Anatomy Exam 2
Multifidus insertion
Lateral surface of C2-L5
Anterior circumflex humeral
Origin is axillary artery. Smaller than posterior; supplies shoulder
Coracobrachialis blood supply
brachial artery
Dura mater blends with
epineurium
Anconeus insertion
lateral surface of olecranon and superior part of posterior surface of ulna.
rotators function
vertebral rotation and proprioception
Dura- arachnoid interface
(wrongly called subdural space) is not usual space. Bleeding into layer can create space where subdural hematoma forms
Secondary centers of vertebral column
1 spinous process, 2 transverse process, 2 epiphyseal ring
Spinal Veins drain to
12 anterior and posterior medullary and radicular veins
Thoracic vertebrae
12, articulate with ribs
First part of axillary artery
1st rib to medial border of pectorals minor. Has 1 branch, superior thoracic artery
Superficial sensory supply
2 dermatome, segmental progression, both are approximations
Xray
2D. White, black, and shades of gray. Inexpensive.
Veins
3 anterior and 3 posterior spinal veins in subarachnoid space
Central lymph nodes
3-4 nodes, receive lymph from pectoral, sub scapular, humeral nodes, mammry glands, some upper limb. Deep to pectorals minor and found in axillary arteries.
Coccyx
3-4 small coccygeal vertebra. Fused.
Pectoral (anterior) lymph node
3-5 nodes, receive lymph from anterior thoracic wall, include mammary gland. Important during breast exam
coccygeal vertebrae
3-5, fuse to form coccyx
Pectoralis Minor Proximal Attachment
3rd-5th ribs near their costal cartilages
Humeral (lateral; brachial) lymph nodes
4-6 nodes, receive lymph from upper limb, become inflamed during upper limb infections
Nerves of the Breast
4th - 6th intercostal nerves Rami communicans Sympathetic fibers
Growth and development of vertebral column
4th wk- 25 yrs. Primary centers: 1 centrum, 2 neural arch.
sacral vertebrae
5, fussed to form sacrum
Lumbar vertebrae
5, large bodies
Apical lymph nodes
6-12 nodes, receive lymph from all axillary nodes, mammry gland, vessels running with cephalic vein. Connection with deep cervical nodes resulting in spread of breast cancer to deep neck
Subscapular( posterior) lymph nodes
6-7 nodes, receive lymph from posterior aspect of thoracic wall and scapular region.
Cervical vertebrae
7 including axis and atlas, transverse foramen
Dislocated shoulder of Humerus at Glenohumeral Joint signs and symptoms may include:
A visibly deformed or out-of-place shoulder Swelling or bruising Intense pain Inability to move the joint
Abduction Muscles of arm
A-Deltoid Supraspinatus (1st 15 degrees)
Thorotrast
Absorbed by liver, spleen, and skeleton. Half-life of 22 years
Pectoralis Major Main Action
Adducts and medially rotates humerus; draws scapula anteriorly and inferiorly Acting alone, clavicular head flexes humerus and sternocostal head extends it from the flexed position
Breast Quadrants and Cancer
Anatomical location and description of tumors and cysts Carcinoma of the breast are usually adenocarcinomas- Malignant neoplasm of epithelial cells with a glandular or glandlike pattern Lactiferous ducts in the mammary gland lobules
Subclavius Main Action
Anchors and depresses clavicle
Serratus posterior superior innervation
Anterior rami T2-T5
Serratus posterior inferior innervation
Anterior rami T9-T12
3 longitudinal spinal cord arteries
Anterior spinal artery, 2 posterior spinal arteries.
Humeral nutrient artery
Arise from lateral aspect of brachial artery
Supraspinatus Clinical Muscle Test
Arm in scapular plane Same as deltoid otherwise
Teres major (lower subscapular nerve) Clinical Muscle Test
Arm is abducted Resistance to adduction Palpate in posterior axillary
Deltoid (axillary nerve) Clinical Muscle Test
Arm is abducted more than 15 degrees Apply resistance to abduction Middle section of deltoid can be palpated
Axilla
Armpit . No bones or muscles in this area
Blood supply to the breast
Arterial supply- Internal thoracic artery Lateral thoracic artery and thoracoacromial arteries Posterior intercostal arteries Venous drainage- Axillary vein Internal thoracic vein
Arachnoid mater
Avascular membrane. Elastic and fibrous tissue. Enclose CSF, held against dura mater by pressure from CSF, lumbar cistern
Base (Inferior boundary)
Axillary fossa bounded by anterior and posterior axillary folds. Formed by concave skin, subcutaneous tissue and axillary (deep) fascia
Brachial artery
Begins at inferior border of trees major. Ends in cubital fossa
MRI(magnetic resonance imagery)
Better tissue differentiation than CT scans. Body pulsed with radio waves. Strong magnetic field. H atoms provide basis. Axial, coronal. sagittal planes. Shades of gray.
Interspinales
Between adjacent spinous processes( on interspinous ligament)
Intertransversarii
Between adjacent transverse process
Symphyses
Between vertebral bodies. Limited motion,
Antebrachial fascia
Bicipital aponeurosis, interosseous membrane, palmar carpal ligament, flexor and extensor retinaculum. Cover forearm
Lateral wall
Bony wall formed by inter tuberclar sulcus of humerus
Biceps brachii blood supply
Brachial artery
Upper Limb Fasciae
Brachial fascia -Two intermuscular septa Antebrachial fascia- Bicipital aponeurosis Interosseous membrane Palmar carpal ligament Flexor and extensor retinaculum Hand fascia-Palmar aponeurosis
Floor of cubital fossa is formed by
Brachialis and supinator muscles of arm and forearm
Lymphovascular supply to breast
Breast cancer and lymphogenic metastasis Subareolar lymphatic plexus Axillary lymph nodes- Anterior or pectoral nodes Clavicular lymph nodes Subclavian lymphatic trunk Parasternal lymph nodes- Bronchomediastinal lymphatic trunk Right and left venous angles
T2 weighted images
Bright signal from fluid and an intermediate signal from fat.
