Musculoskeletal Flashcards
What does NAVL stand for?
N: Nerves
A: Artery
V: Vein
L: Lymphatic
What is the difference between intramembranous ossification and endochondral ossification?
Intramembranous: bones of skull formation
Endochondral: Formation of bones in the body from chondrocytes that is replaced by bone
What is the basic process of intramembranous ossification?
Mesenchymal cells differentiating into bone-forming cells called osteoblasts that lay down bone matrix
What is the term for bone-forming cells
Osteoblasts
What is the most common type of joint in the body?
Synovial joint
Name the three types of joints
1.) Synovial
2.) Cartilaginous
3.) Fibrous
Name 3 types of fibrous joint
How does their movement function?
- Synarthroses, sutures of the skull, joints between teeth and jaw
- They have little to no movement
List the 4 types of synovial joints
1.) Plane/gliding
2.) Hinge
3.) Pivot
4.) Ellipsoidal/Condyloid
The wrist and ankle are a type of _________________ joint which is a ______________ joint
Ellipsoidal/condyloid
Synovial joint
What is the purpose of cartilage
absorbs shock
What are diarthroses?
Synovial joints
Describe the bony landmark: Fissure
Narrow opening or slit in the bone that can serve as a passageway for blod vessels and nerves
Describe the bony landmark: Foramen
Round or oval shaped opening in the bone that allows structures like blood vessels and nerves to pass through
Describe the bony landmark: Fossa
Depressed or concave area on the surface of a bone that can accommodate and protect underlying structures
Describe the bony landmark: Meatus
Tube-like passageway such as external auditory meatus in the temporal bone, which allows for the passage of structures like nerves and vessels
What are peritoneal ligaments?
Ligaments of the peritoneum, the membrane lining the abdominal cavity, pass b/t organs or organs in the abdominal wall to help hold organs in place and transmit blood vessels and nerves
Describe an aponeurosis
Tendon that spreads out as a broad flat sheet-like layer that connects muscles to each other or to bones
What are the two main goals of bursa?
Reduce compression and friction
A ____________ ___________________ is a special type of bursa that is tubular-shaped, surrounding a tendon. To reduce friction and enable smooth gliding of the tendon as it moves through an area
Synovial sheath
Tendons attach:
Muscle to bone
With respect to muscles: ___________ moves less, while the _________ moves toward the _____________________
The origin point moves less, while the attachment point moves toward the origin
Describe a pennate muscle
- Fibers arranged at an angle to the tendon
- Pennate muscles resemble the shape of a feather, with muscle fibers approaching a central tendon at an oblique angle
- The diagonal orientation of the fibers maximizes the muscle’s force potential. Many more muscle fibers fit into the muscle compared with a similarly sized fusiform muscle.
Describe a fusiform muscle
- Fibers run parallel to the long axis of the muscle belly
- having a spindle-like shape that is wide in the middle and tapers at both ends
When muscles have the prefix “bi”, “tri” etc. what does that indicate?
The prefix corresponds to the number of origins the muscle has
What does “brevis-“ mean?
Shortest
What is the difference between isotonic and isometric contractions
Isotonic = Change in length of muscle
Isometric = no change in muscle length, ONLY TENSION
A reflexive contraction is:
Involuntary
__________________ contractions are involuntary and represent the normal resting state of balanced muscle tension
Tonic
What are the two main ducts of the lymphatic system?
Thoracic and right Lymphatic duct
Where are two places the lymphatic system or its components NOT found?
Brain and spinal cord
Paresthesia corresponds to what type of nerves?
Paralysis corresponds to what type of nerves?
Sensory
Motor
Every nerve is ____________________! What does this mean?
Mixed
Means they contain both sensory and motor fibers
What does ipsilateral mean?
Same side
What is the most distal portion of the limbs?
phalanges
Define flexion
Bending of a joint that DECREASES the angle between body parts
Define extension
Straightening of a joint that INCREASES the angle between body parts
Name the five bilateral regions of the back
What is a hint to use to name 4/5?
