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Musculoskeletal > Clinical Anatomy of the Back > Flashcards

Clinical Anatomy of the Back Flashcards

1
Q

Indications for imaging of the back? (7)

A
  1. Trauma
  2. Progressive Neuropathic Pain
  3. Congenital Defects
  4. Suspicion of infection
  5. History of cancer
  6. Fever
  7. Progressive or prolonged back pain
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2
Q

Attenuation of structures in an X-ray?

A

Metal (white) > Bone > Soft Tissue > Fat > Air (black)

Attenuation increases of a structure/material increases density

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3
Q

Walls of blood vessels deep to superficial (3)?

A

Tunica initma: inner endothelial lining
Tunica media: middle smooth muscle layer, may contain elastic fibers
Tunica externa (adventitia): outer connective tissue layer

Tunica intima have valves in veins to prevent backflow

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4
Q

Circulatory route (common)

A

Heart-Arteries-Arterioles-Capillary bed-Venules-Veins-Heart

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5
Q

Circulatory Route: Portal System

A

Blood flows through consecutive capillary beds before returning to heart

Examples:
1. Between intestines/liver
2. Anterior Pituitary

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6
Q

Arteriovenous Shunt

A

Artery flows directly into a vein.
Examples: fingers, toes, ears

Allows blood to bypass exposed areas during cold. For DECREASE heat loss

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7
Q

Anastomosis

A

Union of branches of two or more vessels

Venous: allows for alternate drainage of organs

Arterial: collateral circulation

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8
Q

Where does the R side of the body drain lymph?

A

R lymphatic duct

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8
Q

Where does the R side of the body drain lymph?

A

R lymphatic duct

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9
Q

Where does most of the body drain lymph into?

All Left and lower R

A

Thoracic duct

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10
Q

Where do Somites form from?

A

Paraxial mesoderm

Develop alongside the developing neural tube as paired segments

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11
Q

What are the two major parts of the somites?

A
  1. Sclerotome: verterbral column
  2. Dermomyotome:
    Dermatome: skin
    Myotome: muscles of trunk and limb

General Concept: dermatome and myotome develop from a single segment and is invervated by a single spinal nerve

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12
Q

Where does spinal nerves C1 and C8 exit?

A

Above same number vetebra

C8 exits above T1 as there is no C8 vertebra

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13
Q

Where do spinal nerves C2-C7, T1 to end of cord exit?

A

Below their respective vetebra

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14
Q

Somatic Plexuses

A

Cervical: C1-C5
Brachial: C5-T1
Lumbar: L1-L4
Sacral: L5-S4

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15
Q

General concept for afferent sensory fibers

3 neuron chain

A
  1. First order: arises at the organ (or muscle) and has two processes. One on either side of the cell body. Cell body is located outside of CNS (DRG). NO SYNAPSE HERE
    -Central process enters the CNS and synapses on the next neuron (FIRST SYNAPSE)
  2. Second order: arises from the gray horn of the spinal cord or brainstem nucleus and synapses in the thalamus
  3. Third order: arises from the thalamus and ends in the cortex

Olfactory does not follow the pattern

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16
Q

General concept of sympathetic efferent fibers

Target tissue

A

Lateral grey horn of T1-L2
Ventral roots–>ventral rami–> white rami communicants–> grey rami commmunicants

  1. Synapse and exit through grey rami communicants
  2. Travel up or down the chain to synapse in a different location
  3. Exit without synapsing=splanchnic nerves (directly to organ)

Target tissues: Heart, BV, Organs, SM, Glands

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17
Q

General Concept of Parasympathetic efferent fibers

Brainstem

A

Cranial nerve–>Parasympathetic Ganglion

Target tissue: Visceral motor fibers
1. Constrictor pupillae
2. Lacrimal gland
3. Salivary gland
4. Minor glands along the mucous membrane

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18
Q

General Concept of Parasympathetic efferent fibers

Spinal Cord S2-S4

A

Ventral roots–>ventral rami–> pelvic splanchnic nerves–>ganglia in organ walls

Target tissue: BV, Organs, SM, Glands

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19
Q

Dermatomes

A

C6: Thumb
T4: Nipple
T10: Umbilicus
L5: Big Toe
S2: Back of Thigh

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20
Q

Referred Pain definition?

