A&P3: HNTorso Flashcards
What are the 5 types of bones?
Long Short Flat Irregular Sesamoid
Define sutural bones
Joint between skull bones
Characteristics of Long Bones
Greater length than width
Contains shaft and extremities
Slightly curved for strength
What are examples of Long Bones?
Femur Tibia Humerus Ulna Radius
Characteristics of Short Bones
Equal length and width
What are examples of Short Bones?
Carpal bones
EXCEPT pisiform- sesamoid
Characteristics of Flat Bones
Thin, provide protection
Extensive area for muscle attachment
What are examples of Flat Bones?
Cranial
Sternum
Ribs
Scapulae
Characteristics of Sesamoid Bones
Develop in tendons w/ friction, tension and stress
Protect tendons, may change direction of pull
Improves mechanical advantage at joints
Characteristics of Sutural Bones
Classified by location
Commonly found in lamboid suture
What are examples of Irregular Bones?
Vertebrae
Hip
Calcaneus
What are the functions of depressions and openings on bone surfaces?
Participate in joints
Passage of soft tissue
What are processes?
What is their function?
Projections/outgrowths
Form joints, attachment points for CT
Define Fossa
Shallow depression
Define Sulcus
Groove
Define Meatus
Tubelike passage/canal
Define Condyle
Large, round prominence at end of a bone, part of joint
Define Malleolus
Bone prominence on each side of ankles
Define Facet
Smooth flat articular surface
Define Crest
Prominent ridge or elongated projection
Define Trochanter
Very large projection
Define Tuberosity
Where are they usually found?
Large, round, rough projection
On shaft, at base of bones
Define Tubercle
Where are they found?
Small, round projection
Usually near head of a bone
Define Insertion and Origin
Origin: Bone that doesn’t move when muscle shortens
Insertion: Moveable bone
What is the belly of a muscle?
Fleshy portion in between attachment sites
What are the 7 characteristics used to name muscles?
Pattern of fascicles Size Shape Action Number of origins Location Sites or Origin/Insertion
How many different Fascicle Arrangements are there?
Parallel Fusiform Circular Triangular Unipennate- one side of tendon Bipennate- central tendon Multipennate- several tendons
Define Prime Mover
Agonist
Contracts to cause desired movement
Define Antagonist
Stretches and yields to prime mover
Define Synergist
Contracts to stabalize
Define Fixators
Stabilize the origin of the prime mover
Define Hilton’s Law
A nerve that innervates a joint also innervates the muscles that move the joint AND the skin that overlies the attachment of the muscles
How does Hilton’s Law develop/arise?
Embryological development
Define Entrapment Neuropathy
Neuralgia
Neuritis
Pinched/trapped nerve
Physical compression/irritation of major nerve trunks and their peripheral nerves
S/Sx of Entrapment Neuropathy
Sx: Tingling/pain
Reduced sensation
Numbness
S: weakness, atrophy
What are the four branches of the aorta?
Ascending
Arch
Thoracic
Abdominal
The close proximity arrangement of veins and arteries provide what two benefits?
Countercurrent heat exchange
Arteriovenous pump
What does Venae Comitantes mean?
Close proximity of vein running near/parallel to artery in small/confined area
How many bones are in the skull?
22
Define paranasal sinuses
Mucous membrane line cavities within the skull bones
What are the only moveable bones in the skull?
Mandible
Ossicles
What are the two parts of the skull?
Neurocranium: cranial vault, brain box
Facial skeleton: viscerocranium, splanchnocranium
What are the components contained within the neurocranium?
Brain
Cranial meninges
CNs
Associated structures
What are the components contained within the facial skeleton?
Orbits
Nasal cavities
Maxilla
Mandible
What are the parts of the neurocranium?
Frontal Parietal x 2 Temporal x 2 Occipital Sphenoid Ethmoid
Define Calvaria
Skullcap
Made by superior portions of frontal, occipital, parietal bones
Define Basicranium
Cranial Base
Floor of the cranium
What does the Basicranium comprise of?