1.) Lumbar
2.) Scapular
3.) Suprascapular
4.) Interscapular
5.) InFRAscapular
Hint: 4 are related to the scapular region
Describe the location back region:
INFRAscapular
SUPRAscapular
INTERscapular
Infra is BELOW the scapula
Supra is ABOVE the scapula
Inter is between the scapula and the vertebra
Name the two UPAIRED regions of the back
Where are the located?
1.) Vertebral region
2.) Sacral region
Medial
The back contains
Skin & ______
Extrinsic muscles: DEFINE
Intrinsic muscles: DEFINE
Fascia
Extrinsic: Moving the UPPER LIMBS
Intrinsic: Moving or maintaining the axial skeleton
Which muscles are considered the “true back” muscles?
Intrinsic muscles
Very generally, where are extrinsic muscles located?
Intrinsic
Extrinsic are more superficial and intermediate
Intrinsic are more intermediate and deep
Does the back contain the appendicular or axial skeleton?
Axial
What internal structure approximation can be found at C7 spinous process?
Apex of the lungs, ismuth of the thyroid
What internal structure approximates to the spinous process T3
Formation of the superior vena cava
The spine of the scapula is a palpable landmark that is approximate to which vertebrae?
This vertebrae can be use to approximate what internal structure?
T3
The inferior angle of the scapula is a palpable landmark that corresponds to which vertebra?
What internal structure does this correspond to?
T7
Level of nipple on anterior thoracic wall
What is PSIS?
Which vertebra can this help locate?
Dimple overlying the posterior superior iliac spine
S2
S2 can be located using the dimple overlying the posterior superior iliac can be used to locate what internal structure?
Inferior extent of the dural sac/subarachnoid space
The tips of the 12th rib are palpable landmarks that correspond to which vertebra?
What internal structure do these correspond to?
L2
Bifurcation of the aorta
Which vertebrae can be used to approximate the central tendon of the diaphragm and the base of the lungs?
T9-T10
How many cervical vertebrae?
7
How many total vertebrae?
33
How many thoracic vertebrae?
12
How many lumbar vertebrae?
5
How many sacral vertebrae?
5
How many coccygeal vertebrae?
4
Significant motion occurs only between 25 superior vertebrae, what regions does this comprise?
C, Thoracic, Lumbar and the first sacral vertebrae
The lower most ______________ of the vetabral column is functionally immobile
Sacrum
What is significant about the lumosacral angle?
The mobile region where moves to an immobile region
Which region(s) of the spine fuse as we age?
The sacrum and coccyx
What is housed in the vertebral foramen
Spinal column and mentees
Describe the 9 most common features of vertebrae?
1.) Body
2.) Vertebral arch
3.) 7 spinal processes
There are normally 7 spinal processes on a vertebra. How can you differentiate them?
1.) 1 spinous process
2.) 2 transverse process
3.) 4 Articular process: Remaining 4 will articulate with other vertebrae and form synovial joints
What is significant about the transverse and spinous process of vertebrae?
They are for muscle attachments to the vertebrae
What is the vertebral body?
What is it comprised of?
Anterior region of the vertebrae that is large and cylindrical normally
Spongy bone & compact bone
The body of a vertebra is comprised of spongy bone also known as:
And enclosed by a thin external layer of compact bone
Trabecular
Cancellous
Where is the most actively hematopoietic tissue found?
In the red bone marrow of the trabeculae
Where are basivertebral veins found?
What do they do?
In the foramina on the posterior surface of the vertebral body
Drain marrow
T5-L5 are:
Robust
As it is weight bearing
The superior and inferior surfaces of the vertebral body are covered in _________________ ____________________ also known as vertebral end plates
Hyaline cartilage
What is the epiphysial rim?
Smooth bone surrounding the vertebral body that derives from the anular epiphysis
The vertebral foramen is formed by the vertebral arch and the posterior portion of the vertebral body. What comprises the vertebral arch?