A

Pain felt in an area that is different to where the injury occurred

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21
Q

Adult/Newborn Conus Medullaris ends at…?

A

Adult: L1-L2
Newborn: L3-L4

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22
Q

Pia Mater derived from?

Creates what (2)

A

Derived from neural crest cells

Creates: Denticulate Ligament
Filum Terminale

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23
Q

What is in the epidural space?

A

Nerves and Batson’s plexus

Batson’s Plexus has no valves-infections can metastasize

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24
Q

What is in the subarachnoid space?

A

CSF

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25
Q

Why perform a fasciotomy?

A

Relieve increasing pressure in MSK compartments

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26
Q

Importance of Fascia? (4)

A
  1. Interconnects all structures of the body-contains collagen fibers in sheets orientated in different directions
  2. Allows for sliding of the muscular structure
  3. Reduce friction
  4. Increase force of contraction
27
Q

Splenius Muscle (Function, innervation, blood supply)

Intrinsic Back Muscles

A

Fx: Bilateral: extension of neck
Unilateral: ipsilateral lateral flexion and rotation of vertebral column
Innervation: Posterior (Dorsal) Rami of Cervical Spinal Nerves
Blood Supply: Deep Cervical Artery/Occipital Artery

28
Q

Erector Spinae Muscle Group (Function, innervation, blood supply)

Intrinsic Back Muscles

A

Fx: Bilateral: extension of vertebral column and head; during flexion of back allow for control movement by gradually lengthening fibers
Unilateral: ipsilateral flexion of vertebral column

Innervation: Posterior (Dorsal) Rami of Spinal Nerves

Blood Supply: Vertebral artery, deep cervical artery, occipital artery, transverse cervical artery, Posterior Intercostal Artery, Lumbar Artery, Lateral Sacral Artery

29
Q

Semispinalis Muscle (Function, innervation, blood supply)

Intrinsic Back Muscles

A

Fx: Bilateral: extends head, cervical and thoracic regions of vertebral column
Unilateral: Contralateral rotation of the vertebral column contralaterally
Innervation: Posterior (Dorsal) Rami of Spinal Nerves
Blood Supply: Deep Cervical Artery, Posterior Intercostal Artery, Subcostal Artery, Lumbary Artery

30
Q

Multifudus (Function, innervation, blood supply)

Intrinsic Back Muscles

A

Fx: Stabilizes vertebrae
Innervation: Posterior (Dorsal) Rami of Spinal Nerves
Blood Supply: Deep Cervical, Posterior Intercostal Artery, Subcostal Artery, Lumbar Artery

31
Q

Rotatores (Function, innervation, blood supply)

Intrinsic Back Muscles

A

Fx: Stabilizes vertebrae and assist with local extension and rotatory movement of vertebral column
Innervation: Posterior (Dorsal) Rami of Spinal Nerves
Blood Supply: Deep Cervical, Posterior Intercostal Artery, Subcostal Artery, Lumbar Artery

32
Q

Interspinales Muscle (Function, innervation, blood supply)

Intrinsic Back Muscles

A

Fx: Posturual and stabilizes vertebrae
Innervation: Posterior (Dorsal) Rami of Spinal nerves

33
Q

Intertransversarii Muscle (Function, innervation)

Intrinsic Back Muscle

A

Fx: Postural and stabilizes vertebrae
Innervation: Posterior (Dorsal) Rami of Spinal Nerves

34
Q

Levatores Costarum (Function, innervation)

Intrinsic Back Muscle

A

Fx: Elevation of ribs (respiratory function)-assist with lateral flexion of vertebral column
Innervation: Posterior (Dorsal) Rami of Spinal Nerves

