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MSK Exam II > Deep Back And Suboccipital Triangle > Flashcards

Deep Back And Suboccipital Triangle Flashcards

1
Q

What are the 2 deep back muscles that are considered extrinsic?

A

Serratus posterior superior m.

Serratus posterior inferior m.

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2
Q

Origin/insertion/innervation/action:

Serratus posterior superior m.

A

Origin: lower part of ligamentum nuchae and cervical and thoracic spines

Insertion: ribs 2-5

Innervation: anterior/ventral rami of spinal nn. Of brachial plexus

Action: elevates ribs 2-5

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3
Q

Origin/insertion/innervation/action:

Serratus posterior inferior m.

A

Origin: thoracic and lumbar spines

Insertion: ribs 9-12

Innervation: anterior/ventral rami of spinal nn. of brachial plexus

Action: depresses ribs 9-12

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4
Q

What muscles of the deep back are considered intrinsic?

A

Splenius muscles
Erector spinae group
Transversospinalis group
Minor deep back muscles

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5
Q

What are the primary functions of extrinsic back muscles?

A

Move the limbs; thoracic proprioception

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6
Q

What are the primary functions of intrinsic back muscles?

A

Support upright posture; movements of vertebral column + proprioception

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7
Q

In general, what provides innervation to intrinsic back muscles?

A

Posterior/dorsal rami of spinal nn.

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8
Q

Origin of both splenius mm. (Splenius cervicis and Splenius capitis)

A

Nuchal ligament and spinous processes of T1-T6 vertebrae

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9
Q

Insertion of splenius capitis m.

A

Mastoid process and occipital bone of skull

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10
Q

Innervation of splenius capitis m.

A

Posterior (dorsal) rami of spinal nn. C3-4

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11
Q

Origin of splenius cervicis m.

A

Nuchal ligament and spinous processes of T3-6

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12
Q

Insertion of splenius cervicis m.

A

Transverse processes of C1-4

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13
Q

Innervation of splenius cervicis m.

A

Posterior (dorsal) rami of lower cervical spinal nn.

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14
Q

What are the unilateral vs. bilateral actions of the splenius muscles (capitis and cervicis)?

A

Unilateral: laterally flex neck and rotate head to ipsilateral side

Bilateral: extend head

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15
Q

What muscles are included in the erector spinae group?

A

Iliocostalis
Longissimus
Spinalis

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16
Q

What are the 3 parts to iliocostalis?

A

Iliocostalis lumborum, thoracis, and cervicis

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17
Q

What are the 3 parts to longissimus m.?

A

Longissimus thoracis, cervicis, and capitis

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18
Q

What are the 3 parts to spinalis m.?

A

Spinalis thoracis, cervicis, and capitis

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19
Q

What is the origin of all erector spinae muscles?

A

They have a common tendinous origin at the sacrum via erector spinae aponeurosis

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20
Q

Insertion of iliocostalis m.

A

Costal angle of ribs and cervical transverse processes

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21
Q

What provides innervation to ALL erector spinae mm?

A

Posterior rami of spinal nn.

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22
Q

Insertion of longissimus m.

A

Lower ribs, transverse processes of C2-T12, mastoid process of skull

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23
Q

Insertion of spinalis m.

A

Spinous processes of C2, T1-8, and occipital bone

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24
Q

What are the unilateral vs. bilateral actions of the erector spinae group?

A

Unilateral: laterally flex vertebral column

Bilateral: extend vertebral column and head

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25
Q

What muscles are included in the transversospinalis group?

A

Semispinalis m.
Multifidus m.
Rotatores m.

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26
Q

What muscle group is the deep layer occupying the trench between transverse and spinous processes?

A

Transversospinalis group

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27
Q

Origin of semispinalis m.

A

Transverse processes of C4-T10

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28
Q

Insertion of semispinalis m.

A

Spinous processes of C2-T4 and occipital bone

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29
Q

What innervates ALL muscles in transversospinalis group?

A

Posterior rami of spinal nn.

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30
Q

3 parts of semispinalis m.

A

Semispinalis thoracis, cervicis, and capitis

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31
Q

What muscle makes up the middle layer of short triangular bundles in the transversospinalis group and is the thickest in the lumbar region?

A

Multifidus m.

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32
Q

Origin of multifidus m.

A

Broad origin from sacrum, PSIS, common tendinous origin of erector spinae, mamillary processes of lumbar vertebrae, transverse processes of T1-3 and articular processes of C4-7

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33
Q

Insertion of multifidus m.

