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MSK anatomy - Year 2 > Back > Flashcards

Back Flashcards

1
Q

what are the layers of tissue of the back?

A 
skin 
fascia (superficial and deep) 
muscles 
vertebral column (bones, joints, discs and ligaments) 
spinal cord
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2
Q

what are the movements of the back?

A

extension and flexion
lateral flexion
rotation (left and right) of the head and neck
rotation of trunk

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3
Q

superficial layer of muscles are concerned with?

A

positioning and moving of the upper limbs

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4
Q

deep layers of muscles are concerned with?

A

posture, moving or maintaining the position of the axial skeleton

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5
Q

muscles related to extension, adduction and internal rotation of the back?

A

trapezius, latissimus dorsi and thoracolumbar fascia

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6
Q

which muscle causes scapular rotation?

A

trapezius

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7
Q

trapezius innervation

A

accessory nerve, CNXI motor fibers and C3,C4 (pain and proprioceptive fibers)

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8
Q

latissimus dorsi attachments

A

attaches to the thoracolumbar fascia

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9
Q

what are the movements of the latissimus dorsi?

A

extension of the shoulder joint, when arm is fully flexed,
adduct the upper limb
internal/medial rotation

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10
Q

what is the innervation of the latissimus dorsi?

A

thoracodorsal nerve C6,7,8

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11
Q

what are the superficial posterior thoracioappendicular (extrinsic shoulder muscles)?

A

trapezius and latissimus dorsi

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12
Q

what are the deep posterior thoracioappendicular (extrinsic shoulder) muscles?

A

levator scapulae and rhomboid major and minor

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13
Q

levator scapulae innervation?

A

dorsal scapular (C5) and C3,C4 cervical nerves

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14
Q

what muscle is behind the trapezius?

A

levator scapulae and rhomboids major and minor

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15
Q

rhomboid major and minor innervation?

A

dorsal scapular nerve C4,C5

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16
Q

levator scapula action?

A

elevates scapula and rotate scapula

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17
Q

rhomboid major and minor action?

A

retract scapula and depress glenoid cavity and fix scapula to thoracic wall

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18
Q

deep superficial back muscles (intermediate muscles)?

A

laid out in two columns

erector spine group - paravertebral muscles

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19
Q

paravertebral muscles innervation?

A

both the groups act together- extend the vertebral column, right side is acting unilaterally: rotation and lateral flexion of the vertebral column

acting bilaterally extend the vertebral column

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20
Q

what causes the flexion of the vertebral column?

A

abdominal wall muscles

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21
Q

what are the deep back muscles?

A

numerous muscles within the book, space between the transverse and spinous process also contribute to movement of the vertebral column, proprioception

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22
Q

as we move inferiorly down the vertebral column?

A

generally getting larger and at the sacrum generally become smaller, more weight onto the vertebrae at the sacrum the weight is distributed down both legs and hence becomes smaller

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23
Q

how many vertebrae?

A

33 in total, 7 cervical, 12 thoracic and 5 lumbar and 5 sacral and 4 coccygeal

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24
Q

vertebrae prominens?

A

C7, first bony prominence, spinous process of the C7

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25
Q

top of iliac crests?

A

spinous process of L4 - practical procedure of lumbar puncture and epidural

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26
Q

how many curves of the back in the fetus?

A

1

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27
Q

what are the effects of learning to hold up head and then stand up causes?

A

normal secondary curvatures to develop

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28
Q

lordosis?

A

anterior curve: cervical and lumbar

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29
Q

kyphosis?

A

posterior curvature: thoracic and sacral kyphosis

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30
Q

abnormal curvatures of the back?

A

congenitally or develop throughout the life, kyphosis and lordosis and scoliosis

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31
Q

excessive thoracic kyphosis?

A

classic hump appearance, elderly women, osteoporosis

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32
Q

excessive lumbar lordosis?

A

patient with larger BMI, pregnant women, weight distribution, excessively curve lumbar area of spine

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33
Q

scoliosis

A

S shaped curvature - congenital curve from birth

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34
Q

vertebral formen?

