Anatomy 1 Flashcards
1
Q
How many vertebra are in the
- cervical
- thoracic
- lumbar
- sacral
- coccygeal region
A
- cervical = 7
- thoracic = 12
- lumbar = 5
- sacral = 1 fused (5)
- coccygeal region = 1 fused (4)
2
Q
what area of the spine are primary and secondary curves
A
Primary - Kyphosis
Secondary - Lordosis
Primary
- thoracic spine
Secondary
- Lordosis
- Cervical
3
Q
describe the features of the cervical spine
A
- Triangular cell body
- bifid spinous process
- Transverse foramina – holes in the transverse processes. They give passage to the vertebral artery, vein and sympathetic nerve
4
Q
describe the features of the thoracic spine
A
- vertebral body is heart shaped
- demi facets and costal facets
- spinous process is long, has transverse spinous processes
5
Q
Describe the features of lumbar
A
- kidney shaped vertebral body
- triangular shaped vertebral foramen
- articulating facets become interlocked, superior point medially and inferior point laterally
6
Q
describe the features of sacral and coccygeal
A
- The sacrum is a collection of five fused vertebrae. It is described as an inverted triangle, with the apex pointing inferiorly.
- On the lateral walls of the sacrum are facets for articulation with the pelvis at the sacro-iliac joints.
- The coccyx is a small bone which articulates with the apex of the sacrum.
- It is recognised by its lack of vertebral arches. Due to the lack of vertebral arches, there is no vertebral cana
7
Q
What is C1 called and describe it
A
atlas
- bifid spinous process
- no vertebral body
- posterior and anterior arch instead
8
Q
what is C2 called
A
axis
- Dens
- helps form the synovial pivot joint with rotation
9
Q
what can C7 be used for
A
easily palpable, landmark that can be identified for counting the other vertebrae from this point
10
Q
what is the clinical application of T7
A
Xiphoid, tip of the scapula
11
Q
What is the clinical application of L1
A
Conus medullaris
12
Q
What is the clinical application of L3
A
aorta bifurcation
13
Q
What is the clinical application of L4
A
iliac crest
14
Q
What type of joints are in the vertebral column
A
- Between vertebral bodies = cartilaginous joint
2. between articular facets = synovial plane joint that is interlocking
15
Q
what is a Jefferson fracture associated with
A
This type of fracture is associated with an impact or load on the back of the head
- force compresses anteriorly and posteriorly and breaks the weakest point in the vertebra
- breaks C1
16
Q
What is a hangman’s fracture
A
- this is a result of hyperextension of the head on the neck breaking the dens
- severe injuries to the body of the C2 vertebra is displaced anteriorly with respect to C3 this is likely to injure the spinal cord and/or brainstem
- bhyoid bone in the neck can be damaged as well
17
Q
why does osteoporosis affect the vertebral bodies
A
Osteoporosis affects the vertebral bodies as they have a high proportion of trabeculae bone compared to cortical bone.
