Exam 1 Flashcards
What are the 6 different types of synovial joints?
- Pivot
- Ball and socket
- Saddle
- Ellipsoid
- Hinge
- Gliding
S2 tubercle is found approximately at the level of what other anatomical structure?
PSIS
The apex of the heart is found approximately at what vertebral layer?
T10
Vertebral notches are found as part of which vertebral structure?
Pedicle
Supination and pronation movements occur in which plane?
Transverse
List sympathetic responses
Pupils dilate, eyes widen
Mucous membranes of nose/mouth dry
Erector pili muscles contract, sweating
Blood supply to skin and GI tract constricted
Blood supply to heart, lungs, skel muscles dilated
Cardiac stroke volume increases, brachiodilation
List parasympathetic responses:
Pupils constrict
Mucous membranes secrete
Peristalsis of GI tract
Blood supply increased to GI tract and skin
Blood supply decreased to skel muscle, heart, lungs
Bronchoconstriction and decreased cardiac output
Medial and lateral movements occur in what plane?
Sagittal/Median
Anterior and posterior movements occur in what plane?
Coronal/frontal
Movement along an axis is what?
Translation
Movement around an axis is what?
Rotation
Theta movement moves in what direction?
Counterclockwise
How many fused vertebrae make up the coccyx?
3-5
Which 2 segments contain no discs between vertebrae?
C0-C1 and C1-C2
The 7 processes from the posterior aspect are made of which processes?
1 SP, 2 TP, 4 APs
The median furrow surface connects from ____ to ____.
EOP Gluteal cleft (S3)
Inferior angle of scapula positioning while prone and while standing?
Prone- T6
Standing- T7
T1 is the most prominent SP in what population percentage?
30-40%
The mastoid process is felt by coming off the TP of which vertebra?
C1 (atlas)
Which cervical vertebra has the smallest SP?
C3
The C3 SP is approximately the same level as what feature of the hyoid bone?
Greater cornua
C4 disc sits level with ____.
Thyroid cartilage
Lamina contact point or the articular pillars are approximately how far lateral from the cervical SPs?
1.5 cm
Carotid tubercle (C6) is level with cricoid cartilage and which tracheal ring?
1st tracheal ring
The root of the spine of the scapula is found off which SP?
T3 SP
The most convex point of thoracic kyphosis is which SP?
T4
T12 is a 1/2 measurement point between ____ and ____.
IAS
Superior iliac crest
T5-9 are how many spinous interspaces superior to their SP?
2
Rib angles are approximately how far lateral to the midline at the level of their TP?
4 cm
Which SP is the last palpably movable through flex/extend?
L4
80% of the time, L4 SP is at level of ____.
Iliac crests
What processes are found 2cm lateral on the superior articular processes?
Mammillary
Mammillary processes are level with which bony landmark?
PSIS
Which sacral tubercle is located at the upper end of the gluteal cleft?
S3
Tip of coccyx is approximately how far posterior of the anus?
1cm
Spinal nerves exit at the same level as their vertebral body down the foramen magnum at what month of development?
3rd month
At birth, conus medullaris (spinal cord) extends to ____.
L3
In adults, conus medullaris is located at which vertebral body?
L1 or L2
Cervical cord runs along foramen magnum
SP C6
Upper thoracic cord runs T1-T6 and approximates with ____.
SPs of C6-T4
Lower thoracic cord runs T7-T12 and approximates with ____.
SPs of T4-T9
Lumbosacral coccygeal cord approximates with ____.
SPs of T10-L1 conus medullaris
Cervical cord enlargement C4-T1 approximates with ____.
C4-C7 vertebral bodies
Lumbar cord enlargement L2-S3 approximates with ____.
T10-L1 vertebral bodies or T9-12 SPs
Aorta runs down which side of the vertebral bodies?
Left
Which portion of the aorta extends T12-L4?
