Musculoskeletal Anatomy Exam 2 (Final!) Flashcards

Question

Arteries of Upper Limb

Answer 1

Arteries of Upper Limb Subclavian Øbetween anterior & middle scalenes; Axillary ØFrom the lateral part of 1st rib To lower edge of teres major Brachial ØExtends from teres major down to bifurcation of radial and ulnar arteries ØProfunda brachii (follows radial nerve in posterior arm) Radial ØPulses often taken here (both conventional and TCM), as well as ABG’s Ulnar Deep and Superficial Palmar Arches Digital Arteries

Answer 2

Collateral Circulation ØThe situation of having multiple pathways for blood to reach a particular organ or region of the body ØOften involves an anastamosis – connecting branches formed between adjacent blood vessels == ØThe body will create anastamosises to get blood around blockages ØWhile good in many cases, can also work against us, as in diabetic retinopathy

Answer 3

Collateral circulation around scapula ## Footnote Branches from subclavian and axillary arteries anastomose around scapula ØDorsal scapular a. (vertebral border of scapula) ØSuprascapular a. (supra- & infraspinous fossa) ØCircumflex scapular a. (medial triangular space) Ø Effect: If axillary artery is occluded, blood is shunted from subclavian artery to distal axillary artery by reverse flow in circumflex scapular/subscapular arteries

Answer 4

Neurovascular Compression Syndrome (“Thoracic outlet syndrome”) Compression of brachial plexus and blood vessels at three possible locations. ØScalenes ØCostoclavicular ØPectoralis minor Ø Cervical Ribs (0.5 to 1% of population) ØNerves stretching over rib can cause compression ------ The Adson Test 1) Pt’s arm is abducted and externally rotated. 2) Pt is instucted to turn head away from affected arm and inhale deeply. 3) Radial pulse is monitored to see if it is diminished by this manuver. http://videos.rehabstudents.com/allens-test-thoracic-outlet-syndrome/

Answer 5

Radial Artery ØSite for taking pulse on anterior styloid process of radius ØDeep palmar arch: Radial artery passes through anatomical snuffbox and around 1st metacarpal to enter palm ØAnastomoses with branch of ulnar artery Ø Ulnar artery ØThrough tunnel of Guyon ØSuperficial palmar arch: artery forms arch to anastomose with branch off radial artery

Answer 6

Superficial palmar arch ØFormed primarily by the ulnar artery, as it comes into the palm, through the tunnel of Guyon. ØAnastamosis with the radial artery == Deep Palmar Arch ØFormed primarily by the radial artery as it passes through the anatomical snuff box and through the heads of the 1st dorsal interosseus ØAnastamosis with the superficial palmar arch

Answer 7

ØPalmar arches branch into metacarpal, common, & proper digital arteries paralleling the cutaneous nerves ØNerves and blood vessels run along sides of digits! Need to know this for minor surgery -- Digital nerve block ØAnesthetic is injected on either side of the affected digit to numb all branches of the digital nerves ØNever use epinephrine (adrenaline) containing anesthetics

Answer 8

Superficial veins Cephalic: nAnterolateral forearm, over biceps, between deltoid and pectoralis major n Basilic: nanteromedial forearm npenetrates medial side of arm n Median cubital: ncommunicating vein between cephalic and basilic vv. nVenipuncture can be done in any of these superficial veins

Answer 9

Venae comitantes nPaired veins accompany major arteries nRadial, ulnar, brachial, etc. nAlternate course for venous return to heart; used for thermoregulation

Answer 10

Cubital fossa ## Footnote Triangular space bordered by: npronator teres nbrachioradialis nline connecting the medial and lateral epicondyles of humerus n Structures in the fossa: nsuperficial veins nmedian and radial nerves nbrachial artery nbiceps tendon

Answer 11

Peripheral lymph vessels drain to regional nodes nLymphatic vessels in limbs drain extracellular fluid nFluid is propelled primarily via action of the muscles around vessel nThere is smooth muscle in the walls of some lymphatics, with rhythmic, peristaltic action