Roots
Bundles of rootlets. Anterior and posterior
Medial Muscles of arm
C-Deltoid ( and flex) Subscapularis Teres Major
Innervation of splenius capitis
C3&C4
Supraclavicular nerve (1)
C3, C4
Multifidus origin
C3-C7, T1-T12, L1-L5, Sacrum, posterior superior iliac spine
Innervation of splenius cervicis
C5 & C6
Inferior lateral cutaneous nerve of arm
C5, C6
Posterior cutaneous nerve of arm
C5-C8, cutaneous branch of radial nerve
Cervical enlargement
C5-T1 . Brachial plexus arise for innervation of upper limb.
Radial nerve
C6-C8, back of hand
Median nerve
C6-C8, first 3 fingers
Levator costarum origin
C7-T11
Medial cutaneous nerve of forearm
C8-T1
Ulnar nerve
C8-T1, 5th and 4th digit
Medial cutaneous nerve of arm
C8-T2
Parasympathetic nerves arise
CN III, VII, IX, X, S2-S4
Lumbar puncture diagnosis
CNS disorder, detect virus, bacteria, proteins, blood
cervical vertebra
Can be bifid, uncinate process, transverse foramen, superior and inferior articular process, vertebral foramen. Short spinous process. Dens/odontoid process. No intervertebral disc between C1-C2.
Axillary vein is common site for
Central lines(IV)
Pectoralis Major Proximal Attachment
Clavicular head: anterior surface of medial half of clavicle Sternocostal head: anterior surface of sternum, superior six costal cartilages, aponeurosis of external oblique muscle
CSF
Clear, colorless, acellular fluid. Produced in choroid plexus.
Dislocation of Humerus at Glenohumeral Joint Treatment usually involves 3 steps
Closed Reduction Sling Rehab
Spinal cord
Continuation of medulla oblongata, conduction pathway , major reflex center, 42-45cm long, From foramen magnum to conus medullar is around L1-L2. Give rise to 31 pairs of spinal nerves
Brachialis distal attachment
Coronoid tuberosity, cover anterior elbow joint
Dural root sheath
Covers posterior an anterior nerve roots, blend with epineurium
Anterior segmental medullary arteries
Create anterior spinal nerve
Superior lateral cutaneous nerve of arm
Cutaneous branch of axillary nerve, C5 &C6
Myelomeningocele
Cystic dilation contains neural tissue
Triceps brachii blood supply
Deep brachial artery and posterior circumflex humeral artery
Clavipectoral fascia
Deep, cover pectorals minor and pectorals major
Arachnoid trabeculae
Delicate CT attaching arachnoid to Pia, look like spider webs
Posterior circumflex humeral artery of Blood Supply
Deltoid
Septa
Divide arm into posterior and superior part of arm
Levator scapulae muscle arterial supply
Dorsal scapular (subclavian origin)
Rhomboid muscle arterial supply
Dorsal scapular (subclavian origin)
Sometimes transverse doesn't exist. What will supply blood to where transverse would have if it were there?
Dorsal scapular artery
Levator scapulae, rhomboid minor, and rhomboid major innervation
Dorsal scapular nerve
Venous and Lymphatics of UL
Dorsal venous network- Cephalic vein and basilic vein Perforating veins- Connect deep and superficial together Cephalic vein- Clavipectoral triangle Costocoracoid membrane Basilic vein- Accompanying veins (L. venae comitantes)
Posterior roots
Dorsal, sensory (afferent) fibers, bring information from periphery to CNS
Teres minor Clinical Muscle Test
Elbow flex, arm 90 degrees in scapular plane Resistance to lateral rotation
levator costarum action
Elevate ribs for ventilation
Levator scapulae action
Elevates and rotates the scapula to tilt the glenoid cavity inferiorly
obliques capitis superior action
Extension of head and bends it to same side
Rectus capitis posterior major action
Extension of head, rotation of face to same side as muscle
Serratus Anterior Proximal Attachment
External surfaces of lateral parts of 1st-8th ribs
Classic Meningitis symptoms
Fever, headache, nuchal rigidity.
Subarachnoid space
Filled with CSF
Sentinel nodes
First node that lymph would drain to.
Superior and inferior articular process of thoracic vertebra
Flat and vertical
Infraspinatus Clinical Muscle Test
Flex elbow, adduct arm Resistance to lateral rotation Palpate muscle inferior to scapular spine
Medial wall
Formed by thoracis wall and serrates anterior
Axillary vein
Formed by union of brachial and basilica veins. Tributaries are abundant and highly variable. Cephalic vein joins with axillary vein close to where vein becomes subclavian vein
Posterior wall
Formed mainly by subscapularis and scapula. Posterior axillary fold is inferior most portion
Gadolinium
GBCA, enhance quality of MRI or MRA, Contain gadolinium ion and chelating molecule
What type of contrast causes still birth?
