Exam 1- Back Flashcards
Peau D’Orange
Orange like skin- Dimpling of skin of breat due to cutaneous lymphatic edema. From lymphatic tissue blockage from a cancerous tumor.
Retracted nipple
From a cancerous mass causing a retraction of the milk ducts.
Dimpling of Skin
From a cancerous mass on a suspensory ligament causing a pull of one part of the skin in the breast.
Extrinsic Back Muscles
Consist of the Superficial and Intermediate layers of back muscles.
Triangle of Ausculatation
Listening section of the back bordered by the vertebral border of the scapula, superior border of the latissimus dorsi, and the lateral border of the trapezius.
Lordosis
Cervical and Lumbar regions- inward curvature of the spine (spine towards stomach)
80% are ideopathic and the remaining are neuromuscular in origin.
Associated with weak trunk muscles, pregnancy, or beer belly
Kyphosis
Thoracic and Sacral regions- outward curvature of the spine, causing hunching of the back (spine away from stomach)
Common cause in from wedge fracture result of osteoporosis
Results from erosion of anterior part of vertebrae and cause an overall loss of height
Scoliosis
Abnormal lateral curvature accompanied by rotation of vertebrae.
Asymmetric intrinsic back muscle weakness, difference in length of lower limbs, developmental defect in vertebrae.
Altered center of gravity, reduced lung function, can lead to equilibrium problems
Cervical Vertebrae Movements
Protraction (sticking chin out) cause extension of atlas and axis and flexion of C3-C7
Retraction (pulling chin in) cause flexion of atlas and axis and extension of C3-C7
Lateral Flexion naturally causes the head to turn and look down and in the direction of the tilt. The atlas and axis naturally have rotation that keeps the face looking forward.
Spinal Regions with Most Ruptures
Cervical (most movement is here) and Lumbar (most weight stress in here,
T12 is the most fractured vertebra
Superficial Landmarks of the back
Roof of the spine of the scapula- T3
Inferior Angle of the Scapula- T7
Iliac Crest- L4-L5
External Occipital Protuberance (bump on head)
Spinous Processes (Visible parts of the vertebrae)
Iliac Crest- Hip Bones
Importance of Surface Anatomy
Helps determine locations of organs and other parts of the body that are deep to the skin.
Purpose of Curvature of the Spine
The curvature of the spine is there to protect against damages from shock and therefore prevents lectute
Spinous Process and Transcerse Process
Mostly serve as connections for the ligaments and muscles
Vertebral Artery
Passes through the Transverse Foramen
Dens or Odontoid Process
(Teeth… Dontoid) The bone of the axis that sticks up through the atlas.
If the Atlas shifts too much on the Axis, it could sever the spinal cord.
Atlanto-Axial Joint
The transverse ligaments limit rotational events by essentials oally hugging the Odontoid Process
The atlanto-occipital, concave convex, part of the atlas permit movement to be able to say yes.
Atlanto-Axial Joint rocks back and forth
Axio-Occipital Joint is the rotation of the head as when indicating “no”
Thoracic Vertebrae
Looks kind of like a giraffe (to be able to distinguish it)
T12
Looks kind of like a moose
Lumbar vertebrae don’t permit rotation. Therefore this vertebrae experiences the most stress since it’s the transition between the rotation of the thoracic and the lack thereof in the lumbar.
Most fractured vertebrae
L5
Occasionally fuses into Sacrum making 1 more sacrum and 1 fewer Lumbar
Intervertebral Discs (IV Discs)
A lot like jelly donuts. Nucleus Pulposus (jelly) and Anulus Fibrosus (dough) make up the IV discs. Can grow a half inch over night since they are compressed during the day.
Herniated Disc
The Nucleus Pulposus (jelly) squirts out of the Anulus Fibrosus (dough) and causes nerve pain by pressing against parts of the nerves.
Herniation of the nucleus pulposus of an IV disc usually occurs posterolaterally.
