Neuro-RIBS-Part1-Part2-part3 & RIBS-Spinal Anatomy-Dr. Dirks Flashcards
1
Q
Neuro-RIBS-Part1
1–Central Nervous System = Brain and
Spinal Cord
2–Peripheral nervous system = cranial
and spinal NERVES
A
know
2
Q
Neuro-RIBS-Part1
Peripheral nervous system:
2 Parts= (LOWER MOTOR NEURON)
1-• Somatic INNERVATES Skeletal muscle
2–• Autonomic INNERVATES Smooth muscle “Visceral”
(POST GANGLIONIC NEURON)
NEUROTRANSMITTORS =
1–SYMPATHETIC = __________________
2–PARASYMPATHETIC OR SKELETAL MUSCLE = __________
A
NOREPINEPHRIN
ACETYLCHOLINE
3
Q
Neuro-RIBS-Part1
________________ involves:
– 1) Formation of a neural plate
– 2) Neural plate becomes neural groove surrounded by crests
– 3) Groove becomes closed tube in highly ordered fashion
A
Neurulation = “CLOSURE OF THE TUBE”
***PLATE TO GROOVE TO TUBE!!!
4
Q
Neuro-RIBS-Part1
THE (((ROSTRAL))) END OF THE NEURAL TUBE DIFFERENTIATES TO FORM THE THREE “VISICLES” THAT WILL GIVE RISE TO THE ENTIRE BRAIN!!
1–PROENCEPHALON OR ____________
2–MESENCEPHALON OR____________
3–RHOMBENCEPHALON OR__________
A
FOREBRAIN
MIDBRAIN
HINDBRAIN
5
Q
Neuro-RIBS-Part1
1–Of the 3 vesicles MES stays “MES”..NO changes!! DOES NOT DIVIDE!
2–PRO = divides into _____ &_____
3–RHOMB = _____ &__ELENCEPHALON
**WHEN THE TUBE BECOMES THE SPINAL CORD, IT IS DIVIDED INTO TWO PARTS. THAT DIVIDING PART (INTO DORSAL AND VENTRAL PART) IS CALLED THE ________ ________
*BASAL PLATE = (aka bottom) VENTRAL TO SL = MOTOR
***ALAR PLATE = DORSAL TO SL = SENSORY
A
TEL and DIE
MET AND MY
SULCUS LIMITANS
6
Q
Neuro-RIBS-Part1
Neural crest cell fate organized by ______ level
Somite = Division of _______ in developing embryo along the neural tube.
A
somite
mesoderm
7
Q
Neuro-RIBS-Part1
Somites include:
A
Dermatome
Myotome
Sclerotome
8
Q
Neuro-RIBS-Part1
Parasympathetic organization
• Sacral spinal cord (mostly S2 and S3)
• Cranial Nerves:
– III: Oculomotor
– VII: Facial
– IX: Hypoglossal
– X: Vagus —–___% of all parasympathe’c control is through CN X
A
75%
**REMEMBER PARASYMPATHETIC ARE
3….7..9…10!!!!
9
Q
Neuro-RIBS-Part1
Enteric nervous system
• Nervous system of the GI tract
• Two intramural plexuses:
__________ & ______________
• ENS is a fully functional nervous
system on its own, functions like the CNS
– There is no ________ barrier
**More neurons reside in the gut than in the spinal cord
A
Myenteric
submucous
blood/ENS
10
Q
Neuro-RIBS-Part 1
Applicaton of the basal and alar plate rules
• Rexed Laminae
– 10
– Top 5
– Bottom 2-3
A
know
11
Q
Neuro-RIBS-Part 1 review slide 17!
ASCENDING TRACTS:
1–DORSAL PART OF SPINAL CORD divides into ______ ________ …which divides into FASC. GRACILUS AND FASC. CUNEATUS
2–LATERAL PARTS ARE DORSAL AND VENTRAL SPINOCEREBELLAR TRACT
DESC TRACT. = LATERAL CORTICOSPINAL WILL AFFECT THE LIMBS
VENTRAL CORTICAL SPINAL WILL AFFECT THE AXIAL SKELETON
A
DORSAL COLUMNS
12
Q
Neuro-RIBS-Part 1
Organization of motor neurons in the
spinal cord = ???
A
PROXIMAL MUSCLES ARE MEDIAL AND DISTAL MUSCLES ARE LATERAL OFF THE SPINAL CORD
13
Q
Neuro-RIBS-Part 1
Frontal lobe = contains ________ areas
• Precentral gyrus • Superior • Middle • Inferior • Orbitofrontal cortex • Gyrus rectus • PRIMARY MOTOR CORTEX (Area\_\_\_\_\_) • PREMOTOR and SUPPLEMENTARY MOTOR CORTEX (Area 6) • BROCA’S AREA (Areas\_\_\_ \_\_\_\_ \_\_\_\_) • PREFRONTAL CORTEX (Areas 9, 10, 11, 46) • Frontal eye fields (Area 8)
A
motor
4
44, 45, 47)
14
Q
Neuro-RIBS-Part 1
Parietal lobe contains ____________
areas
• Postcentral gyrus • Superior lobule • Inferior lobule – Supramarginal gyrus – Angular gyrus • Precuneus • Primary somatosensory cortex (Areas\_\_\_ \_\_\_\_ \_\_\_) • \_\_\_\_\_ \_\_\_\_\_ (around border with temp., frontal) • Spatial orientation and perception
A
somatosensory
1,2,3
Language comprehension
15
Q
Neuro-RIBS-Part 1
Temporal lobe contains _____ areas
- Superior
- Middle
- Inferior
- Fusiform
- Primary auditory cortex (Areas___ _____)
- Wernicke’s Area (Area 22)
- Ventral stream of “_____”
- Learning and ________
A
auditory
41, 42
what?