Occipital Sphenoid Temporal (petrous portion) Vomer Palatine Parts of maxillae
There are _ cranial bones
There are _ facial bones
8
14
Function of the Frontal Bone
Forehead, roof of orbits, anterior cranial floor
Frontal Sinus
Define metopic suture
Frontal suture that is not gone by age 6
Function of Parietal Bone
Side and roof of cranial cavity
Function of Temporal Bone
Zygomatic process External auditory meatus Mastoid/styloid process Stylomastoid foramen CN7 Mandibular foss TMJ Petrous portion CN8 Carotid/jugular foramen
Function of the Occipital Bone
Foramen Magnum
Occipital condyles
Occipital protuberance- attachment for ligamentum nuchae
Superior/inferior nuchal lines
Function of Sphenoid Bone
Keystone bone- articulates with all cranial bones
Pterygoid process- attachment site for jaw muscles
What do the greater and lesser wings of the Sphenoid bone make?
Greater: Anterolateral floor of cranium and lateral skull
Lesser: Posterior orbit of eye and part of cranium floor
Define Superior Orbital Fissure
Passageway for CN 3 4 6 and V1
What foramen does CN V2 pass through?
Foramen Rotundum
What foramen doe CN V3 pass through?
Foramen Ovale
What skull bone does the Foremen Rotundum and Foramen Ovale pass through?
Sphenoid
What is the Mnemonic for Trigeminal Nerve Foramina?
Standing Room Only
Superior Orbital V1
F. Rotundum V2
Ovale V3
What does the Sella Turcica hold?
What are the parts of this structure?
Pituitary Gland
Anterior= tuberculum sellae
Central= hypophyseal fossa
Posterior= dorsum sellae
What does the Ethmoid Bone make?
Anterior cranial floor
Medial wall of orbits
Superior nasal septum
Superior walls of nasal cavity
What is a major superior supporting structure of the nasal cavity?
Ethmoid bone
What foramina passes through the Ethmoid Bone?
Olfactory Foramina for CN1 to pass
The Falx Cerebri connects to what structure in the ethmoid bone?
Crista galli
Lateral Masses of the Ethmoid bone contains what?
Ethmoid sinuses
What is the Perpendicular Plate?
Upper part of nasal septum
What are the Superior and Middle Nasal Conchae?
Turbinates
Superior- smell, olfactory receptors
Increases SA to warm air
Filters air by causing inhaled air to swirl and impact mucus
The are 14 facial bones, what are the names and quantity of each?
Nasal- 2 Mandible Inferior nasal conchae- 2 Maxillae- 2 Lacrimal-2 Vomer Zygomatic-2 Palatine- 2
The sockets in the Maxilla and Mandible are called what?
Alveoli
What does the Maxillary Bones make up?
Orbit floor
Nasal cavity floor
Hard palate
Maxillary sinus
What causes a Cleft Palate?
Lack of union of maxillary bones
What two bones make up the lateral wall of the orbit?
Sphenoid
Zygomatic
What two bones make up the zygomatic arch?
Zygomatic bones
Temporal
Where are the lacrimal sacs located?
Lacrimal Fossa
Inferior nasal concha is aka?
Turbinate
What nerve passes through the mandibular foramen?
Inferior alveolar nerve
What are the three parts, two processes and two foramens of the mandible?
Body Angle Ramie
Condylar and Coronoid
Mandibular and Mental
What makes up the posterior part of the nasal septum?
Vomer
What facial bone looks like two Ls back to back?
What do the two Ls make up?
Palatine
Back of hard palate
Part of orbit
What bones make up the nasal septum?
Vomer
Perpendicular plate
Ethmoid bone
Septal cartilage
Each orbit has five important foramina, what are they
Optic Superior orbital fissure Inferior orbital fissure Supraorbital Lacrimal fossa
Parts of seven bones make up the orbits, what are the seven bones?
Maxillary- floor, medial Frontal- roof Zygomatic- lateral, floor Ethmoid- medial Lacrimal- medial Sphenoid- roof/lateral/medial Palatine- floor
What are the sutures of importance in the skull?
Coronal
Sagital
Lambdoidal
Squamous
Which sutures unite parietal and occipital bones?
Which sutures unit the two parietal bones?
Lambdoid- p/o
Sagittal- parietal
What does the coronal suture join?
What does the squamous suture join?
