Lecture Exam 3 Flashcards
What motion(s) is particular associated with lumbar spondylolysis?
hyperextension coupled with rotation
What fills the space in a lumbar spondylolysis?
fibrocartilagenous material
What name has been given to the material filling the space in a lumbar spondylolysis?
spondylolysis ligament
What types of neural function(s) have been associated with the sponodylolysis ligament?
nociception, neuromodulation and autonomic function
What is the appearance of the lumbar vertebra upon oblique x-ray view?
a Scotty dog
What is the appearance of a pars defect in a lumbar vertebra upon oblique x-ray view?
a collared Scotty dog
What is the appearance of a spondylolysis in a lumbar vertebra upon oblique x-ray view?
a collared Scotty dog
In an oblique x-ray, spondylolysis below the superior articular process of a lumbar pars interarticularis is associated with what part of the Scotty dog?
the neck of the Scotty dog
What part of a lumbar vertebra forms the eye of a Scotty dog?
the pedicle
What part of a lumbar vertebra forms the ear of a Scotty dog?
the superior articular process
What part of a lumbar vertebra forms the nose of a Scotty dog?
the transverse process
What is the incidence of sacral spondylolysis in the general population?
it’s rare
What ethnic group is associated with a high incidence of sacral spondylolysis?
the native Alaskan (Inuit) popoulation
Is sacral spondylolysis the result of congenital conditions, acquired conditions or an age-related conditions?
it seems to be acquired
What activities are associated with sacral spondylolysis?
kayaking and harpooning
What is the definition of spondylolisthesis?
a vertebral slippage
What vertebral condition results in spondylolisthesis?
bilateral spondylolysis
What is the direction of spondylolisthesis?
anterior or forward displacement
What is the posterior direction of vertebral slippage called?
Retrospondylolisthesis or retrolisthesis
identify all names given to type I spondylolisthesis?
dysplastic spondylolisthesis, congenital spondylolisthesis
What is the location bias of type I spondylolisthesis?
L5 or upper sacral segments
What is the location of the defect associated with type I spondylolisthesis?
more frequently the vertebral arch
What additional conditions are linked to type I spondylolisthesis?
spina bifida occulta and nerve root compression of the S1 nerve
Identify all names given to type II spondylolisthesis?
isthmic spondylolisthesis
Which subtype of type II spondylolisthesis is stressed in spinal II?
Lytic spondylolisthesis or stress fracture induced spondylolisthesis
What is the cause most frequently given for type II spondylolisthesis?
microfractures as the result of repetitive stress during hyperflexion and rotation
What is the age group typically associated with type II spondylolisthesis?
teenagers or young adults
Will spondylolysis always result in type II spondylolisthesis?
no, particularly in cases of unilateral spondylolysis
What spinal canal dimensions are associated with type II spondylolisthesis?
isthmic spondylolisthesis demonstrates an increase in sagittal diameter of the spinal canal
What is the gender bias and locational bias associated with type II spondylolisthesis?
isthmic spondylolisthesis is common in men at the L5/S1 level
What conditions are often associated with type III spondylolisthesis?
degenerative spondylolisthesis is often associated with osteoarthritis, intervertebral disc degeneration, ligament laxity and articular facet remodeling
What is the gender bias, locational bias, and spinal canal dimension changes often associated with type II spondylolisthesis?
degenerative spondylolisthesis is more common in women, particularly at L4/L5, and demonstrates no change in sagittal diameter of the spinal canal
Identify all names given to type IV spondylolisthesis?
traumatic spondylolisthesis
What causes type IV spondylolisthesis?
fracture of the neural arch components
Is there a gender, locational, or age bias associated with type IV spondylolisthesis?
no
Identify all names given to type V spondylolisthesis?
pathologic spondylolisthesis
What are the cause(s) associated with type V spondylolisthesis?
bone diseases such as Paget disease or osteogenesis imperfecta
What determines the length of the intervertebral foramen?
the width of the pedicle
What may extend the length of the intervertebral foramen?
the transverse process, muscles or ligaments
What forms the superior boundary for the typical intervertebral foramen?
the inferior vertebral notch of the pedicle above
What is the average height of the intervertebral foramen?
about 13mm
What percent of total vertebral column length does “true” intervertebral foramina height from C2-S1 equal?
40%
What percent of total vertebral column length does all intervertebral foramina height from occiput Co1 equal?
53%
What are the generic contents of the intervertebral foramen?
neural tissue, connective tissue, vascular tissue, lymphatic tissue
What is the percent of neural tissue in the intervertebral foramen?
from 8 to 50 percent
What are the characteristics of the Artery of Adamkiewicz?
it is a left side, anterior medullary feeder artery, located in the T9/T10 intervertebral foramen, and the primary vascular supply to the lumbar enlargement
What is the most likely region of the thoracic spine for herniation?
below T8
What will the intervertebral veins drain into?
the external vertebral venous plexus or Batson’s plexus
What is a unique histological feature of the veins of the vertebral column?
they appear to lack valves
What size lymphatic vessels lie in the intervertebral foramen?
medium sized lymphatics
What type(s) of connective tissue will be present in the intervertebral foramen?
adipose tissue and loose areolar connective tissue
What is the relationship of cervical intervertebral foramen height to nerve root size?
the height increases but the nerve root size stays about the same from cranial to caudal
What parts of the cervical vertebra will modify the intervertebral foramen?
the lateral groove and uncinate process
What is the relationship between aging and cervical spine nerve root characteristics?
the length of the nerve root increases as it descends from its apparent origin on the spinal cord, but the cross-sectional area of the nerve root decreases
What are the specific attachment sites for a cervical spinal nerve?
the sulcus for the ventral primary ramus on the costotransverse bar and the vertebral artery
What contributes to the anterior boundary of the thoracic intervertebral foramen?
the costocentral joint
What is the amount of contribution of the intervertebral disc to the height of the lumbar intervertebral foramen?
about half
Which are the largest spinal nerves?
L5 and S1 spinal nerves
What increases the length of the intervertebral foramen at L5?
the lumbosacral tunnel
What forms the lumbosacral tunnel?
the lumbosacral ligament, transverse process of L5 and sacral ala
What condition is the result of encroachment on the L5 spinal nerve?
the far out syndrome
What ligaments may contribute to the loss of size in the lumbar intervertebral foramen?
the transforaminal ligament and the corporotransverse ligament
What is unusual about the sacral intervertebral foramen compared to other intervertebral foramina?
a completely osseous boundary exists
What is more likely the cause of nerve irritation at the sacral intervertebral foramen?
the tilt or position of the entire sacrum relative to the pelvis
What is unique about the relationship of spinal nerve to intervertebral foramen at S5-Co1?
there are two nerves present, S5 nerve & Co1 nerve
What are some examples of destructive lesions of the vertebral body?
tuberculosis, hemangiomas, osteoporosis
What may reduce the impact of intervertebral disc loss of integrity on the intervertebral foramen in the cervical and thoracic spine?
the joint of Luschka in the cervicals, the costocentral joint in the thoracics
What are examples of osteophyte formation that influence the intervertebral foramen?
the bony spurs of the vertebral body and para-articular processes on the lamina
What are examples of acquired alterations of the spinal curves identified in class?
obesity, pregnancy and the use of heavy backpacks
What is the recommended weight of a backpack compared to individual weight for the developing spine?
backpack weight should not exceed 10% individual body weight
What are the curvatures of the vertebral column?
anterior, posterior, and lateral
What is the direction of the primary curve of the vertebral column?
posterior
Why is the posterior curve also called the primary curve?
it is the first curve to appear embryologically
What are the adult remnants of the primary curve along the vertebral column?
the thoracic or dorsal curve and the pelvic or sacrococcygeal curve
What are the names given to curves that form during development to reverse the direction of regions along the vertebral column?
anterior curve, secondary curve, compensatory curve
What are the names of the anterior curves, secondary curves, and compensatory curves?
cervical curve and lumbar curve
What segmental levels form the cervical curve?
C2-T1
What segmental levels form the lumbar curve?
T12-L5
What is the earliest time of appearance of the cervical curve?
the third fetal month
What is the traditional time of appearance of the cervical curve said to be?
during the last trimester in utero
What is the time during which the “adult” cervical curve is said to appear?
Within the first year after birth
What developmental events are indicated in the formation of the adult cervical curve?
