Exam 1 Flashcards
What is in the triangle of auscultation?
Trapezius and latissimus dorsi (no bone for stethoscope)
What happens if long thoracic nerve is injured?
Winging of the scapula
(the medial border of the scapula moves laterally and posteriorly away from the thoracic wall).
What is the boxer’s muscle?
Serratus anterior
LTN and LTA
Func: protracts scapula forward
orgin: upper 8 ribs
Insertions: vental medial border of scapula
What do only the 7 cervical vertebrae have?
Foramen transversarium
holes in transverse processes that transmit the vertebral vessels
Describe C1
Atlas
No vertebral body or spinous process
Articulates with head and axis
Ring shaped
Describe C2
Axis
odontoid process = DENS as body
Strong bifid spinous process
C1 fuses to body of C2
What vertebrae is most prominent?
C7
long non bifid spinous process
What is the atlanto-occipital joint?
Yes yes joint
nodding = flexion and extension
Between C1 (atlas) and skull
What is the atlanto axial joint?
No no joint
rotation
between C1 atlas and axis dens
Median atlanto-axial = Pivot (around dens)
Lateral atlanto-axial = Gliding (facets)
Where is the best place for a noose?
Between C1 and C2 so that dens crushes spinal cord
What must be removed to expose the suboccipital triangle?
Trapezius
Sternocleidomastoid
Splenius capitis
Semispinalis capitis
What three muscles form the suboccipital triangle?
Obliquus capitus superior
Obliquus capitus inferior
Rectus capitus major
What is the floor and roof of suboccipital triangle?
Roof: semispinalis capitis
Floor: posterior arch of Atlas C1
What structures are in the floor of suboccipital triangle?
Posterior arch of Atlas
1) Dorsal rami C1 (suboccipital nerve)
2) Vertebral artery
What structures are in the roof of the suboccipital triangle?
semispinalis capitis
1) great occipital nerve C2
2) occipital artery
What is vertebral artery a branch of?
The subclavian artery
comes in at C6
What is the occipital artery a branch of?
The external carotid artery
Describe suboccipital nerve
Doral ramus of C1
Purely motor
supplies 4 suboccipital muscles
Describe greater occipital nerve
Dorsal ramus of C2 purely sensory- DO NOT INNERVATE lower border of inferior oblique pierces semispinalis capitis and trapezius supplies scalp to vertex
Origin and insertion of rectus capitis posterior major
origin: spinous process of vertebra C2
insert: lateral part of inferior nuchal line of occipital bone
Origin and insertion of rectus capitis posterior minor
origin: posterior tubercle of posterior arch of vertebra C1 atlas
insert: medial part of inferior nuchal line of occipital bone
Origin and insertion of obliquus capitis inferior
origin: posterior tubercle of posterior arch of C2 axis (spine of axis)
insert: transverse process of C1 atlas
Origin and insertion of obliquus capitis superior
origin: transverse process of C1
insert: occipital bone between superior and inferior nuchal lines
how many vertebrae in the vertebral column?
33
How may cervical vertebrae?
7
How many thoracic vertebrae?
12
for ribs
How many lumbar vertebrae?
5
last flexible- support weight
How many sacral vertebrae?
5
fused- stability
How many coccyx vertebrae?
4
co2-4 are fused
What are the 4 curvatures of the vertebral column?
Cervical lordosis- 2ry- when infant can support weight of head
Thoracic kyphosis- primary- fetal position
Lumbar lordosis- 2ry- when infant walks and can support own weight
Sacral kyphosis- 1ry curvature
What are abnormal spinal curvatures?
Excessive kyphosis- humpback
Excessive lordosis- hollow back
Scoliosis- lateral curvature
what are some vertebral abnormalities?
Cervial rib- extra rib at C7- can cause thoracic outlet syndrome (compress BP or sub V)
Lumbar rib- extra rib at L1
Sacralization- L5 incorporated into Sacrum
Lumbarization- S1 partially separated from rest of sacrum
What are the joints of the vertebral column?
1) joints of vertebral bodies (intervertebral discs)
2) joints of vertebral arches
3) craniovertebral (atlanto-axial and atlanto-occipital)
4) costovertebral joints
5) sacroiliac jionts
What kind of joints are IV discs?
secondary cartilaginous
designed for weight bearing and strength
annulus fibrosis= outer fibrous ring of concentric lamellae of fibrocartilage
nucleus pulposus= gelatinous central mass core
What is a herniated disc?
protrusion of the nucleus pulposus into or through the annulus fibrosus
can hit nerves and cord if pushes forward
usually posterolaterally
What are the joints of the vertebral arches?
zygapophysial Z joints
plane synovial joints between superior and inferior articular processes of adjacent vertebrae
some gliding and sliding movement
What is a laminectomy?
Excision of spinous process and adjacent supporting vertebral laminae in a region of the vertebral column
gain access to vertebral canal and expose spinal cord
relieve pressure on the spinal cord or nerve roots from tumor herniated IV disc or bony hypertrophy
Where does the spinal cord run?
Medulla oblongata to conus medullaris
in vertebral canal
extends from foramen magnum to the L1 or L2 vertebrae in adults and L3 in children
What are the two enlargements?
cervical (upper extremity) C5-T1
lumbosacral (lower extremity) -L1-S3
What is the cauda equina?
horse tail
loose bundle of spinal nerve roots arising from lumbosacral enlargement
Blood supply of the spinal cord
one anterior spinal artery
two posterior spinal arteries that are branches of vertebral artery superiorly
anterior and posterior receive blood fro radicular arteries derived from spinal branches of arteries in the vicinity (posterior interocostal, lumbar, iliolumbar lateral sacral)
Where does the spinal cord venous draingage?
epidural space of vertebral canal
internal vertebral plexus
Where is cerebral spinal fluid?>
subarachnoid space
Where do dura and arachnoid end?
S2
fuse with pia
What is filum terminale?
delicate ligament from conus medullaris to coccyx
made of pia matter and then fuse with dura and arachnoid
What are the two parts of the filum terminale?
pial part (internal) dural part (externum)
What is dentriculate ligament?
ligament formed by pia matter that laterally pierces the arachnoid to be attached to the dura between the two spinal roots
Where is a lumbar puncture?
subarachnoid space to get CSF between L3 and L4
no spinal cord here because ends at L1/L3 in adults
Name the structures of the vertebral canal
1) epidural space
2) dura mater (outside tough layer)
3. subdural space
4. arachnoid mater (whispy connections)
5. subarachnoid space with CSF
6. pia mater (tender mother signel layer around cord)
7. spinal cord and cauda equina
How many spinal nerves are there?
31 pairs
8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal
Where does serratus anterior attach?
medial border of scapula
How does humerous abduct?
supraspinatus initiates 10-15 degrees
deltoid raise to 90
trapezius completes to 180
What are the rotator cuff muscles?
SitS
supraspinatus (most frequently torn)
infraspinatus
teres minor
subscapularis
Where do the SitS insert?
Supraspinatus, infraspinatus, teres minor insert into greater tubercle of humerus
subscapularis inserts onto lesser tubercle of humerus
What is the lady between two majors?
Lati dors inserts on Floor of bicipital groove of humerus after spiraling around teres major
Teres major and pectoralis major
What are the subclavian artery branches?
Vitamin c and sometimes D
Vertebral artery
internal thoracic artery
thyrocervical trunk
Costocerival trunk
Dorsal scapular artery