Abdominal aorta
Abdominal aorta bifurcates as the ____ below L4.
Common iliac veins
Inferior vena cava forms at the joining of the common iliac veins at which level of the vertebral bodies?
L5
Inferior vena cava travels up which side of the vertebral bodies?
Right
3 functions of the spine:
Support body
Protect spinal cord/nerve roots
Movement of trunk
The neural groove is made of the combinations of ____ and ____.
Neural tube
Neural crest
Somites are derived from what?
Paraxial mesoderm
Somites develop into what? (3)
Dermatomes
Myotomes
Sclerotomes
Dermatomes make up ____.
Dermis and subcutaneous tissue
Myotomes make up ____.
Axial muscles
Sclerotomes migrate centrally forming ____.
Vertebral column and associated ligaments
What are the 3 layers that the inferior portion of neural tube differentiates into?
Ependymal
Mantle
Marginal
Ependymal layer is located ____.
Around central canal
Mantle layer makes up ____.
Neurons and glia
Marginal layer is associated with ____.
Axons of the tract cells (white matter)
Neural crest makes up sensory neurons of the ____ and postganglionic neurons of the ____.
PNS
ANS
Which type of cells form 3 pairs of chondrifaction centers forming a cartilage model?
Sclerotomal cells
Of the 3 primary centers of ossification, 1 forms the ____ of the vertebral body and 2 form the ____.
Future anterior portion
Future posterior portion
Fusion of either side of the vertebral body with the neural arch is called what?
Neurocentral synchdrosis
Secondary ossification centers develop between what ages?
10-13
Where are the 5 secondary ossification centers located?
Superior endplate-1
Inferior endplate aka annular or ring epiphyses- 1
TP- 1 each
SP- 1
Growth ends between what age range?
14 and 25 years
Thoracic kyphosis apex is at what vertebra?
T4
In thoracic kyphosis, the vertebral bodies are ____ posteriorly than anteriorly.
Taller
In pelvic kyphosis, lumbosacral junction to coccyx faces ____ and ____.
Anterior
Inferior
Cervical lordosis occurs around what age?
3-4 months, reinforced around 9 months
At what age does lumbar lordosis occur?
10-18 months
In lumbar lordosis, disc and vertebral bodies are ____ anteriorly than posteriorly.
Taller
What are the cervical segments where compression fractures from superior force occur?
C4-C6
What are the cervical segments where compression fractures from inferior force occurs?
T9-L2
Hyperflexion of trunk injury most commonly affects which segments?
T5-T6
Trabeculae are orientated in which direction relative to lines of greatest stress (such as axial compression)?
Parallel
Smooth region around the edge of the superior and inferior surfaces of vertebral body is formed by what?
Annular apophysis
Most vertebral bodies concave posteriorly towards the ____.
Vertebral foramen
Pedicles attach to the posterior ____ aspect of vertebral body.
Lateral
Pedicles are ____ to the midpoint of the vertebral body.
Superior
Laminae are continuous with what structures?
Pedicles
Laminae thickness ____.
Varies regionally
Spinous processes may normally deviate in which directions?
Left and right
Borders of vertebral foramen are composed of what structures?
Vertebral body, R/L pedicles, R/L lamina, spinous process
Which ligaments are found within the the vertebral canal?
PLL, ligamentum flava
Transverse processes project laterally from the junction of which structures?
Lamina and pedicle
Cervical transverse processes project ____.
Obliquely anterior between sagittal and coronal plane
Located anterior to articular process and lateral to pedicles
Thoracic transverse processes project ____.
Obliquely posterior
Located posterior to articular processes, pedicles
Lumbar transverse processes project ____.
Anterior to articular processes, posterior to pedicles
Cervical costal element:
Anterior tubercle of transverse foramen
Thoracic costal element:
Ribs
Lumbar costal element:
Anterior aspect of TP
Sacral costal element:
Sacral ala
Superior articular process projects ____.
