Helen's Practice Questions for Exam 2
What innervates the quadratus lumborum
Lumbar plexus T12, L1, L2, L3
What helps orient you to where the C7 spinous process is?
Most prominent vertebra on normal developing person
What special feature does C2 have?
Odontoid or dens
Distinguish between PROM, AROM, AAROM
PROM: when the joint is moved by an outside force such as a therapist • Generally a slightly higher number than AROM • Extra range from elasticity, protects joint because it allows extra "give" AROM when the joint is moved by muscles that act on that joint • If this value is grossly less than PROM, weakness is likely involved AAROM: outside force assists with motion of a joint
Superior angle of the scapula is in line with which spinous process
T2 (body type and muscular contraction could cause this to be inaccurate)
What are feeling limit movement for a soft end feel and name a joint which you would expect to have soft end feel
Adipose or muscle tissue • e.g. Knee flexion/elbow flexion
What muscles rotate the vertebral column?
All unilaterally: external oblique (opposite side) internal oblique (same side) multifidi (opposite side) rotatores (opposite side)
What does wrist abduction look like?
Also known as radial deviation of the radiocarpal joint
Name function, origin, insertion, and nerve for semispinalis capitis
F: extend the vertebral column and head O: transverse processes of C4- T5 I: between the superior and inferior nuchal lines of the occiput N: cervical
What do the palmar interossei do
Finger adduction
The lumbricals sprout from the sides of the tendons of ____________
Flexor digitorum profundus
What is tenodesis grasp?
Tenodesis grasp and release is a biomechanical occurrence that allows for some opening and closing of the fingers by movement of the wrist. The tendons of the forearm and fingers cross multiple joints and act as a complex pulley system. When the wrist is extended the tendons along the fingers shorten and pull the finger joints into flexion. Conversely, when the wrist is flexed the tendons along the finger joints lengthen and allow the finger joints to extend passively.
How do you test endfeel
Tested at end of AROM by performing PROM
How do you establish what is normal ROM for a patient
Testing uninvolved side to establish normal ROM for person tested
How do you palpate the multifidi
They are surprisingly think and directly accessible in the lumbar spine; only muscle fibers on the posterior surface of the sacrum p. 200 Trailguide
What is the function of the transverse foramen?
This is an opening on each of the transverse processes which gives passage to the vertebral artery and vein and a sympathetic nerve plexus.
What is the ligamentum nuchae
a fin-like sheet of connective tissue that runs along the sagittal plane form the external occipital protuberance to the spinous process of C7 in the neck; chief function is to help stabilize the head and neck. Attachment to superficial muscles of posterior neck p. 218 TG
What is significant about the T8 vertebra? Think about if it were to be fractured? What is nearby?
abdominal aorta, lungs; at risk for internal bleeding, punctured lung
What is a hiccup
an involuntary contraction of the diaphragm causing air to rush into the lungs and the vocal cords to snap shut
Levator Scapula is a/an ________________ to cervical flexion
antagonist
Palmaris longus is a/an ________ to extension of the wrist
antagonist
Both sternocleidomastoids are ______ to cervical extension
antagonists
Where do the scalenes insert
anterior and middle: 1st rib posterior: 2nd rib
Ribs are designed to move which directions
anterior, posterior, lateral, superior
Which vertebrae has a bifid process a. thoracic b. atlas c. axis d. lumbar
axis
Name some flexors of the neck
bilaterally: longus capitis, longus colli
When you're standing, the entire weight of your trunk/head/arms is transferred where?
bodies of vertebrae (lumbar vertebrae bear the brunt of this weight)
What structure is superficial to the SCM (could be tricky while palpating it) and what structure is deep to it?
carotid artery passes deep and medial to SCM external jugular vein lies superficial to it
the transverse fibers of the flexor retinaculum and the and carpal bones form the _____ _____
carpal tunnel
What is the insertion of the diagphragm
central tendon
Which vertebrae have transverse foramen?
cervical
The first rib is deep to which bone along the anterior axis
clavicle
What is the function of the transverse abdominis?
compress abdominal contents
Function of palmaris brevis
cup hand on medial side of hand
The transversospinalis group is ____________ to the erector spinae group
deep
What is the function of the serratus posterior inferior
depress ribs during inhalation
Synergists are internal intercostals (assists) and serratus posterior inferior; the antagonist is external intercostals (assists) What action is occurring
depression of the ribs
Abduction of phalanges 2-4 is performed by what muscle group
dorsal interossei
What is the function of the external intercostals
draw the ribs superiorly (increasing space in the thoracic cavity to assist with inhalation
What is the function of the serratus posterior superior
elevate ribs during inhalation
You want to discern the posterior scalene from the levator scapula...what could you have your client do?