Answer 12

Lymphadenopathy & Diff. Diagnosis nRight supraclavicular node Mediastinum, lungs, esophagus Lung, retroperitoneal or gastrointestinal cancer nLeft supraclavicular node Thorax, abdomen via thoracic duct Lymphoma, thoracic or retroperitoneal cancer, bacterial or fungal infection nAxillary Arm, thoracic wall, breast Infections, cat-scratch disease, lymphoma, breast cancer, silicone implants, brucellosis, melanoma Epitrochlear Ulnar aspect of forearm and hand Infections, lymphoma, sarcoidosis, tularemia, secondary syphilis

Answer 13

What happens at the lymph nodes nFilters and monitors interstitial fluid nAntigen presenting to lymphocytes and immune response == Lymphatics follow superficial veins and deep arteries and drain into venous system

Answer 14

Breast and Mammary glands ## Footnote Mammary glands: n15-20 lobes, modified sweat glands embedded in adipose tissue nLactiferous ducts drain milk into lactiferous sinuses nSuspensory (Cooper’s) ligaments support breast from deep fascia nLymphatic channels carry lymph (and cancer cells!) from breast to nodes in four local regions npectoral nodes in axilla (most common site of metastasis) nopposite breast nparasternal nodes nabdominal nodes Axillary lymph nodes, enlarge in a systemic infection such as the flu.

Answer 15

Axial Skeleton * Skull * Hyoid Bone * Ossicles (of middle ear) * Vertebral Column * Sacrum & Coccyx * Rib Cage * Sternum * All other bones belong to the Appendicular Skeleton

Answer 16

The Skull •8 Cranial Bones: •Parietal (2) •Temporal (2) •Frontal •Occipital •Ethmoid •Sphenoid ==== * 14 Facial Bones: * Maxilla (2) * Zygomatic (2) * Nasal (2) * Palantine (2) * Lacrimal (2) * Vomer (1) * Mandible (1) * Inferior Nasal Concha (2)

Answer 17

Vertebral Column * 26 Bones make up the Vertebral Column: * 7 Cervical Vertebrae * 12 Thoracic Vertebrae * 5 Lumbar Vertebrae * 1 Sacrum (5 fused segments) * 1 Coccyx (3-5 fused segments)

Answer 18

Somites form divisions both lateral to the notocord and longitudinally •Somites form discrete bundles of tissue longitudinally along the long axis of the embryo. •These bundles, or segments, are what associates different parts of the body to different levels of the spinal cord. === Somitic differentiation * Sclerotome → vertebrae and ribs * Dermatome →becomes dermis of skin * Myotome → muscles of back and limbs

Answer 19

Sclerotome cells form vertebrae * Cells migrate medially * Surround neural tube and notochord * Form vertebral foramen and body

Answer 20

Formation of vertebrae \>\>\>Only need to know: scleretomic elements form vertebrae and intervertebral disks! Scleretom divides to top & bottom parts •Fusion of dense and loose tissues of adjacent somites forms the intersegmental vertebra • •Notochord becomes nucleus pulposus • •Myotomes span adjacent vertebrae • •Spinal nerves interposed between vertebrae

Answer 21

Echondral ossification of vertebrae \>\>\>It takes a long time to form, and a HIGH percentage of cartilage in vertebrae at birth. We want to give the brain and spinal cord room to develop! ==== •Mesoderm differentiates into cartilage models of bone •Chondrification around neural tube •Endochondral ossification replaces cartilage with bone • •1˚ ossification centers form vertebral parts that fuse between ages 3 to 5 years. •2˚ ossification centers form on vertebral periphery in puberty. •Growth cartilage plates between ossification centers permit growth in size

Answer 22

Curvature of spine Primary & secondary •Primary – present during fetal life oThoracic, sacral oKyphosis (bottom kyphosis region when curved without different curves...) • •Secondary – develop after birth, through the actions of holding head up, sitting and walking oCervical, lumbar oLordosis

