LAB II FINAL EXAM Flashcards
typical vs. atypical C-spine vertebrae
TYPICAL: C3, C4, C5, C6
ATYPICAL: C1, C2, C7
which C-spine vertebrae are bifid and which are not
C2 = bifid
C7 = not bifid
C1 (atlas) divided into 3 sections
anterior arch
lateral mass
posterior arch
what is atypical about C7?
elongated SP
not bifid
ligaments of spine (order)
ALL
PLL
ligamentum flavum
interspinous
supraspinous
tectorial membrane
turns into PLL after C2
cruciate / cruciform / transverse ligament
holds the dense of C2 against C1
creates pivot
COUPLED MOTIONS
rotation & lateral flexion always together except at C1/C2
C2-T5: ipsilateral side
T6-L5: contralateral side
muscle testing deep neck flexors (longus coli)
patient: supine, elbows bent, hands overhead
test: flex C-spine by lifting head off table, chin depressed
pressure: against forehead in posterior direction
muscle testing SCM
patient: supine, elbows bent, hands beside head
fixation: firm downward pressure on thorax
test: anterolateral neck flexion
pressure: against temporal region of head in obliquely posterior direction
function of suboccipital muscles
maintain postural stabilization of head
COSTAL CARTILAGE
-smooth, elastic resilient CT, connects ribs to sternum
-made of cartilage cells in a glycoprotein matrix strengthened by collagen
-contributes to elasticity in walls of thorax allowing chest to expand & retract during breathing
landmarks of the sternum
manubrium
body
xiphoid process
where is the infrasternal angle?
at xiphoid process
(xiphisternal joint)
muscle layers
layer 1 (most superficial): traps, lats
layer 2: levator scap, rhomboid major & minor
layer 3: serratus posterior superior & inferior
layer 4: splenius capitis & cervicis
layer 5: erector spinae group
layer 6: transversospinalis group
serratus posterior superior
O: SP C7-T3
I: ribs 2-5 on superior external border
A: expands chest, elevates ribs
N: ventral rami
serratus posterior inferior
O: SP T11 - L3
I: lower 4 ribs
A: draws ribs backward & downward
N: ventral rami
muscle testing posterior lateral neck extensors (group test)
Patient: prone, hands clasped behind head
Fixation: examiner stabilizes legs firmly on table
Test: trunk extension to full range
Pressure: gravity
erector spinae actions
BILATERAL: extension
UNILATERAL: lateral flexion
spinalis & semispinalis actions
BILATERAL: extension
UNIALTERAL: contralateral rotation
which muscle attaches on the mamillary process?
MULTIFIDUS LUMBORUM
O: mamillary process L1-L5
RIBS (true, false, floating)
TRUE (vertebrosternal): ribs 1-7
FALSE (vertebrochondral): ribs 8-10
FLOATING (vertebral): ribs 11 &12
atypical vs. typical ribs
TYPICAL: 3-9
ATYPICAL: 1, 2, 10, 11, 12
muscle attachments on 1st & 2nd ribs
1st rib: anterior & middle scalenes, subclavius
2nd rib: posterior scalenes
SUBCLAVIUS
O: 1st rib (junction of costal cartilage)
I: middle ⅓ of clavicle
A: assist in stabilization of clavicle & depresses clavicle
N: nerve to subclavius
function of intercostal muscles
aid in posture & respiration
*ALL innervated by intercostal nerves
external intercostals
O: lower border of ribs
I: upper border of ribs below
A: elevates ribs in inspiration, supports intercostals in inspiration & expiration
N: intercostal nerves
Fibers travel inferior & medial
internal intercostals
O: inner surface of ribs & costal cartilages
I: upper borders of adjacent ribs below
A: prevents pushing out / drawing in of intercostal spaces in inspiration & expiration, lowers ribs in forced expiration
N: intercostal nerves
Fibers travel inferior & lateral
innermost intercostals
O: lower border of ribs
I: upper border of ribs below
A: elevates ribs
N: intercostal nerves
Fibers travel inferior & lateral
typical vs. atypical lumbar spine
TYPICAL: L1-L4 (mammillary proces)
ATYPICAL: L5
what is atypical about L5?