Gadolinium
Filum terminale externum
Gains dural layer, attaches to coccyx, arcs as anchor for inferior portion of spinal cord and meningitis
Positron Emmission Tomography (PET)
Gamma ray emitting tracers in body that detect tissue with high metabolic activity. Used for physiological processes like rapidly growing tumor. Better understand where metabolic activity is occurring
why knee to chest position for spinal tap
Help spread the spinous processes and lamina of vertebrae so insertion of needle is easier
Dissection of axillary lymph nodes
Help staging and treatment of cancer. arrangement of nodes allows systemic order of removal for examination. Lymphedema(axillary nodes removed or radiated). Nerves at risk are long thoracic and thoracodorsal
Lateral radiographs, radiopaque letters (R or L)
Image take on the side
Superiorly boundary of triangular cubital fossa
Imaginary line connecting medial and lateral epicondyles
Embryological note of spinal cord
In embryos the spinal cord is entire length of vertebral column. Wk 8 the coccygeal portion atrophies. During fetal period column grows faster than spinal cord causing cord to ascend
Herniated disc
In lumbar and below, the herniation will affect the nerve of the spinal nerve below it .
Serratus posterior inferior lateral attachments
Inferior border of ribs 9-12, lateral to their angles
Subclavius Distal Attachment
Inferior surface of middle third of clavicle
Conus medularis
Inferior, tapering end of spinal cord
Lateral Muscles of arm
Infraspinatus Teres minor S-Deltoid (and extend)
Spinalis capitis
Inseparable from semispinalis capitis
scapular anastomosis
Involve branches from subclavian and axillary arteries.
Injuries of axillary vein
Involve damage to axillary vein. Proximal vein wound causes profuse bleeding, but also risk of producing air emboli
Subclavius Proximal Attachment
Junction of 1st rib and its costal cartilage
Transverse ligament of cruciate
Keep dens against anterior arch of atlas, pivot on axis. strong. Dens breaks before ligament tears. Prevent compression of spinal cord during flexion of head and neck
Root compression
L5 nerve root is largest and IV foramen is smallest. Increase risk of nerve compression id osteophytes(bony spurs) develop or IV disc herniations occur. lumbar spinal nerves increase, intervertebral foramen decrease.
Pectoralis Major Innervation
Lateral and Medial Pectoral nerves Clavicular head: C5, C6 Sternocostal head: C7, C8, T1
What are the boundaries of the triangle of auscultation?
Lateral border of trapezius, superior border of latissimus dorsi, medial border of scapula
Denticulate ligaments
Lateral extension of Pia, help anchor spinal cord, suspended CSF. Attach between posterior and anterior roots to dural sac
Pectoralis Major Distal Attachment
Lateral lip of intertubercular sulcus of humerus
Rhomboid minor medial attachments
Ligamentum nuchae, SP C7-T1
C&D dermatome
Limb development. Lateral outgrowths of trunk
Gray matter
Location of nerve cell bodies. Dorsal horn (sensory input), ventral horn (motor output).
Thoracic vertebra
Long and thin spinous process, heart or kidney bean shape, attach for rib of head. Transverse process attach for rib tubercle
Serratus Anterior Innervation
Long thoracic nerve (C5, C6, C7)
Clinical correlate: paralysis of the serratus anterior
Long thoracic nerve- Winged scapula Abduction above the horizontal position
Triceps brachii
Long, medial, and lateral heads. not affected by pronation and supination of forearm.
Cuada equina
Loose bundles of spinal nerves roots arising from inferior end of spinal cord
Where is CSF withdrawn for a lumbar puncture, aka spinal tap?
Lumbar cistern
meningitis diagnostic test
Lumbar puncture
Epidural
Lumbar, sacral, caudal. Affect nerve rotos of caudal equine as they exit dural sac. Loss of sensation inferior to injection site. Uses indwelling catheter in sacral canal
Mammography
Lumps- Fluid-filled cysts Masses with a jagged outline and irregular shape Calcifications (calcium deposits) are of two types- Macrocalcifications Microcalcifications Dense breast tissue- Almost entirely fatty breast tissue Scattered areas of dense glandular tissue and fibrous connective Heterogeneously dense breast tissue Extremely dense breast tissue
What imaging determines what's wrong in a macro sense?
MRI
What imaging is used for tissue differentiation?
MRI
What imaging works with hydrogen and radio waves?
