1b.Superficial back and posterior shoulder part II

Question 1

Describe the unique characteristics of c1. what does the dens articulate with?

Answer 1

no spinous process or vertebral body; anterior tubercle, FACET for dens, posterior and anterior tubercle, transverse foramen, superior articular facet. *dens is anterior and articulates with occipital condyle and the dens of the C2 or axis

Question 2

describe unique characteristics of c2, what is it called?

Answer 2

c2 is the axis and the dens is posterior here. dens articulates with C1 at the facet for dens on C1

Question 3

what is a jefferson fracture? what is it caused by?

Answer 3

burst fracture of the atlas (C1) ; often caused by blow to the top of the head. arch broken in one or more places

Question 4

what is a type 1 fracture of the c2?

Answer 4

type I is an oblique fracture through the upper part of the odontoid process. avulsion fraction (fragment of bone tears away from major bone) this is mechanically stable but associated with life threatening atlantooccipital dislocation. incidence is very low at <5%. treat: hard collar immobilization for 6-8 weeks. caused by motor vehicle accidents and falls

Question 5

what is the cause of odontoid fractures?

Answer 5

usually falls and motor vehicle accidents (C2)

Question 6

what is a type II odontoid fracture?

Answer 6

type 2- 60% incidence; occurs at base of the densrequire halo immobilization of 12-16 weeks; internal fixation (screw dens parts back together); posterior atantodental arthrodesis may be required.

Question 7

what is a type 3 c2 fracture?

Answer 7

type 3- 30% (more frequeent that type 1 but also rare) ; halo immobilization, internal fixation; c1/c2 arthrodesis= where you have clamps, screws or wire bolting the parts together and leaves 50% rotation/mobility

Question 8

Which C spine injuries are the worst?

Answer 8

the higher or more superior, the higher the morbidity and mortality; craniocervical
junction injiries are the deadliest

Question 9

What are symptoms, mechanism of injury and clincial findings of c-spine injuries?

Answer 9

a. b.
mechanism of injury: combination of flexion, extension, and rotation
symptoms: pain and inability to actively move neck, sensation of instability so patients may present holding thier head
clinical findings range: quadriplegia w/ respiratory center problems or minimal sensory/motor deficits
c.

Question 10

Describe cause hangmans fracture; where is the fulcrum? What type of extension?

Answer 10

both pedicles are broken
being hanged, falls, or motor vehicle accidents: momentum carries body forward into windshield and rebound movement or whiplash, causes forceful hyperextension that breaks the pedicles
forced hyperextension with cervical spine as fulcrum

Question 11

Know xray for hangman’s fraction/ presentations

Answer 11

broken bilateral pedicles forward displacement of C1

speration of upper cervical spine from lower cervical spin

Question 12

how does fusion happen

Answer 12

Lateral mass screws and pedicle screws go at an angle and then stablize with fusion rods to connect between. This is called a fusion. Laminectomy is sometimes coupled with this (spinous process being removed therefore need stabilization)

Question 13

How do you repair a hangman’s fracture?

Answer 13

intervention: c2 pedicle arthrodesis: lateral mass screws in c1 and pedicle screws in
c2 and 2 plates for stabilization

Question 14

describe vertebral subluxation

Answer 14

displacement of vertebrae that can stress spinal cord and nervous system causes: poor posture and sleeping posture, mva, slips/ falls, strenous excercise,
can cause impinged nerve

Question 15

why kind of joint is the anterior intervertebral joint?

Answer 15

synarthrosis joint: specifically a secondary cartilagenous, also known as a syphysis type joint where the bodies of adjacent vertebrae would articulate with the intervertebral disc located betwen them

Question 16

what are the 2 types of cartilaginous joints?