Superiorly from lamina pedicle junction
Superior articular process forms ____.
Zygapophyseal joints (facets)
Cervical and lumbar articular surfaces face ____.
Posteromedial
Thoracic articular surfaces face ____.
Posterolateral
Inferior articular processes articular surface faces ____.
Anterior
Which functional components of a typical vertebra determine spinal movement?
Superior/inferior articular processes
Which functional component of a typical vertebra acts to transfer weight?
Posterior arches
What are the 3 AKAs for zygapophyseal joints?
Z joint, facet joint, interlaminar joint
Z joints are what kind of synovial joint?
Planar
What is the function of the z joint?
Determine direction/limitation of movement between vertebrae, help carry load during extension/rotation
Anterior and medial portions of z joint are covered by the ____.
Ligamentum flavum
Which layer of z joint has sensory and autonomic innervation?
Synovial
Ligamentum flavum and z joint capsule have ____ receptors.
Nociceptive
Z joints are innervated by the medial branch of the ____ primary rami.
Dorsal
Broad pain referral pattern within z joints comes from innervation of what nerve?
Medial branch of dorsal primary rami
What are the 3 types of sensory receptors which innervate the z joints?
Nociceptors, free nerve endings
Complex unencapsulated nerve endings
Proprioceptors, encapsulated nerve endings
Z joint pathology for back pain?
Facet syndrome
What are the facet angles in the cervical spine?
45 degrees, loose joint capsule
What are the facet angles in the thoracic spine?
60 degrees
Allows rotation, limits flex/extend and lateral flex
What are the facet angles in the lumbar spine?
90 degrees
Allows flex/extend, limits rotation and lateral flexion
Movement is limited/determined by what 4 main structures?
IVD
shape/orientation of articular facets
ligaments
muscles
Spinal ligaments are most effective when carrying loads when ____.
The stress parallels the direction that ligament fibers run
Ligamentum nuchae runs what length of the spinal column?
C7 SP to EOP
Lamellar and funicular portions
Supraspinous ligament and ligamentum nuchae limit which range of motion?
Flexion
Interspinous ligaments run what length of spinal column?
Inferior aspect of 1 SP to the superior aspect of 1 SP below
Limits flexion
Intertransverse ligaments run what length of the spinal column?
Connect inferior aspect of 1 TP to superior aspect of 1 TP below
Limits contralateral lateral flexion
Ligamentum flava connects ____ to ____.
Lamina to lamina
Ligamentum flava lies directly ____ to the spinal cord.
Posterior
PLL runs down which aspect of the vertebral canal?
Anterior
Posterior to vertebral bodies
PLL begins at which vertebral body?
C2
PLL functions to limit which movements?
Flexion
Posterior disc protrusion
Tectorial membrane runs what length of the vertebral column?
Posterior body of C2 up to anterior rim of foramen magnum
Tectorial membrane functions to limit what movement?
Flexion and extension of atlas and occiput
What are the 4 specialized upper cervical ligaments?
Accessory atlanto-axial
Cruciate ligament of atlas
Alar ligaments
Apical
Cruciate ligament of atlas functions to ____.
Keep the transverse ligament of C1 centered on the dens with superior/inferior bands
Alar ligaments function to limit what movement?
Contralateral axial rotation
Alar ligaments run what length of the vertebral column?
Posterior lateral dens to occipital condyle
Apical ligament runs what length of the spinal column?
Posterior superior dens to anterior rim of foramen magnum
ALL runs what length of the spinal column?
Runs occiput and anterior tubercle of atlas to each vertebral body limiting extension
Anterior atlanto-occipital membrane runs what length of the spinal column?
Anterior margin of foramen magnum to superior aspect of anterior arch of atlas
Limits extension of occiput on C1
Anterior atlanto-occipital membrane is located ____ to ALL.
Posterior
Spinal flexion is limited by which ligaments?