Answer 23

Vertebrae Common features Vertebrae (common features) Body is the anterior part that bears most of the weight Vertebral foramen: space enclosed by vertebral arch Vertebral canal: column of vertebral foramina which encloses the spinal cord Vertebral arch •Lamina join to form a spinous process •Pedicles and laminae fuse to form a pair of transverse processes oMammillary processes on lumbar vertebrae are important landmarks, but can be confused with transverse processes. •Superior and inferior notches form intervertebral foramina between vertebrae •Superior and inferior articular processes form the zygapophyseal (facet) joint

Answer 24

Cervical, Thoracic, and Lumbar vertebrae

Answer 25

Sacrum Sacrum (S1-5) * 5 sacral vertebrae fuse after 20 years * Sacral foramina: convey ant & post rami of sacral nerves * Promontory: prominent body of S1 * Sacral crests: median (fused spines); lateral (fused TVP's) * Sacral canal: passage for spinal nerves ends at sacral hiatus * Coccyx: 3-5 small fused vertebrae serve as origin for pelvic muscles and ligaments * The Sacrococcygeal Symphysis is a fibrocartilaginous joint between the sacrum and the coccyx

Answer 26

Intervertebral Joint * Symphysis joint connects vertebral bodies * When thick, provides wide tipping action * Annulus fibrosus: criss-cross pattern of collagenous fibers interconnecting lips of vertebrae * Nucleus pulposus: gelatinous center; provides shock absorption

Answer 27

herniated disk Herniated Disc * Compression extrudes fluid, relaxation restores fluid * Nucleus pulposus can herniate through annulus and pinch outgoing spinal nerve against articular processes within intervertebral foramen === MRI of herniated disk * Positive MRI does not always equal pain * Boden et al 1990 - performed MRI’s on 67 asymptomatic individuals; 57% read as abnormal, bulging discs seen on 36%

Answer 28

Zygapophyseal or facet joint * Synovial joint connects vertebral arches * Orientation of facets determines direction of movement in cervical, thoracic and lumbar regions •Ligaments: oSupraspinous: joins tips of vertebral spines oInterspinous: spans between vertebral spines oLigamentum flavum: elastic CT helps extend vertebral column

Answer 29

anterior and posterior longitudinal joints * Support intervertebral joints * Affixed along anterior and posterior surfaces of vertebral bodies

Answer 30

Atlanto-axis joint * Dens and anterior arch of the atlas form pivot joint for rotation of head * Transverse ligament holds dens against the anterior arch of the atlas * Alar and apical ligaments attach the dens to the margin of the foramen magnum and limit the degree of checks rotational movement

Answer 31

Atlanto-occipital joint •Superior articular processes of atlas articulate with occipital condyles of the skull •Permits flexion & extension of head Atlanto-occipital Membrane •penetrated by C1 & vertebral artery

Answer 32

Posterior Atlanto-Occipital membrane (PAO) and suboccipital muscles •Rectus Capitis Posterior minor attaches onto posterior surface of the Posterior Atlanto-occipital membrane • •Note entry of vertebral artery through PAO membrane === PAO membrane connects rectus capitis posterior minor muscle to dorsal spinal dura at the atlanto- occipital junction. •Potential source of cervicogenic headache (?)

Answer 33

ribs * Head of rib – articulates with vertebral bodies * Neck – between head and tubercle * Tubercle of rib - costotransverse articular facet * Angle of rib – sharp curve in rib distal to tubercle * Shaft – main body of rib * Sternal end - attaches to costal cartilages * Costal Groove – intercostal vessels and nerve

Answer 34

costovertebral articulations * Usually only at thoracic vertebrae * Occurs at 2 locations, the vertebral body and transverse process * Wedge-like shape of head of rib allows hinge-like motion

Answer 35

Sternum •Flat, bony plate anterior protion of rib cage •Attached to rib by costal cartilage •Sternal angle is where manubrium connects to body of sternum, rib #2 •3 parts oManubrium oBody oXiphoid Process