- centers for vision and equilibrium will appear in the brain
- musculature attaching the skull, cervical region, and upper thorax together develops
- the head is held upright
- the intervertebral disc height becomes greater anterior than posterior
At what age will the infant begin to hold the head erect?
usually between the third and fourth month after birth
What is the name given to the integration of visual and motor pathways associated with holding the head erect?
the righting reflex
What is the location for the apex of the cervical curve?
typically between C4 and C5
What is the location for the cervical kyphosis?
between occiput and C1
What is the name given to the primary cervical curve?
cervical kyphosis
What is the time of appearance of the lumbar curve?
between 12 and 18 months after birth
What infant activities are associated with the development of the lumbar curve?
- crawling will cause the abdomen to put tension on the lumbar region and pulls it forward
- muscle development is promoted to compensate for the swayback of the lumbars
- intervertebral disc height will become greater anterior compared to posterior
- walking will further promote muscle and intervertebral disc development
What happens within the intervertebral disc to facilitate the lumbar curve development?
the nucleus pulposus of L4 will shift its position within the annulus fibrosis
Which sense is a requirement for holding the head erect, standing, sitting, and walking?
vision
What is the gender bias associated with lumbar curve convexity?
females have a greater convexity of the lumbar curve
What is the vertebral relationship between the lumbar curve and the lumbar enlargement?
lumbar curve T12-L5; lumbar enlargement T9-T12
What is the formation of the lateral curve often correlated with?
faster development of the muscles on the side of handedness
What is the time of appearance of the lateral curves?
they appear after 6 years old
What locations of lateral curves are recognized?
cervical, thoracic or dorsal, and lumbar
Which lateral curves are best developed?
thoracic or dorsal, and lumbar
What is the relationship between curve direction and handedness?
a right handed person has a high probability for a right thoracic, left lumbar curve combination
What is the incidence of a right thoracic, left lumbar curve combination in the population?
about 80% of the population demonstrates this
What does the suffix “osis” mean?
a condition
Does “osis” infer a normal or an abnormal condition?
neither, its non-judgemental
What generic names identified abnormal curves of the vertebral column?
lordosis, kyphosis, scoliosis
What is the definition of lordosis?
a forward bending condition
What is the definition of kyphosis?
a humpback or hunchback condition
What is the definition of scoliosis?
a warped or crooked condition
What is the direction of the curve deviation in lordosis?
to the anterior
What is the direction of the curve deviation in kyphosis?
to the posterior
What is the direction of the curve deviation in scoliosis?
to the side (it is a lateral curve deviation)
Is there a locational bias for the classic definition of lordosis?
no, there would be an increase in the anterior direction in the cervical spine, a decrease in the posterior direction in the thoracic spine, an increase in the anterior direction in the lumbar spine and a decrease in the posterior direction in the pelvic or sacrococcygeal region
Is there a locational bias for the classic definition of kyphosis?
no, there would be a decrease in the anterior direction in the cervical spine, an increase in the posterior direction in the thoracic spine, a decrease in the anterior direction in the lumbar spine and an increase in the posterior direction in the pelvic or sacrococcygeal region
What clinical abnormal curvatures of the vertebral column were stressed in class?
military neck, humpback or hunchback, and swayback
What is military neck?
a decreased anterior curve in the cervical region, a straight neck
What is humpback or hunchback?
an increased posterior curve in the thoracic region
What is swayback?
an increased anterior curve in the lumbar region
What is classic classification of humpback or hunchback?
a kyphosis
What is classic classification of military neck?
a kyphosis
What is classic classification of swayback?
a lordosis
What does the use of the term lordotic try to imply?
a normal cervical and normal lumbar anterior curve
What does the use of the term kyphotic try to imply?
a normal thoracic or dorsal and normal pelvic or sacrococcygeal posterior curve
What prefixes are used to convey abnormality in curve patterns?
hyper and hypo
What does the term hyperlordotic infer?
an increase in the anterior curve of the cervical or lumbar region
What does the term hypolordotic infer?
a decrease in the anterior curve of the cervical or lumbar region
What does the term hyperkyphotic infer?
an increase in the posterior curve of the thoracic/dorsal or pelvic/sacrococcygeal region
What does the term hypokyphotic infer?
a decrease in the posterior curve of the thoracic/dorsal or pelvic/sacrococcygeal region
What are the curve classifications for military neck?
a kyphosis or hypolordotic curve
What are the curve classifications for humpback or hunchback?
a kyphosis or hyperkyphotic curve
What are the curve classifications for swayback?
a lordosis or hyperlordotic curve
What is the more complete, accepted definition of scoliosis?
an abnormal lateral curve coupled with axial rotation
What is the radioloical test for skeletal maturity?
the Risser sign, an indication of bone maturity in the iliac apophysis
What are the classifications of scoliosis according to the Scoliosis Research Society?
magnitude, location, direction, etiology, structural scoliosis and non-structural scoliosis
What does magnitude of scoliosis refer to?
the length and angle of the curve deviation on x-ray
What is often used to measure the magnitude of scoliosis?
the Cobb method
What does location of scoliosis infer?
the location of the vertebral segment forming the apex of the curve deviation
What does direction of scoliosis refer to?
the side the convexity of the curve will bend toward
What does etiology of scoliosis mean?
the cause of the scoliosis
What is structural scoliosis?
a more radical form of scoliosis, it may worsen, associated with structural deformities of the vertebra or intervertebral disc, frequently has a fixed angle of trunk rotation
What is nonstructural scoliosis?
a mild from of scoliosis, unlikely to worsen, not associated with structural deformities of the vertebra or intervertebral disc and lacks a fixed angle of trunk rotation
What is the classification of scoliosis that is unique to the individual patient?
idiopathic scoliosis
What does idiopathic scoliosis infer?
the scoliosis is unique to the individual, it has no known cause, unknown etiology
What is the incidence of idiopathic scoliosis in the population?
1% to 4% of the population
Based on age of onset, what are the types of idiopathic scoliosis?
infantile, juvenile, and adolescent
What is the age range for infantile idiopathic scoliosis?
from birth to 3 years old
What is the age range for juvenile idiopathic scoliosis?
from 3 years old to 10 years old
What is the age range for adolescent idiopathic scoliosis?
over 10 years old
Identify curve direction, location, gender bias and incidence of infantile idiopathic scoliosis.
left thoracic, male, less than 1% incidence
Identify curve direction, location, gender bias and incidence of juvenile idiopathic scoliosos
right thoracic, females over 6 years old, and 12% - 21% incidence
Identify curve direction, location, gender bias and incidence of adolescent idiopathic scoliosis
right thoracic or right thoracic and left lumbar, females, and 80% incidence
What is the genetic factor associated with adolescent idiopathic scoliosis?
an autosomal dominant factor that runs in families
What is the relationship between curve deviation, incidence, and curve worsening?
the greater deviation, the lower the incidence, and the more likely to worsen
What is the name given to segments that lie in the transition zones of the vertebral column?
transition vertebrae
What are the transition zones of the vertebral column?
occipitocervical, cervicothoracic, thoracolumbar, lumbosacral, and sacrococcygeal zones
How are specific segments within a transition zone identified?
by adjacent region of the segment, process of transition, and specific segment (occipitalization of C1)
What does the suffix “ization” refer to?
in the process of becoming like
What are the possible transition zone - segmental combinations?
cervicalization of occiput, occipitalization of C1
dorsalization of C7, cervicalization of T1
lumbarization of T12, dorsalization of L1
sacralization of L, lumbarization of S1
coccygealization of S5, sacralization of Co1
What is/are the characteristic(s) of cervicalization of occiput?
an increase in occipital bone size, formation of new or larger lines on the occipital bone
What is/are the characteristic(s) of occipitalization of C1?
the atlas may be partially or completely fused to the occiput
What is another way of implying occipitalization of C1?
atlas assimilation
What is the incidence of occipitalization of C1?
0.1% to 0.8%
When do the centers of ossification for the odontoid process first appear?
during the last trimester in utero
When do the bilateral ossification centers for the odontoid process fuse?
at or shortly after birth
What joint forms between the odontoid process ossification centers and the centrum of C2?
the subdental synchondrosis
What joint classification is present between the C2 odontoid process and centrum?
amphiarthrosis synchondrosis
Ossification between the odontoid process and centrum joint of C2 first appears at what age?