C= frontal and parietal S= parietal and temporal
What are the major fontanels during infancy?
Anterior
Posterior
Anterolaterals
Posterolaterals
What are the two functions of the fontanels?
Allows skull to move during birth
Allows rapid brain growth
What are paranasal sinuses and what are their functions?
Cavities in skull that communicate with nasal cavitiy
Lighten skull weight
Resonate chamber for speech
Which cranial bones have paranasal sinuses?
Frontal
Sphenoid
Ethmoid
Maxillae
What are the 3 mastication muscles?
What movements do the allow?
Masseter- bites
Temporalis- retracts, bites
Pterygoids
Protraction, elevation and retraction
What movements does the pterygoid muscle provide?
Lateral- protraction and depresses (opens)
Medial- elevates and protracts
Together= side to side grinding
What are the 4 muscles that insert into the tongue? Which one is paralyzed during anesthesia?
Genioglossus- surgery concern
Styloglossus
Palatoglossus
Hyoglossus
Define Bell’s Palsy
Facial paralysis
Idiopathic
Cold temperatures
What is the Mnemonic for facial nerve branches?
To Zanzibar By Motor Car
Where do the terminal branches of CN7 arise from?
Parotid plexus, emerge from glands, radiate anteriorly
What muscle closes the eye?
Orbicularis oculi
What muscle puckers the mouth?
Orbicularis oris
What muscle assists with whistling, blowing, sucking and chewing?
Buccinator
What muscle of the face is NOT considered a muscle of facial expression
Levator palpebrae superioris- opens eye
Dermatome of the face?
CN5
Dermatome of CN2
Occipital tuberance
Dermatome of CN3
Gentlemens collar
What are the layer of the scalp?
Which parts are intimately connected?
Skin CT Aponeurosis- epicranial aponeurosis Loose CT- Danger space Pericranium SCA are connected
What is the Danger Area of the scalp and why?
Loose CT
Pus, blood and infections can spread easily
What does the pericranium form?
Dense irregular CT forms the external periosteum of calvaria
What are the three parts of the hyoid bone?
Body
Lesser/Greater horns
Function of the Hyoid Bone?
Supports tongue
Attachment for tongue, neck and pharyngeal muscles
Where does the SCM arise and insert?
Arise- sternum
Insert- mastoid process of temporal bone
Which CN innervates the trapezius and SCMs?
CN11
Putting your chin to your chest contracts what muscle?
SCM
Also extends head, chin thrust
Define the Suboccipital Region and what muscles it includes
Upper back of neck, inferior to occipital region
Rectus capitis posterior, major/minor
Obliquus capitis inferior/superior
The muscles within the suboccipital region have what primary purpose?
Postural muscles
Some flexion/extension/lateral bending and rotation at atlanto-occipital/atlanto-axial joints
Flexion/extension of the atlanto-occipital joint creates what head movements?
Nodding yes
What are the two muscle groups of the ANTERIOR neck and what do they form?
Suprahyoid
Infrahyoid
Create base for tongue to move on
What are the Suprahyoid muscles?
As a group, what do they do?
Digastric Stylohyoid Mylohyoid Geniohyoid Elevate hyoid bone, oral cavity floor, elevate tongue during swallowing
What are the infrahyoid muscles?
As a group, what do they do?
Omohyoid Sternohyoid Sternothyroid Thyrohyoid Depress hyoid bone, move larynx during swallow/speech
What is the function of the scalene muscle group?
Attach cervical vertebrae to upper ribs
Flex and rotate head
Forceful inspiration
Innervated by C3-C8
What does the thoracic aorta supply blood to?
Pericardium Esophagus Bronchi Diaphragm Intercostal/chest muscles Mammary glands Vertebrae/spine
What are the paired arteries that supply blood to the head?
Vertebral
Internal carotid
Vertebral arteries branch off of what artery?
Subclavian
Pass through transverse foramina of cervical vert.
Unite to form unpaired basilar artery on ventral surface of the pons
Internal carotids branch off of what artery?
Common carotid
Enter skull through carotid canal/foramina
Inferrer anterior surface of the brain
What doe the external and internal carotid arteries supply?