MRI
Breast Tissues
Mammary glands Bed of the breast- Pectoral fascia Retromammary space Axillary tail Non-lactating breasts- Fat Glandular tissue and fibrous tissue Nipple and areola breast size and shape
Superior and inferior articular process of lumbar vertebra
Mammory bodies, concave (superior), convex (inferior)
Laterally boundary of triangular cubital fossa
Mass of extensor muscles of forearm arising from lateral epicondyle and supraepicondylar ridge; brachioradialis is most superficially
Medially boundary of triangular cubital fossa
Mass of flexor muscles of forearm, arise from common flexor attachment on medial epicondyle. pronator terms is most superficially
Insertion of splenius capitis
Mastoid process, lateral 1/3 of superior nuchal line
Pectoralis Minor Distal Attachment
Medial border and superior surface of coracoid process of scapula
Pectoralis Minor Innervation
Medial pectoral nerve (C8, T1)
Nerve
Mix of sensory of and motor nerve fibers d
Meningocele
Most common congenital neural tube defects. Dilation of meninges that have CSF but no neural tissue
Trapezius innervation
Motor: spinal accessory nerve. (CN XI). Proprioreception: C3-C4
Rotator Cuff Muscles
Musculotendinous cuff Protective Supportive
Other meningitis complaints
Nausea, vomiting, photophobia
Rami
Nerve splits to head posteriorly or anteriorly and further splits will happen to form the named nerves. Mixed fibers but can be motor or sensory nerve based on majority of fibers
Subclavius Innervation
Nerve to subclavius (C5, C6)
Atlas
No spinous process, facet for dens, transverse foramen, lamina. No vertebral disc
Ulnar nerve branches
None in arm, supplies articular branches to elbow joint
Median nerve branches
None in axilla or arm, does supply articular branches to elbow joint
Origin of splenius capitis
Nuchal ligament, SP C7-T4
Imaging uses barium
Nuclear medicine
SPECT or PET
Nuclear medicine imaging
Rectus capitis posterior major insertion
Occipital bone below inferior nuchal line
Obliques captis superior insertion
Occipital bone between superior and inferior nuchal lines
Rootlets
Often omitted form diagrams for simplicity anterior and posterior
Thoracic-acromial artery
Origin is axillary artery. 4 branches: acromial, deltoid, pectoral, clavicular
Subscapular artery
Origin is axillary artery. Branch of axillary that is greatest in diameter and shortest in length. Give rise to circumflex scapular and thoracodorsal
Posterior circumflex humeral
Origin is axillary artery. Larger than anterior; supplies glenohumeral joint, deltoid, tires major, tires minor, long head triceps. Pass through quadrangular space with axillary nerve
Lateral thoracic artery
Origin is axillary artery. Supply pectoral, serrates anterior and intercostal muscles; axillary lymph nodes; lateral aspect of breast. Highly variable origin. Travel down thoracic region
Superior thoracic artery
Origin is axillary artery. Supply subclavius, muscles in 1st and 2nd intercostal space, superior portion of serratus anterior, pectoral muscles
Throacodorsal artery
Origin is subscapular artery. Unnamed branches to latissimus dorsi; anastomoses around scapula
Circumflex scapular artery
Origin is subscapular artery. Unnamed branches to teres major, teres minor, infraspinatus. Anastomose with supra scapular and dorsal scapular
Clinical Correlate: heart attack referred pain
Pain perceived at a location of the painful stimulus Angina pectoris -Pain in the chest (site of injury) Spinal level that receives visceral sensation from the heart simultaneously receive cutaneous sensation from parts of the skin on the shoulder
Hand fascia
Palmar aponeurosis
Ulnar nerve
Pass distally from axilla anterior to insertion of trees major and long head of triceps, on medial side of brachial artery
Sympathetic ganglion
Path for sympathetic autonomic nerves. Enter through white rami communicans. Exit through gray rami communicans, doesn't synapse and exit splanchnic nerve
Pectoral Girdle
Pectoral region covers anterior thoracic wall and part of the lateral thoracic wall Breasts are tissues overlying the chest muscles - Mammary glands Pectoral muscles
Deep fascia
Pectoral, axillary, clavipectoral (gliding, protection, support)
Pectoral region muscles attachments, nerves, and function
Pectoralis major Pectoralis minor Subclavius Serratus anterior
Anterior wall
Pectoralismajor and minor with fascia, anterior axillary fold is inferiormost portion
Filum terminale internum
Pial part, still within dural sac
Clinical correlate: Absence of the pectoral muscles
Poland syndrome Congenital- 1 in 10,000 to 100,000 Cause- Six-week mark Blood flow Genetic markers Reconstructive surgery- TRAM flap
Lateral cutaneous nerve of forearm
Posterior and anterior branch
Serratus posterior superior/anterior muscle arterial supply
Posterior intercostal arteries (branches of aorta)
Innervation of Superficial, erector spinae, transversospinalis, segmental
Posterior ramus
Subarachnoid hemorrhage
Pressure often elevated appearance clear to bloody, Xanthochromia often present, RBC> 50mm, WBC slightly increased, Normal glucose, protein elevated, normal gram stain
Bacterial meningitis
Pressure often elevated, clear to turbid, negative Xanthochromia, RBC <5mm, WBC elevated and many PMNs, Low glucose, elevated protein, Gram stain organisms
Viral meningitis
Pressure often elevated, often look clear, negative xanthochromia, RBC <5mm, WBC elevated and many lymphocytes, Glucose normal, Protein elevated, normal gram stain
Meningitis
Progress rapidly in hours or progress over days.
3 Functions of CSF
Protect brain and spinal cord from trauma, supply nutrients to nervous tissue, remove waste products
Serratus Anterior Main Action
Protracts scapula and holds it against thoracic wall; rotates scapula
What nerves supply the hand
Radial nerve, superficial branch, median nerve, ulnar nerve
Great anterior segmental medullary artery
Reinforce circulation to 2/3 spinal cord including lumbosacral enlargement. Only on left side. In 65% of people. Arise form left posterior intercostal artery.
Levator costarum
Resemble lateral continuations of rotators
Ligamentum flava
Resist separation of lamina in flexion. Run between posteriro surface of lamina on vert below to anterior surface of vert above
Spinal nerve C8
Responsible for sensation from skin of 5th digit and proximal past wrist. Innervation of digit flexors
Rhomboid major and rhomboid minor action
Retracts and rotates the scapula to tilt the glenoid cavity inferiorly
Nuclear medicine imaging
Reveal radioactive substances. Rates of metabolism and or abnormal chemical activities. Diagnose many cancers, heart disease, GI, endocrine, and neurological disorders.
Iliocostalis cervicis origin
Ribs 3-6
Trapezius actions
Rotates scapula to tilt the glenoid cavity superiorly, elevates (superior part), retracts (middle part), and depresses (inferior part) scapula
obliques capitis inferior action
Rotation of face to same side
Dura mater
Run from foramen magnum to sacral hiatus, lateral rot IV foramen. Ends around S2, separated from bone by extradural (epidural) space.