4 years old
a joint between the odontoid process and centrum of C2 is last identified at what age?
7 years old
What is the name given to the condition in which the joint formed between the odontoid process and centrum of C2 persists beyond age 7?
os odontoideum
What is an os odontoideum?
a persistence beyond age 7 of the joint formed between the centrum and odontoid process centers of ossification
What is the name given to the joint between the odontoid process and centrum of C2 which is still evident beyond age 7?
persistent subdental synchondrosis
What is the name given to the joint formed between the tip of the dens and the odontoid process centers of ossification?
tip of the dens synchondrosis
What is the classification of the joint formed between the tip of the dens and odontoid process centers of ossification?
amphiarthrosis synchondrosis
At what age will the tip of the dens center of ossification appear?
sometime in early adolescence
Based on the age of appearance, how is the tip of the dens center of ossification classified?
secondary center of ossification
At what age will the tip of the dens fuse with the odontoid process?
before age 12
If the joint formed between the tip of the dens and odontoid process centers of ossification persists beyond age 12, what is the condition called?
terminal ossicle
What is a basilar impression?
persistence of the nonunion of the basilar and condylar parts of the chondrocranium such that the cartilage deforms due to the weight of the brain
What is a basilar invagination?
the upper cervical spine appears to be invaginated into the skull on x-ray analysis
What is/are the characteristic(s) of dorsalization of C7?
the addition of a rib and changes in superior articular facet orientation are typical
What is the incidence of rib-related changes following dorsalization of C7?
from one-half to two and one-half percent of the population
Do patients typically present with symptoms specific for dorsalization of C7?
no, they are typically asymptomatic
What is the gender bias suggested in dorsalization of C7?
female
What alteration in C7 facet orientation may accompany dorsalization?
the superior articular facet of C7 may change from back, upward, and medial to that of a typical thoracic facet…back, upward, and lateral; the inferior articular facet is unchanged
What alteration in C6 facet orientation may accompany dorsalization?
C6 demonstrates a change in inferior articular facet orientation from forward, lateral, and downward to forward, medial, and downward; the superior articular facet unchanged
What percent of the population may demonstrate thoracic-like features at C7?
up to 46%
What rib related changes may accompany cervicalization of T1?
the first rib may decrease in mean relative length or become absent
What will result from fusion of a short rib to the T1 transverse process?
the transverse foramen
What T1 facet orientation changes may accompany cervicalization?
the superior articular facet may change from back, upward, and lateral to back, upward, and medial; the inferior articular facet is unchanged
What C7 facet orientation changes may accompany cervicalization?
the inferior articular facet may change from forward, medial, and downward to forward, lateral, and downward; the superior articular facet is unchanged
What is the incidence of cervicalization of T1 in the population?
up to 28% of the population
What rib related changes may accompany dorsalization of L1?
elongated bones shaped like ribs may appear
What is the incidence of lumbar ribs in the population?
over 7% of the population demonstrates lumbar ribs
What is the gender bias associated with dorsalization of L1?
males are two to three times more affected
What L1 facet orientation changes may accompany dorsalization?
the superior articular facet may change from concave, back, upward, and medial to flat, back upward and lateral; the inferior articular facet is unchanged
What T12 facet orientation changes may accompany dorsalization?
the inferior articular facet may change from convex, forward, lateral, and downward to flat, forward, medial, and downward; the superior articular facet is unchanged
What rib-related changes may accompany lubarization of T12?
a significant shortening of the mean relative length of 113 mm of the twelfth rib or it becomes absent
What T12 facet orientation changes may accompany lumbarization?
the superior articular facet may change from flat, back, upward, and lateral to concave, back, upward, and medial; the inferior articular facet is unchanged
What T11 facet orientation changes may accompany lumbarization?
the inferior articular facet may change from flat, forward, medial, and downward to convex, lateral, and downward; the superior articular facet is unchanged
What is characteristic of lumbarization of S1?
the failure of snyostosis between S1 and S2, squaring of the vertebral body of S1 and flaring of the sacral ala
What unique characteristics of lumbarization of S1 were stressed in class?
squaring of the vertebral body of S1 and flaring of the sacral ala
What is failure of synostosis between S1 and S2?
the segments do no completely fuse together
What articular facet changes may accompany lumbarization of S1?
none
What is characteristic of sacralization of L5?
L5 may be partially or completely fused to the sacrum
What is the incidence of sacralization of L5 in the population?
41% to 85%
Which segment demonstrates the greatest morphological variation along the spine?
L5
What articular facet changes accompany sacralization of L5?
none
What is the incidence of variation within the sacrococcygeal region in the population?
up to 14%
What is characteristic of sacralization of Co1?
the premature fusion of Co1 to the sacrum
What is characteristic of coccygealization of S5?
the separation of S5 from sacrum and its premature fusion to Co1
What forms the spinal accessory nerve innervating the trapezius?
C1-C5 cord levels contribute to the spinal root of the spinal accessory nerve
What forms the thoracodorsal nerve innervating the latissimus dorsi?
ventral rami from C6-C8
What forms the dorsal scapular nerve?
the ventral ramus of C5
What part of the vertebra forms the osseous origin for the splenius muscles?
the spinous process
Splenius Capitis will attach to what locations on the skull?
mastoid process of temporal bone, superior nuchal line of the occipital bone
What is the innervation of the splenius capitis?
dorsal rami of middle cervical spinal nerves (C3-C5 cord levels)
Splenius cervicis will attach to what locations on the spine?
lateral mass of C1 and posterior tubercle of transverse process of C1-C4
What is the innervation of the splenius cervicis?
dorsal rami of lower cervical spinal nerves (C5-C7 cord levels)
Which muscles represent the fourth layer of the true back?
the erector spinae group or sacrospinalis muscles
Which muscles are identified as erector spinae or sacrospinalis muscles?
iliocostalis, longissimus, spinalis
What osseous parts of the vertebral column serve as an origin to the iliocostalis lumborum?
spinous processes of T11-T12, L1-L5, median sacral crest, lateral sacral crest
What is the insertion for the iliocostalis lumborum?
costal angles of the lower 6-9 ribs (rib 6-rib 12 or rib 3- rib 12)
What is the innervation of the iliocostalis lumborum?
dorsal rami of lower thoracic and all lumbar spinal nerves
What osseous parts of the vertebral column serve as an origin to the iliocostalis lumborum pars lumborum?
spinous processes of L1-L5
What is the insertion for the iliocostalis lumborum pars lumborum?
iliac crest of the innominate bone
Which subdivision of the iliocostalis muscle appears to have a reversal of origin - insertion?
iliocostalis lumborum pars lumborum
What is the origin for the iliocostalis thoracis?
costal angles of the lower 6-7 ribs (rib 5 or 6-rib 12)
What is the insertion for the iliocostalis thoracis?
costal angles of the upper 6-7 ribs, transverse process of C7
What osseous part of the vertebral column serves as an insertion for the iliocostalis thoracis?
transverse process of C7
Which subdivision of the iliocostalis primarily originates and inserts on the ribs?
iliocostalis thoracis
What is the innervation of the iliocostalis thoracis?
dorsal rami of upper 6 thoracic spinal nerves (T1-T6 cord levels)
What is the origin for the iliocostalis cervicis?
costal angles of the upper 3-6 ribs (ribs 1-3 or ribs 1-6)
What is the insertion for the iliocostalis cervicis?
posterior tubercle of transverse process of C(3) C4-C6
Double check the book his answer is odd
What is the innervation of the iliocostalis cervicis?
dorsal rami of T1, T2 spinal nerves, sometimes C8 spinal nerve (C8, T1, T2 cord levels)
What muscles are classically identified as longissimus muscles?
longissimus thoracis, longissimus cervicis and longissimus captis
What osseous parts of the vertebral column serve as an origin to the longissimus thoracis?
accessory process and transverse processes of L1-L5, spinous process of L3-L5 and median sacral crest S1-S3
What is the insertion for the longissimus thoracis?
transverse tubercle of all thoracic segments between tubercle and costal angle of the lower 9-10 ribs (rib2 or 3-rib 12)
Which erector spinae muscle is attached to the accessory process?
longissimus thoracis
What is the innervation of the longissimus thoracis?