External- structures external to skull (maxillary and superficial temporal branches)
Internal- contribute to Circle of Willis, supplies eyes and parts of brain
What is the function of the Circle of Willis?
Connect post/ant blood supplies to the brain by interconnecting basilar artery w/ branches of internal carotid arteries
What is the importance of the Circle of Willis?
Controlling blood supply when pressure is higher unilaterally
Provides alternate source of blood if occlusion occurs
What veins of the head/neck drain blood and where to?
Ex/internal jugular veins drain head/neck to superior vena cava
Dural venous sinuses empty to internal jugular vein
Where does the thoracic duct drain lymph back into circulation?
Where does the right lymphatic duct drain lymph back into circulation?
TD: L internal jugular and L subclavian junction
RLD: R internal jugular and R subclavian junction
Ventral rami are formed from what vertebraes?
C1-C5
What does the cervical plexus supply nerves to?
Head
Neck
Upper shoulders
C3-C5 phrenic nerve innervates diaphragm
What does the Lesser Occipital Nerve do?
Skin of the neck and scalp posterosuperior to auricle
What does the Great Auricular nerve do?
Skin over parotid gland
Mastoid process
Auricle
Mandible angle to mastoid process (posteriorinferior part of face and inferior part of auricle)
What is the difference of origin between the greater and lesser occipital nerves?
Greater occipital is not a branch of cervical plexus
Where does the Greater Occipital nerve arise from and travel to?
Between C1 and C2, beneath obliquus capitis inferior muscle, through semispinalis capitis and tapezius muscles
Supplies skin along posterior scalp to vertex
What causes Occipital Neuralgias?
Greater Occipital nerve gets trapped by obliquus capitis inferior muscle
What is TMJ syndrome?
Dysfunction of TMJ
What are the muscles of the TMJ?
Temporal
Masseter
Lateral pterygoid
Medial pterygoid
What is the Occipital Triangle?
Occipital artery at its apex
Accessory nerve crosses here
Contains cervical plexus nerves
What is the Subclavian Triangle?
Contains subclavian artery/vein
What is the Submandibular Triangle?
Digastric triangle, nearly filled by submandibular gland
Facial artery and vein are here
What are the components of the Carotid Triangle?
Common carotid artery Internal/external carotid Internal jugular vein Vagus nerve Thyroid gland Larynx
What is in the Muscular Triangle?
Infrahyoid muscle Neck viscera Para/thyroid glands Trachea Larynx
What are the transient nerves?
Vagus
Phrenic
What makes up the trunk of the skeleton?
Vertebral column (26 bones)
Sternum
Ribs
What are the 4 normal curves of the vertebral column?
Cervical/lumbar- ant convex
Thoracic/sacral- ant concave
What are the Primary and Secondary Curves?
Primary- thoracic/sacral during fetal development w/ single anterior concave curve
Secondary- cervical formed when infant raises head at 4mon, lumbar forms when infant sits/walks at 1yo
Define Dowagers Hump
Wedge formation in older women thoracic area resulting from osteoporosis
How is Kyphosis characterized?
How is Lordosis (sway back) characterized?
How is scoliosis characterized?
K=Abnormal increase in thoracic curvature
L=Ant. rotation of pelvis due to weakened trunk muscles
S= abnormal lateral curvature, spinal processes turn toward cavity of abnormal curvature causing ribs to protrude when PT bends over
What can cause lordosis?
Pregnancy
Obesity
What are the parts of a typical vertebrae?
Body Vertebral arch Vertebral foramen Precesses x 7 Vertebral notches
What are the 7 vertebral processes?
2 transverse
1 spinous
4 articular
Which spinous processes are often bifid?
C2-C6
What is the function of the transverse foramina?
Transmit the vertebral arteries
What are the two craniovertebral joints?
What type of joints are they?
Atlanto-occipital- between atlas and occipital bone
Atlanto-axial- between atlas and axis
Synovial
Craniovertebral joints involve what 3 things?
Occipital condyles
Atlas
Axis
What make up the body of the Axis?
Dens or Odontoid process of the Atlas
Nodding movement moves what joint?
Shaking movements moves what joint?
Atlanto-occipital
Atlanto-axial
What is the function of the transverse ligaments?