Inferior longitudinal ligament
Run from transverse ligament to body of C2
Superior longitudinal ligament
Run from transverse ligament to foramen magnum. Hold transverse ligament in place and limit extension
Transverse cervical artery
Runs towards back
Serratus posterior superior medial attachments
SP C7-T3
Serratus posterior inferior medial attachments
SP T11-L2
Rhomboid major medial attachments
SP T2-T5
Latissimus dorsi medial attachments
SP T7-L5, thoracolumbar fascia, sacrum, iliac crest, ribs 10-12
sacrum and coccyx
Sacral base, 5 fused elements (transverse lines), anterior sacral foramen, anterior sacral facets, sacral canal (continuation of spinal cord)
Subscapularis Clinical Muscle Test
Same as infraspinatus Resistance to medial rotation
Lumbar vertebra
Short spinous process, large body, short transverse process, widely spaced lamina.
Lumbar puncture
Spinal tap. Withdrawal of CSF, Lateral decubitus, Knee-chest position. Pressure, proteins, microbes. Insert between L3/4 or L4/5
spinalis cervicis insertion
Spinous process C2-C5
Obliquus captis inferior origin
Spinous process of axis (C2)
Pectoralis Minor Main Action
Stabilizes scapula by drawing it inferiorly and anteriorly against thoracic wall
Hypoechoic
Structures that reflect some sound (liver cells)
Anechoic
Structures that transmit all sound waves without reflection. (blood vessels or air).
Origin of axillary artery
Subclavian artery
Fascial components
Subcutaneous tissue- (superficial fascia) Named deep fasciae- Pectoral fascia Axillary fascia Clavipectoral fascia- Gliding, protection, and support
Subscapular and lateral thoracic of Blood Supply
Subscapularis
Whiplash
Sudden and forceful hyperextension and hyper flexion of neck. Lead to damage of anterior and posterior longitudinal ligament, herniated intervertebral disks.
Anterior spinal artery
Sulcal arteries. Form from union of 2 vertebral arteries, posterior from either vertebral or posteroinferior arteries.
Trapezius muscle arterial supply
Superficial branch of the transverse cervical artery
Lymphatic drainage
Superficial lymphatic vessels- Lymphatic plexuses Cubital lymph nodes Humeral (lateral) axillary lymph nodes Apical and axillary lymph nodes and deltopectoral lymph nodes Deep lymphatic vessels- Humeral (lateral) axillary lymph nodes
Serratus posterior superior lateral attachments
Superior borders of ribs 2-5, lateral to their angles
Roots of spinal nerves
Supplied by radicular arteries (arise from same arteries as segmental medullary)
Suprascapular of Blood Supply
Supraspinatus Infraspinatus
Meninges
Surround, support, and protect spinal cord and spinal nerve roots
Sympathetic nerves arise from
T1-L2/3. White rami also found. Gray rami are at all levels
Lumbosacral enlargement
T11- S1, anterior rami give rise to lumbar and sacral plexuses, innervates lower limbs
Does T1 or T2 specifically look for fluid?
T2
Intercostobrachial nerve
T2
Levator scapulae medial attachments
TP C1-C4
superior part of humerus provide attachments for
Tendons of shoulder muscles
Adduction Muscles of arm
Teres Major
Circumflex scapular of Blood Supply
Teres Major Teres Minor
What should you always remember about images?
They are always in reverse
Pia mater
Thin and transparent, vascular layer of CT. Cover brain, spinal cord, nerve roots, spinal blood vessels. From conus medullaris to film terminale internal
Latissimus dorsi muscle arterial supply
Thoracodorsal artery (branch of axillary)
Latissimus dorsi innervation
Thoracodorsal nerve (middle sub scapular nerve)
White matter
Tracts and fascicle
Longissimus cervicis insertion
Transverse process C2-C6
Longissimus capitis origin
Transverse process C4-T4
Longissimus cervicis origin
Transverse process T1-T6
Obliquus captis superior origin
Transverse process of atlas (C1)
Superficial Sensory Supply
Two dermatome maps- Clinical findings (A & B) Limb development (C & D) Segmental progression Both are approximations
Brachial fascia
Two inter muscular septa
Computed Tomography(CT)
Use Xrays to create transverse anatomical images, table moves through gantry, generator circles, transform info into "slice" images. Uses Ionization radiation.
Barium
Used in GI, mixed in slurry and ingested. Risks are allergic, stomach cramps, GI problems.
Ultrasound
Uses high-frequency soundwaves
Spondylolisthesis
Vertebral body slip anteriorly with or without fracture to the pars interacrticularis. Due to pars interarticular defects or fracture. Most common in L4 & L5. cause back pain.
Filum terminale
Vestigial remnant of coccygeal portion of cord. Internal and externum.
Dermatome map
Visualize area that will be affected from different levels of anesthetic injections
Lateral cutaneous nerve of forearm
When musculocutaneous nerve emerges lateral to biceps
What is important about cervical and lumbosacral regions?