35
Q

Trapezius (Function, innervation, blood supply)

Superficial Back Muscle

A

Fx: Assists in rotating scapula during abduction of humerus above horizontal
1. Upper: elevate scapula
2. Middle: adduct the scapula
3. Lower: depress scapula
Innervation: Accessory nerve (CN XI), cervical spinal nerves C3/C4 (proprioception)
Blood Supply: Superficial branch of transverse cervical artery

36
Q

Latissimus Dorsi (Function, innervation, blood supply)

Superficial Back Muscle

A

Fx: Extends, adducts, and medially rotates humerus
Innervation: Thoracodorsal nerve (C6-C8)
Blood Supply: Thoracodorsal artery

37
Q

Levator Scapulae (Function, innervation, blood supply)

Superficial Back Muscle

A

Fx: Elevate scapula
Innervation: C3-C4, Dorsal scapular nerve
Blood Supply: Transverse and ascending cervical arteries

38
Q

Rhomboid Major/Minor (Function, innervation, blood supply)

Superficial Back Muscle

A

Fx: Retract (adduct) and elevate scapula
Innervation:Dorsal scapular nerve (C4-C5)
Blood Supply: Deep branch of transverse cervical artery and/or dorsal scapular artery

39
Q

Serratus Posterior Superior (Function, innervation, blood supply)

Superifical Back Muscle

A

Fx: Elevate ribs 2 to 5
Innervation: Anterior rami of upper thoracic (intercostal) nerves T2-T5
Blood Supply: Segmental supply through intercostal arteries

40
Q

Serratus Posterior Inferior (Function, innervation, blood supply)

Superficial Back Muscle

A

Fx: Depress ribs 9-12 and may prevent lower ribs from elevating when diaphragm contracts
Innervation: Anterior rami of lower thoracic (intercostal) nerves T9-12
Blood Supply: Segmental supply through intercostal arteries

41
Q

Supraspinatus (Function, innervation, blood supply)

Superficial Back Muscle

A

Fx:Rotator cuff muscle; initation of abduction of the humerus to 15 degreeas at the shoulder joint
Innervation Suprascapular nerve (C5-C6)
Blood Supply: Suprascapular Artery

42
Q

Infraspinatus (Function, innervation, blood supply)

Superficial Back Muscles

A

Fx: Rotator Cuff Muscle; lateral rotation of the humerus at the shoulder joint
Innervation: Suprascapular nerve (C5-C6)
Blood Supply: Suprascapular and Circumflex Scapular Arteries

43
Q

Teres Minor (Function, innervation, blood supply)

Superficial Back Muscle

A

Fx: Rotator Cuff Muscle; Lateral rotation of the arm at the shoulder joint
Innervation: C3-C4 Dorsal Scapular Nerve
Blood Supply: Posterior Humeral Circumflex Artery

44
Q

Teres Major (Function, innervation, blood supply)

Superficial Back Muscles

A

Fx: Medial Rotation and extension of the arm at the glenohumeral joint
Innervation: Axillary Nerve (C5/C6)
Blood Supply: Posterior Circumflex Artery and Thoracodorsal branch of the Subscapular Atery

45
Q

Triceps Muscle-Long Head (Function, innervation, blood supply)

Superficial Back Muscle

A

Fx: Extension of the forearm at the elbow joint; accessory adductor and extensor of the arm at the glenohumeral joint
Innervation:Radial Nerve (C6-C8)
Blood Supply: Deep Brachial Artery (Profunda Brachii)

46
Q

Hilton’s Law

A

A joint is innervated by a nere innervating the muscle moving the joint. This nerve also innervates the skin over the joint

47
Q

Lymph drainage: Occipital, Deep Cervical, Axillary (posterior), Paravertebral Nodes

A

Occipital, Deep cervical, Axillary: Skin of the back and neck drains
Paravertebral: muscles of the back

48
Q

Triangle of Auscultation Borders

A

Prime Pulmonary Auscultation

Inferior: Superior border of Latissimus Dorsi
Medial: Lateral border of Trapezius
Lateral: Medial Border of Scapula

49
Q

Triangle of Petit

Inferior Lumbar Triangle/Lumbar Triangle

A

Inferior: Iliac Crest
Posterior: Latissimus Dorsi
Anterior: External Oblique
Floor: Internal Oblique and Transversus Abdominus

Bulge in the lumbar region-may be unilateral/bilateral.