A

Spinous processes of vertebrae

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34
Q

Action of multifidus m.

A

Stabilizes vertebrae during location movements of vertebral column

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35
Q

What muscle is the deepest layer of rotator muscles in the transversospinalis group and is most developed in the thoracic region?

A

Rotatores m

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36
Q

Origin of rotatores m.

A

Vertebral transverse processes

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37
Q

Insertion of rotatores m.

A

Lamina and spinous processes of immediately superior vertebrae

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38
Q

Action of rotatores m.

A

Stabilizes vertebrae and assists with local extension and rotatory movements; possibly proprioception

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39
Q

What 3 muscles are included in the minor deep layer of the back?

A

Interspinalis m.
Intertransversarii m.
Levatores costarum m.

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40
Q

What muscle of the minor deep muscles of the back elevates the ribs, assists with respiration, and lateral flexion?

A

Levatores costarum m.

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41
Q

What muscle of the minor deep muscles of the back spans between adjacent SPINOUS processes?

A

Interspinalis m.

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42
Q

What muscle of the minor deep muscles of the back spans between adjacent transverse processes?

A

Intertransversarii m.

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43
Q

Action of interspinalis m.

A

Aids in extension/rotation in vertebral column

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44
Q

Action of intertransversarri m.

A

Aids in lateral flexion, bilateral stabilization of vertebral column

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45
Q

Origin of levatores costarum m.

A

Transverse processes of C7-T11, attaches to rib immediately below

46
Q

The suboccipital region includes posterior aspects of what vertebrae?

A

C1 - atlas

C2 - Axis

47
Q

Which vertebra has no body associated with it?

A

C1 - Atlas

48
Q

What portion of the atlas articulates with the occipital condyles?

A

Superior articular facets

49
Q

What structure associated with the atlas is continuous with the ligamentum flava?

A

Posterior atlantooccipital membrane

50
Q

How does the axis articulate with the atlas?

A

C2 articulates with C1 via median and lateral atlantoaxial joints

51
Q

What are the 3 muscles that form the borders of the suboccipital triangle?

A

Rectus capitis posterior major m.
Obliquus capitis superior m.
Obliquus capitis inferior m.

52
Q

What forms the floor of the suboccipital triangle?

A

Posterior atlantooccipital membrane and posterior arch of C1

53
Q

What forms the roof of the suboccipital triangle?

A

Semispinalis capitis m.

54
Q

What structures are contained by the suboccipital triangle?

A

Vertebral a.
Suboccipital n.
Suboccipital venous plexus

55
Q

What are the 2 primary blood supplies to the suboccipital region?

A

Vertebral a.

Occipital a.

56
Q

The vertebral a. begins at the root of the neck where it branches off the ________ artery.

It ascends through transverse foramina of C7 to C2, perforates the dura and passes through the foramen magnum, ultimately forming the _______ arteries

A

Subclavian; basilar

57
Q

What provides sensory innervation over neck and occipital bone?

A

Greater occipital n.

58
Q

What nerve supplies motor innervation to suboccipital muscles?

A

Suboccipital n.

59
Q

What provides sensory innervation to superolateral neck and scalp?

A

Lesser occipital n.

60
Q

Origin of rectus capitis posterior major m.

A

Spinous process of C2

61
Q

Insertion of rectus capitis posterior major m.

A

Lateral part of inferior nuchal line of occipital bone

62
Q

Innervation of rectus capitis posterior major m.

A

Suboccipital n.

63
Q

Action of rectus capitis posterior major m.

64
Q

Origin of rectus capitis posterior minor m.

A

Posterior tubercle of C1

65
Q

Insertion of rectus capitis posterior minor m.

A

Medial part of inferior nuchal line of occipital bone

66
Q

Innervation of rectus capitis posterior minor m.

A

Suboccipital n.

67
Q

Action of rectus capitis posterior minor m.

68
Q

Origin of obliquus capitis superior m.

A

Transverse process of C1

69
Q

Insertion of obliquus capitis superior m.

A

Occipital bone between superior and inferior nuchal lines

70
Q

Innervation of obliquus capitis superior m.

A

Suboccipital n.

71
Q

Action of obliquus capitis superior m.

A

Lateral flexion

72
Q

Origin of obliquus capitis inferior m.

A

Posterior tubercle of C2

73
Q

Insertion of obliquus capitis inferior m.