Where limbs and nerves arise
C1 to C7 nerves exit _______ the corresponding vertebrae, C8 nerves exit _____
above, below C7
Deep veins
accompany arteries
semipro position
active only against resistance for pronated forearm and biceps flexor
Rank the different tissues that are visible in X-rays (water and most tissues, spongy bone, fat, compact bone, air) from least radio dense to most radiodense
air, fat, water and most tissues, spongy bone, compact bone
Rank the different tissues that are visible in X-rays(water and most tissues, spongy bone, fat, compact bone, air) from most radiolucent to least radiolucent
air, fat, water and most tissues, spongy bone, compact bone
Musculocutaneous nerve supplies
all 3 muscles of anterior arm
Superficial and deep veins
anastomose freely with each other. Have valves (more numerous in deep veins), venae comitantes
Vasocorona pal anastomosis of
anterior and posterior spinal arteries, supplies most of whit matter. Could be tested in terms of blood clot
Serratus Anterior Distal Attachment
anterior surface of medial border of scapula
Rotatores origin
anterior surface of transverse process
Dural sac ends
around S2, so cannot extract CSF this low
sacral cornu of sacrum and coccyx
articulates with coccygeal Cornu
Spinal dysraphism/ spina bifida occulta
asymptomatic
Boundaries of axilla lateral view shows
axillary boundaries and contents. Artery, nerves, vein, lymph, and fat
rotatores insertion
base of spinous process
Superior articular process of atlas
bean shaped
Axillary artery
begin at lateral border of 1st rib and ends at inferior border of trees major. 3 parts
Musculocutaneous nerve
begins opposite inferior border of pectorals minor, pierces coracobrachialis, continues distally between biceps and brachialis
Thoracic, lumbar, sacral, and coccygeal nerves exit
below vertebrae with same name
Pars interarticularis fracture
between superior and inferior articular surfaces. Vertebral body can slip and compress vertebral cancel.
Semispinalis capitis Insertion
between superior and inferior nuchal lines
Synovial
between superior vertebra's inferior articular process and inferior vertebra's superior articular process
Roof of cubital fossa is formed by
brachial and ante brachial(deep) fascia reinforced by bicipital aponeurosis, subcutaneous tissue, and skin
Origin of axillary vein
brachial and basilic vein. veins origin is one step away from heart.
Brachialis blood supply
brachial artery and radial recurrent artery
Workhorse of elbow flexors
brachialis
Levator costarum insertion
brevis dorsal of rib 1 inferior, Longus dorsal of rib 2 inferior
Aneurysm of axillary artery
can form in first part of axillary artery. May compress trunks of brachial plexus
X-radiation exposure
carcinogen, cause very few cancers. Mutagen, so radiation to testes or ovaries is problematic. Harmful to fetuses.
Enlargement of axillary lymph nodes
caused by lymphangitis due to infection in upper limb affecting humeral nodes first. Infection in pectoral, breast or superior abdomen can produce enlargement of pectoral nodes first.
Pectoral, sub scapular, and humeral lymph nodes pass to
central nodes, the apical nodes, then supraclavicular.
two enlargements of the spinal cord
cervical and lumbosacral
Apex (superior border)
cervico-axillary canal, bound by 1st rib, clavicle, superior edge of scapula
Common uses of X-rays
chest X-rays, initial image of skeletal system
Two dermatome maps
clinical findings (A&B), limb development( C&D)
Sacral hiatus of sacrum and coccyx
closed by sacroccygeal ligament
Scapular anastomosis
collateral circulation. Needed due to legation of lacerated subclavian or axillary artery or vascular stenosis.
Herniation
common cause of back pain. Can cause upper and lower limb pain.
Iiocostalis thoracis lumborum origin
common tendon
Longissimus thoracis origin
common tendon, lumbar transverse process
Join internal vertebral (epidural) plexus
communicate with dural sinuses and veins in cranium
Enlargement of apical nodes may
compress cephalic vein
Alar ligaments
connect dens to medial surface of occipital condyles. help prevent excessive rotation of head and atlas.
Axillary fascia
continuation of the pectoral fascia, forms the floor of the axilla
Coracobrachialis proximal attachment
coracoid process
Pectoral fascia
covers pectorals major, becomes axillary fascia
Long head of triceps brachii
cross glenohumeral joint to attach to infraglenoid tubercle. Aid in extension and adduction of arm.
Median nerve descends into
cubital fossa, lies deep to bicipital; aponeurosis and median cubital vein
Superficial branch of radial nerve
cutaneous in distribution, supply sensation to dorsal of hand and fingers
Arteries that arise from medial aspect of brachial artery
deep artery(profunda brachii artery), superior and inferior ulnar collateral arteries
Anconeus blood supply
deep brachial artery and recurrent interosseous artery
Radial nerve travels with
deep brachial artery, pass through humeral shaft in radial groove
Transversospinalis
deep to erector spinae. From transverse to spinous process
Rotatores
deepest transversospinalis muscle
Serratus posterior inferior actions
depresses ribs 9-12
Cubital fossa
depression on anterior aspect of elbow. Boundaries of triangular cubital fossa are Superiorly, medially, and laterally
lumbar lordosis
develop when infant begins walking
What is ultrasounds useful in examining?
developing fetus, abdominal and pelvic organs, muscles and tendons, heart and blood vessels
Major use for central venous catheters
difficult peripheral venous access, delivery of certain medications or fluids, prolonged intravenous therapies, specialized treatment
Erector spinae inferior attachment
dorsal surface of sacrum, iliac crest, and spinous processes of lumbar vertebrae
main action of arm muscles is at
elbow joint
What is the ultrasound process?
electric current, piezoelectric crystals vibrate rapidly, ultrasound beam, echoes(reflected sound waves), gray-scale images
Serratus posterior superior actions
elevates ribs 2-5
Lumbar cistern
enlargement of subarachnoid space caudal to conus medullaris. CSF and caudal equine, From L2-S2
Radial nerve
enter posterior to brachial artery, medial to humerus, anterior to long head of triceps, gives branches to long and medial heads of triceps
What is CT's used for?
evaluate lung parenchyma. Soft tissues of neck, chest, and abdomen, and pelvis.
