Block A Gross Flashcards
Muscles associated with the upper limb and accessory respiratory muscles are innervated by ______
ventral rami of spinal nerves
Deep back muscles are innervated by
dorsal rami of spinal nerves
Vertebral Reference levels: Sternal notch- Sternal Angle- Esophageal hiatus- End of spinal cord in adult- Iliac crest- End of dural sac, arachnoid, and subarachnoid space-
- T2
- T4
- T10
- L1 or L2
- L4
- S2
End of spinal cord in adult is called:
conus medullaris
_____ is a postural compensation for thoracic kyphosis
lordosis
Cervical Superior articular facets face _____ and _____
posterior and superior
Cervical Inferior articular facets face _____ and _____
anterior and inferior
The spinous processes of C2-C6 are considered _____
bifid
Which vertebrae have uncinate processes?
C3-C7
what is an uncovertable joint?
What processes make up the joint?
- A cup shaped joint
- uncinate processes
Which thoracic vertebrae have long spinous processes?
T5-T8
Costal facets on sides of body and on transverse processes of ______
most thoracic vertebra
There are NO costal facets on transverse processes of which T vertebrae?
T11 or T12
costovertebral joints are between:
head of rib and verteral body
costotransverse joints are between:
tubercle of rib and transverse process
Do lumbar vertebra have costal facets?
no
Do lumbar vertebra have transverse foramina?
no
Lumbar superior articular process has a rounded _____ process
mamillary
Lumbar Superior articular facets face _____;
Inferior articular facets face _____
- medially
- laterally
The parts of the Lumbar Dog Superior articular process- Inferior articular process- pedicle- pars interarticularis-
- ear
- front leg
- eye
- neck
Spondylolysis =
fracture of pars interarticularis
Spondylolisthesis-
a unilateral or bilateral defect or fracture of the pars interarticularis
accompanied by anterior displacement of the vertebral body
Symptoms of spondylolisthesis
bilateral lower back pain that radiates into both lower limbs and weakness in muscles of the legs.
cervical superior facets face ____
posterior/superior
cervical inferior facets face _____
anterior/inferior
Thoracic superior facets face
posterior/lateral
thoracic inferior facets face
anterior/medial
lumbar superior facets face
meidal
lumbar inferior facets face
laterally
cervical vertebrae allow movement in what directions?
flexion/extension, lateral bending, and rotation
thoracic vertebrae allow movement in what directions?
lateral bending, rotation, and flexion/extension
lumbar vertebrae allow movement in what directions?
flexion/extension
Each intervertebral disc is composed of a central ______ surrounded by the peripheral ______ and 2 layers of cartilage that cover the superior and inferior aspects of the disc.
- nucleus pulposus
- annulus fibrosus
are the nucleus pulposus and annulus fibrosus innervated?
annulus fibrosus is, nucleus pulposus is not
The annulus fibrosus is composed of concentrically arranged lamellae made of _______
collagen fibers
Floor of suboccipital triangle
Posterior atlanto-occipital
membrane and posterior arch of C1
Rectus capitis posterior major origin and insertion
spinous process of C2 and lateral part of inferior nuchal line
rectus capitis posterior minor origin and insertion
posterior tubercle of posterior arch of C1 and medial part of inferior nuchal line
obliquus capitis inferior origin and insertion
spinous process of C2 and transverse process of C1
obliquus capitis superior origin and insertion
transverse process of C1 and occipital bone between the
superior and inferior nuchal lines
which membrane does the vetebral artery pass through to enter foramen magnum?
posterior atlanto-occipital membrane
the spinal cord is a continuation of the
medulla oblongata
to approximate the spinal cord segment at a particular vertebral level:
add one to the vertebral level in lower
cervical region, add two in the upper thoracic region, add three in the lower thoracic region. Clinically the procedure is reversed (subtract from cord segment)
most common places for cervical disc herniation
C5-C6 and C6-C7
most common lumbar disc herniation locations:
L4-L5 and L5-S1
Clinical differentiation of herniation btw L4/L5 and L5/S1 is:
L4/L5- weak dorsiflexion of ankle
L5/S1- weak plantar flexion of ankle
3 layers that make up meninges:
dura mater + arachnoid mater + Pia mater
dural sac is also called:
thecal sac
the point at which the dural sac terminates:
filum terminale externum
what tissue strands connect arachnoid and pia mater?
arachnoid trabeculae
how is pia mater connected to dura mater?
denticulate ligament
spinal cord is supended within the dura by the
denticulate ligament
which arteries supply blood to the spinal cord?
anterior spinal artery (supplies anterior 2/3 of spinal cord) and 2 posterior spinal arteries (Supply posterior 1/3 of the spinal cord)
anterior spinal artery is supplemented by:
radicular and segmental arteries
which artery that supplements the ASA is most important and why?
Artery of Adamkiewicz because it is very large and if it is cut it could make person paraplegic.
location of Artery of Adamkiewicz
usually T10
The vertebral venous plexus has no valves, so blood can flow where?
lots of places. up AND down the spinal column and between the anterior and posterior plexuses.
what is the easiest route for prostate cancer to metastasize to the brain?
up the vertebral venous plexus
lumbar puncture is performed btw which 2 vertebrae?