dorsal rami of all thoracic and lumbar spinal nerves (cord levels T1-T12, L1-L5)
What osseous parts of the vertebral column serve as an origin to the longissimus thoracis pars lumborum?
accessory process and medial part of transverse process of L1-L5
What is the insertion for the longissimus thoracis pars lumborum?
posterior superior iliac spine (PSIS) of the innominate bone
What osseous parts of the vertebral column site serve as an origin to the longissimus thoracis pars thoracis?
spinous processes of L3-L5 and median sacral crest S1-S3
What is the insertion for the longissimus thoracis pars thoracis?
transverse process of all thoracics, between tubercle and costal angle of all ribs (rib1-rib12)
Which subdivision of the longissimus muscle appears to have a reversal of origin-insertion?
longissimus thoracis pars lumborum
What osseous parts of the vertebral column serve as an insertion for the longissimus cervicis?
posterior tubercle of transverse processes of C2-C6 or C7, articular processes from C2-C6 or C7
What is the innervation of the longissim cervicis?
dorsal rami of C4-C8 and T1-T2 spinal nerves (C4-C8 & T1-T2 cord levels)
What osseous parts of the vertebral column serve as an origin to the longissimus capitis?
transverse tubercle of T1-T5 and articular processes of C4-C7
What is the insertion for the longissimus capitis?
mastoid process of temporal bone
What is the innervation of the longissimus capitis?
dorsal rami of C1-C3 or C4 spinal nerves, (C1-C3 or C4 cord levels)
Which erector spinae muscles attach to cervical articular processes?
longissimus cervicis and longissimus capitis
What muscles are classically identified as spinalis muscles?
spinalis thoracis, spinalis cervicis and spinalis capitis
What osseous parts of the vertebral column serve as an origin to the spinalis thoracis?
spinous processes of T11 and T12-L1 and L2
What is the insertion for the spinalis thoracis?
spinous process of T1-T4 or as low as T8
What is the innervation of the spinalis thoracis?
dorsal rami of all thoracic and upper lumbar spinal nerves
What osseous parts of the vertebral column serve as as origin to the spinalis cervicis?
spinous process of C7 and T1-T6
What osseous parts of the vertebral column serve as an insertion for the spinalis cervicis?
spinous processes from C2-C4
What is the innervation of the spinalis cervicis?
dorsal rami of all cervical spinal nerves (C1-C8 cord levels)
What osseous parts of the vertebral column serve as an origin to the spinalis capitis?
spinous process of C7 and T1-T6 or T7
What is the innervation of the spinalis capitis?
dorsal rami of lower cervical and upper thoracic spinal nerves
What muscles are identified as transversospinalis muscles?
semispinalis, multifidus, and rotators
How many vertebrae can be attached to a single segment by transversospinalis muscles?
as many as nine vertebrae
What osseous parts of the vertebral column serve as an origin to the semispinalis thoracis?
transverse tubercles of T6-T10 or as low as T12
What segment will represent the lowest attachment site for the semispinalis thoracis?
T12
What is the insertion for the semispinalis thoracis?
spinous processes of C6-C7 and T1-T4
What is the innervation of the semispinalis thoracis?
dorsal rami of T1-T6 spinal nerves (cord levels T1-T6)
What osseous parts of the vertebral column serve as an orgin to the semispinalis cervicis?
transverse tubercles of T1-T5 or T6 and articular processes of C4-C7
What is the insertion for the semispinalis cervicis?
spinous processes of C2-C5
What is the innervation of the semispinalis cervicis?
dorsal rami of C6-C8 spinal nerves (cord levels C6-C8)
What osseous parts of the vertebral column serve as an origin to the semispinalis capitis?
transverse tubercles of C7, T1-T6 or T7 and articular processes of C4-C6
What is the insertion for the semispinalis capitis?
below the superior nuchal line of the occipital bone
What is the innervation of the semispinalis capitis?
dorsal rami of C1-C6 spinal nerves (cord levels C1-C6)
The semispinaliscapitis and spinalis capitis may fuse to form what muscle?
biventer cervicis
What regional subdivisions are now identified with multifidus muscles?
lumbar multifidus, thoracic multifidus and cervical multifidus
What osseous parts of the vertebral column serve as an origin to the classic multifidus?
articular process of C4-C7, transverse process of T1-T12, mammillary processes of L1-L5 and the dorsal surface of S1-S4 or S5
What is the insertion for the classic multifidus?
spinous process 3-5 segements above the origin
Which transversospinalis muscle attaches to articular and mammillary processes along the spine?
multifidus
Contraction of the classic multifidus will result in what movements of the vertebral column?
lateral flexion and rotation of the spine, maintains the lumbar lordotic curve and prevents entrapment of zygapophyseal capsular ligament during movement
What is the innervation of the classic multifidus?
dorsal rami of C3-C8, T1-T12, L1-L5 and S1 spinal nerves (cord levels C3-C8, T1-T12, L1-L5 and S1)
What osseous parts of the vertebral column serve as an origin to the multifidus cervicis?
articular process of C4-C7
What is the attachment site and most cranial vertebra of insertion for the multifidus?
spinous process of C2
Contraction of multifidus cervicis will result in what movements?
alters the zygapophyseal capsular ligament response to load distribution
Determines the cervical spine response to injury as evidenced by neck pain and is a significant contributor to postural control of the head and neck
Which subdivision of multifidus may demonstrate a reversal of origin-insertion?
multifidus lumborum`
Contraction of multifidus lumborum will result in what movements?
lateral flexion and rotation of the lumbar spine, maintains the lumbar lordotic curve and prevents entrapment of lumbar zygapophyseal capsular ligament during movement
Which muscles of the spine exhibit a reversal of the expected origin-insertion combination?
iliocostalis lumborum pars lumborum, longissimus thoracic pars lumborum and multifidus lumborum
What muscles are included in the suboccipital muscle group?
rectus capitis posterior major, rectus capitis posterior minor, obliquus capitis inferior and obliquus capitis superior
Which suboccipital muscle lacks an attachment to the skull?
obliquus capitis inferior
Which nerve will innervate all suboccipital muscles?
the dorsal ramus of C1, the suboccipital nerve
What is the origin of the rectus capitis posterior major?
the spinous tubercle of C2
What is the insertion of the rectus capitis posterior minor?
inferior nuchal line laterally
What is the origin of the rectus capitis posterior minor?
the posterior tubercle of the posterior arch of C1
What is the insertion of the rectus capitis posterior minor?
inferior nuchal line medially
What is the origin of the obliquus capitis inferior?
C2 spinous process and lamina
What is the insertion of the obliquus capitis inferior?
transverse process of C1
What is the origin of the obliquus capitis superior?
the posterior tubercle of the transverse process of C1
What is the insertion of the obliquus capitis superior?
between superior nuchal line and inferior nuchal line
An increase in the density of muscle spindles is most apparent in which suboccipital muscle?
obliquus capitis inferior
What is the result of communication between suboccipital muscles, visual centers and vestibular centers?
coordination of head and eye position
What is the proposed function of the suboccipital muscle group?
postural stabilizers of the atlanto-occipital and atlanto-axial joints
Which subocciptial muscles are known to attach to dura mater?
rectus capitis posterior major, rectus capitis posterior minor and obliquus capitis inferior
Interspinalis is paired in which regions of the spine?
cervical and lumbar regions
At what locations will interspinalis be absent along the spine?