Pedicle
Lamina
1 on each side
What is different about the intervertebral foramen vs the vertebral foramen?
1.) The vertebral foramen houses the spinal cord, etc and is seen from a top down view
2.) Intervertebral foramen is can be seen laterally is where the spinal nerves emerge from the vertebral column
Where are the superior and inferior articular processes?
What do they form?
Notches above and below the spinal processes
Form the intervertebral foramen
Inferior vertebral notch and inferior vertebral notch what do they form
Intervertebral foramen
Where spinal nerve converge?
What is spinal stenosis?
Narrowing of the vertebral foramen in one or more vertebrae
What might the treatment be for lumbar spinal stenosis?
Laminectomy to stop the compression of one or more spinal nerve roots
What is a laminectomy?
Removal of one ore more spinous process and the adjacent supporting vertebral laminae
Transverse process is superior to the _________________ process
Spinous
The spinous process is ________ to the transverse process
Medial
Where is the Pars interartcularis found on a vertebra?
Connects the superior and inferior articular process on each side of a vertebra
Runs laterally to the spinous process
Where is a zygapophysial (facet) joint found?
The joint where a superior and inferior articular process of 2 vertebrae meet
The facets determine the plane of rotation of the body. For example, the articular facets of thoracic vertebrae are nearly vertical, this arrangement allows for:
Rotation and lateral flexion of the vertebral column in the thoracic region
What are the smallest of the movable vertebrae
Cervical
Intervertebral discs of the cervical spine are:
Small
Intervertebral discs of the cervical spine are:
How does their size compare to their corresponding vertebral bodies?
Small
The discs are larger compared to the vertebral body
Other than the more triangular/oval vertebral foramen, what is significant about the foramen in the cervical spine?
The presence of a transverse foramen
Where are the foramen transversarium found?
What is the purpose of this?
Cervical spine
Location for vertebral arteries, nerve and veins to pass through
Why does C7 sometimes lack a transverse foramen?
Because C7 only transmits small accessory veins and the larger components exit a C6
So the foramen is often smaller and sometimes absent
On the lateral edge of the foramen transversarium (transverse foramen) there are a perforated transverse process that split into two tubercle-anterior and posterior. What is different about these component(s) of C6
The anterior tubercles are called carotid tubercles
Here the common carotid artery can be compressed b/t the tubercle and body to slow bleeding
What is the Ucinate processes
Cervical spine
The superior surface of these vertebrae are convex in shape
The ridges at the edge are elevated and named uncus of body AKA ucinate process
Why are the cervical foramina larger compared to others?
To accommodate the cervical enlargement of the spinal cord
Which vertebrae is call Vertebrae prominent? Why?
C7
Because it has a longer spinous process
What is unique about C1-C6 in regard to spinous process
They are short and bifid (divided by a notch forming 2 parts)
What is atlas?
C1 that lacks body or spinous process
Articulates with occipital chondyles
Where is the atlanto-occipital joint?
What is the significance of this?
Where the superior articular surfaces of C1 articulate with the occipital condyles
Allows for “yes” motion when nodding head
What is the axis (vertebrae)?
Describe 1 defining feature
- C2
- strongest of the cervical vertebrae
- provides ability for C1 to rotate since C1 does not rotate on the superior portion
Where is the Dens?
Distinguishing feature that projects from the body of C2
Atlas encircles it
Serves as a pivot point for head rotation
What holds the Dens and atlas in place?
The transverse ligament of Atlas
Which of the cervical spine lacks a disc? Why
C1 & C2
Describe Jefferson fracture also known as burst fracture.
T/F: This always results in a spinal cord injury
Occurs at C1
Breaking/fracturing of the anterior or posterior arch
False, although more likely if the transverse ligament is also ruptured
Describe Hangman’s fracture
Fracture pars interarticularis of atlas AKA C2
What is spondylosis?
What might cause this?
Defect or stress fracture of the pars interarticularis
Hyperextension of the head ON the neck
The ___________ vertebrae have special anatomical components to help interaction with the ribs. What are these called?