Answer 16

1) Primary cartilaginous joints: (synchondrosis): In this subtype the bones are united by a plate of hyaline cartilage so that the joint is immovable and strong. These joints are temporary in nature because after a certain age the cartilaginous plate is replaced by the bone. Examples of this type of joints are joint between the epiphyses and diaphysis of a growing long bone, the costochondral joint and the first chondrosternal joint.
2) Secondary cartilaginous joints: (symphysis): These are also known as fibro-cartilaginous joints. There articular surface is covered by a thin layer of hyaline cartilage and the bones are united by fibro-cartilage. These joints are permanent and persist throughout the life of an individual. Typically the secondary cartilaginous joints occur in the median plane of the body and permit limited movements because of compressible pad of cartilage in them. The thickness of the fibro-cartilage in these joints is directly related to the range of movement the joint offers. Examples of this type of joints are; symphysis pubis, manubrio-sternal joint and intervertebral joints between the vertebral bodies.

Question 17

Describe the zygapophyseal joint. what type is it?

Answer 17

has superior and infereior facets- the superior articulates with the inferior one above it, forming a diarthrosis joint (plane) therefore movements are gliding or sliding.
Intervertebral formaina is between adj vertebrae and allows for spinal nerves

Question 18

in facet joint degeneration, what do we see at L4/5? from what view?

Answer 18

coronal view we see severe bilateral facet joint degeneration at L4/5 with air in the joints (show as gaps on X-ray)

Question 19

How do zygapophyseal joints prevent movement? Difference btwn disc and joint? Describe regional differences

Answer 19

disc controls AMOUNT of movement whereas joint controls DIRECTION of movement
in cervical region- 45 degrees; transverse to frontal plane allows rotation, flexion, and extension
in throacic region- 60 degrees; front plate has sets that permit rotation
in lumbar is 90 degrees (sagittal place); sagittal plane only permits extension and flexion

Question 20

what are the ligmental supports?

Answer 20

posterior longitudinal= NARROW band from sacrum to C2 on posterior vertebral bodies and discs

ligamentum favum= runs from lamina to lamina from axis to sacrum

anterior longitudinal= WIDE band from sacrum to occiput on anterior vertebral bodies and discs

facet joint capsule

interspinous and intertransverse= goes from spinous processes to spinous process and the intertransverese goes from transverse to transverse

supraspinous= continuous attachment to tips of spinous process from sacrum to C7

nuchal= thickened continuation of supraspinous ligament from C7 to occiput

Question 21

what are the 3 region specific joints in the cervical region?

Answer 21

uncovertebral
atlantodental
atlantoccipital

Question 22

where is the uncovertebral joint and what does it do

Answer 22

it prevents lateral translation and is at the uncinate procces (edge of the body) and the one above

Question 23

what type of joint is the atlantodental?

Answer 23

synovial/diarthrotic joint of the pivot type (move in one plane about vertical axis). artculation btwn dens and posterior facet of anterior tubercle
rotation: just say no! (antlantoaxial),

Question 24

what type of joint is the atlantooccipital?

Answer 24

synovial/diathrotic, of the condyloid type, superior articular facets of c1 articulate with the occiptal condyles on the occiptal bone of the skull

Question 25

what is a condyloid joint

Answer 25

here articular surfaces consist of two distinct condyles in which one is convex surface (called the male surface) fitting into a concave surface (called the female surface) of the other bone. These joints mainly permit the movement in plane around a transverse axis. Example of this type of joints is knee joint.

Question 26

at the atlantodental joint, the dens is held in place by

Answer 26

transverse ligament

Question 27

DIffrence btwn pivot joint and condyle joint?

Answer 27

pivot joint allows movement in only 1 plane- transverse; while condyle joint allows sagittal and frontal plane movement. so this joint allows you to laterally flex but also to say yes

Question 28

what is a demifacet?

Answer 28

partical facet; demifacet of neighboring vertebrae have rotaiton with both vertebrae

Question 29

which don’t have transverse costal facets?

Answer 29

T11 and T12

Question 30

Costovertebral joint? what region is this in?