elevate scapula
Bilaterally what do the scalenes do
elevate the ribs during inhalation anterior scalene also flexes the head and neck
All scalenes (bilateral) and serratus posterior superior work in synergy (with internal intercostals as an antagonist) to do what action
expansion of the ribs (inhalation)
Spinalis and iliocoastalis (bilaterally) are synergists and rectus abdominis is an antagonist. What movement is occurring
extension of the spine
When used bilaterally what do the 2 quadratus lumborum muscles do
fix the last rib during forced inhalation and exhalation
The carpal tunnel is a passageway for what?
flexor tendons and median nerve
Between bodies of vertebrae you find
intervertebral discs which cushion the shock. They are composed of tough outer layer, annular fibrosus, and a liquid center nuclear pulposus
Name distinguishing characteristics of the lumbar vertebrae
larger than the other vertebrae; Blunter spinous processes; 5 lumbar vertebrae;
Unilaterally what do the longus colli and longus capitis do?
laterally flex the head and neck to the same side rotate the head and neck to the same side
What is the action of the oblique capitis superior?
laterally flex the head to the same side
What actions does the QL do unilaterally?
laterally tilt (elevate) the pelvis laterally flex the vertebral column Assist to extend the vertebral column
Name some muscles that anchor to the thoracolumbar aponeurosis
latissimus dorsi and erector spinae group
Which spinalis would be an antagonist to right lateral flexion of the vertebral column
left spinalis
Passive rotation of the head and neck to the same side would _______ the SCM
lengthen
Name the curvature of the cervical spine
lordosis
What makes a strong muscle strong?
lots of sarcomeres
Insertion of longissimus
lower 9 ribs & transverse processes of thoracic vertebrae (thoracis) transverse processes of cervical vertebrae (cervicis) Mastoid process of temporal bone (capitis)
When bilateral external and internal obliques work in synergy, what motion happens (QL would be antagonist)
lumbar flexion
Name the muscles that are part of the transversospinalis group
multifidi rotatores semispinalis capitis
How many muscles go between ilium and sacrum?
none
What is in the posterior abdominal wall
o 5 lumbar vertebrae and associated discs o Muscles: psoas, quadratus lumborum, iliacus, transversus abdominis, and oblique muscles o Diaphragm o Fascia o Lumbar plexus o Fat, nerves, blood vessels,(aorta, IVC) and lymph nodes
All scalenes unilaterallly rotate head and neck to the ____ side
opposite
Which span of connective tissue is a continuation of the antebrachial fascia into the palm of the hand?
palmar aponeurosis
The fibers of the internal and external intercostals are ______ to each other
perpendicular
What nerve innervates the diaphragm
phrenic nerve (C3, C4, C5) Remember C5 keeps the diaphragm alive
Name this muscle Long, thick, fusiform muscle lateral to lumbar spine Comes from transverse processes of lumbar vertebrae, vertebral bodies and discs to lesser trochanter on femur Innervated by anterior rami of lumbar nerves L1-3 Flexes hip, laterally flexes trunk
psoas major
What muscles assists vertebral column extension
quadratus lumborum latissimus dorsi (assists when arm is fixed)
What are the flexors of the vertebral column?
rectus abdominis external oblique (bilaterally) internal oblique (bilaterally) psoas major (with insertion fixed) iliacus (with insertion fixed)
Which suboccipitals rotate the head to the same side?
rectus capitis posterior major, oblique capitis inferior
Which suboccipitals rock and tilt the head back into extension
rectus capitis posterior major, rectus capitis posterior minor, oblique capitis superior
Costal cartilage attachess ______ to the ______
ribs to the sternum
To access the first rib, you must palpate between the _____
scalenes
Passive rotation of the head and neck to the opposite side would ______ the scalenes
shorten
You want to feel the first rib move, what do you instruct your client to do
slow, deep breaths into upper chest
The lamina groove is located between which two bony landmarks of the vertebrae?
spinous and transverse processes
Upper arm articulates to trunk at what joint
sternoclavicular The shoulder girdle or pectoral girdle, composed of the clavicle and the scapula, connects the upper limb to the axial skeleton through the sternoclavicular joint (the only joint in the upper limb that directly articulates with the trunk).