Strong band extending from R/L tubercles of C1 which holds the dens of C2 against anterior arch of C1
This forms the posterior wall of of a socket for the dens
What is the tectorial membrane?
Superior continuation of posterior longitudinal ligament across atlantoaxial joint through foramen magnum to floor of cranial cavity
What is a Hangman’s Fracture?
Fracture of both pedicles of C2 axis from hyperextension of head
Which vertebrae have facets for tubercle of ribs?
T1-10
Tubercle articulates with ______
Head articulates with _____
T= transverse process H= vertebral bodies
What is the auricular surface of the sacrum?
Synovial part of sacroiliac joint
What is the neural component of the sacrum?
Sacral canal is continuation of vertebral canal of sacrum containing nerve roots of cauda equina
Median/medial/lateral sacral crest represents ?
Median: Fused rudimentary spinous processes
Medial: fused articular processes (intermediate)
Lateral: tips of transverse processes of fused sacral vertebrae
Spinous processes are not present in what parts of the sacrum?
S5, sometimes S4
This causes large sacral hiatus due to lack of processes and associated laminae
What doe the sacral cornu provide landmarks for?
Inferior articular of S5
Location of sacral hiatus
What is the coccygeal cornua?
Rudimentary articular processes of the coccyx
Where is an epidural block performed?
Sacral canal at sacral hiatus, numbs from waist to knees
Sacral and coccygeal cornu or landmarks for this injection
Flexion of vertebral column pushes the nucleus pulposus in what direction?
Posteriorly towards thinnest part of anulus fibrosus
If degeneration of posterior longitudinal ligament and wearing of anulus have occurred, what will happen?
Nucleus pulposus herniates into vertebral canal and compresses spinal cord or nerve roots of cauda equina
When an intervertebral disc protrudes, it may compress the nerve roots numbered in which direction?
Inferior to disc
What are the most commonly ruptured intervertebral discs?
C5/6 and C6/7
Compresses roots of C6 and C7
Hyperextension of the neck can stretch/tear which ligament?
How does this commonly happen?
Anterior longitudinal
Rear end car crashes
What are the Zygapophysial joint?
Joints of the vertebral arches
Plane synovial joints to allow gliding between superior/inferior articular processes of adjacent vertebrae
Accessory ligaments of the zygapoplysial joints unite what?
Laminae, transverse processes and spinous processes to help stabilize joints
What happens when there’s injury/disease at the zygopophysial joints?
Pain along dermatomes
Spasm in muscles from associated myotomes
What is Foraminal Stenosis and where does it most commonly occur?
Narrowing of one of more spinal foramina
C5/6/7
L3/4/5/S1
What are symptoms of foraminal stenosis?
Sciatica
Brachialgia
Where does the anterior longitudinal ligament start and end?
What does it cover?
What does it protect from?
Atlas to sacrum
Anterior aspects of vertebral bodies and intervetebral discs
Stability between vertebral bodies and prevent hyperextension of vertebral column
What does the posterior ligament cover and protect from?
Posterior aspect of vertebral bodies
Prevents hyperflexion of vertebral column
Herniation/posterior protrusion of discs
What is the ligamenta flava?
Elastic fibrous tissue that joins laminae of adjacent vertebral arches
Prevent separation of vertebral lamina, stop sudden flexion of vertebral column and prevent injury to intervertebral discs
Where does the supraspinous ligament run from and to?
Spinous processes from C7 to sacrum
What is the ligamentum nuchae
Thickening of supraspinous ligament in neck that extends from C7 to occipital protuberance
Define Segmental Artery
Related around and supplies vertebrae
Define basivertebral veins
Define intervertebral veins
Basi= large, tortuous in substance of vert. bodies Inter= accompany spinal nerves through foramina and receive blood from spinal cord and vertebral plexuses
Why is the physiology of the vertebral venous plexuses unique?
Valveless, allows cancer to metastases to travel
What are externally visible features of the thoracic wall?
Serratus anterior
Costal margin
Pec major
Bony thorax produces what type of marrow?
Red
What are the two openings in the thorax?
Sup. thoracic aperture
Inf. thoracic aperture
What are the 3 sections of ribs in the thorax?