IV Disc most prone to rupture
Lumbo-Sacral Joint- Between L5 and S1
Drastic change from lordotic to kyphotic curve
More lordosis in the lumbar can increase the likelihood of a rupture (pregnancy, beer belly, or obesity)
Spinal Fractures
Stress fracture of the Pars Interarticularis is the most common type of fracture resulting in back pain in adolescents
The Lamina is the weakest part of the vertebrae
Spondylolysis is a common break and spondylolythesis is where there is a break with a shift (most common in young girls who are doing gymnastics)
Scottie Dog
This is Spondylolysis- a defect through the pars interarticularis (a narrow strip of bone located between the lamina and inferior articular process below, and the pedicle and superior articular process above)
It is most common at the L5 vertebral segment
If Scottie has a collar, then there is a fracture.
Lactiferous Ducts
Openings are in the nipples
Generally 15-20
The ducts that provided milk for the child
Lactiferous Sinus
The collection of milk that squirts out to encourage the child to continue drinking.
Mammary
The lymph nodes around the nipple and areola are collected and sampled by the body
Suspensory Ligaments
Greatly contribute the the “perkiness”/”nonsagginess” of the breast.
Lymphatic Drainage
Drain into the following groups of lymph nodes
Axillary (5 subgroups) (75%) drainage
Parasternal (Along Internal Thoracic Vein) (20%)
Supraclavicular
Posterior Intercostal
Lymph Nodes are arranged along all of the arteries and veins
Difference between Cyst and Carcinoma
Cysts are well defined smooth opacity
Carcinomas are irregular density, distortion of breast tissue, calcification
Supernumery Nipples
Nipples somewhere else on the milk line
Polythelia (nipples over breast), Athelia (no nipple over breast), Polymastia (accessory breast along milk ridge), Amastia (no breast development), and Amazia (no nipple or breast development)
T4 and T10
Nipple and Belly button lines of innervations
Serratus Anterior Nerve
This nerve is exposed as it runs across the surface of the muscle.
This is the “wing” muscle next to the ribs
Proximal, Distal
Proximal=Origin
Distal=Insertion
Intercostal Muscles
There are three layers of intercostal muscles:
External Intercostal Muscles start back two thirds of the way around to the front with a small downward angle
Internal Intercostal Muscles start front and run two thirds of the way around to the back.
Innermost Intercostal Muscle essentially just sills the space in between
VAN- In order Superior to Inferior- Vein, Artery, Nerve
Axilla
Functionally it’s a large quadrangular space
Clavipectoral Fascia
Thick bilateral connective tissue structure deep to the pectoralis major muscle. Extends superiorly from the clavicle, medially from the costochondral joints, and superolaterally from the coracoid process.
Converges with the axilla where it acts as a protective structure over the neurovascular structure of the axilla.
Fascia can pinch nerves and cause problems.
Parts of the fascia include the costocoracoid ligament, costocoracoid membrane, and suspensory ligament of the fascia
Axillary Sheath
Enclosed in it are the brachial plexus and veins and arteries.
Axillary Artery*****
Divided into three parts:
1-from sternum to medial side of pec minor- has just one vessel, Superior Thoracic Artery
2-the part just below pec minor- two vessels, Thoracoacromial Artery (4 branches: pectoral, deltoid, clavicular, and acromial) and Lateral Thoracic Artery (the most variation and supplies serratus anterior)
3-part of the lateral side of the pec minor- three vessels, Subscapular Artery, Anterior Circumflex Humeral Artery (Corocobrachialis and Biceps), and Posterior Circumflex Humeral Artery (Deltoid, Teres Major/Minor, Long Head of Triceps)
Axilla Nerves, Arteries, and Veins
Between people, Nerves are the most varied, veins are the least varied, and arteries are somewhere in between.
Anterior Rami
They basically contribute to all of the muscles that are not postural
Brachial Plexus Order
Randy Travis Drinks Cold Beer
Roots, Trunk, Divisions, Cords, Branches
Comes from C5, C6, C7, C8, T1
The Cords are the first section that we are able to see.
5 Roots, 3 Trunks, 6 Divisions, 3 Cords, 5 Branches
Formed by the anterior rami of C5-T1.
Which then unite to form 3 trunks: Superior (C5, C6), Middle (C7) , and Inferior (C8, T1).
Each trunk divides into a posterior and anterior, making up 6 divisions as it passes through the cervico-axillary canal (posterior to the clavicle)- Anterior division supplies flexors and posterior provides extensors
The division of the trunks for 3 cords: Lateral cord (anterior divisions of superior/middle), Medial cord (anterior division of the inferior trunk continues), and the Posterior cord (all of the posterior divisions)- Their names indicate where they are compared to the axillary artery.