T3-T4 down to T110-T11
Based on the density of muscle spindles what is the proposed function of the interspinalis?
acts as a proprioceptive transducer in conjunction with intertransversarii to coordinate the smooth movement of the spine and to maintain appropriate posture
Intertransversarii are paired in which region(s) of the spine?
cervical and lumbar regions
Which of the cervical intertransversarii is innervated by dorsal rami of cervical spinal nerves?
posterior medial belly, cervical intertransversarii
What are the names of the parts of the intertransversarii in the lumbar spine?
medial belly, anterior lateral belly, posterior lateral belly
What is the origin of the medial belly of the lumbar intertransversarii?
accessory process of transverse process L1-L4
mammillary process of superior articular process L1-L4
Which of the lumbar intertransversarii is innervated by dorsal rami of lumbar spinal nerves?
medial belly, lumbar intertransversarii
Which of the lumbar intertransversarii is innervated by ventral rami of lumbar spinal nerves?
anterior lateral belly and posterior lateral belly, lumbar intertransversarii
Which muscle group is innervated by both dorsal rami and ventral rami of spinal nerves?
intertransverarii
Based on the density of muscle spindles what is the proposed function of the intertransversarii?
acts as a proprioceptive transducer in conjunction with interspinalis to coordinate the smooth movement of the spine and to maintain appropriate posture
What is the origin of the longus colli muscle?
vertebral bodies of C5-C7, T1-T3 and anterior tubercles of transverse processes C3-C5
What is the insertion of the longus colli muscle?
anterior tubercle of the anterior arch C1, vertebral bodies of C2-C4, and anterior tubercles of transverse processes C5-C6
What will innervate the longus colli?
ventral rami of C2-C6 or C7 spinal nerve
What is the origin of the longus capitis muscle?
anterior tubercles of transverse processes C3-C6
What is the insertion of the longus capitis?
basilar part of the occipital bone
What will innervate the longus capitis?
the ventral rami of C1-C3 spinal nerves
What is the origin of the rectus capitis anterior?
lateral mass and costal element of the transverse process of C1
What is the insertion of the rectus capitis anterior?
basilar part of the occipital bone
What will innervate the rectus capitis anterior?
ventral rami of C1-C2 spinal nerves
What is the origin of the rectus capitis lateralis?
costal element of the transverse process of C1
Contraction of rectus capitis lateralis will result in what movements?
laterally flex the head to the ipsilateral side
What will innervate the rectus capitis lateralis?
the ventral rami of C1-C2 spinal nerves
What is the origin of the anterior scalene?
anterior tubercles of transverse processes C3-C6
What is the insertion of the anterior scalene?
ridge and anterior scalene tubercle of the first rib
What will innervate the anterior scalene?
the ventral rami of C2-C6 spinal nerves
What is the origin of the middle scalene?
transverse processes of C1, C2 and posterior tubercles of transverse processes C3-C7
What is the insertion of th emiddle scalene?
between the tubercle and groove for the subclavian artery on the first rib
What will innervate the middle scalene?
the ventral rami of C3-C8 spinal nerves
What is the insertion of the posterior scalene?
outer surface of second rib
Contraction of posterior scalene will result in what movements?
laterally flex the neck; elevates the second rib
What will innervate the posterior scalene?
the ventral rami of C6-C8 spinal nerves
What muscle is said to form the iliolumbar ligament?
quadratus lumborum
What osseous part of the vertebral column serves as an origin to the quadratus lumborum?
transverse process of L5
What is the insertion of the quadratus lumborum?
transverse tubercle of the transverse process of L1-L4 and 12th rib
What will innervate the quadratus lumborum?
the ventral rami of T12 and L1-L3 or L4 spinal nerves
What is the origin of the psoas major?
vertebral bodies T12, L1-L5, S1 and transverse processes of L1-L5
What is the insertion of the psoas major?
lesser trochanter of the of the femur
What will innervate the psoas major?
primarily the ventral rami of L2 and L3, may include ventral rami of L1 and L4 spinal nerves
What is the origin of the psoas minor?
vertebral bodies of T12, L1
What is the insertion of the psoas minor?
iliopubic eminence of the innominate bone
What will innervate the psoas minor?
the ventral ramus of L1 spinal nerve
What osseous part of the vertebral column serves as an origin to the iliacus?
superolateral margin of sacrum
What non-vertebral column site serves as an origin to the iliacus?
iliac crest and upper two thirds of the iliac fossa of the innominate bone
What is the insertion of the iliacus?
lesser trochanter of the femur
What will innervate the iliacus?
the femoral nerve, primarily the ventral rami of L2 and L3
What is the origin of the levator costarum brevis?
transverse tubercles of transverse processes from C7, T1-T11
What is the insertion of the levator costarum brevis?
between the costal tubercle and costal angle of the rib below
What will innervate the levator costarum brevis?
the dorsal rami of T1-T12 spinal nerves
What is the origin of the costarum longus?
transverse tubercles of transverse processes from T7-T10
What is the insertion of the levator costarum longus?
near costal angle of rib9-rib12
What will innervate the levator costarum longus?
the dorsal rami of the lower thoracic spinal nerves
What is the origin of the serratus posterior superior?
spinous tubercles of spinous processes from C7, T1 and T2 possibly T3
What is the insertion of the serratus posterior superior?
upper outer border of rib2-rib5
What will innervate the serratus posterior superior
the ventral rami of T2-T5 spinal nerves…intercostal nerves
What is the origin of the serratus posterior inferior?
spinous tubercles of spinous processes from T11, T122, L1, L2 and possibly L3
What is the insertion of the serratus posterior inferior?
inferior outer border of ribs 9-12
What will innervate the serratus posterior inferior?
the ventral rami of T9-T11, the intercostal nerves and the ventral ramus of T12 the subcostal nerve
What are the characteristics of a (amphiarthrosis) symphysis?
limited motion, median plane location, support ligaments both anterior and posterior to the joint, more permanent in longevity than synchondrosis and they occur between bones developing by endochondral ossification
What are the four consistent features of synovial (diarthrosis) joints?
articular or fibrous capsule, synovial membrane, articular cartilage and synovial fluid
Thickening of the fibrous capsule connective tissue will form the….
capsular ligament
What generic accessory ligaments may accompany and support the capsular ligament?
intracapsular and extracapsular ligaments
What are the common characteristics of type 1 articular receptors?
located in the superficial layer of the fibrous capsule, resemble ruffini endings, most numerous in cervical zygapophyses and they monitor the joint at rest
What are the characteristics of type 2 articualr receptors?
located in deeper strata of the fibrous capsule, resemble pacinian corpuscles, most numerous in the cervical spine and monitor the joint during normal range of motion
What are the the characteristics of type 3 articular receptors?
present in collateral and intrinsic ligaments, resemble golgi tednon organs, not initially observed along the vertebral column and monitor extreme joint motion
What is the function of type four articular receptors?
nociceptive, they monitor pain
Type IVa articular receptors would be present in what locations?
fibrous capsule, articular fat pads or adventitia of blood vessels
Type IVb articular receptors would be present in what locations?
accessory ligaments in general, dense in the posterior longitudinal ligament of the spine
What are three modifications of articular synovial membrane?
- synovial villi, 2.articular fat pads or haversian glands, 3. synovial menisci and intra-articular discs
What is the generic function of modifications of articular synovial membrane?
aid in spreading synovial fluid
Articular fat pads are most numerous in what location along the vertebral column?
lumbar zygapophyses
Condensed fibrous connective tissue or fibrocartilage projections of the synovial membrane are called___.
synovial menisci or intra-articular discs
Synovial menisci are a feature of what joint examples?
femur-tibia articulation, cervical zygapophyses and lumbar-zygapophyses
What are the specific functions of type a synovial cells?
are phagocytic
What is the specific function of type B synovial cells?
secrete proteinaceous substances and hyaluronic acid
What is the common function of type A and B synovial cells?
formation and absorption of synovial fluid
What is the substance of nutrition for articular cartilage?
blood vessels in the synovial membrane, sinuses of the bone marrow cavity and from synovial fluid itself
What are the primary constituents of articular cartilage?
water, cells, collagen type 2 fibers and proteoglycan gel
What is the primary function of bound glycosaminoglycans in articular cartilage?
form a network for water retention
What is implied when cartilage is said to have elastic properties?
cartilage can deform and returns to original volume rapidly, a time independent property
What is implied when cartilage is said to have viscoelastic propteries?
cartilage can deform but returns to original volume slowly, a time dependent property
What is the function of articular cartilage?
to provide a wear-resistant, low friction, easily lubricated surface for joint movement
What are the properties of synovial fluid?
it is yellow-white, viscous, slightly alkaline and tastes salty
Synovial fluid consists of what specific chemical groups?
fats, salts, albumins and hyalurante
Which substance in synovial fluid was first thought to be responsible for its viscosity and lubricating behavior?
hyaluronate
What substance of synovial fluid has been proposed to be responsible for its viscosity and lubricating behavior?
lubricin
What are the classifications of synovial joints (diarthroses) based on the number of articulating surfaces?
simple and compound synovial joints
What is a complex synovial joint (diarthrosis)?