Thoracic
Costal facets articulate with the ribs
Why are foramen of the thoracic vertebrae smaller?
No spinal enlargement here
The spinous process of the thoracic are in what direction
Angled downwards
The thoracic vertebrae articulate process are nearly vertical, this allows for:
Rotation
These three distinguishing features describe what vertebrae?
Long, almost horizontal spinous process
Complete costal facet found on the superior lateral body
A demifacet on the inferior edge for articulation with the 2nd rib
T1
T/F: The whole region of thoracic vertebrae are subject to rotation
False, inferior half of lumbar vertebrae do not have costal facets and are more limited to flexion and extension
What anatomic component limits the lumbar vertebrae to flexion and extension and NOT rotation?
The L5-S1 facets being coronally oriented
How many lumbar vertebrae?
5
But there can be variation
Which of the vertebrae carry the most weight?
Lumbar
Where are there two regions of the vertebrae have spinal enlargement?
Cervical and to a lesser extent Lumbar region
What is the largest vertebae? What anatomical components are enlarged?
L5
T/F: The sacrum has no internal canal because it solely provides structure for the gluteus and pelvic girdle
False, there is a sacral canal where spinal nerves will pass through and pass through the posterior and anterior sacral foramina
What is the cauda equina?
Spinal nerve roots arising inferior to the L1 vertebra that descend past the termination of the spinal cord into the sacrum
What is the significance of the SACRAL PROMONTORY
What occurs at the apex of the sacrum?
Articulation with the coccyx
Describe the pelvic (anterior) vs posterior surface of the sacrum
Fused spinal processes where transverse lines still remain (anterior)
Posterior has crests that are formed from transverse, spinous and articular processes that fused
What is significant about the Sacral hiatus
Leads into the sacral canal
What is the Sacral Cornua
Represents the inferior articular process of S5
What protects the sacral canal at the sacral hiatus?
A sacrococcygeal ligament
What is the filum terminae
Connective tissue extending from the tip of the spinal cord to the coccyx
How is the location of a caudal epidural anesthesia determined?
Using the sacral cornua (S5) and inferior to the S4 spinous process that forms the sacral hiatus
When do the coccygeal vertebrae fuse?
Between 3-5 yoa
What is the difference between caudal epidural anesthesia and transsacral epidural anesthesia?
The caudal is done through the sacral hiatus and spreads to the epidural space acting on S2 to Co1
Transsacral block is injected through a posterior sacral foramina into the sacral canal for more precise blocking of spinal nerve roots
T/F: Co1 fuses with the sacrum
True
Which side of the coccyx is smooth and which is not?
Why is this so?
Anterior (pelvic) surface is smooth
Posterior is not because of the rudimentary spinous process
Intervertebral discs become more convex shape when? Why?
With age
Because overtime the articular surface of the body of the vertebrae become convex
The sacral triangle is formed by:
S2 spinous process in the middle top
2 superior tips formed by the posterior superior iliac spines
How might one approximate where to perform a lumbar puncture for a sample of cerebrospinal fluid in adults?
Start at the highest point of the iliac crest passes though the L4 spinous process and can help approximate L4-L5 IV disk
An increase # of vertebrae occur more often in:
A Reduced number of vertebrae occur more frequently in:
Males
Females
Describe a cranial shift of the vertebrae and its repercussions
Describe a caudal shift of the vertebrae
relationship between presacral vertebrae to ribs
Which might happen to the C spine in whiplash
Crush components of the vertebral arch
Crush components of the vertebral body
What is Spondylolisthesis
dislocation between adjacent vertebrae
What is facet jumping?
What is the difference between spondylosis and spondylothesis?
Spondylosis is a fracture at the pars interartcularis
Spondylolisthesis is dislocation between adjacent vertebrae
The L__-S____ are prone to _______________________ which is the dislocation between adjacent vertebrae due to their downward tilt at this joint
L5 - S1
Spondylolisthesis
What is typically found between the vertebral symphysis?