18
Q
what happens in osteoporosis
A
There is net loss of bone and as a result the quality of the remaining bone is compromised and reduced
- decrease in the density of the bone
19
Q
what are the most important areas affected by osteoporosis
A
the most affected areas are the neck of the femur (see lower limb) and the bodies of the vertebrae, the metacarpal and the radius as these are the weight bearing parts of the body
20
Q
What is osteoporosis characterised by in vertebral bodies
A
For the vertebral bodies early to moderate osteoporosis is characterised by vertical striation of the vertebral bodies
21
Q
what happens to the pattern of osteoporosis in the later stages
A
In later stages of osteoporosis the striated pattern is lost as more spongy (trabeculae) bone is lost. There is uniform radiolucency in the body of the vertebrae, because of the relative sparing of the cortical bone it may appear more prominent and a white rim is seen around the vertebral bodies
22
Q
What happens to the bone in middle age
A
- there is an overall decrease in bone density and strengthen
- the articular surface bows inwards and intervertebral disc becomes increasingly convex to fit
- loss of height with age
- loss of disc space
- vertebral bodies changing shape result in an increase in the compressive forces at the periphery of the vertebral bodies
23
Q
what happens to the bone in late stage osteoporosis
A
- the vertebral bodies especially in the thoracic region collapse and become excessive in their hypothesis
24
Q
What is the name of the type of fracture produced by osteoporosis in the vertebral column
A
Vertebral compression fractures
25
what is lumbar spinal stenosis
- this is a narrowing of the vertebral foramen
26
What can cause a lumbar spinal stenosis
- genetic conditions
| - age related changes
27
as the spinal cord goes down
- the spinal nerves that exit the lumbar region increase in size but he intervertebral foramina decrease in size
28
what is the surgical treatment of a lumbar stenosis
- decompressive laminectomy
29
How does spinal enthsopathy happen
- paraspinal ligaments undergo degeneration that is secondary to attrition
- they then ossify
30
why is the left side of the spine not involved in DISH
For unknown reasons the left side of the spine is spared or less involved which might have to do with the pulsating aorta
31
What does DISH stand for
Diffuse idiopathic skeletal hyperostosis
32
what is the difference between DISH and analysing spondylitis
Unlike anklyosing spondylitis DISH does not involve the sacroiliac joint
33
what are the elements of a clinical examination of a spine
- gait
- alignment
- posture
- skin
- palpate bony structures
- palpate soft tissues
34
what is the positive and negative about the upper limb
positive is that it is designed for movement
| negative is that is has less stability therefore it is more prone to dislocations of the joints
35
what is the only joint that holds the upper limb onto the axial skeleton
- sternoclavicular joint
36
how can clavicles have fractures
- Clavicle is designed for strength but you can either have fractures by direct or indirect force applied to it
37
what is one of the most commonest bone to fracture
clavicle
38
what happens to the clavicle when it ia fractured
After the fracture the actions of the sternocleidomastoid muscle pulls the medial fragment upwards. The tapezius muscle is unable to hold the lateral fragment up because of the weight of arm and gravity, thus the shoulder drops
39
what is the glenohumeral joint between
the glenoid fossa of the scapula and head of the humorous
40
what is the most common joint to dislocate
- the gelonhuemral joint
41
what dislocation is most common in the glenohumeral joint
- the anterior dislocation
42
what does a dislocation of a glenohumeral joint look like
- loss of the rounded profile of the shoulder as the arm is dragged inferiorly
43
Why are anterior dislocations of the glenohumeral joints more common
less muscles in the front?
44
what nerve can be injured in the glenohumeral joint
- the axillary nerve
| - this is because of the close relationship to they nferior part of the joint capsule
45
what is paralysed in an axially nerve injury
- paralysis of the deltoid muscle and loss of sensation in a small area of skin covering the deletion (regimental patch)
46
what is the consequence of paralysis of the deltoid on movements of the arm
- Resulting in a loss of shoulder abduction beyond 15 degrees
47
name the 4 rotator cuffs
supraspinatus muscle
the infraspinatus muscle
teres minor muscle
the subscapularis muscle.
48
what can cause rotator cuff injuries
- repetitive use of the upper limb above the horizontal level
49
what is the most common rotator cuff muscle to be damaged
- the surpaspinatus tendon is the most common
| - this is especially due to it passing under the acromion of the scapula where it can be impinged
50
where do the majority of fractures of humerus take place
- proximal end and around the surgical neck
| - especially common in older patients with osteoporosis
51
what results from a fall on the acromion
- avulsions fractures of the greater tubercle are often seen in middle aged and older people and are the result of falls of on the acromion
52
what causes a fracture to the mid shaft
direct force
53
what causes supracondylar and intercondylar fractures
- result of falling on a flexed elbow
54
what causes a Avulsion fractures of the medial epicondyle
fall on the outstretched arm with the elbow forced into valgus
fall on the point of the elbow with the olecranon driving the medial condyle proximally and medially
Finally pure avulsion fracture due to violent contraction of the flexor and pronator muscles (3), which attach to the medial epicondyle, this can occur with arm wrestling!