L4/L5
An automatic unconscious muscular response to a situation in an attempt to maintain body homeostasis
reflex arc
General Visceral Efferent nervous system is also known as
the autonomic nervous system
Special somatic afferent neurons detect
hearing and vision
special visceral afferent neurons detect
smell and taste
special visceral efferent neurons innervate the
pharyngeal arch musculature
the cauda equina consists of ______
nerve roots
Medial branches of the dorsal root ganglions supply the _____ in the superior region of the body and the______ supply deeper muscles. That role is switched as you go towards the inferior portion of the body.
- skin
- lateral branches
Dorsal rami supply from the head to the _______. Ventral rami supply everything else
gluteal region
Dorsal rami supply _____ muscles of the back
deep
Which portion of the spinal column does not form a plexus?
T1-T12
Dermatome-
an area of skin supplied by a single spinal nerve
If an area of skin is supplied by multiple peripheral nerves, it is called a _____
peripheral nerve field
3 types of fascia
subcutaneous, deep, and subserous
The space behind breast tissue is called:
retro-mammary space
Medial border of breast tissue:
lateral border of sterum
lateral border of breast tissue:
mid axillary line
superior border of breast tissue:
2nd rib but can extend up to clavicle
inferior border of breast tissue:
6th rib but can be deceptive due to ptosis
clavipectoral fascia is ____ to the pectoralis major muscle
deep
the breast is attached to the dermis by the _______
Suspensory Ligaments of Cooper
Each Lactiferous Duct ends in 15-20 ______ which make milk
lobules
Lactiferous ducts dilate into _______ deep to the nipple-areolar complex to drain to the surface.
Lactiferous Sinuses
lymph primarily drains from the breast into the
sub-areolar lymphatic plexus
Secondary drainage of lymph from breast is into:
axillary nodal basin
after primary and secondary drainage, remaining lymph drains into:
parasternal nodes, to the opposite breast, or to inferior phrenic nodes
After lymph drains from the breast, it goes fro the axilla into the ______ and _____ nodes, then into the _____ or _______, then into venous circulation at the junction between ______ and _____ Veins.
- supraclavicular and subclavian nodes
- Right lymphatic duct or Thoracic duct on the Left
- Subclavian and Internal Jugular
Level I Axillary Nodes are lateral to the __________
Level II Axillary Nodes are deep to the ___________
Level III Axillary Nodes are medial to the _________
- border of the pectoralis minor muscle
- pectoralis minor muscle
- border of the pectoralis minor muscle
Older surgical procedures would remove Levels I and II of axillary lymph nodes.
Current procedures stop at _______ as maximal borders of nodes removed
Level I
Adenocarcinoma of the breast is 90-95% ____
Ductal
most breast cancers are in what quadrant
upper outer
4 clinical signs of breast cancer:
venous dilation, Peau d’ orange, skin dimpling, and nipple retraction
Functions of General Visceral Afferent (GVA) nerves:
Stretch, Strong Contractions, Ischemia, Visceral Reflexes
Function of General Visceral Efferent neurons
ANS
The ANS is broken down into the:
sympathetic and parasympathetic
GVE effector cells:
smooth muscle, cardiac muscle, and glands
2 neuron chains of GVE:
pre- and post-ganglionic
Of the Pre and post ganglionic GVE neurons, which are myelinated?
preganglionic chain is myelinated. postganglionic is not
Sympathetic chain location-
thoraco-lumbar (T1-L2)
How do the lengths of the pre and post ganglionic chains differ between sympathetic and parasympathetic?
Sympathetic: short preganglionics and long postganglionics
Parasympathetic is opposite
Sympathetic nervous system decreases _____ and increases heart rate
peristalsis
the 4 types of prevertebral sympathetic ganglia:
Celiac
Superior mesenteric
Inferior mesenteric
Aorticorenal
What does IMLCC stand for?
intermediolateral cell column
What is a common name for IMLCC?
Lateral horn
Which spinal segments contain a lateral horn?
T1-L2
Which ramus communicans is myelinated?
White ramus communicans
The preganglionic sympathetic axon travels through the ____ to the sympathetic chain ganglion
white ramus communicans
The postganglonic sympathetic axon travels through the ______ to reach the ventral ramus
gray ramus communicans
What is a splanchnic nerve?
a preganglionic sympathetic axon that passes through sympathetic chain ganglion without synapsing. It synapses later on at its target organ
All spinal nerves are associated with _____ramus communicans, but only the spinal nerves between T1 and L2 are associated with _____ ramus communicans.
- gray
- white
Why is the sympathetic chain enlarged at the top of the neck?
It is the last place that the sympathetic nerves going all over the head have access to the spinal cord.
The greater splanchnic nerve is renamed _______ as it travels inferiorly
lesser splanchnic then least splanchnic
ptosis
droopy eyelid
miosis
constricted pupil
anhidrosis
decreased sweating
Horner’s syndrome
Due to lesion/compression of one side of the cervical or thoracic sympathetic chain, which generates symptoms on the ipsilateral side of body.
Causes ptosis, miosis, anhidrosis, enopthalmos, and flushing of the face
enopthalmos
the impression that the eye is sunk in
the parasympathetic nervous system originates from what areas?