Latissimus dorsi actions
extends, adducts, and medially rotates humerus
semispinalis capitis function
extension and lateral flexion of head
semispinalis thoracis and cervicis function
extension and lateral flexion of vertebrae
rectus capitis posterior minor action
extension of head
All back muscles are
extension of neck region or back region
paired action of splenius cervicis and splenius capitis
extension of the neck
Motions of spine
extension, flexion, lateral flexion, lateral extension, rotation of head and neck, rotation of upper trunk
Spina bifida
failure of vertebral arches to fuse together. Occur in lumbosacral juncture. Can cause issues with walking, bladder issues, and neurological defects. Folic acid helps prevent.
when elbow is close to 90 degrees and forearm is supinated, biceps is most efficient in producing
flexion
Solo action of splenius capitis
flexion and rotation of neck to same side
Solo action of splenius cervicis
flexion and rotation of neck to same side
movements of cervical spine
flexion, extension lateral flexion, rotation. Highest range of motion
arm movements
flexion-extension, pronation-supination
when elbow extended
flexor of forearm
Latissimus dorsi lateral attachment
floor of intertubercular sulcus of humerus
Superior and inferior ulnar ollateral arteries
form periarticular anastomosis of elbow region
Third part of axillary artery
from lateral border of pectorals minor to inferior border of teres major. 3 branches: sub scapular, anterior circumflex humeral and posterior circumflex humeral.
nucleus pulposus
gelatinous. Absorbs compression forces between verts
Iodinated compounds
general IV but can be put in abdomen. Harmless, but can cause infection, allergic reaction, etc.
some arm muscles also act at the
glenohumeral joint
lordosis
help bring our center of gravity into a vertical line and balance our body weight on vertebral column allowing bipedal movement
Coracobrachialis action
help flex and adduct arm, stabilize glenohumeral joint. Resist downward dislocation of humeral head when carrying something
Anconeus
help triceps extend to forarm. Tenses of capsule of elbow joint, prevent it from being pinched during extension.
Erector spinae muscles
iliocostalis, longissimus, spinalis
T1 weighted images
images show dark fluid and bright fat
Herniated disc between C7-T1
impinges spinal nerve C8 .
Parasympathetic synapse
in ganglia near or in wall of organ they supply
Supraclavicular nodes
inferior deep cervical nodes that drain into veinous system
What does scapular anastomosis often result in?
insufficient supply to arm, forearm and hand. Not developed enough for surgical ligation of axillary between sub scapular and profound brachia.
Thoracic aorta
intercostal arteries
Extradural (epidura) space
internal venous plexus embedded in fatty matrix
Spinal nerve passes through
intervertebral foramen
Thoracolumbar fascia
investing fascia surrounding quadrates lumborum. Continue as nuchal fascia and gluteal fascia.
Trapezius lateral attachments
lateral 1/3 of clavicle, acromion, and spine of scapula
Median nerve orginates
lateral and medial cords
Anconeus origin
lateral epicondyle
Unilateral contraction of erector spinae
lateral flexion of neck or trunk, rotation of head, side of contracting muscle
After reaching lateral border of humerus, radial nerve pierces
lateral inter muscular septum in cubital fossa. Divides into deep branch and superficial branch
Musculocutaneous nerve emerges
lateral to biceps as lateral cutaneous nerve of forearm
Biceps brachii proximal attachments
long head to supraglenoid tubercle and short head to coracoid process
What is the advantages of ultrasounds?
low cost, portable, real-time images
Lumbar and sacral plexuses innervate
lower limbs
Herniated disc
lumbar region can result in caudex equine syndrome. Result in numbness and tingling and pain in lower limbs or loss of bowel or bladder function
Brachialis
main flexor of forearm, the only pure flexor, product greatest flexion force, flexes forearm in all positions, Not affected by pronation and supination
Sulcal artery supplies
majority of gray matter
Longissimus capitis insertion
mastoid process
Rhomboid minor lateral attachment
medial border of scapula at spine
Rhomboid major lateral attachment
medial border of scapula below spine
Ulnar nerve pass posterior to
medial epicondyle and medial to olecranon to enter forearm, posterior to medial epicondyle
Ulnar nerve pierces
medial intermuscular septum with superior ulnar collateral artery, descend between septum and medial head of triceps
Rectus capitis posterior minor insertion
medial portion of occipital bone below inferior nuchal line
Dura mater innervation
meningeal nerves that branch off after nerve is formed, before rami split
Mammillary processes of lumbar vertebra is attachment for what muscles?
multifidus and longissimus
Deep branch of radial nerve
muscular an articular in distribution
Biceps brachii, brachialis, and coracobrachialis innervation
musculocutaneous nerve
Cancer metastasize to apical nodes
nodes may adhere to axillary vein
Multiphase CT
non-contrast scan taken then a contrast scan is taken. Look for cryptic bleeding/hemorrhaging . Not routine because of high radiation dose
Scottie dog sign fracture
normal appearance of lumbar spine in oblique radiograph. "Collar"
what are some limitations of ultrasounds?
not effective at imaging body parts that have gas or are hidden by bone
Lateral, medial, and long head of briceps brachii converge inferiorly to attachment to (distal attachment)
olecranon of ulna
Brachial artery end in cubital fossa
opposite neck of radius, under bicipital aponeurosis. Divides into ulnar and radial artery
Anulus fibrosus
outer ring of collagen surrounding fibrocartilage arranged in lamellar configuration. Limit rotation between vertebra.