within the simple joint or the compound joint, the articulating surface are separated by an articular disc (intra-articualr disc) or meniscus
identify the common ligaments of the vertebral column
the 9 common ligaments are the anterior longitudinal ligament, the intervertebral disc, posterior longitudinal ligament, ligamentum flavum, capsular ligament, interspinous ligament, ligamentum nuchae, supraspinous ligament and intertransverse ligament
What is the maximum number of common ligaments identified with a vertebral couple?
eight
What is the reason that nine common ligaments are identified but only eight will be attached at any specific vertebral couple?
the ligamentum nuchae and supraspinous ligaments attach to the spinous tubercles, but only one of these will identified at a single vertebral couple
What is the number of true intervertebral discs identified in the adult?
twenty three
In the adult, which vertebral levels will demonstrate a true intervertebral disc?
those between C2 and S1 inclusive
What percent of the vertebral column length is contributed by the intervertebral disc?
twenty to twenty five percent
What is the length of the intervertebral disc contribution to the vertebral column length?
about seven inches
What is the percent of the intervertebral disc contribution to the vertebral column length?
about seven inches
What is the percent of intervertebral disc height contribution to the length of each region of the vertebral column?
cervical 22-25%; thoracic 20%; lumbar 33%
What is the cervical nucleus pulposus compsed of?
fibrocartilage
What is the water concentration in the lumbar nucleus pulposus at birth and after thirty?
birth = 88%; thirty = 70%
What cell is associated with the nucleus pulposus until about age eleven?
notochord cells
What cells are associated with the mature nucleus pulposus?
reticulocyte-fibroblast and chondroblast
Which type of collagen is dominant in the nucleus pulposus?
collagen type 2
What is the organizational pattern for collagen fibers in the nucleus pulposus?
they are irregularly oriented and randomly scattered
What is unusual about the cervical annulus fibrosis?
it lacks any lamellar or layered organization
What is the appearance of the cervical annulus fibrosis?
a horse-shoe with the anterior margin thick and the lateral margins tapering to the uncinate processes; the posterior margin is thin
What compensates for the thinness of the posterior part of the cervical annulus fibrosis?
posterior longitudinal ligament
What is the organization of the lumbar annulus fibrosis?
it has 12-14 concentric cylindrical lamellae
What is the water concentration in the lumbar annulus fibrosus at birth and after thirty?
birth 78%; thirty 70%
Which type of collagen is dominant in the annulus fibrosus?
collagen type 1
What is the organizational pattern for collagen fibers in the annulus fibrosus?
they are parallel with one another in a singe lamellus and angled
What is the organization of collagen fibers between lamellae?
collagen fibers will be angled in the opposite direction such that a spiral - counter spiral organization is observed
What is the average angle of collagen fibers within the annulus fbrosus?
they average 50 to 60 degrees
What is the thickest part of the cartilage end plate?
around the periphery
What is the principal type of collagen fiber within the cartilage end plate?
the type 2 collagen fiber
What is the direction of collagen fibers within the cartilage end plate?
collagen fibers are aligned anterior to posterior
What is the attachment site for collagen fibers of the inner lamellae of the annulus fibrosus?
the cartilaginous end plate
What part of the intervertebral disc is innervated?
the outer lamellae of the annulus fibrosis
What are the types of receptor endings in the intervertebral disc?
nociceptors and proprioceptors
What is the relationship between size of the intervertebral disc and receptor endings?
the larger the disc, the greater the variety of receptor endings
What is the proposed function of receptor ending density in the anterior part of the intervertebral disc?
they provide feedback during extension
What innervates the annulus fibrosus at the posterior part of the intervertebral disc?
the recurrent meningeal/sinu-vertebral/sinus vertebral nerve
What innervates the annulus fibrosus at the anterior part of the intervertebral disc?
fibers from the ventral primary ramus
What is the name given to the white ramus communicans which becomes embedded within the annulus fibrosus of the intervertebral disc?
the paradiscal ramus communicans
What vertebral levels will the anterior longitudinal ligament attach to?
those between occiput and S3 inclusive are traditionally indicated
What is the lowest extent of the anterior longitudinal ligament based on recent studies?
L3
What is the function of the anterior longitudinal ligament?
it brakes or limits dorsi-flexion or hyperextension of the vertebral column
What was ossification of the anterior longitudinal ligament in the lumbar region identified as?
Forestier’s disease
Anterior longitudinal ligament ossification in the lumbar region is now identified as____?
Diffuse idiopathic Skeletal hyperostosis or DISH
Which vertebral levels will the posterior longitudinal ligament attach to?
those between C2 and S3 inclusive are traditionally indicated
What is the innermost layer of the posterior longitudinal ligmanet called?
the perivertebral ligament
What is the function of the posterior longitudinal ligament?
it brakes or limits flexion of the vertebral column
Where is ossification of the posterior longitudinal ligament most commonly identified?
the cervical spine with an 80% incidence
What is the clinical sign of posterior longitudinal ligament ossification in the cervical spine?
a loss of hand and finger dexterity
What is the incidence of posterior longitudinal ligament ossification in the thoracic and lumbar spine?
about 10% at the thoracic and 10% at the lumbar spine
What is the clinical sign of posterior longitudinal ligament ossification in the lumbar spine?
faltering gait
What is the gender, age, and ethnic bias associated with ossification of the posterior longitudinal ligament?
it is greater in males over 50 and has a higher incidence in the Japanese
What is the acronym for ossification of the posterior longitudinal ligament?
OPLL
At one time ossification of the posterior longitudinal ligament was an example of what condition?
Diffuse idiopathic skeletal hyperostosis or DISH
What vertebral levels will the ligamentum flavum be attached to?
those between C2 and S1 inclusive are traditionally indicated
What is the relationship of the ligamentum flavum to the vertebral foramen?
it forms the posterior boundary of the spinal canal
What is the histology of the ligamentum flavum?
it is formed primarily with elastic fibers, which are yellow in appearance
What is the name given to the ligamentum flavum based on appearance and histology?
it is a yellow elastic ligament
What is the function of the ligamentum flavum?
it brakes or limits flexion of the vertebral column
What is now thought to be a major function of the ligamentum flavum?
it is an early prime factor in extension of the vertebral column
Where is ossification of the ligamentum flavum most commonly identified?
the thoracic spine or thoracolumbar transition zone
What is the acronym for ossification of the ligamentum flavum?
OLF
What is the relationship between the capsular ligament and mobility?
the more lax/loose the capsular ligament is, the greater the motion of the joint
What regions of the vertebral column demonstrate the greatest laxity of capsular ligaments?
the cervical and lumbar regions
The capsular ligament may blend with which other commmon ligament?
the ligamentum flavum
What muscle will blend with the capsular ligament posteriorly?
the multfidus
If the zygapophyseal capsular ligament is not significantly involved in restricting motion what is its function?
it is probably involved in proprioceptive feedback to the muscles stabilizing the vertebral couple during movement
What vertebral levels will the interspinous ligament be attached to?
those between C2 and S1 inclusive are traditionally indicated
What is now thought to be a major junction of the interspinous ligament?
it is more likely a proprioceptive transducer for the spinal reflex
What will the ligamentum nuchae be attached to?
the external occiptial protuberance, external occipital crest, the posterior tubercle of the posterior arch of C1, and spinous tubercles between C2 and C7 inclusive are traditionally indicated
What is the name given to the superficial layer of the ligamentum nuchae?
the funicular layer or part
What is the name given to the deep layer of the ligamentum nuchae?
the lamellar layer or part
What are the attachment sites for the superficial layer of the ligamentum nuchae?
the external occipital protuberance, external occipital crest, and spinous tubercle of C7
What is the histological makeup of the ligamentum nuchae in quadrupeds?
it is a yellow elastic ligament
What is the histological make up of the human ligamentum nuchae?
it is a yellow elastic ligament, but has more collagen fibers than in quadrupeds
What is the primary yellow elastic or elastic ligament of the spine?
the ligamentum flavum
What is the classic function of the human ligamentum nuchae?
it brakes or limits flexion of the cervical spine
What will the supraspinous ligament be attached to?
the spinous tubercles along the vertebral column from C7 to sacrum
What is the termination level inferiorly for the supraspinous ligament according to current literature?
primarily at L4 (73%); between L4 and L% (5%)
Where is the supraspinous ligament said to be best developed?
in the lumbar spine
What is the classic function of the human supraspinous ligament?
it brakes or limits flexion of the spine
What is now thought to be a major function of the supraspinous ligament?