Many of the cervical transverse processes are deep to which neck muscle?
sternocleidomastoid
What innervates the subclavius
subclavian nerve
What nerve innervates the suboccipital muscles?
suboccipital p. 205 Trail guide
What are deepest muscles of the upper posterior neck?
suboccipitals (8 small muscles):
What structures are near the abdominal aorta
Lies on anterior surface of vertebrae Deep to small intestines Lateral to the aorta is the psoas major
Describe how you would palpate the diaphragm
1. Partner in supine, with knees bolstered. Locate the inferior edge of the rib cage, lateral to the xiphoid process. 2. Lay your thumbpads just inferior to the ribs on the abdomen and ask your partner to take slow, deep breaths. 3. Moving only as your partner exhale, slowly press and curl your thumbpads underneath the edge of the ribs. During inhalation, you may not feel the tissue of the diaphragm, but your will most likely feel its contraction as it pushes other tissues into your thumbpads.
Which rib attaches to the sternum at the level of the sternal angle
2nd
Name some characteristics of the abdominal region
Abdomen connects pelvis and thorax Houses vital organs of alimentary and urogenital systems Bound superiorly by diaphragm and inferiorly by pelvis Can adjust pressure based on voluntary or reflexive contractions to expire air or release fluid or feces
What is the blood flow from the abdominal aorta
Abdominal aorta: ◦Common iliac arteries (right and left) ◦Internal iliac arteries (then enters pelvis) ◦External iliac arteries (gives off 2 branches: deep circumflex iliac and inferior epigastric) ◦Femoral arteries Abdominal aorta divides into right and left common iliac arteries; each of those divide into an internal and external iliac artery; external iliac artery turns into femoral artery once it passes inguinal ligament
What is another name for C1
Atlas
What is another name for the C2 vertebra?
Axis
What limits movement for a firm end feel? Name an example of firm end feel
Capsule or ligament or tendon • e.g. Shoulder external rotation
Name the primary muscle of respiration
Diaphragm
Distal ______ is based on proximal _______
Distal mobility is based on proximal stability
What innervates the rhomboids?
Dorsal scapular nerve (C4, C5)
What is the function of the internal intercostals?
Draw the ribs inferiorly (decreasing space in thoracic cavity) to assist with exhalation
Name that muscle Large triangular mm lateral to psoas major Comes from superior 2/3 of iliac fossa, ala of sacrum, and anterior sacro-iliac ligaments to lesser trochanter of femur and shaft of femur Innervated by femoral nerve L2-4 Flexes and stabilizes hip joint
Iliacus
Lumbar Plexus (describe)
Ilioinguinal and iliohypogastric nerves (L1) Supply the abdominal muscles and skin of the inguinal and pubic areas Femoral nerve L2-L4 To the anterior thigh and supplies the flexors of the hip and extensors of the knee. Obturator nerve L2-L4 Innervates the iliacus; supplies the adductor muscles Lumbosacral trunk L4-L5 Participates in the formation of the sacral plexus with the anterior rami of S1-S4 Genitofemoral nerve (L1,L2) Pierces psoas major, divides lateral to common and external iliac arteries into femoral and genital branches Lateral cutaneous nerve of the thigh (L2-3) Supplies skin on anterolateral surface of thigh Accessory obturator nerve (L3-4)
How does the diaphragm help with inspiration
Its muscle fibers contract and pull the central tendon inferiorly. Because the central tendon is attached to the connective tissue that surrounds the lungs, a vacuum is created in the upper thoracic cavity, pulling air into the lungs (increases volume of thoracic cavity during inhalation)
Name some contraindications to ROM testing
Joint dislocation • Post surgery • Fracture • Myositis ossificans • Ectopic ossification
Top of the iliac crest should be in line with which spinous process
L4
Origin and insertion of iliocostalis
O: common tendon (lumborum), posterior surface of ribs 1-12 (thoracis & cervicis) I: transverse processes of lumbar vertebrae 1-3 and posterior surface of ribs 6-12 (lumborum), posterior surface of ribs 1-6 (thoracis), transverse processes of lower cervicals
Origin and insertion of diaphragm
O: costal attachment (inner surface of lower 6 ribs) Lumbar attachment: upper 2 to 3 lumbar vertebrae sternal attachment: inner part of xiphoid process I: central tendon
Name origin and insertion of external oblique
O: external surfaces of 5th through 12th ribs I: Anterior part of the iliac crest, abdominal aponeurosis to linea alba
Name origin and insertion of transverse abdominis
O: lateral inquinal ligament, iliac crest, thoracolumbar fascia, and internal surface of lower 6 ribs I: abdominal aponeurosis to linea alba
Name the origin and insertion of the quadratus lumborum
O: posterior iliac crest I: last rib and transverse processes of the 1-4 lumbar vertebrae
Name origin and insertion of the rectus abdominis
O: pubic crest, pubic symphysis I: cartilage of the 5th, 6th, 7th ribs and xiphoid process
Multifidi origin and insertion
O: sacrum and transverse processes of lumbar and through sacral veretbrae I: spinous processes of lumbar vertebrae through C2 (span 2-4 vertebrae at a time)
Name origin and insertion of spinalis
O: spinous process of the upper and lower Thoracic vertebrae (thoracis), ligamentum nuchae, spinous process of C-7 (cervicis) I: spinous process of upper thoracic (thoracis), spinous processes of cervicals except C1 (cervicis)
Origin and insertion of SCM
O: sternal head: top of manubrium clavicular head: medial one-third of clavicle I: mastoid process of temporal bone and the lateral portion of superior nuchal line of occiput
Origin and insertion of rotatores
O: transverse process of lumbar through cervical vertebrae I: spinous processes of lumbar vertebrae through C2 (span 1-2 vertebrae)
Name the muscles of vertebral column extension?