55
what can cause a fracture dislocation of the proximal humorous in children
- in children the epiphyseal growth plates are open
- a fracture dislocation of the proximal humours can officer as the joint capsule of the glenohumeral joint is reinforced by rotator cuff muscle tendons and these are stronger than the epiphyseal growth plate
56
what nerves are damaged in fracture of the humerus
radial nerve
57
what three joints make up the elbow joint
the humero-ulnar, the humero-radial and the proximal radio-ulnar joints.
58
what can cause a posterior dislocation of the elbow joint
posterior dislocation of the elbow joint can result from hyperextension or a blow that drives the ulna posteriorly and sometimes laterally as well.
The ulnar collateral ligmanet is often torn and an associated fracture of the head of the radius coronoid process or olecranon process of the ulna may occur.
59
What nerves and blood vessels can be damaged with a posterior dislocation of the elbow joint
brachial artery
| ulnar and median nerves
60
why is a subluxations and dislocation of the radial head normally seen in infants
Subluxation and dislocation of the radial head is normally seen in infants due to the relative small size of the radial head compared to anular ligament into which it fits.
61
what is the most common fracture in the under 45s
fracture of the distal radius commonly called a ‘Colles’ fracture
- presents with the dinner fork deformity
62
What causes fracture of the distal radius/colles fracture
This is usually the result of falls on an outstretched hand that is pronated and extended.
63
what other fracture can be caused by a fall on the outstretched hand that is pronated and extended
- scaphoid
| - as well as distal radius/colles fracture
64
what is the most common carpal fracture
Scaphoid
65
why is a scaphoid fracture clinically relevant
- It is clinically relevant because of the blood supply to the scaphoid can become compromised and result in avascular necrosis.
- There is retrograde blood supply to the proximal pole, so that while the distal pole usually heals the proximal pole may lose its blood supply and die
66
why might a scaphoid fracture go undiagnosed
The complex anatomy of the wrist makes accurate diagnosis challenging and in many cases
67
What is the lower limb designed fro
The lower limb is designed for stability, so dislocations are less common than for the upper limb
68
where does the lower limb stand
The lower limb starts with the pelvis which via the sacroiliac joint is the attachment to the axial skeleton
69
what is the lower limbs attachment to the axial skeleton
sacroiliac joint
70
what kind of joint is the pubic symphysis
fibrocartilage joint
71
what muscle group uses the pelvis as an attachment point
The hamstrings (and rectus femoris muscle of the quadriceps group)
72
where do the hamstrings attach
The hamstrings attach to ischial tuberosity and this small part of bone with a piece of the tendon can be torn away from the main part of the pelvis.
- These fractures occur at the apophyses (bony projections that lack secondary ossification centres)
73
what bony prominence does there rectus femoris attach to
anterior inferior iliac spine
74
what does the fractures experienced in the femur depend on
The type of fracture is age and sex related
75
why is the neck of the femur most frequently fractured
- because it is the narrowest and weakest part of the bone
- lies at a marked angle to the line weight bearing (pull of gravity)
- become more common with increasing age as the neck fo the femur has a high proportion of trabecular bone and is prone to developing osteoporosis fractures
- usually intracapsuale fracture
76
what is the presentation of a femur neck fracture
he limb is usually in external rotation and there is a shortening of the limb.
77
what is shentons line
line continues from the inferior border of the femoral neck to the inferior border of the pubic ramus. If there is any interruption in the line then this is suggestive of an abnormal position of the femoral head.
78
what is the major problem to a femur neck fracture
The major clinical problem is that they often disrupt the blood supply to the head of the femur, most of the blood supply to the head and neck of the femur is via the medial circumflex artery.
