Final OP Flashcards
Spinous Process of C2 TvP of C1 First Rib 11th and 12th Ribs Jugular Notch Manubrium Sternal Angle Body of Sternum Xiphoid process Hyoid Splenius Capitus Splenius Cervicis Iliocostalis Longissimus Spinalis Semispinalis Multifidus Suboccipitals Sternocleidomastoid Anterior Scalene Middle Scalene Posterior Scalene External Intercostals Internal Intercostals Diaphragm Rectus Abdominus External Oblique Psoas Major Quadratus Lumborum Sternoclavicular joint Acromioclavicular j
Posterior Scalene
O: TVP of C4-C6
I: Second Rib
A: Bi-Lat- Flex the cervicle spine , raise 2nd rib durning inhalation
Unilaterally- Lateral Flexion & rotation
FD: Inferiorly / Posteriorly
Supine
Start at mastoid process, move inf and and posteriorly onto the neck
C: Bring head to right shoulder - resisting at the head
Description: Deep or superficial tubular muscle
Finish off palpation in the junction of the first rib
Body Of Sternum
Supine
Trail: Mid shaft of clavicle medially and inf to jug notch inferiorly onto manubrium pass sternal angle - outline the whole body
Attachment: Pectoralis Major
Feel: Flat superficial bone
External Intercostals
O: Inferior border of superior ribs
I: Superior border of inferior ribs
A: Elevate the ribs durning inhalation
Supine
Iliac cres sup and slightly laterally to ribs, place fingers into spaces between ribs
C - ask to take a breath in
Feel - superficial flat muscle
Splenius Cervicis
O: Spinous process of T3-T6
I: TVP of C1-C3
A: Bilaterally - Extend the head and neck
Unilaterally- Rotate head ipsilaterally, Laterally- flex head/neck ipsilaterally
Prone
Starting Landmark: EOP
Inferiorly along the spine, until you’ve outlined t3-t6, move slightly laterally off of it onto the muscle, move back up superiorly
C: Ask to push head up into your hand
Feeling - deep broad muscle
Finish it by side of neck at tvps of c1-c3
External Oblique
O: External surfaces of 5-12 ribs
I: Anterior half of iliac crest, pubic tubercle & linea alba
A: Bilaterally: Compress & supports abdominal viscera, flexes the trunk
Unilaterally: Rotate the trunk contralaterally laterally
CONSENT BORDER
Xiphoid move slightly inf and lat onto ribs, ask to create border,
C- Ask your body to take the shoulder on the same side your palpating the muscle to their opposite hip
Feel a superficial bulky muscle
Relax and finish off palp inf generally at the pubic tubercles/crest region
Splenius Capitus
O: Inferior aspect of nuchal ligament, SP’s of C7-T3
I: Mastoid process, lateral 1/3 of nuchal ligament
A: Bilaterally: Extend head/neck
Unilaterally: Rotate head ipsilaterally, laterally flex head & neck ipsilaterally
Starting Landmark: EOP
Move inferiorly until you outline from c7-t3 (outline with your fingers) then move slightly laterally onto the muscle belly
C: Ask them to lift their head into your hand as you palpate upwards with the other (moving superiorly - backwards now)
Feeling: flat broad muscle underneath my fingers
o Follow fibers up to mastoid process and superior nuchal line (end it at the mastoid process).