Vertebrosternal ribs- 1-7, attach to sternum
First rib- sharpest curvature, articulates w/ manubrium
Ribs 3-7- true ribs
What ribs are known as true ribs?
1-7
Ribs 1-7 are called ____ ribs
Ribs 8-10 are called ____ ribs
vertebrosternal
vertebrochondral- false ribs
Where do the heads of ribs articulate?
Head- facet w/ corresponding vertebra or 2 facets with demifacets of bodies of adjacent vertebrae and intervertebral disc
What is the rib tubercle?
Site of articulation of rib with transverse process of post vertebrae
What does the neck of the rib attach to?
head of rib to shaft of rib
What is the sternal extremity of a rib?
Site of costochondral articulation of rib to its cartilage
What is the costal groove of a rib?
near tubercle on body of rib and provides protection of intercostal nerves/vessels
What is the costal angle of a rig?
Abrupt change in curvature of the rib shaft
What are the 3 parts of the sternum?
Manubrium
Body- gladiolus
Xiphoid process
What are the notches in the sternum
Suprsternal notch
Sternoclavicular notch
What is the sternal angle
Junction of manubrium and sternum body
Location of cartilaginous articulation of second pair of ribs
Each rib articulates posteriorly with the body and ________ of a thoracic vertebrae?
Transverse
Posterior articulation of each rib is ____ in position to the anterior articulation
Superior
Define the Xiphisternal joint
Articulation between xiphoid process and sternum body
Synchondrosis
As person ages, the xiphisternal join fuses becoming a _____
Synostosis
Interchondral joints are between what ribs and are what types of joints?
6-9
synovial plane
Define the Costochondral joint?
What type of joint is it?
Articulation of lateral costal cartilage w/ sternal end of rib
Cartilaginous joint
Define Costochondritis
Inflammation of junctions where ribs meet sternum
Function of the Extrinsic Back Muscles
Superficial muscles controlling limb movements
Intermediate muscles aid respiration
Function of Intrinsic Back Muscles
True back muscles
Act on vertebral column, produces movements and maintains posture
What muscles are comprised in the Superficial Back Muscles?
Trapezius
Levator Scapulae
Rhomboidues- minor/major
Latissimus dorsi
What muscles are in the Intermediate Back Muscles?
Serratus Posterior group comprises superficial respirator muscle
Superior- underneath scapula
Inferior- deep to lats
Both innervated by intercostal nerves
Function of the Serratus Posterior Superior muscles
Respiratory muscles
Deep to rhomboideus muscles
Elevates ribs
Innervated by spinal intercostal
Function of Serratus Posterior Inferior muscles
Respiratory Muscles
Leep to lats
Depresses lower 4 ribs- forceful expiration
Innervated by spinal intercostal
What are the Intrinsic Muscle Groups?
Erector spinae
Transversospinal
What are the 3 groupings of Erector Spinae Fibers
Spinallis- medial
Longissimus- intermediate
Iliocostalis- lateral
What are the muscles that run from transverse processes to dorsal spine of vertebrae and help rotate vertebrae?
Transversospinalis group:
Semispinalis
Multifidis
Rotatores
What is the origin and function of the Erector Spinae
Iliac Crest
Extension of spine, control flexion, lateral bending
What is the mnemonic for the Erector Spinae muscles?
Rotate- rotatores
My- multifidus
Spine- semispinalis
What are the actions of the Transversospinal muscles
Stabilize vertebrae
Rotation
Extension
Lateral bending
Know highlighted part
Slide 205
What are the Thoracoappendicular Muscles and their functions
Ant thorax/axial muscles
Produce and control limb movements
What are the muscles of the thorax that alter the size of the thoracic cavity?
Diaphragm
Scalenes
Intercostal
Throcoappendicular
What are the Thoracoappendicular muscles
Ant: pect major
pect minor
subclavius
serratus anterior
Post: Lat dorsi
What are the layers of the innermost layer of intercostal muscles?
Transversus thoracis- ant
Subcostal muscle
Inner intercostal muscle
How are all intercostal muscles innervated?
Segmental Intercostal Nerves
How do External Intercostal muscles run and where do the attach?