Transitional
Body = largest
TVP = thick & short
SP short with rounded tip
where spinal cord ends & what it turns into
ends at L1/L2
becomes CAUDA EQUINA
linea alba
“White line”
Fibrous structure of CT → runs down midline of abdomen from xiphoid process to pubic symphysis
external oblique
O: external surface ribs 5-12
I: linea alba, pubic tubercle, anterior half iliac crest
A: bilateral – flexion
A: unilateral – lateral flexion, contralateral rotation of trunk, compression & stabilization of abdomen
N: intercostal nerves
internal oblique
O: anterior & middle ⅓ iliac crest, lateral ⅔ inguinal ligament
I: inferior borders ribs 10-12, linea alba, crest pubis
A: bilateral – flexion
A: unilateral – lateral flexion, ipsilateral rotation of trunk, compression & stabilization of abdomen, depress thorax, assist in respiration
N: intercostal nerves
transverse abdominis
O: internal surfaces costal cartilages 7-12, thoracolumbar fascia, anterior ¾ iliac crest, lateral ⅓ inguinal ligament
I: linea alba with abdominal aponeurosis, pubic crest, pectineal line
A: acts like girdle, compression & stabilization of abdomen
N: intercostal nerves
rectus abdominis
O: pubic crest & pubic symphysis
I: costal cartilage ribs 5-7 & xiphoid process
A: flex trunk, posterior pelvic tilt, compression & stabilization abdomen
N: intercostal nerves
quadratus lumborum
O: iliolumbar ligament, iliac crest
I: inferior border 12 rib, TVP L1-L4
A: unilateral – elevate pelvis, lateral flexion of trunk, depress 12th rib
A: bilateral – extend lumbosacral spine
N: lumbar plexus
which muscle depresses ribs 9-12?
SERRATUS POSTERIOR INFERIOR
structure of spinal discs
Cervical disc – thicker anteriorly
Thoracic discs – equal thickness
Lumbar discs – thicker anteriorly
articular surfaces in lumbar spine
L5 = last intervertebral disc & facet articulation with sacrum
Superior articular facet
OS COXAE
Ilium
Ischium
Pubis
joints of lumbar spine
Facet joints
Intervertebral joints
-lumbar spine EXTENSION coupled with SACRAL NUTATION
-lumbar spine FLEXION coupled with SACRAL COUNTERNUTATION
movement occurring at SI joint
Gliding (slight), nutation & counternutation
NUTATION
Base of sacrum moves inferiorly & anteriorly
Enlarges pelvic outlet
Ischial tuberosities move apart
Pubic symphysis approximates
Iliac crests approximate
PSIS separates
ASIS flares in
COUNTERNUTATION
Base of sacrum moves superiorly & posteriorly
Enlarges pelvic inlet
Ischial tuberosities approximate
Pubic symphysis separates
Iliac crests separate
PSIS approximates
ASIS flares out
pubic ligaments
Superior pubic ligament
Inferior pubic ligament (arcuate pubic ligament)
diaphragm
O: sternal part: two slips from dorsum of xiphoid process
O: costal part: lower 6 ribs & their costal cartilage
O: lumbar part: bodies upper lumbar vertebrae
I: into central tendon (aponeurosis)
A: separates thoracic & abdominal cavities, contracts during inspiration (dome descends), relaxes during expiration (dome ascends)
N: Phrenic nerve
External rotators of HIP - insertions
Gluteus maximus: gluteal tuberosity, IT band
Gluteus medius: greater trochanter
Piriformis: greater trochanter
Superior gemellus: greater trochanter
Inferior gemellus: greater trochanter
Obturator internus: greater trochanter
Obturator externus: trochanteric fossa
Quadratus femoris: quadrate line
Hip flexors – psoas group – unilateral vs. bilateral
*prime mover for hip flexion