Cranial nerves III, VII, IX, X (but we are only currently concerned with X) as well as spinal cord segments S2, 3, 4
What is the only parasympathetic nerve in the thoracic cavity or abdominal viscera
Vagus nerve (Cranial nerve X)
Where are sacral parasympathetic nerves located?
wall of pelvic viscera
Vagus Nerve:
Preganglionic cell body location:
Postganglioinic cell body location:
- Dorsal motor nucleus of X
- -Wall of organ
Sympathetic NT released on target tissue:
Parasympathetic NT released on target tissue:
- NE
- ACh
General visceral afferents (GVA) travel back from the organ (e.g., heart) to the CNS along with the _____supplying that specific organ.
GVE fibers
Generally, those GVA pain fibers from thoracic organs and abdominal organs travel back to CNS with _______, while those GVA pain fibers from pelvic organs travel back to the CNS with __________.
- sympathetics
- parasympathetics
Visceral Afferent–> ______–> _____–> ______–> ______–> ______–> Dorsal Horn
Visceral Afferent–> splanchnic Nerve–> sympathetic chain–> white ramus communicans–> ventral ramus–> dorsal root–> dorsal horn
Visceral Afferent fibers never travel through the ____ rami communicans!
gray
referred pain
Pain originating in one location in the body but perceived by the patient as coming from another location in the body.
Referred pain example: appendicitis
Why does appendicitis initially hurt in the umbilical region, then travel to the RLQ?
appendix is innervated by T10, which also innervates belly button region. However, subsequent peritonitis will irritate the parietal peritoneum in the RLQ innervated by T12 & L1.
The 3 joints of the shoulder-
sternoclavicular, acromioclavicular, and glenohumeral
pectoral girdle-
consists of clavicle, scapular, and part of the sternum (both sides). One side is 1/2 pectoral girdle
Suprascapular notch is traversed by
superior transverse scapular ligament
which arteries and nerves are associated with the suprascapular notch/foramen?
suprascapular artery (goes over ligament) and suprascapular nerve (goes under ligament)
where does the clavicle attach to the scapula?
the acromion
Describe the sternoclavicular joint in 2 words
synovial/saddle joint
describe the acromoclavicular joint in 2 words
synovial/plane joint
3 ligaments that reinforce the acromioclavicular joint
acromioclavicular, coraclavicular, and coracoacromial ligaments
Pectoral girdle consists of:
scapulae, clavicles, and sternum
due to muscles pulling on clavicle, clavicle breaks can lead to 2 manifestations:
clavicular shortening and tenting
the suprascapular artery anastomoses with the _____ artery in the _______
- dorsal scapular
- infraspinous fossa
3 muscles that attach to the greater tuberosity of the humerus
teres minor, supraspinatus, and infraspinatus
3 muscles that attach to the intertubercular groove
long head of biceps, lat dorsi, and teres major
which side of humerus are greater and lesser tubercles on?
anterior
_______ in sternoclavicular joint cavity helps absorb shock from the upper extremity and aids in mobility
articular disc
Coraco-acromial ligament aids in reinforcing _______ joint
glenohumeral
_______ stops glenohumeral joint from abducting too far
coraco-acromial ligament
________ movement occurs along the long axis of glenohumeral joint
medial and lateral rotational
biceps tendon is ensheathed by:
a bursa
________ protects supraspinatus from deltoid
subacromial bursa
what nerve and artery emerge from the quadrangular space?
axillary nerve and posterior circumflex humeral artery
what arteries lie deep to the trianglular space of the scapula?
circumflex scapular arteries
what nerve and artery lie deep to the triangular interval
radial nerve and profunda brachii artery
distal attachment of pectoralis major is where on the humerus?
intertubercular sulcus
innervation of pectoralis major
lateral and medial pectoral nerves, which originate in C5-T1. C6 main clavicular head innervation and C7/8 main sternocostal head innervation
pectoralis minor inferomedial attachments-
3rd-5th ribs
pectoralis minor superolateral attachment-
coracoid process of scapula
action of pectoralis minor-
stabilizes scapula by drawing it inferiorly and anteriorly against thoracic wall
innervation of pec minor
medial pectoral nerve
proximal attachment of subclavius muscle
1st rib
distal attachment of subclavius muscle
middle 1/3 of clavicle
innervation of subclavius muscle
nerve to subclavius from C5
main function of serratus anterior
hold scapula against thoracic cage
innervation to serratus ant.
long thoracic nerve (C5-7)
blood supply to serratus anterior
lateral thoracic artery
injury to long thoracic nerve is characterized by _____ of the scapula
winging
extrinsic muscle-
starts in one zone of interest and ends in different zone of interest
intrinsic muscle-
starts and ends in same zone of interest
innervations of trapezius-
spinal accessory nerve (motor) and C3/4 (sensory)
3 parts of trapezius muscle:
descending (superior), transverse, and ascending (inferor)
innervation of the lat
thoracodorsal nerve (C6-8)
proximal attachment of lat dorsi
spinous processes of lower thoracic, iliac crest, thoracolumbar fascia, and lower thoracic ribs
distal attachment of lat dorsi
floor of intertubercular sulcus of humerus
innervation of levator scapulae
dorsal scapular nerve (C4/5) & cervical nerve (C3/4)
action of levator scapulae muscle
elevate and rotate scapula, depress glenoid cavity
proximal attachment of levator scapulae
transverse process of C1-C4 vert.
