of the back. Attach mainly to? Main role? Innervated by?

Transverse and spinous processes. Postural muscles that resist the pull of gravity. Dorsal rami of spinal nerves

Obliquus capitis superior. Attaches? Action? Crosses?

Transverse process of C1. Extension/lateral flexion. Atlanto-occiptial joint "yes"

What will reflection of the Erector spinae reveal? What are the 3? Fibers run?

Transversospinalis. Semispinales, Multifidus, and the Rotatores. Superiorly, posteriorly, and medially.

Posterior Thoracoappendicular Muscles

Trapezius, Lat, Levator Scap, Rhomboids

Superficial muscles of the back

Trapezius, Latissimus Dorsi, Rhomboid Major and Minor, and Levator Scapulae

Back anatomy. Superficial layer. What 2 muscles do you see? What innervates the 2? Not innervated by?

Trapezius- CN XI Latissimus Dorsi- Brachial plexus. Not innervated by the dorsal rami, but ventral rami

Destructive peripheral nerve injuries. Caused by? Can initiate what kind of symptoms?

Trauma or neuropathy. Motor and sensory symptoms

What are the 2 major features of the humeral condyle?

Trochlea and Capitulum

What ligament of the elbow is particularly important in throwing athletes? Why? Surgery type?

UCL- places significant forces on the elbow when cocking the arm and accelerating it forward. Tommy John's.

What is the strongest ligament of the elbow capsule and what does it do?

UCL-stabilizes the joint against valgus stress resulting from an application of force from the lateral side

Relative size of the Radius and Ulna from top to bottom. What connects them?

Ulna looks a lot bigger proximally and the radius looks a lot bigger distally. Interosseous membrane (syndesmosis joint)

C8 dermatome

Ulnar 2 digits and the medial aspect of the hand and wrist

Median cord terminal branches. What are the 2? What do they innervate?

Ulnar nerve (C8-T1). Innervates 1.5 muscles of the forearm and all but 5 intrinsic hand muscles and the skin of the medial 1.5 digits. Also the Median Nerve

Cubital Tunnel. What travels here? From where? Lies between? Roofed by? Floor? Contents drawn taught in what position?

Ulnar nerve from the Arcade of Struthers. It lies between the medial epicondyle and the olecranon, roofed by the aponeurotic origins of the Flexor Carpi Ulnaris (FCU). Floor is the oblique band of the UCL. Referred to as the Ligament of Osborne. Contents are drawn taught and stretched when in flexion (prolonged cell phone conversations, sleeping on a flexed arm i.e.).

Why could an older woman with an unknown uncinate process pass out when tilting back to get her hair done?

Uncinate process could be impinging the vertebral arteries traveling to the brain and could cut off her blood supply to the brain

Subclavius. Where is it? What is its main role?

Under the clavicle. Minimal function relevant to ROM at the shoulder but present to protect the neurovasculature through the apex from common fracture of the clavicle at the middle 1/3.

If the Long Thoracic nerve gets damaged during a mastectomy, what motion might the patient have trouble with?

Upward rotation of the scapula

Brachial plexus is formed by fibers from? Gradient?

Ventral rami of 5 different spinal nerves- C5 to T1. Proximal-distal gradient of innervation by the somatic motor fibers in the brachial plexus.

The vertebral foramina of the upper 27 vertebrae are stacked to form the?

Vertebral (neural) canal.

What does the epidural space contain?

Vertebral venous plexus

Spinal rotation occurs in what plane?

Vertical axis

How much muscle activity is required to maintain an erect posture when standing? What happens after a long period of time?

Very little- start to get pulled into flexion

Lance Armstrong. Originally had testicular cancer. How could it have metastasized to his brain?

Via the vertebral venous plexus

"Popeye deformity"

Virous contraction may cause rupture or dislocation out of the bicipital sulcus

Paresis

Weakness of skeletal muscle

When can the musculocutaneous nerve become entrapped? Will a post-plexus lesion of this nerve result in paralysis/paresis of the biceps brachii and brachialis?

When it passes through the coracobrachialis. No- it already passed through them, so it is downstream that will be affected (Lateral ABC)

Platysma muscle. Where is it found? What does it do? Innervated by? Under this?

When reflecting the skin and superficial fascia or the anterolateral neck- found embedded in the subcutaneous fat. Controls facial expression. Investing layer of deep cervical fascia which surrounds the neck like a collar

What can cause damage to the ALL? How can the vertebrate also be affected?

Whiplash- violent hyperextension followed by violent hyperflexion. There can also be multiple fracture dislocations of vertebrae

How does biceps tendonitis develop?

Within the bicipital sulcus, the long head is subject to frictional stress despite its synovial sheath and may develop tendonitis

Choroid Plexus

Within the ventricles of the brain and produces CSF

What is the point of the humeral "circumflex" arteries?

Wraps around the humerus to supply the cartilagenous growth plates

The inferior articular process and superior articular process of a lumbar vertebrae come together to form a?

Zygapophysial (facet) joint.

Proximal Radioulnar joint

between the radial head and the radial notch of the ulna (on the coronoid process)

C5 dermatome

lateral aspect of the arm

C6 dermatome

lateral aspect of the forearm, hand and radial 2 digits

Spinal cord. Descends from the caudal portion of the______ through the______ at the________

medulla oblongata, foramen magnum, base of the skull

C4 dermatome

shoulder pad area

C8 spinal nerves pass b/w?

the IV foramen of C7 and T1

C2 spinal nerves pass b/w?

the IV foramen of the atlas and axis (C1 and C2)

C1 spinal nerves pass b/w?

the skull and atlas (C1).