A

Transverse process of C1

74
Q

Innervation of obliquus capitis inferior m.

A

Suboccipital n.

75
Q

Action of obliquus capitis inferior m.

A

Extension and rotation of head

76
Q

Origin/insertion/innervation/action of:

Serratus posterior superior m.

A

Origin: lower part of ligamentum nuchae and cervical and thoracic spins

Insertion: ribs 2-5

Innervation: anterior rami of spinal nn. of brachial plexus

Action: elevates ribs 2-5

77
Q

Origin/insertion/innervation/action of:

Serratus posterior inferior m.

A

Origin: thoracic and lumbar spines

Insertion: ribs 9-12

Innervation: anterior rami of spinal nn. of brachial plexus

Actions: depresses ribs 9-12

78
Q

Origin/insertion/innervation/action of:

Splenius capitis m.

A

Origin: lower aspect of ligamentum nuchae and spinous process of C7-T3/4

Insertion: mastoid process and occipital bone

Innervation: posterior rami of spinal nn. C3-4

Action: unilaterally laterally flexes neck and rotates head to ipsilateral side, bilaterally extends head

79
Q

Origin/insertion/innervation/action of:

Splenius cervicis m.

A

Origin: spinous processes of T3-6

Insertion: transverse process of C1-3/4

Innervation: posterior rami of lower cervical spinal nn.

Actions: unilaterally laterally flexes neck and rotates head to ipsilateral side; bilaterally extends head

80
Q

Origin/insertion/innervation/action of:

Iliocostalis m.

A

Origin: common tendinous origin

Insertion: costal angle of ribs and cervical transverse processes

Innervation: posterior rami of spinal nn.

Action: lateral flexion of vertebral column, bilaterally extends vertebral column and head

81
Q

Origin/insertion/innervation/action of:

Longissimus m.

A

Origin: common tendinous origin

Insertion: lower ribs, transverse processes of C2-T12, mastoid process

Innervation: posterior rami of spinal nn.

Actions: lateral flexion of vertebral column; bilateral extension of vertebral column and head

82
Q

Origin/insertion/innervation/action of:

Spinalis m.

A

Origin: common tendinous origin

Insertion: spinous processes of C2, T1-8, and occipital bone

Innervation: posterior rami of spinal nn.

Action: lateral flexion of vertebral column; bilateral extension of vertebral column and head

83
Q

Origin/insertion/innervation of:

Semispinalis m.

A

Origin: transverse processes of C4-T10

Insertion: spinous processes of C2-T4 and occipital bone

Innervation: posterior rami of spinal n.

84
Q

Origin/insertion/innervation/action of:

Multifidus m.

A

Origin: broad origin from sacrum, PSIS, common tendinous origin of erector spinae, mammillary processes of lumbar vertebrae, transverse processes of T1-3 and articular processes of C4-7

Insertion: spinous processes of vertebrae

Innervation: posterior rami of spinal nn.

Action: stabilize vertebrae during movements of vertebral column

85
Q

Origin/insertion/innervation/action of:

Rotatores m.

A

Origin: vertebral transverse processes

Insertion: lamina and spinous processes

Innervation: posterior rami of spinal nn.

Action: stabilize vertebrae and assist with local extension and rotatory movements; possibly proprioception

86
Q

Origin/insertion/innervation/action of:

Recus capitis posterior major m.

A

Origin: spinous process of C2

Insertion: lateral part of inferior nuchal line of occipital bone

Innervation: suboccipital n.

Action: extension

87
Q

Origin/insertion/innervation/action of:

Rectus capitis posterior minor m.

A

Origin: posterior tubercle of C1

Insertion: medial part of inferior nuchal line of occipital bone

Innervation: suboccipital n.

Action: extension

88
Q

Origin/insertion/innervation/action of:

Obliquus capitis superior m.

A

Origin: transverse process of C1

Insertion: occipital bone between superior and inferior nuchal lines

Innervation: suboccipital n.

Action: lateral flexion

89
Q

Origin/insertion/innervation/action of:

Obliquus capitis inferior m.

A

Origin: posterior tubercle of C2

Insertion: transverse process of C1

Innervation: suboccipital n.

Action: extension and rotation of head

90
Q

__________ vertebrae are less tightly interlocked and thus more prone to dislocation; if severe enough, damage/trauma to spinal cord may occur

91
Q

How does fracture of the atlas typically occur?

A

Sudden, forceful compression of C1 (diving accidents, roll-over car accidents, etc.)