innervation of rhomb major
dorsal scapular nerve (C4/5)
what action does levator scapulae, rhomboid major, and rhomboid minor have in common?
depress glenoid cavity
how do proximal attachments of levator scapulae differ from the rhomboids?
levator scapulae attaches to transverse processes but rhomboids attach to spinous processes
proximal attachments of rhomboid major
spinous processes of T2-T5
distal attachment of rhomboid major
medial border of scapula INFERIOR TO SPINE
innervation of rhomb minor
dorsal scapular nerve
proximal attachments of rhomboid minor
spinous processes of C7/T1 & nuchal ligament
distal attachment of rhomboid minor
medial border of scapula, SUPERIOR TO SPINE
proximal attachment of deltoid
inferior region of scapular spine and acromion, lateral 1/3 of clavicle
innervation of deltoid
axillary nerve (C5,C6)
innervation of teres major
lower subscapular nerve (C5/6)
teres major nicknamed _____ because of its similarity in function to the lat dorsi
little lat
SITS muscles:
supraspinatus, infraspinatus, teres minor, subscapularis
supraspinatus innervation
suprascapular nerve (C4-6)
distal attachment of supraspinatus
superior facet of greater tubercle of humerus
most common muscle torn in a rotator cuff injury
supraspinauts
infraspinatus innervation
suprascapular nerve (C5/6)
distal attachment of infraspinauts
middle facet of greater tubercle
teres minor distal attachment
inferior facet of greater tuberosity of humerus
teres minor innervation
posterior branch of axillary nerve (C5/6)
subscapularis inneravtion
superior and inferior subscapularis nerves C5-7
distal attachment of subscapularis
lesser tubercle of humerus
global tear-
muscles of rotator cuff torn and joint capsule is torn or disarticulated
clinically, rotator cuff tears usually include at least ____ of the SITS muscles
2
conduit
means by which neurovascular structures enter and leave the upper extremity from the cervical region
the 6 sides of the axilla
Apex, Base, Anterior Wall, Posterior Wall, Medial Wall, and Lateral Wall
What makes up the axillary apex?
posterior aspect of clavicle, superior edge of scapula, lateral aspect of 1st rib
What makes up the axillary base?
axillary fossa/depression, which consists of skin, subcutaneous tiissue, and deep axillary fascia
What makes up the axillary anterior wall?
pectoralis major and minor with their fascia
What makes up the axillary posterior wall?
subscapularis, scapula, teres major, latissimus dorsi
What makes up the axillary medial wall?
thoracic wall (1st-4th ribs and first 4 intercostal spaces and muscles, along with serratus anterior)
What makes up the axillary lateral wall?
intertubercular groove/sulcus of humerus
which muscle in the axilla is innervated superficially?
serratus anterior
axillary artery and vein and brachial plexus are wrapped in
axillary sheath
axillary sheath-
continuation of pre-vertebral fascia of the cervical region in the neck but still distinct from other nearby fascia
when does the subclavian artery become the axillary artery?
at the lateral border of the 1st rib
when does the axillary artery become the brachial artery?
at the inferior border of teres major
name the branch in the 1st part of the axillary artery
superior thoracic artery
define the boundaries of the first part of the axillary artery.
lateral border of 1st rib to medial border of pec minor
define the boundaries of the second part of the axillary artery
portion deep to pec minor
define the boundaries of the third part of the axillary artery
lateral border of pec minor to inferior border of teres major
2 branches of 2nd part of axillary artery
thracoacromial artery and lateral thoracic artery
what does thoracoacromial artery branch into? (4)
clavicular, acromial, deltoid, and pectoral artery
what does lateral thoracic artery supply
serratus anterior
3 branches of the 3rd part of axillary artery
subscapular artery, anterior circumflex humeral artery, and posterior circumflex humeral artery
what does subscapular artery divide into?
circumflex scapular artery and throacodorsal artery
what artery emerges from the triangular space?
circumflex scapular artery
what artery and nerve emerge from quadrangular space?
posterior circumflex humeral artery and axillary nerve
what artery and nerve lie deep to the triangular interval?
radial nerve and profunda brachii artery
anastomoses-
allow collateral circulation. region where arteries share vessels. occlusion of a vessel can be compensated by more blood flow through the other one(s)
which 2 veins unite to form axillary vein?
brachial vein and basilic vein
borders of axillary vein
begins at inferior border of teres major and ends at lateral border of 1st rib
C4 contribution to brachial plexus is called a
prefixed brachial plexus
T2 contribution to brachial plexus is called a
postfixed brachial plexus
does brachial plexus include sympathetic fibers?
yes
what nerve branches from the roots of the brachial plexus?
long thoracic nerve
_______ nerve branches from the C5 root of the brachial plexus
dorsal scapular nerve
name the 2 nerves that branch from the superior trunk of the brachial plexus
suprascapular and subclavius nerves
cords of the brachial plexus are named in relation to:
the axillary artery
3 branches of lateral cord of brachial plexus
lateral pectoral nerve, musculocutaneous nerve, and lateral root of median nerve
5 branches of medial cord of brachial plexus
medial pectoral nerve, medial brachial cutaneous nerve, medial antebrachial cutaneous nerve, ulnar nerve, and medial root of median nerve
5 branches of posterior cord of brachial plexus
ULTRA*
upper subscapular nerve, thoracodorsal nerve, lower subscapular nerve, axillary nerve, and radial nerve
what does the upper subscapular nerve innervate?