Answer 36

Hyoid bone •Is the only bone that is not directly attached to any other bone •Located in anterior neck, anchored by muscles of speech, swallowing

Answer 37

Zygapophyseal or facet joint * Synovial joint connects vertebral arches * Orientation of facets determines direction of movement in cervical, thoracic and lumbar regions •Ligaments: oSupraspinous: joins tips of vertebral spines oInterspinous: spans between vertebral spines oLigamentum flavum: elastic CT helps extend vertebral column

Answer 38

Functions of Core Musculature •Balance/Posture – standing/sitting/walking •Valsalva – coughing/vomiting •Proprioception – where we are in space and how our weight is distributed •Respiration – expanding thorax/compressing abdomen •Circulation – pressure variations to create fluid movement === INclude the following: * Erector Spinae * Multifidus * Transversus Abdominus * Internal Abdominal Obliques * External Abdominal Obliques * Rectus Abdominus * Quadratus Lumborum * Iliopsoas * Diaphragm * Pelvic Floor Muscles

Answer 39

Erector Spinae Common tendinous origin on sacrum and iliac crests oLongitudinal portions are aligned medial to lateral and named regionally oSuffixed by region i.e. lumborum, thoracis, cervicis and capitis portions * Spinalis: Interconnect thoracic and cervical spinous processes. Most medial of the erector spinae muscles * Longissimus ("longest") middle of the 3 groups inserts onto transverse processes and angles of ribs/capitis portion inserts onto mastoid processes •Iliocostalis: From iliac crest up to ribs. Most lateral of the erector spinae muscles. === •Erector Spinae oBilaterally, they stabilize the vertebral column and extend the vertebral column oUnilaterally, they ipsilaterally (same side) side-bend and rotate the vertebral column

Answer 40

Transversospinalis group •This muscle group extends from sacrum to base of skull • •Within groove between transverse and spinous processes • •TVPs to spinous processes • •Groups differentiated by number of vertebrae spanned and depth == •Semispinalis ospans 5-8 vertebrae in oupper ½ of vertebral column •Multifidus ospans 3-4 vertebrae othickest over sacrum •Rotatores span 1-2 vertebrae throughout spine •Intertransverse and Interspinous muscles oAttaches transverse process to transverse process and spinous process to spinous process, respectively === Transversospinalis Muscles (except for the rotatoraes) Bilaterally, extends vertebral column and maintains posture Unilaterally, Side-bending of vertebral column Rotatoraes rotate vertebral segements

Answer 41

Splenius •Splenius capitis o Originates on lower portion of nuchal ligament and spinous processes of C3-T3. oInserts at superior nuchal line and mastoid processes •Splenius cervicis o Originates from spinous processes T3-T6 oInserts at transverse processes of C2-C4 ## Footnote Actions: Acting bilaterally, these muscles extend head and neck. Unilaterally, they rotate and laterally bend head and neck.

Answer 42

Innervation of deep back muscles Innervation of deep back muscles •Posterior rami of spinal nerves innervate odeep back muscles oCutaneous innervation to overlying skin

Answer 43

Suboccipital muscles

Answer 44

Anterior neck muscles RECTUS CAPITIS ANTERIOR and LATERALIS O: atlas TVP I: occiput A: flex head or laterally flex head stabilize atlanto-occipital joint LONGUS COLLI and CAPITIS O: lower cervical bodies and TVPs I: upper cervical bodies & TVPs and occiput A: flex head, neck Nerves for all: C1-4

Answer 45

Lateral neck muscles Scalenes Anterior/Middle: O: TVP I: 1st rib Posterior: TVP I: second rib N: lower cervical nerves A: lateral flex neck; raise ribs (inspiration) STERNOCLEIDOMASTOID (SCM) O: manubrium, clavicle I: mastoid N: motor-spinal accessory (CN XI); sensory- C 2,3 A:ipsilaterally flex & contralaterally rotate head (unilateral) flex head (bilateral)

Answer 46

Torticollis (Wry neck) * Spasm of the Sternocleidomastoid muscle * May be congenital or acquired * Treated with braces, hydrotherapy, physical therapy and manipulation. Surgery if all else fails.

