Lec 7 Flashcards

1
Q

Thoracic cavity (floor and openings)

A

floor is diaphragm

superior thoracic aperture and inferior thoracic aperture

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2
Q

Bad things about rib one

A

it can impede vessels and brachial plexus that run close to it

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3
Q

Sternal angle

A

manubriosternal joint

located at level T5 (or T4/T5 intervertebral disc, but of course on anterior side)

when looking laterally at sternum it is the second indention down

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4
Q

what joint does the tubercle of a rib form

A

costotransverse joint

synovial joint that forms the connection between the tubercle of a rib and the transverse process of the corresponding thoracic vertebra

7th rib connects to T7 tubercle

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5
Q

Crest of rib

A

seperates the two articular facets on the head of the rib

articular facts of head articulate with thoracic vertebrae on

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6
Q

where do the ribs articulate posteriorly

A

articular facts of head articulate with 2 thoracic vertebrae on posterior side

For example, the head of rib 2 articulates with the inferior demifacet of T1 and the superior demifacet of T2

COSTOVERTEBRAL JOINT

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7
Q

Rib angle

A

region of greatest curvature

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8
Q

True/False/Floating ribs

A

True ribs 1-7
False 8-10 (join together)
Floating 11, 12 (lats attach)

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9
Q

What vertebral level is the superior scapular angle, root of spine and inferior scapular angle at?

A

Superior angel of scap - T2

Root of spine T3 (bottom of T3)

Inferior angle of scapula T7

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10
Q

Sternocostal joints

A

cartilage of rib to sternum

ribs 1-7

first rib connects as a fibrocartilaginous joint and the rest are synovial

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11
Q

Xiphisternal joint (symphysis)

A

xiphoid process to sternum

cartilaginous joint

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12
Q

Interchondrol

A

ligaments between coastal cartilages of ribs 6-9/10

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13
Q

Know where the coastal margin is

A
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14
Q

What is special about the vertebral foramen in thoracic vertebrae

A

narrow

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15
Q

Where do nerves exit the vertebral column

A

interverterbral foramen

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16
Q

How to identify thoracic vertebrae

A

BODY is heart shaped
VERTEBRAL FORAMEN is circular

demifacets on body

superior facets face posterior and lsightly lateral

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17
Q

Different SP on thoracic vertebrae

A

T1-3 SP faces over body of same vertebrae

T4-6 SP faces downward over intervertebral foramen

T7-9** SP faces downward over inferior vertebral body

T10-12 SP i back to same vertebrae body

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18
Q

Intercostals

A

MA External intercostals; draws ribs superiorly (increasing space of the thoracic cavity) to assist with inhalation

MA internal intercostals: draws the ribs inferiorly (decreasing space of the thoracic cavity) to assist with exhalation

O: inferior border of the rib above

I: superior border of the rib below

N: thoracic segmental intercostal nerve

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19
Q

What muscles are involved with forced breathing?

A

Serratus posterior inferior and superior

20
Q

Serratus posterior superior

A

SP C7 to T3,

elevates ribs with inhalation

21
Q

Serratus posterior inferior

A

SP T12-L3

depresses ribs with exhalation

22
Q

Thoracic arterial supply (how is it organized)

A

Posterior and anterior intercostal arteries, thoracic aorta, internal thoracic arteries

Mostly segmental except the internal thoracic arteries that come off subclavian artery

The intercostal arteries and nerves travel in the subcostal groove (between intercostal mm)

*intercostal groove is a sliver of space on the actual rib

23
Q

Trunk dermatomes

A

T2 Axillary
T4 nipple
T6 xiphoid process
T10 Umbilicus

They are segmental

24
Q

Shingles

A

virus from chicken pox

sensory nerves get inflamed, only affecting dermatomes (not myotomes)

forms rash

25
Q

The abdominal and pelvic cavities are

A

continuous

26
Q

Inguinal ligament

A

runs from ASIS to pubic tubercle

related to pelvic outlet

27
Q

Diaphragm insertion

A

on it self central tendon

but has connection to arcuate ligaments, crural fibers, psoas muscle and QL

28
Q

Diaphram OINs

A

MA: draw down the central tendon of the diaphragm and increase thoracic volume during inhalation

O:
- costal attachment; inner surface of lower 6 ribs
- lumbar attachment; upper 2 or 3 lumbar vertebrae
- sternal attachment; inner part of xiphoid process

I: central tendon

N: phrenic nerve C3. C4. C5 keep you alive!