subscapularis
what does the thoracodorsal nerve innervate
latissimus dorsi
alternate name for thoracodorsal nerve
middle subscapular
what does the lower subscapular nerve innervate?
teres major
what does the axillary nerve innervate?
deltoid and teres minor
what does the radial nerve innnervate?
most of posterior compartment
5 terminal branches of the brachial plexus:
MARMU
musculocutaneous, axillary, radial, median, and ulnar nerve
roots of musculocutaneous nerve
C5-C7
roots of axillary nerve
C5-6
roots of radial nere
C5-T1
roots of median nerve
C6-T1
roots of ulnar nerve
C8-T1
musculocutaneous nerve
motor innervation:
sensory innervation:
anterior compartment of arm
emerges from cubital fossa and continues in lateral portion of forearm as the lateral antebrachial cutaneous nerve, innervating skin of lateral forearm
what part of median nerve is vulnerable to injury?
portion crossing anterior to the elbow in the cubital fossa
Median nerve motor innervations
all but 1.5 of the muscles of anterior compartment of the forearm, intrinsic thumb muscles, and 1st & 2nd lumbricals
median nerve sensory innervations
thumb half of palmar hand, palmar aspect of thumb + 2.5 fingers, and nail bed of thumb + 2.5 fingers
ulnar nerve is frequently damaged where?
where it runs posterior to the medial epicondyle
ulnar nerve sensory innervations:
digiti minimi half of palmar and dorsal hand, 1.5 fingers including nail beds
ulnar nerve motor innervations
flexor carpi ulnaris and ulnar half of flexor digitorum profundus, and all intrinsic muscles of the hand that arent innervated by median nerve
axillary nerve travels down humerus with what artery?
posterior circumflex humeral artery
axillary nerve motor innervations
teres minor and deltoid
axillary nerve sensory innervations
glenohumeral joint and superolateral arm cutaneous
dislocating shoulder can easily damage _____ nerve
axillary
radial nerve runs in ______ around posterior aspect of humerus, then emerges in ______ anteriorly
- spiral groove
- cubital fossa
motor innervations of radial nerve
all muscles of posterior compartments of arm and forearm
sensory innervations of radial nerve
posterior and inferolateral arm, posterior forearm, dorsal aspect of hand on thumb side up to the nail beds from thumb to half of middle finger
the only nerve on the back of the elbow is the:
ulnar nerve
fracture of humerus often injures the ______ nerve
radial
myotome-
group of muscles innervated by one nerve
Erb-duchene palsy-
upper trunk lesion C5-6 (baby with arm turned out, poor use of arm)
klumpke’s palsy
ulnar nerve damage
Axillary nerve damage can lead to _____ atrophy
deltoid
median nerve injury can lead to ______ atrophy or ______ hand posture
- thenar
- ape hand
wrist drop derives from ____ nerve damage
radial
ulnar nerve injury can lead to 2 visually distinct hand postures:
positive froment’s sign and ulnar claw
suboccipital nerve is _______ branch of dorsal ramus of _______
medial
C2
____ pairs of cranial nerves
12
Cranial nerve XI actually arises from
superior part of spinal cord
which is larger, ventral or dorsal rami?
ventral
where do sacral spinal nerves form and branch into rami?
within the sacrum before leaving anterior and posterior sacral foramina
In the upper area of the body, the medial branches of dorsal rami supply _____ and the lateral branches supply ______. This reverses in lower part of body
skin
deep muscles
Dermatome landmarks:
Nipple-
Umbilicus-
Groin-
- T4
- T10
- L1
Are sympathetics and parasympathetics always found together?
no
Preganglionic GVE is or is not myelinated?
is myelinated
are postganglionic autonomic neurons myelinated?
no
are sympathetic preganglionics long or short?
short
which cranial nerves send out parasympathetics?
3, 7, 9, 10
are parasympathetic preganglionics long or short?
long
will you find parasympathetics in the body wall?
no
ganglion impar-
point of convergence of the paravertebral sympathetic chain ganglions
swellings within sympathetic chain are due to
postganglionic cell bodies
IMLCC stands for
intermediolateral cell column
connection between ventral ramus and sympathetic ganglion referred to as
white ramus communicans
postganglionic sympathetic cell fibers leave ganglion via
gray ramus communicans
which is more distal on the sympathetic chain, white or gray rami?
white
all spinal nerves are associated with ______ rami communicans
gray
4 symptoms of horners syndrome
ptosis, miosis, anhidrosis, and flushing of face
postganglionic sympathetic nerves release what NT to sweat glands?
ACh
parasympathetic neurons (both pre and post ganlionic) release what NT?
ACh
GVA pain fibers from thoracic and abdominal organs travel back to CNS with ________, while GVA from pelvic organs travel back with ________
sympathetics
parasympathetics
do GVA travel through white or gray rami communicans?
always white
suprascapular artery anastomoses with
dorsal scapular artery
bicipital groove is aka
intertubercular groove
coracoclavicular ligament is comprised of what two smaller ligaments?
trapezoid and conoid
contents of triangular space?
circumflex scapular arteries
subclavius muscle innervation
nerve to subclavius
spinal roots of nerve to subclavius
C5,6
what innervates trapezius?
spinal accessory nerve (CN 11)
spinal roots of thoracodorsal nerve
C678
proximal attachments of lat dorsi
SPINOUS processes of lower thoracic, iliac crest, thoracolumbar fascia, lower ribs
levator scapulae innervation
dorsal scapular nerve and cervical nerve
roots of dorsal scauplar nerve
c45
proximal attachments of levator scapulae?