it is a proprioceptive transducer for the spinal reflex
What will the intertransverse ligament be attached to?
the transverse tubercles and transverse processes of adjacent vertebrae along the vertebral column from C1 to L5
What is the status of the cervical intertransverse ligament?
it is said to be paired with an anterior and a posterior intertransverse ligament present
What is the status of the lumbar intertransverse ligament?
it is well developed with two parts identified, a ventral slip and a dorsal slip
What part of the lumbar intertransverse ligament covers the intervertebral foramen?
the ventral slip
What part of the intertransverse ligament in the lumbar spine divides the body wall into an anterior muscular compartment and a posterior muscular compartment?
the dorsal slip
What are the characteristics of the capsular ligament of the atlanto-occiptial joint?
it is said to be loose, thin, and composed of collagen fibers
What other joint space does the atlanto-occipital joint communicate with?
the posterior bursa of the median atlanto-axial joint
What is the median thickening of the anterior atlanto-occipital ligament called?
the anterior longitudinal ligament
Which ribs are classified as typical ribs, true ribs, costa verae, and vertebrosternal ribs in the typical adult skeleton?
ribs 3-7
Which ribs are classified as atypical ribs, true ribs, costa verae, and vertebrosternal ribs in the typical adult skeleton?
ribs 1 ans 2
Which ribs are classified as typical ribs, false ribs, costa spuriae, and vertebrochondral ribs in the typical adult skeleton?
ribs 8 and 9
Which ribs are classified as atypical ribs, false ribs, costa spuriae, and vertebrochondral ribs in the typical adult skeleton?
rib 10
Which ribs are classified as atypical ribs, false ribs, costa spuriae, and vertebral ribs in the typical adult skeleton?
ribs 11 and 12
What joint classification is now given to the joint between the sternum, clavicle and first rib?
synovial saddle (diarthrosis sellar) joint
What ribs will participate in the sternocostal or sternochondral joint?
rib1 to rib 7
What is the classic classification of the first sternocostal or sternochondral joint?
cartilaginous (amphiarthrosis) synchondrosis
What is the newer suggested classification of the first sternocostal or sternochondral joint?
cartilaginous (amphiarthrosis) symphysis
What is the classification of the second-seventh sternocostal or sternochondral joint?
synovial plane (diarthrosis arthrodia)
What is the classification of the sixth through the ninth interchondral joints?
synovial plane (diarthrosis arthrodia)
What is the classification of the fifth-sixth or ninth-tenth interchondral joint?
fibrous (amphiarthrosis) syndesmosis
Which costal cartilages fail to form a joint at their sternal end?
the eleventh and twelfth costal cartilages
What is the name given to the segments of the sternum?
sternabrae (for sternal bodies)
How many primary centers of ossification appear in the manubrium?
1-3 centers have been identified
How many primary centers of ossification appear in the corpus sterni?
typically 6
In what part of the sternum will a secondary center of ossification appear?
the xiphoid process
When does the xiphoid process first demonstrate a center of ossification?
sometime during or after 3 years old
In what part of the rib will primary centers of ossification appear?
the body (corpus, shaft)
In what parts of the rib will secondary centers of ossification appear?
the head, the articular surface of the tubercle and the non-articular surface of the tubercle
Which ribs will demonstrate primary centers of ossification for the body (corpus or shaft)?
all ribs; ribs 1-12
Which ribs will demonstrate secondary centers of ossification?
ribs 1-10
Which ribs lack secondary centers of ossification?
ribs 11 and 12
What part of the skull is derived from endochondral ossification?
chondrocranium
Which bones of the skull are ossified by both endochondral and intramembranous ossification?
the mandible, sphenoid, temporal, and occipital bones
Which bone of the appendicular skeleton is formed by both endochondral and intramembranous ossificatoin?
the clavicle
What are the four subclassifications of synarthrosis joints based on latin groupings?
suture, gomphosis, schindylesis and syndesmosis
What are the characteristics of suture vera (true sutures)?
sutures demonstrating interlocking of the adjacent bone surfaces; typically formed by intramembranous ossification
What are the characteristics of the sutura notha (false sutures)?
sutures lacking interlocking of adjacent bone surfaces; typically formed by endochondral ossification
What is the classification of a joint with a “nail like” condition?
gomphosis
What is the classification of a joint with a “fissure like” condition?
schindylesis
What is the anterior fontanelle?
the diamond shaped remnant of developing membrane bone at the intersection of the frontal bone with parietal bones
What is the posterior fontanelle?
the diamond shaped remnant of developing membrane bone at the intersection of the occipital bone with both parietal bones
What is the name given to the indentation of bone between the nasal and frontal bones?
nasion
What is the name given to the outline of the nasal cavity at the front of the skull?
piriform aperature
What is the name given to the alveolar jugum of the canine tooth in the maxilla?
canine eminence
What forms a bullet like chin?
a large mental protuberance
What forms and indented chin?
well developed bilateral mental tubercles and a slight mental protuberance
What is the tip of the external occipital protuberance called?
the inion
What is the appearance of the suture intersections just above the zygomatic arch called?
the pterion
What is the appearance of suture intersections just above the mastoid process called?
the asterion
What points on the skull are used to measure the skull size?
the nasion, vertex, inion, and gnathion
What points on the skull are used to measure cranial vault capacity?
the nasion, vertex, and inion
What is the appearance of the suture intersections over the hard palate called?
the cruciate or cruciform suture
What is the posterior boundary of the anterior cranial fossa?
a line drawn along the lesser wing of the sphenoid, anterior clinoid processes, and sphenoidal jugum
What passses through the cribiform plate?
fila olfactoria or CN 1, the olfactory nerve
An emissary vein leaves the anterior cranial fossa via what opening?
foramen cecum
What is the posterior boundary of the middle cranial fossa?
superior border of petrous part of the temporal bone, posterior clinoid processes and dorsum sella of sphenoid bone
What boney feature is prominent in the median plane of the middle cranial fossa?
sella turcica
Which cranial nerves exit the skull via middle cranial fossa ostia?
CN 2, 3, 4, 5, 6
What are the contents of the optic canal?
the optic nerve and ophthalmic artery
What are the contents of the superior orbital fissure?
the ophthalmic veins, the oculomotor nerve, the trochlear nerve, the ophthalmic division of the trigeminal nerve, and the abducent nerve
Which single opening will allow the exit of the greatest number of cranial nerves?
the superior orbital fissure
What is unique about the ophthalmic artery and veins?
unlike other artery-vein combinations they will not share the same opening
the ophthalmic artery is in the optic canal, ophthalmic veins are in the superior orbital fissure
The maxillary division of the trigeminal nerve exits the middle cranial fossa via which opening?
the foramen rotundum
What are the contents of the foramen ovale?
the mandibular division of the trigeminal nerve and the lesser petrosal branch of the glossopharyngeal nerve
What opening allows a branch of cranial nerve Vc to enter the middle cranial fossa from the infratemporal region?
the foramen spinosum
Which vessel is located within the foramen spinosum?
the middle meningeal artery
What forms the roof of the posterior cranial fossa?
the tentorium cerebelli
What part of the cerebrum occupies the posterior cranial fossa?
none; the tentorium cerebelli separates the cerebrum into a space above the posterior cranial fossa
What part of the CNS occupies the posterior cranial fossa?
the cerebellum, pons, and the MO
What bony feature is prominent in the medial plane of the posterior cranial fossa?
the clivus or basilar part of the occiptial bone
Which cranial nerves exit the posterior cranial fossa ostia?
CN 7 facial, 8 vestibulocochlear, 9 glossopharyngeal, 10 vagus, 11 spinal accessory, and 12 hypoglossal
What are the contents of the internal acoustic meatus?
CN 7 and 8, the nervus intermedius/nerve of wrisberg/ sensory root of 7 and the motor root of 7, the vestibular and cochlear roots of 8 and the internal auditory/internal labyrinthine artery and vein
What are the contents of the jugular foramen?
the jugular bulb, the inferior petrosal sinus, the tympanic body/tympanic glomus or jugular body/glomus, cranial nerves 9, 10, 11
What is the jugular bulb?
the venous expansion between the sigmoid dural venous sinus and the internal jugular vein
What is the function of the jugular body/jugular glomus?