29
Q

What three structures pass through the diaphragm and at what spinal level

A

From anterior to posterior and right to left orientation

Inferior vena cava (caval opening) T8

esophagus and vagus nerve T10

aorta and thoracic duct T12

30
Q

What level does the abdominal aorta split and into what

A

L4

splits into left and right common iliac artery

lies behind spinal column

31
Q

Phrenic nerve course

A

nerve roots C3-5 stay alive!

exits neck anteriorly and travels back behind the great veins at root of enck

travel lateral to each side of heart and in front of vagus nerve

*Innervates each dome of diaphragm

32
Q

Other functions of the diaphragm

A
  • enhanced venous return from the lower extremities (diaphragmatic pump)
  • controls intra-abdominal pressures (spinal stabilization, coughing, valsalca manuever (litfting heavy weight) and child birthing
  • parasympathetic relaxation
33
Q

what makes up the acetabulum

A

all 3 bones - ilium, pubis, ischium

34
Q

Quadratus Lumborum

A

MA: unilaterally; hike pelvis, laterally flex vertebral column, extend vertebral column

Bilaterally; fix the last rib during forced inspiration

SA: 12th rib, tips of lumbar transverse processes

IA: iliolumbar ligament and iliac crest

N: Ventral branches of T12, L1-L4

LATERAL to errector spinae

35
Q

Hip Flexor muscles (what do they make?)

A

Psoas major
Iliacus

joint together to form common tendon iliopsoas

36
Q

Psoas Major

A

MA: inferiorly flexes hip, superiorly it laterally flexes vertebral column, balance the trunk, when sitting it acts inferiotly w iliacus to flex the tunk

SA: TP of T12-L5 vertebrae, sides of Lumbar bodies and discs between them

IA: less trochanter

N: ventral rami of L1. L2. L3

37
Q

iliacus

A

MA: flexes thigh ans stabilizes hip joint; acts with psoas major

SA: iliac fossa, (ala of) sacrum and anterior sacroiliac ligaments

IA: lesser trochanter and psoas tendon

N: Femoral L2-4 NOT ON EXAM

38
Q

What test can be done for iliopsoas pain? What else is in this region that could be causing the pain?

A

pain with resisted supine hip flexion

lower right Q pain could also be from appendix, ureters, kidneys, sigmoid colon, pancreas, SI joint

39
Q

Rectus Abdominis

A

MA: flex the vertebral (compresses abdominal viscera) column and posterior pelvic tilt (antilordosis)

O: pubic crest and pubic symphysis

I: cartilage of 5-7 ribs and xiphoid process

N: thoraco-abdominal nerves (anterior rami of T6-T12 spinal nerves)

40
Q

What two tissue structures are associated with the rectus abdominis?

A

linea alba and rectus shealth (underneath)

41
Q

External Oblique

A

MA:
- unilateral; laterally flex vertebral column and CONTRA rotation
- bilaterally; flex vertebral column and compress abdominal contents

O: external surfaces of 5-12 ribs

I: linea alba, pubic tubercle, anterior half of iliac crest

N: Thoraco-abdominal nerves of T7-T11 and subcostal nerve

42
Q

What muscle starts where the external obliques start but goes opposite way?

A

serratus anterior

43
Q

Internal oblique

A

MA:
- unilaterally; laterally flex vertebral column, rotate vertebral column to SAME side
- bilaterally; flex vertebral column and compress abdominal contents

O: thoracolumbar fascia, iliac crest and inguinal ligament

I: inferior borders of 10-12th rubs, linea, alba, and pecten pubis via conjoint tendon

N: Thoraco-abdominal nerve (anterior rami T6-T12 soinal nerves and first lumbar nerve

44
Q

Transverse abdominis (dont stress too much on this one)

A

MA: compresses and supports abdominal viscera
*Antagonist of diaphragm with expiration

O: 7-12th costal cartilages, thoracolumbar fascia, iliac crest, connective deep tissue and lateral inguinal ligament

I: linea alba with aponeurosis of internal oblique, pubic crest and pecten pubis via conjoint tendon

N: thoraco-abdominal nerves (T6-T12) and first lumbar nerve

45
Q

What two muscles are often target to help fix back pain?

A

multifidus and transverse abdominas