Down from inferior to superior
Elevates rib for inspiration
How do internal intercostal muscles run and where do they attach?
Originate from superior rib
Insert on inferior rib
Depresses rib cage, expiration
Muscles of inhalation
Sternocleidmastoid
Scalenes
External intercostal
Diaphragm
Muscles of Exhalation
Internal intercostal
Int/External oblique
Transverse abdominus
Rectus abdominus
Where do transverse thoracic muscles originate, insert and do?
Sternum
Cartilage ribs 2-6
Depress ribs
Where do subcostal thoracic muscles run and do?
Bridge two intercostal spaces
Elevate ribs
Where do innermost intercostal muscles and do?
Bridge intercostal space
Expiration
What happens to spinal nerves upon leaving the intervertebral foramina?
Divide into Ant/Post Rami
Ant= T1-T11
Post= joints, muscles and skin in thoracic region
What nerves supply cutaneous sensation to dermatomes of anterior thorax?
C5, T1-T6
C5 and T1 also supply upper arm
What are the dermatome landmarks for the thorax and abdomen?
C5= jugular notch and clavicles T1= ant arm T4= nipples T7= xiphoid process T10= umbilicus
What is the most superior dermatome of the back that does not supply the upper limb?
T1
Where to posterior intercostal arteries arise from?
Arise from aorta
Travel to ant thorax, off lateral cutaneous branch
Where does the internal thoracic artery arise from?
Subclavian artery
Rises to anterior intercostal artery, anastamoses with post intercostal artery from aorta
Internal thoracic artery gives rise to what branch to supply skin in the area?
Perforating Cutaneous branch
Veins of the thoracic wall lie ____ in costal grooves and each side has ____#
Superior
11 posterior
11 anterior
A/P anastamose
Anterior intercostal veins are tributaries of what veins?
Internal thoracic
Most posterior intercostal veins end in _______?
Azygos/hemiazygos venous system
What is the sternal part of the diaphragm?
2 muscle slips attached to xiphoid process
What is the costal part of the diaphragm?
Muscular slips that attach to internal inferior 6 costal cartilages
Define Crura
Vertebral attachment for the diaphragm arising from superior 3 vertebrae
Central diaphragm tendon converges into an ____
Aponeurosis
How does the inferior vena cava perforate the diaphragm?
Central tendon at caval foramen
What happens if half of the diaphragm is paralyzed?
What is this type of movement called?
Paralyzed side ascends during inspiration instead of descending
Paradoxical movement
What are the 2 subdivisions of the thorax?
Pulmonary cavities
Mediastinum
Where does the mediastinum extend from/to?
From Superior Thoracic aperture to diaphragm
Ant- sternum and costal cartilages
Post- thoracic vertebrae
What are the Superior Mediastinum planes?
Glandular- thyroid, thymus, lymph glands
Venous- R/L brachiocephalic vein, Sup vena cava, azygos vein arc
Arterial-nervous- aortic arch, brachiocephalic, L comm carotid, L subclavian art
Nerves- Vagus R/L, phrenic R/L
Visceral-nervous: trachea, esophagus, L recurrent laryngeal nerve
Lymphatic- thoracic duct
What is the L recurrent laryngeal nerve?
Branch of vagus
Innervates larynx, muscles of pharynx, sensory for bronchial tree below vocal cords
Why is the L recurrent laryngeal nerve termed recurrent?
Branches from vagus, progresses inferior, loops superiorly
Where does the thoracic duct dump lymph back into circulation?
Terminates at junction of L subclavian and jugular veins
What is the “blue side” of the mediastinum?
Inferior mediastinum, R side
Dominated by arch of Azygos vein, Sup vena cava, R atrium
What is the “red side” of the mediastinum?
Inferior mediastinum, L side
Arch of aorta, L Comm carotid and subclavian arteries
What is located in the anterior mediastinum?
CT, fat
Blood vessels
Lymph nodes
Lower end of thymus
What makes up the middle mediastinum?
Heart
Pericardium
What makes up the posterior mediastinum?
Thoracic aorta Thoracic duct Lymph nodes Azygos/hemizygos veins Esophagus Esophageal plexus Thoracic symp trunk Thoracic splanchnic nerves
What are most of the intestines covered by?