Pg. 194 Trail guide (aka antagoinists of flexion) longissimus (bilaterally) iliocostalis(bilaterally) multifidi (bilaterally) semispinalis capitis spinalis (bilaterally) interspinalsis intertransversarii (bilaterally)
The following are ______ to ROM testing Inflammation/infection • Medication that mask pain or muscle relaxants • Hemophilia • OP, Hypermobility, subluxation • Hematoma • Bony ankyloses • Carcinoma, fragile bone condition • Post prolonged immobilization
Precautions
Costal facets articulate with what?
Ribs
External and internal obliques are working in synergy for rotation of the spinal column. Left external oblique is contracting and right internal oblique. Which way is the person rotating?
Right
What goes through the vertebral foramen
Spinal cord
12th rib is in line with which spinous process
T12
Nerves of the anterolateral abdominal wall
Thoraco-abdominal nerves: anterior rami of inferior 6 thoracic spinal nerves (T7-11); former inferior intercostal nerves distal to the costal margin •Runs between IAO and TA to supply abdominal skin and mms Lateral (thoracic) cutaneous branches: thoracic spinal nerves T7-9 (or sometimes T10) Subcostal nerve: large anterior ramus of spinal nerve T12 Iliohypogastric and ilio-inguinal nerves: terminal branches of anterior ramus of spinal nerve L1
What patient might benefit form the tenodesis grasp?
Typically we use our finger flexor and extensor muscles to open and close our fingers and the extension of the wrist allows us to have greater force for pinching and grasping. After a spinal cord injury at the C6 level, a person might be able to send a signal to the muscles controlling the wrist, but not the fingers. We can use the passive mechanical advantage of tenodesis to assist in picking up objects and increase independence in activities such as eating meals and brushing teeth.
What are the actions of the splenius capitis and splenius cervicis?
Unilaterally: Rotate head and neck to the same side Laterally flex the head and neck to the same side Bilaterally: Extend the head and neck
Function of sternoclediomastoid
Unilaterally: laterally flex the head and neck (same side) Rotate head and neck to the opposite side Bilaterally: flex the neck assist to elevate rib cage during inhalation
The palmar interossei are difficult to assess because they are deep to what?
the lumbricals They are also situated between the metacarpals
What happens to the diaphragm during exhalation?
the muscle fibers of the diaphragm relax, releasing the central tendon and allowing the lungs to deflate
What is the deepest muscle of the abdomen
the quadratus lumborum
The diaphragm is the barrier for what 2 cavities
thoracic and abdominal
What are the primary curvatures of the spine
thoracic and sacrococcygeal (retained from original fetal curvature)
What is the deepest of the 4 abdominal muscles
transverse abdominis
C1 does not have a spinous process true or false
true
C1 has no body true or false
true
The hypothear is on the ____ side of the palm
ulnar
What muscles do lateral flexion of the vertebral column
unilaterally to the same side: iliocostalis external oblique internal oblique longissimus quadratus lumborum psoas major (assists) intertransversarii spinalis latissimus dorsi (assists)
What limits motion for a hard end feel? What motion should produce a hard end feel
• Hard/bony • Joint surfaces • e.g. Elbow extension/ knee extension