Layer of hyaline cartilage and intervertebral discs
Anulous fibrosi surrounds what?
Surrounds the nucleus pulposus of the IV disc
What is the Uncovertebral joint?
Cleft/joint that is found on the lateral margin of vertebral discs
May articulate with vertebrae
Covered with cartilage moistened by fluid
When a disc herniates, what actually causes the pain?
The herniate nucleus pulposes through the annulus fibrosi will compress the spinal nerve roots below the involved disc
Which is the tougher longitudinal ligament of the vertebrae? What does it do?
Anterior to help prevent hyperextension
Where is the posterior longitudinal ligament found?
Within the vertebral canal along the posterior aspect of the vertebral bodies
Attached from C2 to the sternum
Where are Zygopophyseal joints and what do they do?
B/t superior and inferior articular processes of adjacent vertebrae
Permit gliding movement
What is and where is ligament flava
Ligament that joins adjacent vertebral laminae to form part of the posterior surface of the vertebral canal
Where is Ligamentum nuchae
ligament that starts the external occipital protuberance and posterior border of the foramen magnum to the spinous process of the cervical vertebrae
What does the ligamentum nuchae do?
Provides for muscle attachment
Where is Supraspinous ligament?
tips of spinous process of C7-Sacrum
Where are Interspinous ligament?
Found between adjacent vertebral spinous process
Where are Intertransverse ligaments found and what do they do?
Between adjacent transverse ligaments
Found in Cervical, thoracic, and lumbar region
Where does rotation occur in the spine?
Craniovertebral joints & thoracic region
Where is flexion the greatest in the spine?
Cervical region
Where is extension most allowed in the spine?
Lumbar region
There are __________ curvatures of the spine. Name and describe the two primary curvatures
Kyphosis (natural in this case) where the spine is concave to the anterior
Thoracic and sacral region
There are _______ curvatures of the spine. Name and describe the two secondary curvatures
Lordosis: concave posteriorly
Cervical and lumbar region
What purpose do Kyphosis and lordosis natural curvatures serve in the spine?
Create a center of gravity in a vertical line & makes it so the least amount of muscular energy is needed to maintain an upright bipedal stance+
What another term for hunchback
Excessive thoracic kyphosis
What is another name for swayback? What causes it?
Excessive lumbar lordosis
Weakened trunk muscles
Name the five categories of structures which receive innervation in the back and can be sources of pain
1.) Fibroskeletal structures
2.) Meninges
3.) Synovial joints
4.) Muscles
5.) Nervous tissue
What are the first nerves that exit from the intervertebral foramen?
Recurrent meningeal branches
What is nociception?
Pain
What arterial branch supplies vertebrae of the neck?
Vertebral artery
What artery supplies the vertebrae of the thorax?
Posterior intercostal arteries
What arteries supply the vertebrae near the abdomen?
Subcostal and lumbar arteries
What arteries supply the vertebrae near the pelvis
Iliolumbar and lateral and medial sacral arteries
Spinal veins form venous plexuses along the vertebral column. Where are they found?
What do they do?
Externally (along the spinous process and vertebral body)
Internally (within the vertebral foramina)
- They drain
The spine of the scapula and acromoion are key because they are visible landmarks on many patients, what is also significant about them
They are attachment points of muscles
The _________ ________ attaches to the sacrum
Iliac creast
The root of the scapula corresponds to which vertebrae
The inferior angle of the scapula corresponds to which vertebrae
Inion
Iliac crest
Posterior
External occipital protuberance
AKA inion
Ligamentum nuchae
Only found in the cervical spine and involved in restricting cervical flexion
Where are cutaneous nerves found in
Where is
Suboccipital nerve is the first cervical nerve and is ONLY MOTOR, no skin/sensory component
Where is the greater occipital nerve located?