Multifidus
O: TVP’s Sacrum & maxillary process of lumbar vertebrae
I: SP’s of superior vertebrae (2-4 segments)
A: Bilaterally: Extension of vertebral column & head
Unilaterally: Contralateral rotation
CONSENT, Prone
Start at PSIS move medially to midline slightly sup get to spinous proc of S2 move sup to s1 continue to Lumbar go between L3 and L4 stop there for contraction
C: Ask to lift legs, no resisting
FEEL - Deep rounded muscle
Finish where u stopped for the contraction
Xiphoid process
Subcostal border can start there
Attachment: Rectus abdominis
Feel: Deep or Superficial pointed bone
Spinalis
O: Posterior iliac crest, Posterior surface of sacrum, SacroIliac ligaments, Supraspinous ligament
and the Lumbar spinous processes
Insertion: SP’s in thoracic and cervical regions
A: Bilaterally: Extends vertebral column, chief extensor of spinal column
Unilaterally: Lateral flexion of the vertebral column
Great trochanter move superiorly and posteriorly to midline outlining all origins (lay hand flat) move superiorly to thoracic region
C: Lift both legs up no resisting
Feeling - deep flat muscle
Ask for contract once ur at upper thoraci region Move up to cervical region
C: As move superiorly ask to lift shoulders/chest off table
Feeling - deep flat
Finish off outlining the spinous processes of the thoracic and cervical regions (where you just palpated to)
Diaphragm
O: Sternal attachments: 2 muscular slips from the internal aspect of the xiphoid process
o Costal attachments: Costal cartilages of ribs 6 – 10 and ribs 10-12
o Lumbar attachment: 2 lumbar crurae (means legs) which attach to the lumbar vertebral bodies of L1-L3(4) on the right and L1-L2(3) on the left
I: Central tendon
A: Primary muscle of inspiration
Start at iliac crest move sup to subcostal border med and slightly sup to to xipohid process move off slightly laterally
C: take 2 thumbs and sink in on ribs on inf aspect (lateral to xiphoid process on both sides) as they’re inhaling ask to take deep breath in and out
Feeling - Deep flat muscle
Quadratus Lumborum
O: Medial 1⁄2 of inferior border of 12th ribs, tips of Lx TvP’s
I: Iliolumbar ligament and internal lip of iliac
crest
A: Extends and laterally flexes vert column;
fixes 12th rib during inspiration
subcostal, move posteriorly along rib 10 and slightly inf until on 12th rib
C ask them to shift/hike hip to shoulder on the same side - while youre resisting
Feel - Deep broad muscle
Can finish off palp at iliac crest
Radial (Lateral) Collateral ligament
Partner seated Bend elbow to 90
Starting Landmark: olecranon process
Move Lateral and slight anterior to find the lateral epicondyle
Move superiorly with the opposite hand to find the radial head
Strum in between head of radius and lateral epicondyle
Feel: Superficial taught band
Prevents varus force
Coracoclavicular ligament
Border
Partner supine
Confirm consent: Yes
Starting Landmark: jugular notch
Trail: Move laterally to the distal end of the clavicle. With the other hand find the coracoid
Proces moving inferiorly. Strum in between the two attachment sites.
o Strumming horizontally, you will feel two solid taut bands
Feel: Strong, taught bands
Description: Prevents superior dislocation of the clavicle
Sternal Angle
Partner supine Confirm Consent: YES
Starting Landmark: mid shaft of clav, move med and inf to Jugular Notch move inf to manubrium move slightly and inch or 2 inferiorly again until you feel change in shape then slightly laterally
Attachment: Costal cartilage of the second rib
Feel : Shallow Divot
Iliocostalis
O: Posterior iliac crest, Posterior surface of sacrum, SacroIliac ligaments, Supraspinous ligament
and the Lumbar spinous processes
I: Angles of ribs
and cervical TVP’s
A: chief extensor of the spinal column -bilaterally (extends vertebral column),
unilaterally lateral flexion of the vertebral column
CONSENT
Start at greater trochanter move sup and medially to midline, outline all origins, move to lateral sig of hum,
Lift legs feel a deep flat muscle underneath fingers
Ask continue to move sup
As move superiorly in thoracic region ask to lift chest off table
Deep flat
Finish off at the angle of ribs and cervical TVPs using both hands
(btw angles of ribs are a lil bit off of lateral to the spine sorta thing)
Rectus Abdominus
O: Pubic symphysis, pubic crest and pubic tubercles
I: Xiphoid process and 5th – 7th costal cartilages
A: Flexes trunk and compresses abdominal viscera, stabilizes and controls tilt of pelvis posteriorly
Consent and border over privates
Start at iliac crest move medially (with palm of hand not fingers) and slightly inf onto the origin (pubic crest area)
C - ask body to do a sit up/crunch for u - u can switch hand contact and support their back
Feel superficial bulky muscle
Body can Relax and you finsih off at the xiphoid process
Coracoacromial ligament
Partner supine
Confirm consent: Yes
Starting Landmark: mid shaft of the clavicle
Trail: move laterally to the anterior aspect of the acromion. With the other hand, find the
coracoid process.