Answer 47

Occipital attachments of neck muscles Occipital attachments of neck muscles * Muscle attachments form ring around foramen magnum * Stabilize atlanto- occipital joint

Answer 48

Intercostal muscles * External Intercostals – aids in inspiration * Internal Intercostals – fixes ribs in place, * Both attach from the inferior border of a rib to the superior border of the rib below it ==== Ventral rami of spinal nerves T1-T12 leave the intervertebral foramen and travel anteriorly, along the costal grooves. These nerves are called the intercostal nerves. They travel along with the intercostal arteries and veins.

Answer 49

Abdominal muscles •Multifidus and transversus abdominis work together to support the lumbar spine

Answer 50

rectus abdominis * Paired, ventral muscles that have superior attachments at xiphoid process and cartilage of ribs 5-7 * Inferior attachments on the pubic crest and pubic symphysis * Innervated by lower 6 intercostal nerves * Acts to compress abdominal contents and flex vertebral column * This is the muscle commonly referred to as the “six-pack”

Answer 51

External oblique •Superior insertion – ribs 5-12 •Anterior insertion – abdominal aponeurosis and linea alba •Inferior insertion – anterior portion of iliac crest •Innervated by lower 6 intercostal nerves •Acts to compress abdominal wall contents, flexes vertebral column; Acting unilaterally, ipsilaterally flexes and contralaterally rotates vertebral column

Answer 52

internal obliques * Superior insertion – cartilage of lower 3 ribs * Inferior insertion –iliac crest and inguinal ligament * Anterior insertion – abdominal aponeurosis to linea alba * Posterior insertion – thoracolumbar fascia * Innervated by lower 6 intercostal nerves and ventral rami of L1 * Acts to compress abdominal contents and flex vertbral column; Unilaterally, it ipsilaterally flexes and contralaterally rotates the vertbral column

Answer 53

transversus abdominis * Posterior insertion – thoracolumbar fascia * Anterior insertion – abdominal aponeurosis to linea alba * Superior insertion – cartilage of lower 6 ribs * Inferior insertion – iliac crest and inguinal ligamnet * Innervated by lower 6 intercostal nerves * Acts to compresses abdominal contents

Answer 54

quadratus lumborum •Superior attachment is the 12th rib and transverse processes of L1-5 •Inferior attachment is the iliac crest and iliolumbar ligament •Innervated by T12 and L1-4 spinal nerves •Acts to laterally flex lumbar spine and elevate hip; acting bilaterally, it can extend vertebral column and fixes 12th rib during respiration •

Answer 55

Iliopsoas Muscle * Two muscles that make up this group – psoas major and iliacus * Superior attachment are the TVP’s and vertebral bodies of L1-5 (psoas major) and iliac fossa (Iliacus) * Inferior attachment is lessor trochanter of femur * Can flex the hips or the lumbar spine * Innervated by L1, L2 and Femoral nerve == Numerous nerves pass underneath and through the psoas muscle. Among these are the Femoral N., Genitofemoral N., and Lateral Femoral Cutaneous N

Answer 56

thoracic diaphragm •Muscle fibers radiate from a central tendon to attach peripherally to the inner surface of the lower 6 ribs, upper 3 lumbar vertbrae and the xiphoid process •Contraction of the diaphragm flattens it, compressing the abdominal contents and increasing the volume of the thorax === * Innervated by the phrenic nerves * When the diaphragm contracts, the increased volume of the thorax, reduces the thoracic pressure. In addition to drawing air into the lungs, this pressure change assists with lymphatic and venous return

Answer 57

pelvic floor muscles •Coccygeus •Levator Ani oPubococcygeus oPuborectalis oIliococcygeus === These muscles support the pelvic viscera and provide sphincter-like action to the urethral, vaginal and anal canals. They also assist in positioning the infants head as it travels through the birth canal during delivery.