Answer 30

plane joint therefore just permits linear movement of articulating surfaces past one another ribe is wedge shaped so that each side can articulate with each demifacet articulation btwn tubercle of rib with transverse costal facet; lateral and supiror cosotransverse ligaments support this joint. thoracic region

Question 31

what is the region specific joint of the sacral region? what type of joint is it/

Answer 31

sacroiliac joint is a synarthrosis type joint; auricular suface on coxa with auricular surface (resembles ear) on sacrum. with bilateral erosion of bony surfaces

Question 32

what are the 2 muscle layers of the back? what is their function

Answer 32

1) superficial muscles/ extrinsic : they act on upper limb | 2) deep/intrinsic muscles act on vertebral column

Question 33

What is the function of the trapezius

Answer 33

superior elevation, midline retraction, and inferior depression at the shoulder girdle (not a joint)

Question 34

what is the function of the throracolumbar fascia

Answer 34

suppors secondary curvature

Question 35

what is the function of the latissimus dorsi?

Answer 35

extends, medial rotation, and adduction at the shoulder

Question 36

what is the neuromuscular bundle

Answer 36

vein, artery, nerve

Question 37

what is the trapezius innervated by?

Answer 37

spinal accessery nerve 11, ascending transverse cervical vein and artery

Question 38

what is the latissimus dorsi innovated by?

Answer 38

thoracodorsal v, a, n (aka middle subscapular v,a,n

Question 39

what is the rhomboid maj/min innervated by?

Answer 39

dorsal scapular v, a, n (descnding transverse cervical v, a, n)

Question 40

what is the legator scapulae innervated by?

Answer 40

dorsal scapular v, a, n

Question 41

what are the cutaneous nerves of the back?

Answer 41

sensory to skin, motor to sweat glands and erector pili muscles anterior aspect of trapezius muscle: dorsal rami (come every 2 inches apart and send cutaneous innervation to the skin) , sensory to skin, motor to sweat glands & motor to erecto pili muscles that generate tension when you get scared and hair stands on end

Question 42

Describe nerve distribution to the body wall

Answer 42

spinal cord supplies the cord. can see dorsal root ganglion and spinal nerve which distributes its dorsal ramus through the back muscle to the skin which it supplies and ventral ramus supplies most of the rest of the body wall

Question 43

dermatome vs cutaneous

Answer 43

dormatome is a strip of skin that is innervated bya pair of spinal nerves. cutaneous: areas of skin innervated by cutaneous nerve

Question 44

all joint actions are at the shoulders. which are they?

Answer 44

deltoid: abduction, axilary nerve and posterior humerus circum triceps brachii: lateral H, LH, profunda branch, radial nerve

Question 45

what does the supraspinatus do?

Answer 45

initaites and ends abduction at the shoulder joint; supra scapular n/a

Question 46

what does the infraspinatus do?

Answer 46

lateral rotation at he shoulder joint and supra scapular n/a

Question 47

what does the trees minor do?

Answer 47

lateral rotation at the shoulder joint and axillary n (posterior branch) and scapular circumflex

Question 48

teres major

Answer 48

medial rotation of humerus; abduction at the shoulder joint; lower sub scapular n, scapular circumflex

Question 49

what are the superficial layer muscles of the extrinsic back (hypaxial) muscles? where do they all act?

Answer 49

trapezius, levator scapulae, rhomboideus, and latissimus dorsi all act on the scapula or humerus and associated with movements of the upper limb and respiration http://www.anatomyguy.com/essential-anatomy-series-back-muscle-basics-2/

Question 50

trapezius

Answer 50

a) adducts (aka retraction) of scapula; upper portion elevates and lower portion depresses b) innervated by spinal accessory nerve or cranial 11 c) axio appendicular : meaning it goes from spinal portion of skeleton to limb portion of skeleton d) has upper component which wraps around clavicle, a middle component which wraps spine and scapula and inferior that wraps to root of spine of scapula. e) elevation, retraction or depression of shoulder

Question 51

latissimus dorsi

Answer 51

adducts (aka protraction) humerus and medially rotates humerus -innervated by thoracodorsal nerve (middle sub scapular n or n to lats dorsi)

Question 52

levator scapula

Answer 52

- elevates scapula | - innervated by dorsal scapular nerve

Question 53

rhomboid minor and minor; where do they attach?