o Strum cross-fibre across the wide band of ligament. Explore between these structures, and palpate this ligament deep to the deltoid muscle
Feel: Feel for a strong, deep taught band
Purpose: Prevent superior dislocation of the glenohumeral joint
Spinous Process of C2
Starting Landmark: Mastoid process,
Move posteriorly or medially and then move inferiorly intio a shallow space/valley, feel a small round bone underneath fingers
Attachment: Nuchal ligament
Feel: feel a small round bone
First Rib
Starting Landmark: mid-shaft of the clavicle
move medially and superiorly into the space over that part of the clavicle. ask to take a deep
Attachment: Anterior Saline
Feel: Deep small bone as they inhale
Acromioclavicular joint
Partner seated
Starting Landmark: Clavicle
Trail: Moving laterally and slightly posteriorly, locate AC joint by
sliding finger off
clavicle in between the clavicle and acromion
o Should feel slender ditch between the two structures
When the shoulder elevates the joint space opens, when it depresses the joint space closes
(same as above)
Elevation and depression
Ulnar (Medial) Collateral Ligament
Seated
Starting Landmark: olecranon move medially and superiorly to medial epicondyle. With other hand move to the olecranon and strum inbetween
Feel: Thick taught band
Purpose: Prevent values force
Middle Scalene
O: TVP of C3-C7
I: First Rib
A: Bilaterally- Flex cervical spine, raises first rib durning inhalation
Unilaterally- Lateral flexion and slight rotation
Supine
Start at mastoid process, move inf and slightly anteriorly onto the neck
C: Bring head to right shoulder - resisting at the head
Feel: Deep or superficial tubular muscle
Finish off palpation in the junction of the first rib
THE ONLY DIFFERENCE IS YOU WANT TO SHOW YOU’RE MORE IN THE MIDDLE (slightly, they’re all close together)
Internal Intercostals
O: Superior border of the inferior rib
I: Inferior border of the superior rib
A: Depresses the ribs durning forced expiration
Supine
Iliac crest sup and slighlty laterally to ribs, place fingers into spaces between ribs
C - ask to take deep breath in and forced breath out (forced expiration)
Feel - Deep flat muscle
Longissimus
O: Posterior iliac crest, Posterior surface of sacrum, SacroIliac ligaments, Supraspinous ligament
and the Lumbar spinous processes
I: TVP’s in thoracic and cervical regions and the mastoid process of the occiput
A: Chief extensor of the spinal column
Bilaterally: Extends vertebral column
Unilaterally: Lateral flexion of the vertebral column
Greater trochanter Superiorly and posteriorly to midline, superiorly onto muscle (on to peak of the hill) ask contract
C: Lift legs no resisting
Feel a superficial rounded muscle
As move superiorly into thoracic region
C: ask to bring shoulders/chest off the table (once you are at the upper thoracic region)
Feel superficial rounded muscle
Finish off at mastoid
Jugular Notch
Partner seated
move medially and slightly inferiorly
Attachment: Sternoclavicular Ligament
Feel: Superficial rounded curvature or ditch
Semispinalis
O: TVP’s of C4-T12
I: SP’s in Thoracic and Cervical regions, (spanning 4-6 segments) and also attaches to occiput between nuchal lines
A: Bilateral - Extension of vertebral column and head
Unilateral - Contralateral rotation
Prone
Spine of the scapula, move medially outlining the origins of tvps c4- to thoracic area, using both hands to outline
From there move sightly laterally to be on muscle
Ask them to lift head off the table - reist at their head
Feeling - deep thin muscle
Finish the palpation neart the occiput (lat side of head) (near nuchal lines)
Psoas Major
O: TvP’s of Lx vert, bodies of T12 – L5 and IVD’s
I: Lesser trochanter of femur
A: Flexes thigh (with iliacus), flexes and
laterally flexes vertebral column
Knee Bent, Supine
Do on left side , right side we have our appendix
ASIS Move med to midline slight sup to umbilicus from there move slightly laterally and inf an inch
C: Ask to tak deep breath in and out. Ask to raise knee into hand
Feel: a deep rounded muscle
Aorta
Supine
Iliac crest or ASIS and trail medially and sup to the umbilicus. Move 2 inches superior and push
slowly but deep into the abdomen to feel for the Aortic arterial pulse.