92
Q

What is the Hangman’s fracture?

A

Fracture of vertebral arch of C2 involving fracture of pars interarticularis

Caused by hyperextension of the neck

93
Q

Fracture of the dens most commonly occurs where?

A

At the base, but may also occur along body of axis

94
Q

How does the dens typically get fractured?

A

Horizontal blow to the head

95
Q

What are the 3 types of dens fracture?

A

Type 1: fracture of upper odontoid process

Type 2: fracture at base of odontoid process - most common

Type 3: fracture through odontoid process and into lateral masses of C2

96
Q

The 3 types of dens fracture are:

Type 1: fracture of upper odontoid process

Type 2: fracture at base of odontoid process

Type 3: fracture through odontoid process and into lateral masses of C2

Which of the above is the most common?

A

Type 2 - fracture at base of odontoid process

97
Q

The 3 types of dens fracture are:

Type 1: fracture of upper odontoid process

Type 2: fracture at base of odontoid process

Type 3: fracture through odontoid process and into lateral masses of C2

Which of the above has the best prognosis for healing?

98
Q

The 3 types of dens fracture are:

Type 1: fracture of upper odontoid process

Type 2: fracture at base of odontoid process

Type 3: fracture through odontoid process and into lateral masses of C2

Which of the above is the most rare?

99
Q

What is the most common mechanism of soft tissue injury affecting the suboccipital region?

A

Acceleration/deceleration syndrome aka Whiplash

100
Q

What pathology of the suboccipital region may lead to reduced blood flow to brainstem d/t occlusion of this a. at the atlantoaxial joint

May be caused by trauma, cervical spine abnormalities, or CV disease

Signs/symptoms may include dizziness/vertigo and/or confusion

A

Vertebral artery impingement

101
Q

What condition results from irritation of greater and lesser occipital nerves?

A

Occipital neuralgia

102
Q

What are the symptoms of occipital neuralgia?

A

Burning or stabbing pain triggered by neck movement

Scalp tenderness

Pain behind eyes

Headache

103
Q

What are some causes of occipital neuralgia?

A

Osteoarthritis of cervical vertebrae

Neck injury

Muscle spasms in the neck

Tumors, infection, gout, DM

104
Q

Which of the following arises from the inferior thyroid a., has multiple unnamed muscular branches, and supplies the deep muscles of the neck?

A. Deep cervical a.
B. Cervical ascending a.
C. Lumbar a.
D. Vertebral a.

A

B. Cervical ascending a.

105
Q

Which of the following arises from the costocervical trunk, has multiple unnamed branches, and supplies the deep muscles of the posterior neck?

A. Deep cervical a.
B. Cervical ascending a.
C. Lumbar a.
D. Vertebral a.

A

A. Deep cervical a.

106
Q

Which of the following arises from the 2nd part of the subclavian a., branches into the deep cervical and highest intercostal aa., and supplies the deep muscles of the posterior neck as well as the posterior ends of the first 2 intercostal spaces?

A. Cervical ascending a.
B. Costocervical trunk
C. Lumbar a.
D. Vertebral a.

A

B. Costocervical trunk

107
Q

Which of the following arises from the abdominal aorta, branches into 3 parts, and supplies the psoas major, psoas minor, quadratus lumborum, spinal cord, vertebral column, and deep back muscles?

A. Cervical ascending a.
B. Costocervical trunk
C. Vertebral a.
D. Lumbar a.

A

D. Lumbar a.

108
Q

Which of the following arises from the 1st part of the subclavian a., branches into the inferior thyroid a., transverse cervical a., and suprascapular a., and supplies the lower neck, posterior shoulder, and thyroid gland?

A. Cervical ascending a.
B. Deep cervical a.
C. Costocervical trunk
D. Thryocervical trunk

A

D. Thyrocervical trunk

109
Q

Which of the following arises from the 1st part of the subclavian a., branches into anterior spinal a., posterior inferior cerebellar a., and basilar aa., and supplies deep neck structures, spinal cord, and medulla?

A

Vertebral a.

110
Q

What muscles are typically affected in back strain?

A

Erector spinae mm.

111
Q

What injury commonly occurs due to overly strong contraction of back muscles leading to stretching/tearing of fibers?

A

Back strain

112
Q

What pathology results from injury to ligamentous tissue or ligament attachement to bone due to excessive extension or rotation, but NOT fracture?

A

Back sprain

MSK Exam II (20 decks)

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