TRANSVERSE processes of c1-4
rhomboids innervation
dorsal scapular nerve
dorsal scapular nerve roots
c45
action of levator scapulae
elevates and rotates scapula to depress glenoid cavity
action of rhomboid mm
retract scapula and depress glenoid cavity
proximal attachments of rhomboid mm
SPINOUS processes of C7-T1/T2-T5
teres major innervation
lower subscapular nerve
roots of lower subscapular nerve
c56
suprascapular nerve roots
c456
axillary nerve roots
c56
subscapularis m innervation
superior and inferior subscapular nerves
superior and inferior subscapular nerve roots
c567
action of teres major
adducts and medially rotates arm
action of infraspinatus
lateral rotation of humerus
teres minor action
lateral rotation of humerus
subscapularis action
medially rotates and flexes humerus, helps hold humerus in joint
complete this:
Lobules——–>nipple
lobules–>lactiferous duct–>lactiferous sinus–>nipple
innervation of the breast
supraclavicular nerves
entire lymph of breast first drains into
sub-areolar lymphatic plexus
_______________quadrant breast cancers are hard to diagnose because lymph drains in that reason rather than axillary
upper inner
what artery and nerve supply serratus anterior
lateral thoracic artery and long thoracic nerve
axillary vein mirrors axillary artery except
no thoracoacromial vein
brachial plexus emerges btw what muscles?
anterior and middle scalene muscles in the nect
3 branches of lateral cord
lateral pectoral, musculocutaneous, and lateral root of median nerve
branches of medial cord
medial pectoral, medial brachial cutaneous, and medial antebrachial cutaneous nerves. also ulnar nerve and medial root of median nerve
posterior cord branches
upper, middle, and lower subscapular nerve, and axillary and radial nerve
roots of musculocutaneous nerve
c567
MC nerve pierces the _________ then runs btween _______
coracobrachialis
biceps and brachialis
roots of median nerve
c678 + t1
sensory portion of median nerve
thumb half of palmar hand, palmar aspect of thumb and digits 2, 3, and 1/2 4 plus their nail beds
sensory portion of ulnar nerve
ulnar half of dorsal and palmar hand
roots of axillary nerve
c56
sensory portion of axillary nerve
glenohumeral joint and superolateral arm
sensory portions of radial nerve
posterior compartment and dorsal aspect of hand on thumb side up to the nail beds. just 2.5 fingers, ulnar does the rest
myotome
group of muscles innervated by one spinal nerve
Erb-duchene palsy roots affected
c56
nerve damaged that causes klumpkes palsy
ulnar
roots affected in klumpkes palsy
c8/t1
ape hand is due to what nerve injury
median
positive froments sign is from ____ nerve damage
ulnar
deltoid branch of thracoacromial trunk travels with
cephalic vein
what two things go through snuff box?
superficial radial nerve and deep radial artery
which two nerves branch from deep branch of radial nerve
radial indicis and princeps pollicis
under the trap, what artery will you find?
transverse cervical artery
how to differentiate circumflex scapular from posterior circumflex humeral?
CS more inferior, toward scapula
2 nerves that come off superior trunk
suprascapular and nerve to subclavius
labrum-
ring of cartilage surrounding glenoid fossa
path of lymph drainage from breast:
subareolar lymphatic plexus–> axillary nodal basin–> pectoral, subscapular, and humeral nodal regions–> apical lymph nodes–> subclavian vein
All spinal nerves are associated with _______ rami communicans
grey
preganglionic sympathetic and parasympathetic neurons release
ACh
brachialis distal attachment
ulnar tuberosity and coronoid process
distal attachment of iceps brachii m
radial tuberosity
smiths fracture-
anterior displacement of radial fragment
colles’ fracture/dinner fork fracture-
posterior displacement of distal radial fragment and possible breaking of tip of ulnar styloid process
lateral aspect of brachialis can receive some innervation from
radial nerve
distal attachment of anconeus
posterior ulna and olecranon
pronator teres proximal attachment
coronoid process and medial epicondyle
pronator teres distal attachment
middle convexity of lateral surface of radius
proximal attachment of flexor carpi ulnaris
medial epicondyle, olecranon, and posterior border of ulna
proximal attacments of FDS
medial epicondyle and superior half of anterior border of radius
proximal attacments of FDP
proximal 3/4 of anterior and medial surfaces of ulna and interosseous membrane
proximal attacments of FPL
anterior surface of radius and interosseous membrane
distal attachment of FPL
base of distal phalanx of thumb
proximal attachment of brachioradialis
proximal 2/3 of lateral supraepicondylar ridge of humerus
distal attachment of brachioradialis
lateral surface of distal end of radius, proximal to styloid process
proximal attachment of ECRL
lateral supraepicondylar ridge
extensor digitorum extends digits at what 2 joints
MCP and IP
proximal attachments of ECU
lateral epicondyle and posterior border of ulna through shared aponeurosis
proximal attachments of supinator
lateral epicondyle, radial and ulnar collateral ligaments, supinator fossa, and crest of ulna
proximal attachments of extensor indicis
posterior surface of distal 1/3 of ulna and interosseous membrane
proximal attacments of Abductor pollicis longus
proximal halves of ulna, radius, and interosseous membrane
proximal attachments of extensor pollicis longus
posterior surface of middle 1/3 of ulna and interosseous membrane
distal attachment of extensor pollicis longus
dorsal aspect of base of distal phalanx of thumb
proximal attachments of extensor pollicis brevis
posterior surface of distal 1/3 of radius and interosseous membrane
distal attachment of extensor pollicis brevis
dorsal aspect of base of proximal phalanx of thumb
superficial nerves of cubital fossa
medial and lateral antebrachial cutaneous nerves
what branch does axillary nerve give off
superior lateral brachial cutaneous nerve
median nerve passes between what in the forearm
heads of pronator teres
ulnar nerve runs between what in the posterior compartment?