A

location of the spinal cord

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35
Q

vertebral arch?

A

pedicle and the lamina

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36
Q

pedicle?

A

attaches body to the rest of the foramina

37
Q

the lamina?

A

attaches the spinous process to the rest of the vertebrae

38
Q

how many transverse processes?

A

2

39
Q

how many spinous processes?

A

1

40
Q

C2

A

odontoid process

41
Q

why can’t you see intervertebral space?

A

cartilaginous discs rather than bone

42
Q

unique features of C1

A

no vertebral body, anterior and posterior arches instead, facet for articulation of the occipital bone

Atlanta-occipital joint - nodding head - yes

43
Q

unique features of C2

A 
odontoid process (dens) - axis 
when C1 and C2 articulate - atlanto-axial joint 
shaking head - no
44
Q

unique features of cervical vertebrae?

A

transverse Formen - passage of the vertebral artery

bifid shaped - smaller of the spinous process

45
Q

vertebral artery?

A

branch of the subclavian artery, it passes through the transverse foramen on the right and left side, will pass into the cranial cavity through the foramen magnum and join the basilar artery at the circle of willis

46
Q

thoracic

A

facets of body and transverse process for articulation with ribs

47
Q

lumbar

A

largest, having to deal with the most amount of weight, larger and heavier bones

48
Q

inferior spect of the vertebral column?

A

sacrum joins with the allium of the pelvis - sacroiliac joints

49
Q

ligaments of the vertebral column?

A

fibrous structures, generally connecting bone to bone, keep the vertebral column in alignment and keep the bones together, limit the amount of movement

50
Q

facet joints?

A

synovial joints

between the structures of the articular processes of the vertebral arch -cercival, thoracic and lumbar regions

51
Q

joints between the vertebral bodies?

A

cartilaginous joints - movement does occur

limited mobility

52
Q

movements of the cervical and lumbar regions?

A

extension and flexion

53
Q

what are the movements of the cervical and lumbar regions?

A

lateral flexion

54
Q

what are the movements of the cervical and thoracic regions?

A

rotation

55
Q

degree of flexibility in the lumbar region?

A

orientation of the facet joints determine the degree of flexibility of the region

56
Q

no intervertebral discs between?

A

C1 and C2

57
Q

the most inferior intervertebral disc is between?

A

L5 and the sacrum

58
Q

the outer part of the intervertebral disc?

A

annulus fibrosis - thinner posteriorly, made up of fibrous tissue (strong) than anteriorly, attaches to the vertebral body

59
Q

within the annulus fibrosis?

A

the nucleus pulpous - jelly like and initially a lot more water in the there, dehydrates with age - useful when you consider its role as a shock absorber

60
Q

more weight towards the lumber region?

A

the joints are more developed for weight bearing, little bit of movement can occur at these joints, compressible intervertebral discs

61
Q

what are the 5 main ligaments of the vertebral column?

A

anterior longitudinal ligament - run the entire length of the vertebral column

posteriorly longitudinal ligament - posterior aspect of the vertebral body - narrow than the anterior ligament

ligamentum flavum - between the laminae

supraspinous ligament

interspinous ligament - weaker than the supraspinous, between the one spinous process and the other one

62
Q

what prevents excessive extension and flexion of the spinal cord?

A

anterior longitudinal and posterior longitudinal ligaments

63
Q

will there be pain cause if these ligaments are torn?

A

yes because they are innervated by the sensory nerve fibers - causes sore back pain

64
Q

what else prevents excessive flexion?

A

ligamentum flvum, supraspinous and interspinous ligaments

65
Q

relationship between intervertebral disc and spinal nerves?

A

PLL lies anterior to the spinal cord - come out between intervertebral foramen, spinal nerve emerge bilaterally,

66
Q

prolapsed intervertebral disc?

A

nucleus pulposis herniates through the annulus fibrosis - thinner posteriorly and this is called a slip disc

67
Q

symptoms of prolapsed intervertebral disc?