- the reticular arteries that arise from this are often torn as well
- in servere fractures the only blood supply is via the artery in the ligament of the head of the femur
- can cause avascular necrosis of the head of the femur
79
why is dislocation of the femoral head uncommon
This is uncommon because of the structural adaptations of the hip joint that provide stability
80
what can cause dislocation of femoral head
, it can arise from road traffic accidents where the person is sat down in the car and their flexed knee hits the dashboard and forces the femoral head posteriorly
81
What is the most common type of dislocation of femoral head
posterior
82
describe the presentation of a dislocation of the femoral head
The limb becomes shortened and has medial rotation
83
what happens to the joint capsule in the dislocation of the femoral head
The joint capsule ruptures and out of the acetabulum
84
what nerve runs posterior to the hip joint and may be damaged by a posterior dislocation of femur
sciatic nerve
85
what causes a femoral shaft fracture
These again require high-energy trauma to take place and are often associated with other injuries and are a significant source of blood loss and release of fat emboli.
86
What is a problem with femoral shaft fracture
The large muscles in the thigh can go into spasm and contract displacing the fragments.
87
What is the largest sesamoid bone in the body
Patella
88
what type of bone is the patella
sesamoid
89
How can the patella be fractured
Direct
- Direct forces are usually falls.
Indirect
- Indirect are via the fact that is embedded in the quadriceps tendon/ligament and the pull of the muscles can cause a fracture and also displacement of the fragments.
90
describe a knee dislocation
Knee dislocations are rare and again require high energy trauma
- result in multiple ligament and other soft tissue injuries
- high incidence of neurovascular problems
91
What can cause fractures to the tibia
Fractures to the tibia of the inferior third are common in people who take long hikes before they are conditioned to the activity.
The strain may fracture the anterior cortex of the tibia.
92
what can cause indirect trauma to the tibial shaft
Indirect trauma applied to the tibial shaft when the bone turns with the foot during a fall may produce a fracture
93
what nerve can be damaged by tibia fracture
tibial nerve
94
What is compartment syndrome and why does it occur?
Compartment syndrome describes increased pressure within a muscle compartment of the arm or leg. It is most often due to injury, such as fracture, that causes bleeding in a muscle, which then causes increased pressure in the muscle
95
What is a major complication to tibial shaft fracture
compartment syndrome
96
Where do fractures of the fibula commonly occur
Fractures of the fibula commonly occur 2-6 cm proximal to the distal end of the lateral malleolus and are often associated with fracture dislocations of the ankle.
97
describe the difference between one medial or lateral malleoli fracture and two fractures
If only one malleoli is fractured then it is usually stable but bimalleoli is unstable and an added complication is the fracture dislocation of the talo-crual joint (ankle).
98
what is more common a medial or lateral malleoli fracture
Lateral malleoli fractures are more common than medial malleoli fractures
99
what causes a medial or lateral malleoli fracture
The mechanism of the injury is similar to sprained ankles in that the foot is excessively inverted and the ligaments tear on the lateral side and while the fibula has no role in weight-bearing at the knee it does play a role in the ankle joint and it’s stability.
100
what is plantar fasciitis
Plantar fasciitis is inflammation of the plantar fascia and is often the result of overuse
It causes pain on the plantar surface of the foot and heel.
101
What can cause plantar fasciitis
If a calcaneal spur protrudes from the medial tubercle then the plantar fascia will rub and be irritated by this, as it is the point of attachment.
102
what is osteoarthritis
inflammation t the joints
103
describe how the vertebrae is affected by osteoarthritis
Get bone spurring, they shortern or decrease the space between the vertebral bodies, if this happens you get inflammation in that area
Also affects the articular and synovial joints between the articulating facets
Ligaments begin to ossify and in worse case scenario you get complete ossification of the ligaments that surround the vertebra
If the bone spurs extend into the open space you get compression of the nerves that exit the vertebral column