Rare type of hernia-aquired or congenital

50
Q

How to Read and X-Ray of the Back Region

A

Lateral View: Three Column approach

Anterior-Posterior View: Lateral Lines (2) and Spinous Line

51
Q

Why use an open mouth view? (xray)

A

ALignment of odontoid process with C1 lateral masses

52
Q

T2 vs T1 MRI

A

T2 hyperintensifies water
“H2O”

53
Q

2 “Pop” in an LP

A

First: Ligamentum flavum

Second: Dura mater

54
Q

Supracristal line for LP

A

Palpate for the top of the iliac crest and imagine a horizontal line connecting the two crests
-L4-L5

55
Q

What ligaments are damaged in a whiplash injury?

A

Hyperexention injury of the neck

Anterior longitudinal ligament (hyperextension)
**Nuchal ligament **(hyperflexion)

Symptoms: headache, neck pain radiating to shoulders, upper back pain, dizziness, and neurological signs of concussion

This is a noncontact applied force. Contact injuries can have same S/S

56
Q

Transverse Ligament Rupture

A
  1. Can be a result of whiplash
  2. Causes an increase in flexion angle of the skull and cervicle vertebrae
  3. Disolocation of the dens into vertebral canal leading to compression of spinal cord–>cardiorespiratory issues.

Pt could present, unconscious, paraplegic, incontinent

57
Q

Dens Fracture

Type I,II,III

A

Dens # can occur w/ both flexion or extension injuries

Avulsion of dens posteriorly can compress spinal cord–> +ve neurological symptoms
1. Neck pain
2. Numbness in limbs
3. Quadriplegia
4. Respiratory arrest d/t diaphragm paralysis

Type I: # above mid line of dens
Type II: # horizontal line including all of dens
Type III: # extends into vertebral body

58
Q

Jefferson Fracture

A

Burst fracture of the C1 vertebrae
Axial loading injury –> lateral masses move outward and could cause transverse ligament damage leading towards respiratory issues. Highly unstable #

59
Q

Describe what a disc herniation is

A

Increase in size of nucleus pulposus. Causes a bulge into the spinal cord

60
Q

Spondylosis

A

Arthritis that develops in the facet joints-means bone spurs are forming

61
Q

Spondylolysis

A

Stress fracture of the pars interarticular of lumbar vertebrae.

+/- neuro symptoms
Unilateral or bilateral

Need an oblique view of xray to visualize

62
Q

Spondylolisthesis

A

Anterior slippage which can be a result in narrowing of intervertebral foarmina–>spinal nerve impingements–>neurological S/S

If occuring w/ spondylolysis it is called Spondylolytic spondylolisthesis

63
Q

What is the one “pop” felt for a epidural?

A

Ligamentum flavum

64
Q

What is Sacral Analgesia?

Caudal Anesthesia

A
  1. Provides anesthesia to the caudal nerve roots
  2. Needle inserted into sacral hiatus
  3. Done under U/S guidance
65
Q

What is the difference between Sacralization/Lumbarization?

A

Sacrilization: is when there is a partial fusion of lumbar to sacrum

Lumbarization: is there is a partial separation of S1 from the sacrum

66
Q

What is Klippel Feil?

A

Congenital fusion of cervical vertebrae leading to a shorten neck.

Physical features: shortened neck, decreased ROM, low hairline

Associated w/ scoliosis and hemivertebrae(half of a vertebrae doesn’t form and leads to scoliosis)

Musculoskeletal (3 decks)

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