Greater omentum
Peritoneal fold hanging from stomach
What are the 3 flat muscles of the abdominal wall?
What are the 2 vertical muscles?
Flat: External Oblique
Internal Oblique
Transverse Abdominal
Vertical:
Rectus abdominis
Pyramidalis
What abdominal wall muscle flexes and rotates the trunk?
Obliques
List the layers of the abdominal wall from Skin to deep
Skin Fat Scarpas Fascia External Oblique fascia Internal Oblique Fascia Transverse abdominal Transversalis fascia Endoabdominal fat Parietal peritoneum
Function of the rectus abdominus?
Origin and insertion
Functions
Principal vertical muscle of anterior abdominal wall separated by linea alba
Originates at pubis, inserts at xiphoid and 5-7 costal cartilage.
Flexes trunk, antagonist for expiration
Function of the pyramidalis?
Origin and insertion
Functions
Small triangular muscle absent in 20% of peoples
Anterior to inferior part of rectus abdominus
Attaches to anterior surface of pubis and ends in linea alba
Tenses linea alba
Function of linea alba
Attachments of oblique and transverse abdominal muscles
Contains vessels/nerves for skin
What artery provides blood to the rectus abdominus and superior anterolateral abdominal wall?
Superior epigastric artery, continuation of internal thoracic
What does the inferior epigastric artery supply blood to?
Lower rectus abdominis, arises from external iliac
Where do the superior and inferior epigastric arteries anastomosis?
Umbilical region
Anterior cutaneous arterial branches derive from where?
Superior/inferior epigastric arteries
Inferior epigastric artery is a branch of what artery?
External iliac artery
Where does the abdominal aorta begin and end?
Aortic hiatus of diaphragm
Lumbar vertebra by dividing into R/L iliac artery and visceral/parietal branches
Superior suprarenal artery arises from
Inferior phrenic artery
Inferior suprarenal arteries arise from
Renal artery
What are the unpaired visceral branches of the abdominal aorta?
Celiac trunk
Superior/inferior mesenteric artery
Celiac trunk divides into what three branches?
What do the branches supply?
L gastric, splenic and common hepatic arteries
Left gastric- stomach and esophagus
Splenic- spleen, pancreas, greater omentum, stomach
Common hepatic- liver, gallbladder, stomach, duodenum, pancreas and greater omentum
What does the superior mesenteric artery supply?
Pancreas Duodenum Jejunum Ileum Ascending colon Transverse colon
What does the inferior mesenteric artery supply?
Transverse colon
Descending colon
Sigmoid colon
Rectum
How does blood from abdominal viscera, pelvic viscera and abdominal wall return to the heart?
Inferior vena cava
What does the hepatic portal vein collect blood from?
GI tract Spleen Pancreas Gallbladder Delivers the blood to the liver
What forms a portal system?
Venous capillary system coalesces and branches to form another capillary system without the heart in between
What are the two portal systems in the body?
Hepatic portal
Hypphyseal
What veins join to form the Sup/Inf mesenteric veins?
Capillaries of intestines
What vein systems join to form the hepatic portal vein?
Inf/Sup Mesenteric veins w/ splenic vein
Hepatic portal vein goes to the liver to form _______ capillaries
Sinusoidal
Where does the portal venous system connect with the systemic venous system?
Esophageal veins that drain to azygos vein, rectal vein, paraumbilical veins
Define Caput medusae
Umbilical vein becomes recanalised due to portal hypertenstion
If someone has a black eye, what is the blood collecting site called?
Supraorbital margin
Thoracic outlet syndrom
Neck entrapment neuropathy
Supraclavicular neuritis
Shoulder entrapment neuropathy
Ulnar/Medial/Radial neuritis
Elbow entrapment neuropathy
Carpal tunnel syndrome and ulnar neuritis are caused by
Wrist entrapment neuropathy
Piriformis syndrome is caused by
Hip entrapment neuropathy
Compartment syndrome in the lower legs is caused by
Leg entrapment neuropathy
Foot entrapment neuropathy can lead to what complications?
Tarsal tunnel syndrom
Medial plantar neuritis
Digital neuritis
Deep fibular neuritis (deep peroneal neuritis)