Answer 53

minor comes from above the root of the spine of the scapula * both attach to spinous processes of cervical vertebrae (not the transverse process like the legator does both adduct scapula -innervated by dorsal scapular nerve

Question 54

supraspinatus and infraspinatus

Answer 54

supraspinatus: initiates abduction of shoulder for deltoid innervated by supra scapular nerve infraspinatous: lateral rotator of humerus innervated by supra scapular nerve

Question 55

teres minor and major

Answer 55

major: medial rotator and adductor of humerus innervated by lower sub scapular nerve minor: lateral rotator of humurus innervated by axillary nerve

Question 56

rotator cuff

Answer 56

supraspinatus, infraspinatus, teres minor and subscapularis | support head of humerus in glenoid

Question 57

location of supra scapular nerve and artery?

Answer 57

on posterior view: navy over army under

Question 58

quadrangular space

Answer 58

axillary nerve | posterior humeral circumflex artery

Question 59

triangular space

Answer 59

br of scapular circumflex artery | rearrange space

Question 60

triangular interval

Answer 60

radial nerve | profunda brachii arteyr

Question 61

quadrangular space syndrome

Answer 61

hypertrophy of quadrangular space muscles or fibrosis of muscle edges may impinge on axillary nerve could produce weakness even atrophy in muscles it supplies -deltoid muscle -teres minor muscle===> more common could affect control that rotator cuff muscles exert on glenohumeral joint

Question 62

intermediate layer of posterior back has: why can the intermediate layer still be included?

Answer 62

1. accessory muscles for respiration 2. serratus posterior inferior (deep to latissimus dorsi) and superior (level with clavicle, deep to rhomboid) intermediate layer of muscle but can also be included in superficial back because supplied by ventral rami or 11th cranial nerve (like in the case of the trapezius

Question 63

movements of the lumbar vs thoracic and cervical

Answer 63

both can do lateral flexion, flexion and extension, but only the thoracic/cervical can do rotation

Question 64

list all the diarthrosis/synarthrosis/amphiarthrosis joints discussed so far

Answer 64

diarthrosis: 1) atlantodental (pivot) 2) atlantooccipital (pivot) 3) zygophophyseal (plane) 4) costovertebral (plane) 5) costotransvere (plane) synathrosis: 1) anterior intervertebral 2) sacroiliac jt

Question 65

differentiate these terms/locations: ``` scapular circumflex artery supraspinatous supraspinous suprascapular nerve and artery dorsal scapular nerve ```

Answer 65

scapular circumflex artery: muscles of scapula- teres minor and major supraspinatous: muscles of scapula- supraspinatous initiates abduction and is enervated by the supra scapular nerve supraspinous: ligament of vertebrae, connects tips of spinous processes suprascapular nerve: muscles of scapula, innervates supraspinatous and infraspinatous suprascapular nerve/artery: navy over, army under dorsal scapular nerve: extrinsic back muscles, innervates rhomboid major/minor and levaetor scapula

Question 66

on the back, the skin is innervated by ___ | but the muscles are innervated by ___ except ___

Answer 66

skin innervated by dorsal rami | muscles innervated by ventral rami, excel the trap which is innervated by cranial nerve 11

Question 67

The primary action at the atlanto-axial joint is:

Answer 67

The atlanto-axial joint is a complex joint with multiple articulations between the atlas (C1 vertebra) and the axis (C2 vertebra). The primary action at this joint is rotation of the head on the neck.