Strong Consistent pulse
Manubrium
CONSENT: Supine
Starting Landmark: mid shaft of clav, move med and inf to Jugular Notch move inf to manubrium move slightly and inch or 2 inferiorly again until you feel change in shape then slightly laterally
Attachment: Costal cartilage of second rib
Feel: Shallow divot
Brachial artery
Between elbow and shoulder right in centre
Suboccipitals (TRAIL)
Supine - slightly extended head youre holdin their head
Mastoid process, move posteriorly and inf into shallow ditch where suboccipitals reside
C- Ask them to extend their head into your hands - they’re pushing their head down on table
Feeling - deep flat muscle
Rectus Capitus Posterior Major
O: SP of C2
I: Lateral 1⁄2 occiput’
A: Extends Atlanto-occipital joint, lateral flexion and rotation
Rectus Capitus Posterior Minor
O: Posterior tubercle of C1
I: Medial 1⁄2 occiput
A: Extends head at Atlanta occipital joint
Obliquus Capitus Inferior
O: SP of C2
I: TVP of C1
A: Rotation of Alanto axial joint
Obliquus Capitus Superior
O: TVP of C1
I: Occiput between superior and inferior nuchal lines
A: Extends head at Alanto occipital joint, Lateral flextion of alanto occipital joint
TvP of C1
Starting Landmark: mastoid process move slightly inf and anteriorly until get to anterior surface of neck
Attachment: Levator Scapula
Feel: Deep pea shaped bone
Annular Ligament
Partner seated
Starting Landmark: lateral epicondyle
Trail: Bend elbow to 90o, slowly move distally
off lateral epicondyle distally and anteriorly (horizontally), across small ditch between humerus and radius onto head of radius
o Move the muscle fibers medially using your thumb to find one of the attachments of the annular ligament on the anterior surface of the ulnar. Place your index finger on the posterior surface of the head of the radius. Strum cross- fiber to feel the fibers of the annular ligament
Strum on the head of the radius
Feel : Flat taught band
Purpose: Hold the head of the radius in place while it is pronating and supinating // Or can say acts as a pivot point for the head of the radius
Hyoid
Supine
Base of the mandible, move anteriorly to the mental protuberance (chin), move inf until the level of around C3 - push it back (you’re using both hands while you’re palpating
Attachment:
Feel: Superficial rounded
Sternoclavicular joint
Partner seated
Starting Landmark: jugular notch
Trail: Slide your fingers slightly laterally and feel for the rounded end of the clavicle o Feel for the small gap between
these two structures
Slightly laterally then inferiorly to be on the front/anterior surface
Get them to elevate and depress shoulder to feel joint space open and close
You’ll feel the joint space open with elevation and close when u depress shoulder
Elevation = opens and depression = joint space closes
Anterior Scalene
Origin: TVPs C3 – 6
Insertion: First rib
ACTION:Bilateral: flex cervical spine, raises first rib during inhalation
Unilateral: lateral flexion and slight rotation
supine
Trail is pretty similar for all scalines
Start at mastoid process, move inf and anteriorly onto the neck
C: Bring head to right shoulder - resisting at the head
Feel: Deep or superficial tubular muscle
Finish off palpation in the junction of the first rib
Sternocleidomastoid
ORIGIN: Sternal head: top of manubrium of sternum
Clavicular head: Medial 1/3rd of clavicle
INSERTION: Mastoid process of temporal bone, lateral superior nuchal line of occipital bone
Action: Bilaterally: Flexes cervical spine, Capital extension
Unilateral: Lateral flexion of head to same side, Rotates head to opposite side
11th and 12th Ribs
subcostal border move posteriorly onto the inf margin of rib 10 move inf to get to rib 11 move inf and feel a deep pointed bone of rib 12
Attachment: something that attaches here is quadratus lumborum
Feel: 11 - deep flat bone, move over and feel a deep pointed rib - 12
