Back Angiology/Neurology Flashcards
What three structures does the aorta split into?
The aorta of the heart will split into:
- Brachiocephalic trunk
Which will then split into the
[right subclavian a.] & [right common carotid a.]. - Left common carotid a.
- Left subclavian a.
Off of the aorta,
the subclavian artery will become what?
Subclavian artery becomes the [axillary artery] after it passes the first rib and then eventually the [brachial artery a.]
After we pass the first rib, what does the subclavian artery become?
Axillary artery
Axillary artery becomes the…
Brachial artery
Subclavian splits into what?
- Vertebral A.
- Thyrocervical trunk
- Dorsal scapular A.
Off of the thyrocervical trunk, we will get what artery?
Transverse cervical artery, which supplies the trapezius with blood.
What does the [DORSAL SCAPULAR A.] provide blood to?
Layer 2 muscles:
- Rhomboid major m.
- Rhomboid minor m.
- Levator scapulae m.
The [axillary a.] will give rise to what?
[Subscapular a.] -> [Thoracodorsal a.]
What does the [thoracodorsal artery] supply blood to?
Latissimus Dorsi M.
What supplies blood to the trapezius m.?
Transverse cervical artery
Derived from the [thyrocervical trunk], which is derived from the subclavian artery
What supplies blood to the rhomboid major, rhomboid minor and levator scapulae m.?
Dorsal scapular artery
Derived from the subclavian artery
What supplies blood to the latissimus dorsi m.?
- Thoracodorsal a.
[Subclavian a]–> [axillary a]–> [subscapular a]–> [thoracodorsal a]
Pathway of arteries to supply blood to the latissimus dorsi?
Ask yourself, what supplies blood to the latissimus dorsi?
ANS: Thoracodorsal A.
- Subclavian a.
- Axillary A.
- Subscapular a.
- Thoracodorsal a–> LATTS
Thyrocervical trunk will make the _____________, which provides blood to where?
Transverse cervical artery
Which provides blood to the trapezius m.
The dorsal scapular a. is usually a part of the ____ part of the subclavian a.
Third part of the [subclavian artery]
If the dorsal scapular artery attaches to the transverse cervical a., what is it called?
Deep transverse cervical a.
Vertebral arteries are a branch of the ____ subclavian artery
Left
Left subclavian artery supplies blood to where?
Brain
How do the vertebral arteries travel?
Vertebral arteries run through the transverse foramen of the cervical vertebrae–> to the groove for the vertebral a on the atlas
Creates the spinal arteries
Vertebral arteries produce what?
Vertebral arteries produce the spinal arteries
In the suboccipital triangle, what should we be able to see?
- Suboccipital NERVE
2. Vertebral A.
How many spinal arteries do we have?
3
1 on the anterior side and 2 paired ones on the posterior side
What do spinal arteries do?
Vertebral arteries branch to form spinal arteries, and spinal arteries provide blood to the spinal cord.
However, they do so with the contribution of blood from [8 PARASPINAL A.]
What are the 8 paraspinal arterial SOURCES?
Very Active Dancers Pose Sexy, Leading Idiots Laterally
- Vertebral a.
- Ascending cervical a.
- Deep cervical a.
- Posterior INTERCOSTAL a.
- SUBCOSTAL a.
- LUMBAR A
- Iliolumbar A.
- Lateral Sacral A.
Side note: Spinal arteries branch off of vertebral arteries where?
Near the brainstem
Paraspinal arteries enter the ___________ and branch into the _______________.
Vertebral foramen
Paraspinal artery branches.
Paraspinal artery branches story
Spinal artery will enter the [vertebral canal] by going through the [intervertebral foramen].
There; It will branch into the following
1. Posterior/Anterior Vertebral Canal Branches–> which will give blood to the vertebral canals
- Anterior/posterior radicular arteries
- Anterior/posterior segmental medullary arteries
Anterior/Posterior Radicular arteries
A branch of the spinal artery that does not supply blood to the anterior/posterior spinal arteries
Instead, they supply [R]oots
Anterior/posterior segmental medullary arteries
Branches of the spinal artery that DO provide blood to the anterior/posterior spinal arteries
Other paraspinal artery branches
- Periosteal branch –> enters and feeds the periosteum
- Equatorial branch–> enters and feeds the deep bone (like vertebral bodies)
- Dorsal branch
How are spinal veins grouped?
- External venous plexus
2. Internal venous plexus
Internal venous plexus
located inside the vertebral canal and run along with spinal arteries (but there are alot more veins)
External venous plexus
Located outside the vertebral canal and run near the vertebral bodies.
how many cervical spinal nerves are there?
8 cervical spinal nerves but only 7 vertebrae.
There are 2 areas where the spinal cord “swells” (is enlarged). Where?
Cervical enlargement
Lumbosacral enlargement
Why are there 2 swellings of the spinal cord?
There is a [cervical enlargement] and a [lumbosacral enlargement] because more neural tissue is present because of the nerves going to the upper and lower extremities.