Axillary artery runs behind
pectoralis minor
Arachnoid and pia blend with
perineurium
A&B dermatome
popular in neurology, sensory and motor in skin. More usefully clinically
Radial nerve supplies all muscles in
posterior compartment of arm and forearm
rectus capitis posterior major/ minor and obliques capitis superior/ inferior nnervation
posterior ramus of C1
Rectus capitis posterior minor origin
posterior tubercle of atlas (C1)
Bilateral contraction of erector spinae
primary extensor of vertebral column and neck
Subtendinous olecranon bursa
proximal to distal attachment of 3 heads of triceps brachii. Friction-reducing. Between triceps tendon and olecranon
Branch to lateral head of triceps arise within
radial groove
Triceps brachii and anconeus innervation
radial nerve
Biceps tendon forms distally and attaches to
radial tuberosity
Hyperechoic
reflect most sound waves
Echogenicity or brightness depends on
reflected signal
MRI risks
remain motionless for long periods, bad for pediatrics, claustrophobia, metallic implants, low-quality ferrous tattoo ink can cause burns
Multifidus
resembles continuation of semispinalis
iliocostalis thoracis insertion
ribs 1-6
Iliocostalis thoracis lumborum insertion
ribs 6-12
iliocostalis thoracis origin
ribs 6-12
Inferior articular process of atlas
round and flat
Median nerve
run distally in arm on lateral side of brachial artery until it reaches middle of arm. Cross to medial side and contact brachialis
Anterior longitudinal ligament
runs from base of skull to anterior surface of sacrum.
second part of axillary artery
runs posterior to pectorals minor. has 2 branches, thoracoacromial and lateral thoracic arteries
Intervertebral foramen
same number of spinal nerves as number of vertebras in that region. Except cervical region has 8 because C1 exit between occipital and atlas
Axillary artery clinical application
scapular anastomosis, compression of axillary artery, aneurysm of axillary artery
Spinal injection
similar to lumbar puncture without stylet attached. Anesthetic heavier than CSF, it don't travel upward when pt inclined. Travel superiorly when pt lays flat. Difficult to re-administer if it wears off. Experience sever headaches
How does scapular anastomosis develop?
slow occlusion, sub scapular artery receives blood sue to anastomosis with several arteries . Sudden occlusion doesn't allow enough time for collateral circulation to develop.
Rotatores brevis
spans one intervertebral joint
Rotatores longus
spans two joints
Semispinalis cervicis insertion
spinous process C1-C5
spinalis cervicis origin
spinous process C5-T2
Semispinalis thoracis insertion
spinous process C6-T4
Spinalis thoracis origin
spinous process T10-L3
Spinalis thoracis insertion
spinous process T2-T8
Origin of splenius cervicis
spinous process T3-T6
Rectus capitis posterior major origin
spinous process of axis (CII)
3 boney attachments of thoracolumbar fascia
spinous process, transverse process, angle of rib
Intertransversarii action
stabilize and adjust intervertebral joint
Lateral head of triceps brachii
strongest, activated to work against resistance
Isoechoic
structures that reflect sound waves similar to surrounding structures (diaphragm)
Fascial components
subcutaneous tissue(superficial fascia), deep fascia
Superficial veins are in
subcutaneous tissue. 2 main are cephalic and basilica veins
Levator Scapulae lateral attachments
superior angle of scapula
Trapezius medial attachments
superior nuchal line, external occipital protuberance, ligamentum nuchae, SP C7-T12
Elbow anastomosis
superior ulnar collateral a., inferior ulnar collateral a., radial collateral a., middle collateral a., radial recurrent a., recurrent interosseous a., anterior ulnar recurrent a., posterior ulnar recurrent a.
When forearm is pronated, biceps is primary(most powerful) ____ of the forearm
supinator
Caudal epidurals are useful in pediatric populations for
surgery in groin, pelvis or lower extremities
what should you always do when taking images?
take multiple vies.
Posterior longitudinal ligament
tectorial membrane. Upper part of ligament connecting C11 ro intracranial aspect of skull base
Aponeurosis
thick and tough to get through. Thickened bands. Tendons fusing with fascia
longissimus thoracis insertion
thoracic transverse processes, ribs 2-12
Scapular anastomosis allows blood flow to circumvent in what arteries?
transverse cervical artery, dorsal scapular artery(anastomosing branch of transverse cervical), suprascapular artery, branches of sub scapular artery, branches of thoracic aorta
Lateral crest of sacrum and coccyx
transverse process
Insertion of splenius cervicis
transverse process C1-C3
Iliocostalis cervicis insertion
transverse process C4-C6
semispinalis cervicis origin
transverse process of T1-T6
Obliquus captifs inferior insertion
transverse process of atlas (C1)
Semispinalis capitis origin
transverse processes T6-C7, articular process C4-C6
Semispinalis thoracis origin
transverse processes T6-T10
Veins in the plexuses are
valveless (flow bidirectional). Allow pelvic cancers to metastasize to spinal cord
Anterior roots
ventral, motor( efferent) fibers, bring information from CNS to periphery
Multifidus function
vertebral stabilization
Cervical lordosis
when an infant begins to lift their head
Compression of axillary artery
when injury results in profuse bleeding. 3rd part can be compressed against humerus. Origin compressed with downward pressure in angle between clavicle and inferior attachment of sternocleidomastoid
Medial head of triceps brachii
workhorse of forearm extension. Active at all speeds in presence or absence of resistance