Posterior IVD PLL Ligamentum flava Interspinous ligaments Supraspinous ligaments Ligamentum nuchae Articular capsules Articular facets Muscles (extensors)
Spinal extension is limited by which structures?
Anterior IVD ALL Approximation of SPs Articular processes Laminae
Spinal lateral flexion is limited by which structures?
Lateral IVD
Intertransverse ligaments
Approximation of articular processes
Muscles (antagonists)
Spinal rotation is limited by which structures?
Annulus fibrosus of IVD
Orientation of articular processes/facets
Coupled motion is a combined movement of ____.
Rotation with lateral flexion
Which regions of the spine have slight vertebral body rotation due to orientation of superior and inferior articular facets when laterally flexed?
Cervical and lumbar
Nucleus pulposus comes from the ____ and annulus fibrosus comes from the ____.
Notochord
Mesechyme/sclerotome
A 12-20 layered annulus fibrosus is found in which region of the spine?
Lumbar
A crescent shaped annulus fibrosus is found in which region of the spine?
Cervical
The IVD is connected to the vertebral body by ____ cartilaginous endplates.
Superior and inferior
Joint formed by IVD connecting 2 vertebral bodies is called the ____ or ____.
Anterior interbody joint
Intervertebral symphysis
The anterior interbody joint or intervertebral symphysis is classified as what kind of joint?
Cartilaginous, symphysis joint
At what age has the IVD started to become nearly avascular?
20
Sacral IVD remnants ossify into what structures?
Transverse lines
IVD are thickest in which region of the spine?
Lumbar
IVD are thinnest in what region of the spine?
Upper thoracic
Cervical and lumbar IVDs are thicker ____ than ____ contributing to regional lordosis.
Anteriorly
Posteriorly
Cervical IVDs are approximately ____ height of the vertebral bodies.
2/5
Thoracic IVDs are approximately ____ the height of the vertebral bodies.
1/5
Lumbar IVDs are approximately ____ the height of the vertebral bodies.
1/3
IVDs are connected firmly to the ____ and loosely to the ____.
PLL
ALL
IVD composition includes:
Water, chondrocytes, fibroblasts, proteoglycans aggregates, type I and II collagen fibers
The process by which IVD uptakes fluid is called ____.
Imbibition
What are the 3 regions of the IVD?
Annulus fibrosus
Nucleus pulposus
Vertebral (cartilaginous) endplates
Annulus fibrosus is composed of what kind of tissue?
Type I collagen
Nucleus pulposus is composed of what type of tissue?
Type II collagen
Lumbar and thoracic annulus fibrosus are convex ____.
Anteriorly
Collagen fibers of annulus fibrosus run parallel at ____ degrees from vertical.
65
Most superficial lamella attach to the IVD of the ring apophysis via ____.
Sharpey fibers
Cervical annulus fibrosus are composed of how many rings of crescent shaped fibrocartilage?
1
What part of of the annulus fibrosis limits flexion?
Posterior annulus
What part of the annulus fibrosus limits extension?
Anterior annulus
What part of the annulus fibrosus limits lateral flexion?
Contralateral side of annulus
What part of the annulus fibrosus limits axial rotation?
45 degrees off the plane of the disc, tensile force
During lateral flexion, what direction does the IVD bulge towards?
Side of the concavity
Which region of the IVD is the weakest?
Postero-lateral
Which fibers innervate the annulus fibrosus?
GSA and GVA
Posterior aspect, recurrent meningeal nerve
Anterior/lateral aspect, branches of ventral rami and sympathetic chain
What are the 2 different types of IVD tears?
Circumferential and radial tears
Nucleus pulposus notochordal cells are completely replaced by what type of tissue around 11 years of age?
Fibrocartilage
Nucleus pulposus is made up ____ percent of water?
70-90
At what age does water begin to degenerate from within the nucleus pulposus?