How many thoracic spinal nerves are there?
12
How many lumbar spinal nerves are there?
5
Number of spinal nerves of the
- cervical
- Thoracic
- Lumbar
- Sacrum
- Coccygeal
8 12 5 5 51
Where does the spinal cord end?
The spinal cord forms a cone directly below the lumbosacral enlargement [MEDULLARY CONE] and ends.
How do we send information down to the rest of the vertebrae?
Roots, called the CAUDA EQUINA (look like horse hair) are sent down to the sacral and coccyx regions.
“Mess of nerve roots” is called what?
Cauda Equina
Spinal cord injury at C1-C3
Person has no function below their head. To live, they must be on a respirator
SC injury at C4-C5
They can breathe, but they have no function of limbs
SC injury at C6, C7, C8
Loss of hand and variable upper limb function. They may be able to use a wheel chair
SC injury at T1-T9
Both lower limbs are paralyzed
T10-L1
Problems with their thigh muscle. To walk, they must use leg braces
L2-3
They have function of most of their lower limbs, so they can use a short cane.
Dura mater
Outermost
Tough
FIRBROUS
Arachnoid mater
Thin, membranous layer that lines the dural sac.
Pia mater
A layer that is attached to the spinal cord. The pia mater has protrusions, called denticulate ligaments that enter the arachnoid mater.
What are denticulate ligaments?
Denticulate ligaments are protrusions of the pia mater that enter the arachnoid mater.
They are said to look like teeth.
What is the epidural space?
Epidural space is a fat-filled space on top of the dura mater.
It contains the [internal vertebral venous plexus] and [epidural fat].
Dural arachnoid interface
CSF holds the dura mater and the arachnoid mater together TIGHTLY
If anything gets into this “theoretical” space, it can create pressure on the spine.
Thus, we do not want anything in our dural arachnoid space.
Subarachnoid space
Space between our arachnoid space and pia mater where CSF circulates
Lumbar cistern
Lumbar cistern is located near the medullary cone, where subarachnoid space has swelled so there is a shit ton of CSF floating around.
What do lumbar punctures/ spinal taps do?
They look for any disorders of the CNS.
Where are spinal taps done and where?
Between L3/L4 or L4/L5, so that we can avoid puncturing the spinal cord.
Needle goes through our ligamentum flavum–> lumbar cistern (deep into dura and arachnoid mater), to the subarachnoid space where CSF is circulating.
What is [filum terminale internum]
Filum terminale internum is only pia mater.
Pia mater continues through the medullary cone and to the bottom of the lumbar cistern. At the bottom of the lumbar cistern, the arachnoid mater ends. Before it reaches the end of the lumbar cistern and encounters the dura mater, it is called
FILUM TERMINALE INTERNUM
FILUME TERMINALE EXTERNUM
Is where the pia mater will encounter the dura mater
Where does that arachnoid mater end?
It ends at the inferior end of the lumbar cistern.
Immediately coming off the spine are what?
Posterior and anterior rootlets
They will converge into posterior and anterior roots
The posterior roots form the spinal ganglion (dorsal root ganglion)
When the posterior and anterior roots converge, what is this called?
Spinal nerve
Spinal nerve is really short and will enter and exit the vertebral foramen.
Once this occurs, the spinal nerve splits into
- posterior rami
- anterior rami
Anterior rami feed into where?
The plexuses
Posterior rami innvervate what?
- Intrinsic BACK muscles
- Zygapophyseal joints
- skin of the mid-back through the cutaneous branches
What is the posterior ramus of C1?
Suboccipital nerve
What is the posterior ramus of C2?
Greater occipital nerve
what is the posterior ramus of C3
least occiptal nerve
What does the suboccipital nerve innvervate
rectus capitis posterior minor
rectus capitis posterior major
obliquus capitis superior
obliquus capitis inferior
Where does the great occipital nerve come out of?
entirely below the obliquus capitis inferior
Posterior rami of L1-L3
superior cluneal nerves
Posterior rami of S1-S3
middle cluneal nerves
- Fibroskeletal structures (periostium and ligaments)
- Meninges
are innervated by what
Recurrent meningeal nerves
- Synovial joints
- Intrinsic back muscles
- Spinal nerves and nerve roots
are innervated by what?
Posterior rami
5 common causes of back pain:
- Fibroskeletal structures (periostium and ligaments)
- Meninges
- Synovial joints
- Intrinsic back muscles
- Spinal roots and nerves
2 most common causes of back pains
- Fibroskeletal structures (ligaments and periostium)
- Synovial joints
- [pain of intrinsic back muscles is also common]
what is the second most common reason people go to the doc?
back pain
Muscle pain is due to what?
Spasms of the back muscle, resulting in ischemia.
Joint pain is often caused by what?
osteoarthritis or arthritis
Fibroskeleton pain is often due to what?
fractures or dislocation of ligaments