Myotomes
The sets of muscles innervated by a given nerve
One of the most frequently injured nerves of the brachial plexus is the long thoracic
Fascia
Fascia is a continuous unit. This means that things that are distal in t he fascia can affect things that are proximal.
The thickness is greatest over the flexor and extensor retinacula
Three Components (Functions) of Fascia: Invests all of the muscles and prevents over expansion, Serves as an anchor, and Divides the limbs into functional compartments.
Dorsal Scapular Nerve
Innervates Rhomboid Major, Rhomboid Minor, and Levator Scapula
Erector Spinae Group
Iliocostalis, Longissimus, Spinalis
Naming of Spinal Nerves
C1-C7 Nerves- The vertebrae it lies superiorly to
C8- Inferior to C7
T1 and Down- The vertebrae it lies inferiorly to.
Associated Vertebrae
Pacemaker Placement
Retromammary Space- Between breast and Pectoralis Major
Vertebrae Prominens
C7
“Winged” Scapula
Damage to the long thoracic nerve of the shoulder. If the long thoracic nerve is damaged or bruised it can cause paralysis of the serratus anterior muscle and winging of the scapula
Serratus Anterior muscle is the muscle used for boxing
Supraspinatus
Initiates abduction for the first 15 degrees
Quadrangular Space
Inside is the Axillary Nerve and the Posterior Humeral Circumflex Artery
Bordered by the inferior border of teres minor muscle (superior), superior border of teres major muscle (inferior), long head of triceps brachii muscle (medial), and surgical neck of the humerus (lateral)
Pathway of the Arteries
Subclavian Artery —->
Axillary Artery —->
Brachial Artery —->
Radial Artery + Ulnar Artery.
Pathway of the Veins (technically reverse)
Subclavian Vein —->
Axillary Vein —-> Cephalic Vein AND
Brachial Vein + Basilic Vein
Spinal Accessory Nerve
Innervates the Trapezius
When damage, loses muscular sensation and causes drooping, but does not cause a loss of sensation
Dermatome
The lateral wall of each somite in a vertebrate embryo, giving rise to the connective tissue of the skin
An area of the skin supplied by nerves from a single spinal root
Specific
Cutaneous Field
Cutaneous innervations refer to areas innervated by specific peripheral nerves (e.g. the lateral femoral cutaneous nerve), which can contain fibers from multiple spinal nerve roots. This happens because of how the spinal nerves form plexuses (brachial, lumbar, sacral), which in turn form terminal nerves
General
Number of Spinal Nerves
Baskin Robbins
31: C1-C8, T1-T12, L1-L5, S1-S5, Coccygeal 1.
Breast
Generally run from T2-T6
Nipple, Areola, Lactiferus Sinus, Lactiferus Ducts, Gland Lobules, Suspensory Ligaments, Retromammary Space
Abduction of the Upper Limb
First 15 degrees is Supraspinatus
After that, it’s mostly the Deltoid that deals with Abduction.
Deltoid Muscle
Origin: Spine of scapula, Acromion of the scapula, and the lateral one-third of the clavicle.
Insertion: Deltoid tuberosity of the humerus.
Action: Abducts the humerus
Nerve: Axillary Nerve (out of quadrangular space)
Blood Supply: Posterior circumflex artery (out of quadrangular space)
Teres Minor
Origin: Lateral border of the scapula.
Insertion: Inferior facet of the greater tubercle of the humerus.