30
How does the nucleus pulposus receive nutrients?
Imbibition, sodium and potassium remain inside IVD as compressive forces force out water
Vertebral (cartilaginous) end plate lines everywhere but where?
The most peripheral rim, superiorly and inferiorly
The vertebral (cartilaginous) end plate attaches disc to ____ vertebral body.
Adjacent
During compressive loading of the vertebral column, when does the vertebral (cartilaginous) end plate fail?
First
Cervical (C1-C7) spinal nerves exit through ____ above their respective vertebra.
IVFs
Which spinal nerve would a C4 disc protrusion affect?
C5 nerve
C8 spinal nerves and below enter through IVFs ____ their respective vertebra.
Below
Lumbar spinal nerves exit below its respective vertebra but the nerve ____ preventing a disc protrusion below.
Hugs the pedicle
Narrowing of he vertebral canal is called what?
Spinal canal stenosis
Epidural space is how deep?
4-6 mm deep
Internal vertebral venous plexus is also known as?
Batson’s plexus of veins
What divides the spinal cord into spinal segments?
Rootlets
Medial branches of the dorsal ramus supply what structures?
Z joints and transversospinalis muscles
Lateral branches of the dorsal ramus supply what?
Erector spinae muscles
IVF anterior border is located along what structures?
Vertebral bodies and IVDs
IVF superior border is located along what structure?
Inferior vertebral notch of pedicle above
IVF inferior border is located along what structure?
Superior pedicle notch of pedicle below
IVF posterior border is located along what structure?
Z joints
Function of spinal muscles:
Move spine, maintain posture, absorb shock, protect spine/viscera
Which part of the nervous system controls muscle coordination?
CNS
The 1st of the 6 layers of back muscles connects what portions of the body?
Upper limb to vertebral column
Which muscles make up the 1st layer of the back muscles?
Trapezius and latissimus dorsi
Trapezius is innervated by what structure?
Spinal accessory N (CN XI) and proprioceptive from C3 and C4 ventral rami
Latissimus dorsi is innervated by what structure?
Thoracodorsal nerve (C6-C8 ventral rami off of posterior cord of brachial plexus)
Thoracolumbar (thoracodorsal) fascia is made up of how many layers?
3
2nd layer of the 6 layers of back muscles all attach on what structure?
Medial border of scapula
Muscles of the 2nd layer of 6 layers of the back include:
Rhomboid major and minor
Levator scapular
Rhomboid major and minor muscles are innervated by what structure?
Dorsal scapular nerve (C5 from ventral rami of brachial plexus)
Levator scapula muscle is innervated by what structure?
Dorsal scapular nerve (C5) and ventral rami of C3 and C4 spinal nerves
3rd layer of the 6 layers of back muscles contains the following muscles:
Serratus posterior superior and inferior
Serratus posterior superior is innervated by what structure?
Ventral rami of T2-T5 (via intercostal nerves)
Serratus posterior inferior is innervated by what structure?
Ventral rami of T9-T11 via intercostal nerves and subcostal nerve (ventral rami of T12)
4th layer of 6 layers of back muscles has the following muscles:
Splenius capitis
Splenius cervicis
All deep back muscles (4th-6th layers) are all innervated by what structure?
Dorsal (posterior) rami
5th layer of the 6 layers of back muscles contain the following muscles:
Iliocostalis group
Longissimus group
Spinalis group
5th layer of the 6 layers of the back are innervated by what portion of the dorsal primary rami?
Lateral portions
6th layer of the 6 layers of back muscles contains the following muscles:
Semispinalis group
Multifidus group
Rotatores group
6th group of 6 layers of back muscles are innervated by what portion of the dorsal rami?
Medial branches
Suboccipital muscles are innervated by what structure?
Dorsal rami of C1 (suboccipital nerve)
Diaphragm is innervated by what structure?
Phrenic nerve (ventral rami C3-C5 off cervical plexus)