septum and medial head of triceps brachii
radial nerve gives off posterior antebrachial cutaneous nerve, which pierces ______ and runs laterally
lateral head of triceps
radial nerve partially runs in anterior compartment until it reemerges between what two muscles
brachialis and brachioradials
deep branch of radial nerve winds around ________ in cubital fossa
neck of radius
superficial branch of radial nerve runs between
pronator teres and brachioradials
radial collateral ligamet attaches distally to
annular ligament
3 bands that make up ulnar collateral ligament
anterior, posterior, and oblique bands
distal attachments of ulnar collateral ligament
olecranon and coronoid process
annular ligament does what-
encircles and braces head of radius in radial notch of ulna
synovial membrane of elbow joint extends distally to the
sacciform recess
nurse maids elbow- radial head dislocates from _____ ligament
annular
axis of distal radioulnar joint is through
head of ulna
triangular ligament is a __________ that covers _________
fibroelastic disc
distal head of ulna
what 2 ligaments join distal radius and ulna
anterior and posterior radioulnar ligaments
scaphoid bone forms the radial border of the carpal tunnel along with the
trapezium
which 2 carpals articulate with radius
scaphoid and lunate
which carpal bone articulates with the articular disc
triquetrum
pisiform forms medial border of
canal of guyon
trapezium articulates with
1st and 2nd metacarpals
the largest carpal bone
capitate
hamate forms lateral border of
canal of guyon
which metacarpal has a styloid process?
3rd
what kind of joint is the radiocarpal joint?
condyloid
ulnar collateral ligament of wrist attaches to
ulnar styloid process and triquetrum
radial collateral ligament or wrist attaches to
radial styloid process and scaphoid
movement of 1st metacarpal joint
flexion and extension only
palmar plates-
enable FDP and FDS muscles to slide smoothly along joints
flexor retinaculum is located between
tubercles of scaphoid and trapezium
medial boders of carpal tunnel
hamate hook and pisiform
tendons present in carpal tunnel
FDS, FDP, FPL
borders of anatomical snuff box
abductor pollics, extensor pollicis brevis, and extensor pollicis longus
which muscle is innervated by superficial branch of ulna
palmaris brevis
proximal attachments of abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis
flexor retinaculum and tubercles of scaphoid and trapezium
distal attachment of abductor pollicis brevis and flexor pollicis brevis
lateral aspect of base of proximal phalanx of thumb
distal attachment of opponens pollicis
lateral side of thumb
proximal attachments of adductor pollicis
capitate, base of 2nd and 3rd metacarpals and shaft of 3rd metacarpal
2 heads of adductor pollicis
transverse and oblique
proximal attachment of abductor digiti minimi
pisiform
proximal attachment of FDM
hamate and flexor retinaculum
ODM proximal attachment-
hook of hamate and flexor retinaculum
proximal attachment of lumbricals
FDP tendons
distal attachment of lumbricals
lateral aspect of extensor expansions
proximal attachment of palmar interossei
palmar aspect of 2nd, 4th, and 5th metacarpals
distal attachment of palmar interossei
base of proximal phalanges and extensor expansions of 2nd, 4th, and 5th digits
proximal attachment of dorsal interossei
adjacent sides of 2 metacarpals
distal attachments of dorsal interossei
bases of proximal phalanges and extensor exansions of 2nd-4th digits
what expands into the extensor expansion?
extensor digitorum tendon
lumbricals and interossei ______ at MCP joint and ______ at PIP joint
flex
extend
radial artery branch near thumb
princeps pollicis
radial artery branch near index finger
radialis indicis
a positive allen test is normal/abnormal?
abnormal
what branches of median nerve innervate 1st and 2nd lumbrical?
are they also sensory?
lateral and medial branch of median nerve
yes
branches of ulnar nerve in hand:
palmar cutaneous, dorsal cutaneous, superficial, and deep
do cutaneous branches of ulnar nerve branch before or after canal of guyon?
before
cutaneous innervation of superficial branch of ulnar nerve
5tha dn half of 4th digit and ulnar side of palm
superficial branch of radial nerve provides what sensory to hand?
basically dorsal lateral half of hand minus cuticles
why do you test radial nerve at metacarpophalangeal joint?
because lumbricals and interossei help extend IP joint and you want only muscles innervated by radial nerve to be tested, which would be extensor digitorum on MCP joint
parasternal plane-
vertical line halfway between midclavicular line and sternal plane
sternal plane-
vertical plane along the lateral aspect of the sternum
subcostal plane-
a transverse plane that runs along the bottom of the rib cage
which vertebral area is at the same level as the angle of louis?