Psoas Major: flexion & lateral rotation of hip, flexion & lateral flexion of trunk, anterior pelvic tilt
Psoas Minor: flexion of pelvis on lumbar spine
Iliacus: flex & laterally rotate hip, anterior pelvic tilt
Closed vs. open chain for hip flexors
OPEN (kicking a ball)
Flexion: tibia rolls & glides glides posterior on femur
Extension: tibia rolls & glides anterior on femur
CLOSED (squat)
Flexion: femur rolls & glides posterior on tibia
Extension: femur rolls & glides anterior on tibia
Gluteus maximus – muscle test positions
Patient: prone, knee flexed to 90 degrees
Fixation:
posteriorly – back muscles
laterally – lateral abdominal muscles
Anteriorly: opposite hip flexors
Pressure: against lower part of posterior thigh
Nerve supply for glutes
Gluteus maximus = inferior gluteal nerve
Gluteus medius = superior gluteal nerve
Gluteus minimus = superior gluteal nerve
SUPERIOR GAMELLUS
O: external surface spine of ischium
I: with tendons of obturator internus into medial surface greater trochanter
A: lateral rotation of hip, ABD thigh when hip is flexed
N: nerve to obturator internus
INFERIOR GAMELLUS
O: proximal part ischial tuberosity
I: with tendons of obturator internus into medial surface greater trochanter
A: lateral rotation of hip, ABD thigh when hip is flexed
N: nerve to quadratus femoris
OBTURATOR INTERNUS
O: internal surface obturator membrane & margin obturator foramen, pelvic surface ischium
I: medial surface greater trochanter of femur, proximal to trochanteric fossa
A: lateral rotation of hip, ABD thigh when hip is flexed
N: nerve to obturator internus
OBTURATOR EXTERNUS
O: rami of pubis & ischium, external surface obturator membrane
I: trochanteric fossa of femur
A: lateral rotation of hip, weak ADD of thigh
N: obturator nerve
PATELLA
Sits in trochlear groove of femur
Patellar surface
*Slides in groove on femur as knee flexes & extends
MENISCUS
*Menisci attached to each other anteriorly by TRANSVERSE ligament of knee
-Medial meniscus: attached to MCL & semimembranosus
-Lateral meniscus: attached to PCL & popliteus
FEMORAL TRIANGLE – borders
Inguinal ligament
Sartorius
Adductor longus
When you plantar flex the foot, what muscles are being used?
Soleus
Gastrocnemius
Plantaris
Tibialis posterior
Peroneus (fibular) longus & brevis
Flexor digitorum longus
Flexor hallucis longus
Inversion & eversion muscles
INVERSION: tibialis anterior, tibialis posterior
EVERSION: fibularis longus, brevis & tertius
Ankle ligaments (LATERAL)
Calcaneofibular (CFL)
Anterior talofibular (ATFL)
Posterior talofibular (PTFL)
*typically injured with INVERSION sprain
Ankle ligaments (MEDIAL)
Anterior tibiotalar ligament
Tibionavicular ligament
Tibiocalcaneal ligament
Posterior tibiotalar ligament
Peroneal muscle testing positions (TERTIUS)
Patient: supine / sitting
Fixation: examiner supports leg above ankle joint
test: dorsiflexion of ankle with eversion of foot
pressure: against lateral side, dorsal surface of foot
Peroneal muscle testing positions (LONGUS & BREVIS)
Patient: supine with lower extremity medially rotated
Fixation: examiner supports leg above ankle joint
Test: plantarflexion of ankle with eversion of foot
Pressure: against lateral side of sole of foot
Function of Plantar Fascia
Flat, thick band of CT
Connects calcaneal tuberosity to ligaments around heads of metatarsals
Supports arch on bottom of foot, very strong