A chemoreceptive organ that monitors hypoxia, hypercapnia and increases in the hydrogen ion
What do the five layers of scalp spell?
skin, connective tissue, aponeurosis, loose connective tissue, periosteum
What are the principal sources of blood to the scalp?
internal carotid and external carotid artery branches
What veins drain the scalp?
superficial temporal, posterior auricular, occipital, and ophthalmic veins
Which divisions of the trigeminal nerve receive sensory information from the scalp?
all 3 divisions: ophthalmic, maxillary and mandibular nerves
What is the third layer of the scalp associated with?
muscular component of the scalp
What muscles are specifically associated with the scalp?
frontalis and occipitalis bellies of the epicranius muscle
The bellies of the epicranius muscles are connected by what structure?
galea aponeuroitca
What specific nerves provide motor control to the scalp muscle?
facial nerve: posterior auricular and temporal branches
What is unusual/unique about the muscles of the face?
they do not act as lever muscles; they do not attach to bone at both origin and insertion
What muscles lack any attachment to bone?
orbicularis oris, procerus and risorius
What type of motor fibers to skeletal muscle are given off by the facial nerve?
branchial efferent (BE)
Identify the openings found along each wall of the orbit
Superior wall: optic canal
Medial Wall: anterior ethmoid and posterior ethmoid foramina
lateral wall: superior orbital fissure
inferior wall: inferior orbital fissure
What are the layers of the eyelid?
skin, orbicularis oculi muscles, tarsal plate/tarsus and palpebral conjunctiva
What are the names given to the modified sebaceous gland in the tarsus of the eyelid?
tarsal or meibomian gland
What is the function of the meibomian gland?
produces a thick, hydrophobic substance that prevents tears from overflowing onto the cheeks along the margin of the eyelid
What is the name of the gland located at the base of the eyelash?
ciliary gland
What are the names given to the modified sebaceous glands of the palpebra?
tarsal gland or meibomian gland and ciliary gland
What is the name given to the angle formed between the superior and inferior eyelids at their medial and lateral margins?
canthus
What is the name given to the union of skin at the eyelid margins?
medial palpebral commissure or lateral palpebral commissure
What is the name given to the elevation at the medial canthus?
lacrimal caruncle
What is the crescent shaped appearance of the conjunctiva at the medial canthus called?
plica semilunaris conjunctiva
What is the name given to the elevation at the mideal margin of the eyelid?
superior lacrimal papilla or inferior lacrimal papilla
What is the name given to the opening at the lacrimal papilla?
lacrimal punctum
Parasympathetic stimulation of blood vessels in the lacrimal gland will result in what events?
vasodilation of blood vessels, increased availability of water to secretory units, thinner or more watery product in lumen
Sympathetic fibers synapse in which ganglion in the pathway to the lacrimal gland?
the superior cervical ganglion
Sympathetic stimulation of the lacrimal gland will result in what events?
Vasoconstriction of blood vessels, limited availability of water to secretory units, more viscous or thicker product formed in glandular lumen
What are the names of the layers of the eyeball?
fibrous tunic, uveal tract and retina
What are the parts of the fibrous tunic of the eyeball?
cornea and sclera
What are the parts of the uveal tract of the eyeball?
iris, cillary body, choroid and pupil
What muscles are present in the iris?
sphincter pupillae and dilator pupillae
What is the innervation of the sphincter pupillae?
oculomotor nerve, parasympthetic pathway
What is the innervation of the ciliaris muscle?
oculomotor nerve, parasympathetic pathway
What is the innervation of the dilator pupillae?
internal carotid artery plexus, sympathetic pathway
What are the chambers of the eyeball in front of the lens?
anterior chamber and posterior chamber
What separates the anterior chamber and posterior chamber in the eyeball?
iris
What is contained in the anterior chamber of the eyeball?
aqueous humor
What is the primary cause of glaucoma?
excess aqueous humor in the chambers in front of the lens
What is the name given to the chamber behind the lens?
vitreous chamber
What fills the vitreous chamber?
vitreous body
What are the functions of the bitreous body?
maintain retinal curvature; allows minimal light distortion from lens to retina
What are the common characteristics in origin and insertion of all rectus extraocular muscles?
they all originate from a common annular tendon in the orbit
they all insert into the sclera in front of the coronal equator of the eyeball
What is the common characteristic regarding the insertion of both oblique extraocular muscles?
both insert onto sclera on the lateral margin of the eyeball behind the coronal equator
What is the apparent function of the medial rectus extraocular muscle?
pulls the cornea inward/medially; it adducts the cornea
What is the apparent function of the lateral rectus extraocular muscle?
pulls the cornea outward/laterally; it abducts the cornea
What nerves will innervate specific extrinsic/extraocular muscles?
LR6SO4
3
What are the two unique features of teh fourth cranial nerve?
it is the only cranial nerve with an apparent origin from the brain’s dorsal surface;
it is the only cranial efferent nerve to decussate within the midbrain from its nucleus
Intrinsic muscles of the eyeball are innervated by which visceral efferent (VE) pathways?
ciliaris and sphincter pupillae are innervated by parasympathetics;
dilator pupillae is innervated by sympathetics
The auricle transmits sensory innervation via which specific cranial nerve branches?
auriculotemporal nerve (mandibular div, trigeminal) posterior auricular cutaneous nerve (facial) auricular nerve (vagus)
The EAM lies between what boundaries?
concha of the auricle and tympanic membrane of the middle ear
What part of the EAM is protected by cartilage?
lateral one third
What part of the EAM is protected by bone?
the medial two thirds
Skin lining the external acoustic meatus contains what modified sebaceous glands?
ceruminous glands
What is the cerumen?
the product of ceruminous glands forming the bulk of ear wax
Vascularization of the EAM is derived from which branches of the external carotid artery?
posterior auricular, internal maxillary, superficial temporal artery
PIS
The EAM transmits sensory innervation via which specific cranial nerve branches?
auriculotemporal nerve (mandibular division, trigeminal) auricular nerve (vagus)
What vein is formed within the parotid gland?
the retromandibular vein
Within the parotid gland what branches of the facial nerve are given off?
posterior auricular, digastric, stylohyoid and forms the facial nerve plexus
What branch of the facial nerve penetrates the parotid gland, but is not given off within it?
the chorda tympani nerve
What branches of the mandibular division trigeminal nerve are given off within the parotid gland?
the auriculotemporal and lingual nerves
What forms the lateral boundary of the infratemporal region?
ramus of the mandible
What are the contents of the infratemporal region?
medial and lateral pterygoid muscles, internal maxillary artery and branches, pterygoid venous plexus, internal maxillary vein, branches of the trigeminal and facial nerves and the otic ganglion
What are the attachment sites of the sphenomandibular ligament?
the spine of the sphenoid bone to the lingula of the mandible
What muscles act to depress the mandible or open the mouth?
lateral pterygoid along with the suprahyoid and infrahyoid muscles
What muscles act to elevate the mandible or close the mouth?
temporalis, masseter, and medial pterygoid
What muscles act to protract the mandible or protrude the chin?
masseter, medial pterygoid, and lateral pterygoid
What muscles act to retract the mandible or pull the chin back?
temporalis
What openings are associated with the pterygopalatine region?
inferior orbital fissure, pterygomaxillary fissure, sphenopalatine foramen and foramen rotundum
Which ganglion is located within the pterygopalatine region?
the pterygopalatine or meckel’s ganglion
What neural pathway is the pterygopalatine ganglion associated with?
parasympathetic innervation of the lacrimal gland
Which cranial nerves are associated with the parasympathetic pathway to the lacrimal gland?
the facial and trigeminal cranial nerves
what divisions of the trigeminal nerve will be associated with the parasympathetic pathway to the lacrimal gland?
the ophthalmic and maxillary divisions of the trigeminal nerve
Which of the larger nasal cartilages lacks any attachment to bone?
the major alar cartilage
What is the vermillion border?
the name given to the junction between the red region of the lip
What is the name given to the red region of the human lip?
the vermillion zone
What is unique about the human lip?
the natural red color
What is the name given to the median depression of the upper lip?
the philtrum
What is the name given to the depression extending from the nasal ala to the corner of the upper lip?
the nasolabial groove or nasolabial sulcus
What is the name given to the attaching material in the median plane from the lip to the gingiva proper?
the superior labial frenulum or the inferior labial frenulum