Why is it significant
C2
What is the innervation of the back for skin
Dorsal rami of the spinal nerves
What is fascia
Band or sheet of connective tissue that is composed of collated
How many layers of fascia are there
3
Superficial fascia
Deep fascia
Suberous fascia
What is signicance of the myofacial system
Transmitting forces from one to another and corrdentating movement of the trunk and upper limbs
Intertubercular groove
Roots of the spinal cord come together to form
Spinal nerve
What is the spinal ganglion
Dorsal roots
Dorsal ganglion
Roots from spinal cord to spinal nerve then divide again posterior rami and anterior rami
Ventral rami:
Innerave extrisinic muscle of the back and all muscles of anterior of upper lower limbs and internal organs, SENSORY
Dorsal rami spinal nerves innovate intrinsic nerves and provide motor and SENSORY Innervation of the skin of the back
Extrinsic muscles originate from the vertebral column
Trapezius
Only muscle inneraved by a cranial nerve: CN XI
List 13 extrinsic back muscles:
Latissimus dorsi (2 ea.)
Trapezius (1 ea.)
Rhombus Major (2 ea.)
Rhombus Minor (2 ea.)
Serratus spinae Inferior (2 ea.)
Serratus spinae superior (2 ea.)
Levator scapulae
What is CN XI
Cranial nerve 11 Spinal accessory nerve
List 2 muscles of the back contributing respiratory function. What are they innervated by? How do you know
They are extrinsic muscles and innervated by dorsal ramifications
Name 7 extrinsic muscles of the back
List 3 nerves that innervated the Extrinsic back muscles
Spinal accessory nerve, dorsal scapular nerve, long thoracic nerve
The rhomboids and MAY BE DIVIDED INTO INTERMEDIATE LAYERS
Define muscle origin
Attachment that moves less
Define muscle attachment
Memorize slide 22
Spinal accessory nerve is found under what muscle?
Trapezus
slide 24
InSERTION into the intertubercular groove
What is the swimmers muscle? Why
Latissiumus dorsi
It abducts the arm
Triangle of auscultation
What are the muscles that form the boundary of the triangle fo ausculatation
What is clinically significant about the triangle of auscultation
Where you can auscultation the lungs from the back, THERE are fewer structures in the back to interfere with hearing
Lumbar triangle of petit
The spinotransversalis group of muscles does what generally?
Propioception, postural control,
What nerve is found underneath the latissiumus dorsi?
Splenius capitis originates from :
These fibers travel in oblique, transverse, and superiority to insert
Where do the rhomboids originate from?
Where do they attach
Splenius cervicis
Where do the rhomboids originate from?
Where do they attach
List the erector spinae muscles
Spinalis, longissimus, iliocostalis
In muscles, where is minor generally located
Above something
List the erector spinae muscles
Spinalis, longissimus, iliocostalis
Lavatory scapulae rhomboids major and minor, how do you know they are innervated. by dorsal scapular nerve?
These are extrinsic muscles so dorsal, attach to the scapular
Where do the erector spinae muscles originate from?
From the sacrum
iF There is a fracture of the medial border of the scapula, what muscles and nerve will be affected?
While the muscles of the erector spinae all originate from the sacrum, there are more divisions of each muscle, like longissmus thoracis and longissmus cervicalIS
They insert into different parts of the spine but are still considered the same muscle
iF There is a fracture of the medial border of the scapula, what muscles and nerve will be affected?
T/F: Rhomboid wing in is the same as scapular winging
False
What are the accessory back muscle of respiration
Serratuus posterior superior
Serratus posterior inferior
What is significant about the angle of muscles to their action on the serratus posterior superior serratus posterior inferior
Not very prominent
What nerve innervates Latissmus dorsi
Thoracordorsal
What nerve innervates the Rhomboids Major & Minor?
Dorsal scapulae nerve
What nerve innervates levator scapulae?
Dorsal scapular nerve
What nerve innervates SerratuS Spinae inferior and superior?
ventral rami of the intercostal nerves of T1-T5
What nerve innervates trapezius
Spinal nerve XI, spinal accessory nerve