IV disc between T4 and T5
what marks the devision between the superior and inferior mediastinum?
sternal angle
what marks level of ascending and descending parts of arch of aorta?
sternal angle
what marks level where azygos vein ascends into superior vena cava?
sternal angle
what marks level of bifurcation of trachea?
sternal angle
xiphisternal joint corresponds to what part of spine?
IV disc between T9 and T10
subcostal line is at the _____ vertebral level
L3
umbilicus corresponds to the _____ vertebral level
L4
branches of descending aorta that extend along the inferior aspect of the ribs-
posterior intercostal arteries
posterior intercostal arteries anastomose with-
anterior intercostal arteries, which branched from internal thoracic arteries
internal thoracic arteries terminate inferiorly as what arteries?
musculophrenic and superior epigastric arteries
internal thoracic vein drains into
superior vena cava
thoracic spinal nerves only supply what area?
costal
false ribs-
ribs 8-10 attach indirectly to the sternum through the cartilage of the rib above
floating ribs-
ribs 11-12 have no connection to sternum
typical ribs-
ribs 3-9 share same general structure
inferior aspect of internal surface of true ribs have
costal groove
scalene tubercle-
inferior attachment on first rib for anterior scalene muscle
joint between transverse process of vertebra and tubercle of rib is called a
costotransverse joint
3 ligaments that support costotransverse joints
lateral costotransverse ligament, costotransverse ligament, and superior costotransverse ligament
lungs are of _____ origin and will push out laterally into pleural cavities like a fist into a balloon
endodermal
fascia lying between parietal pleura and thoracic wall
endothoracic fascia
bare area of the pericardium-
area of heart not covered by pleura
parietal pleura will be at the level of the ___ rib at the midclavicular line
8th
parietal pleura will be at the level of the ___ rib at the midaxillary line
10th
parietal pleura will be at the level of the ___ rib at the paravertebral line
12th
visceral pleura will be at the level of the ___ rib at the midclavicular line
6th
visceral pleura will be at the level of the ___ rib at the midaxillary line
8th
visceral pleura will be at the level of the ___ rib at the paravertebral line
10th
4 impressions left on the medial surface of the left lung
sulcus for aortic notch, sulcus for subclavian artery, cardiac notch, esophageal sulcus
4 impressions left on medial surface of right lung
sulcus for superior vena cava, azygos vein, and subclavian vein, and cardiac impression
what is the structural unit of the lung
bronchopulmonary segments
bronchopulmonary segments are supplied by
tertiary branches of pulmonary artery
innervation of the lung
anterior and posterior pulmonary plexuses
nociception-
detection of tissue damage
Superficial lymphatic plexus drains what two areas?
where does it drain into?
- lung parenchyma and visceral pleura
- bronchopulmonary lymph nodes
deep lymphatic plexus drains what areas?
where does it drain to?
- submucosa of bronchi and peribronchial CT
- pulmonary lymph nodes–>bronchopulmonary lymph nodes–>tracheobronchial lymph nodes–>bronchomediastinal lymph trunks
if there was a gunshot through center of manubrium, what structures would the bullet penetrate through?
skin, subcutaneous fascia, manubrium, left brachiocephalic vein, arch of aorta and its major vessels, trachea, esophagus, vertebral column
if there is a 4th branch off the aorta, it is the
left vertebral artery
fibrous pericardium is continuous with
tunica adventitia of roots of great vessels
pericardiophrenic artery can convey pain called
pericarditis
upper left border of heart landmark
2nd left costal cartilage
apex of heart landmark
5th left intercostal space
lower right border of heart landmark
6th right costal cartilage
upper right border of heart landmark
3rd right costal cartilage
only place that fibrocartilaginous skeleton of heart does not act as an insulator
opening between AV and aortic valves (bundle of his)
smooth portion of right atrium
sinus venarum
remnant of primitive atrium of embryo
auricle
thick line that separates rough and smooth portion of right atrium
crista terminalis
small depression that corresponds externally to the crista terminalis
sulcus terminalis
thickening of top of fossa ovalis
Limbus of fossa ovalis
muscular projections of right ventricle
trabeculae carnea
smooth portion at superior part of right ventricle
conus arteriosus
conus arteriosus is separated from rough part of right ventricle by
superventricular crest
right ventricle papillary muscles, which cusps do they attach to?
anterior papillary-
posterior papillary-
septal papillary-
anterior and posterior cusps
posterior and septal cusps
anterior and septal cusps
rough muscle in left ventricle
trabeculae carneae
coronary arteries begin where?
right and left aortic sinuses
openings of coronary arteries are called?
orifices. for example, orifice of right coronary artery
left coronary artery travels in the
atrioventrecular sulcus
great cardiac vein travels parallel to the
circumflex coronary artery
small cardiac vein travels in the
atrioventrcular groove with the marginal nerve
only cardiac veins that don’t drain into coronary sinus
small anterior cardiac veins
Cardiac plexus contains what kind of nerve fibers?
GVA and GVE