A

can hit the spinal nerve that is emerging from the alert aspect - motor symptoms and sensory symptoms

68
Q

what is usual direction of disc prolapse?

A

posterolaterally due to presence of PLL

69
Q

which nerves affected by a prolapsed intervertebral disc?

A

prolapse of a disc tends to impinge upon the nerve which will exit at the next intervertebral foramen inferiorly

i.e. a prolapsed L5 disc impinges upon the S1 nerve

however a prolapsed disc may also impinge on the next nerve inferior, so a prolapsed L5/S1 disc could press on S2 in addition to S1 so can get symptoms affecting both spinal nerves

70
Q

relationship between the number of the disc and nerve emerging from it?

A

the number of the nerve that emerges inferior to the disc

example: L5/S1 disc and the S1 nerve ‘
the number of the nerve that emerges inferior to the disc

71
Q

what is the course of the spinal cord?

A

continuation of the brainstem - medulla through the foramen magnum and down within the vertebral canal of the vertebral column and passes inferiorly and at every level a pair of nerves leave the spinal cord

72
Q

how many spinal nerves are there?

A

31 pairs

73
Q

what does each spinal nerve pair carry?

A

somatic motor nerve fibres

somatic sensory nerve fibres and parasympathetic nerve fibres - innervating the smooth muscle within the skin

74
Q

what does the sacral spinal nerves also carry?

A

parasympathetic nerve fibres for a very short distance before they leave to form pelvic sphlanchnic nerves

75
Q

spinal nerve divides into?

A

anterior and posterior rams, both are mixed

76
Q

posterior ramus?

A

smaller, narrow as it carries fewer nerve fibers passes posteriorly from the posterior nerve and innervates the muscles of the back - somatic motor fires of the posterior rami

77
Q

anterior ramus?

A

greater distribution, thicker

it is the anterior rami of the spinal nerves that form plexuses - lumbar plexus and sacral plexus

78
Q

lumbar plexus

A

femoral nerve L2,L3,L4 - nerve fibres at the respective levels and joined together within the lumbar plexus to form the femoral nerve

79
Q

what is the end of spinal cord?

A

doesn’t run the entire length of the vertebral column and it ends at L2 however the vertebral column runs all the way to the coccyx

80
Q

plexus?

A

certain number of individual spinal nerves passing into the nerve plexus, intertwining of the nerves and on the other side of the plexiglass you get named branches

81
Q

embryology of the spinal cord?

A

the spinal cord and vertebral column were the same length but then the vertebral column grew and spinal cord didn’t hence it is smaller however you do have spinal nerves leaving the entire length of the vertebral column, inferior nerves pulled along with their exit points more inferiorly

82
Q

cauda equina?

A

spinal nerves that are yet to leave the intervertebral foramen - L2

83
Q

spinal cord is covered in 3 layers of meninges?

A

pia, arachnoid and dura

Pia closely aligned to spinal cord

dura is the most outer layer

84
Q

layers of the spinal cord?

A

spinal cord, spinal nerves, pia mater, arachnoid mater and dura mater small part of the spinal nerve also covered in mater

85
Q

what is carrie din the subarachnoid space?

A

CSF - between the Pia and the arachnoid

86
Q

lumbar puncture

A

is when the clinical takes a sample of CSF - meningitis etc. practical procedure taken under certain procedures

87
Q

how to perform a lumbar puncture?

A

feel along the top of the iliac crests = L4, then find L3/L4 or L4/L5 space, needle should be away from spinal cord - far less likely to puncture the nerves of the caudal equina

below layer L2 - superior aspect of the iliac crests - L4 spinous process

patient in a position curled offer to open the spinous process as much as you can - all ligaments prevent excessive flexion - increasing the space between the vertebrae

aim for subarachnoid space

local anesthetic - through skin and fascia - supraspinous, interspinous, ligaments flavum and dura and arachnoid into the subarachnoid space - retrieving CSF

88
Q

location of needle tip for epidural anesthesia?

A

extra-dural space outside of the dura

MSK anatomy - Year 2 (3 decks)

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