Action: Laterally rotates the humerus
Blood Supply: Subscapular and circumflex scapular arteries
Nerve: Axillary Nerve
Teres Major
Origin: Inferior angle of the scapula
Insertion: Medial lip of the intertubercular sulcus of the humerus
Action: Adducts and medially rotates the humerus
Blood Supply: Subscapular and circumflex scapular arteries
Nerve: Lower subscapular nerve (C6 and C7) (C6, C7)
Supraspinatus
Origin: Supraspinous fossa of scapula Insertion: Superior aspect of greater tubercle of humerus Action: Initiates Abduction Blood Supply: Suprascapular Artery Nerve: Suprascapular Nerve (C5)
Infraspinatus
Origin: Infraspinous fossa of the scapula
Insertion: Middle facet of greater tubercle of the humerus
Action: Laterally rotates the arm at the shoulder (glenohumeral) joint
Blood Supply: Suprascapular and circumflex scapular arteries
Nerve: Suprascapular Nerve (C5)
Lateral Cord of Brachial Plexus
Lies immediately lateral to the Axillary Artery
Subscapularis
Origin: Subscapular fossa
Insertion: Lesser tubercle of humerus
Action: Medially rotates the arm at the shoulder (glenohumeral) joint
Blood Supply: Subscapular artery
Nerve: Upper subscapular nerve, lower subscapular nerve (C5, C6)
Humerus Fracture
Most fractures occur at the Surgical neck of the Humerus
Sternoclavicular Joint
It has an articular disk
It allows anterior-posterior movement of the clavicle
It allows some rotation of the clavicle
It allows elevation and depression of the clavicle
Injuries to this area (including dislocation) are relatively uncommon
Axillary Lymph Nodes for Breast Cancer
Organized into three levels by their relative location to the pectoralis minor.
Synovial Joints
Gliding- sliding/twisting Pivot- rotation around central axis Hinge- flexion/extension Saddle- back and forth, side to side Condyloid- variety of movements, no rotation Ball and Socket- all planes of rotation
Pars Interarticularis
Pars for short, is the part of vertebra located between the inferior and superior articular processes of the facet joint
Cruciform Ligament
Strengthens the atlantoaxial joint
Superior Articular Processes
Limits undo movements
Cervical Enlargement
Lumbar Enlargement
C3-T2
L1-S3
Spinal Cord Length
In the embryo, spinal cord completely occupies vertebral column and nerves exit transversely.
As the body grows, nerves begin running longitudinally before exiting in order to exit in the same location.
Growth results in the formation of the cauda equina from the conus medullaris
Splanchnic Nerve
Paired visceral nerves (innervation of the internal organs), carrying fibers of the autonomic nervous system (visceral efferent fibers) as well as sensory fibers from the organs (visceral afferent fibers)
Sympathetic Nerves
Go to literally every part of the body.
Meninges
Dura, Arachnoid, and Pia Mater together form this.
Nervous System
Autonomic Nervous System divides into the sympathetic nervous system (thoracolumbar division) and parasympathetic nervous system (craniosacral division)
The autonomic nervous system functions to regulate the body’s unconscious actions
Sympathetic Nervous System
Fight or flight
Preganglionic neurons in lateral gray horns of spinal segments T1-L2 send preganglionic fibers to ganglia near spinal cord which release ACh, stimulating ganglionic neurons. This sends postganglionic fibers to target organs and release NE at neuroeffector junctions causing a “fight or flight response”
Parasympathetic Nervous System
Rest and Repose
Preganglionic neurons in brain stem and lateral portions of gray horns of S2-S4 send preganglionic fibers to ganglia in target organs which release ACh, stimulating ganglionic neurons. This sends postganglionic fibers to target organs which release ACh at neuroeffector junctions causing and “Rest and Repose” response
Visceral Sensory System
Central Nervous System (brain and spinal cord) leads to the Peripheral Nervous System
PNS (Cranial and Spinal Nerves) leads to a motor divison and a sensory Divison
-Sensory (afferent) divides into Somatic Sensory (normal external sensory and then Hearing, Equilibrium, Vision, and Smell) and Visceral Sensory (normal internal sensory and then Taste)
-Motor (efferent) divides into Somatic Motor (motor innervation of all skeletal muscles) and Visceral Motor (motor innervation of smooth muscle, cardiac muscle, and glands
Visceral Motor divides into the parasympathetic division and sympathetic division
Somatic Neurons are for voluntary movement
Roots of Brachial Plexus
Two Terminal Nerves are formed here
Long Thoracic and Dorsal Scapular.
Trunks of Brachial Plexus
Two Terminal Nerves are formed here
Suprascapular and Nerve to Subclavius
Divisions of Brachial Plexus
Zero Terminal Nerves are formed here
Cords of Brachial Plexus
Seven Terminal Nerves are formed here
Lateral Pectoral, Upper Subscapular, Middle Subscapular (Thoracodorsal), Lower Subscapular, Medial Pectoral, Medial Cutaneous of Arm, and Medial Cutaneous of Forearm
Branches of Brachial Plexus
Zero Terminal Nerves are formed here