Memory
16
Q
Neuro-RIBS-Part 1
Occipital lobe contains ______ areas
• Cuneus – V1 (primary visual cortex) – Area \_\_\_\_ • V2 (visual association cortex) – Area \_\_\_\_ • Calcarine sulcus • Occipital pole =\_\_\_\_\_\_\_\_
A
visual
17
18
fovea
17
Q
Neuro-RIBS-Part 1
Limbic lobe involves _______ and
______
• __________ gyrus
• Parahippocampal gyrus
A
memory
emotion
Cingulate
18
Q
Neuro-RIBS-Part 1 - Association and commissural fibers
1) ______ Fibers = pass from one part of a SINGLE hemisphere to another
2) ________ Fibers = Link matching areas of the two hemispheres
3) ________ Fibers = Run to subcoritcal nuclei
A
Association
Commissural
Projection
19
Q
Neuro-RIBS-Part 1
What is the developmental fate of neurons in
the alar plate?
A
The alar plate specifically later on becomes the dorsal gray of the spinal cord, and develops into the SENSORY nuclei of cranial nerves V, VII, VIII, IX, and X.
20
Q
Neuro-RIBS-Part 1
What is the developmental fate of the metencephalon?
A
PONS AND CEREBELLUM
21
Q
Neuro-RIBS-Part 1
What type of fibers make up the corpus callosum?
A
COMMISURAL
22
Q
Neuro-RIBS-Part 1
What function is associated with Broadmann’s
Area 1?
A
PRIMARY SOMATOSENSORY CORTEX
23
Q
Neuro-RIBS-Part 1
What are the major cell type in Rexed Lamina
VIII?
A
LOWER MOTOR NEURON
24
Q
Neuro-RIBS-Part 1
What kind of information is carried in the
white ramus communicans?
WHITE RAMUS = T1–L2
GRAY RAMUS = THE WHOLE THING!
A
PRE-GANGLIONIC SYMPATHETIC
FYI***GRAY RAMUS IS POST-GANGLIONIC SYMPATHETIC
25
Neuro-RIBS-Part 1 ----last NEURO OF PART 1
What kind of information, sensory or motor, is
carried in the dorsal ramus of a spinal nerve?
BOTH
26
Neuro-RIBS-Part 2
Ipsilaterality and contralaterality
• Cortex is _________ to spinal cord signal
• Cortex and _____ are on the same side
• Basal ganglia and cortex are on the same side
• _____and spinal cord are usually on the same side
– So cerebellum is collateral to _____
• Think pontine nuclei
contralateral
thalamus
Cerebellum
cortex
27
Neuro-RIBS-Part 2
Right Side = Cortex...Thalamus..Basal Ganglia
Left Side = Spinal Cord...Cerebellum....Sensory Input....
......Motor Output
know
28
Neuro-RIBS-Part 2
Descending control of Pain
- ALL points along this pathway are sensitive to ________ and enkephalins
- Bilateral
endorphins
29
Neuro-RIBS-Part 2
Gamma Motor neurons alter ______ sensitivity
• Intrafusal fibers have minor role in contraction
• But innervated by Gamma motor neurons
– Purpose is to always keep the spindle _______ to a certain extent to signal status
spindle
stretched
30
Neuro-RIBS-Part 2-
-Dorsal Columns
```
– Name of pathway
– Type of information in pathway
– Point of origin, receptors involved
– Where primary cell bodies are located
– Where 1st synapse is
– Where in Spinal Cord it enters, travels
– Where/if it decussates
– Where second synapse is
– Final destination
```
The posterior column (dorsal column) refers to the area of white matter in the middle to posterior side of the spinal cord. It is made up of the gracile fasciculus and the cuneate fasciculus and itself is part of the posterior funiculus. It is part of an ascending pathway that is important for well-localized fine touch and conscious proprioception called the posterior column-medial lemniscus pathway.
Joint capsules, tactile and pressure receptors send a signal through the posterior root ganglia up through the gracile fasciculus for lower body sensory impulses and the cuneate fasciculus for upper body impulses. Once the gracile fasciculus reaches the gracile nucleus, and the cuneate fasciculus reaches the cuneate nucleus in the lower medulla oblongata, they begin to cross over as the internal arcuate fibers. Upon reaching the opposite side, they become the medial lemniscus, which is the second part of the posterior column-medial lemniscus pathway.
31
Neuro-RIBS-Part 2
```
Neospinothalamic
– Name of pathway
– Type of information in pathway
– Point of origin, receptors involved
– Where primary cell bodies are located
– Where 1st synapse is
– Where in Spinal Cord it enters, travels
– Where/if it decussates
– Where second synapse is
– Final destination
```
The neospinothalamic tract has few synapses and constitutes the classical lateral spinothalamic tract (LST) (Figure 7.1). The first-order nociceptive neurons (in the DRG) make synaptic connections in Rexed layer I neurons (marginal zone). Axons from layer I neurons decussate in the anterior white commissure, at approximately the same level they enter the cord, and ascend in the contralateral anterolateral quadrant. Most of the pain fibers from the lower extremity and the body below the neck terminate in the ventroposterolateral (VPL) nucleus and ventroposteroinferior (VPI) nucleus of the thalamus, which serves as a relay station that sends the signals to the primary cortex. The VPL is thought to mainly be concerned with discriminatory functions. The VPL sends axons to the primary somatosensory cortex (SCI).
32
Neuro-RIBS-Part 2
Poorly localized pain in other pathways:
```
• C-fibers
• Polymodal receptors
• Terminate in Brainstem, midbrain, hypothalmus
• Called ________________ and/or
Archespinothalmic tracts
• Slow
• _________-related
```
Paleospinothalmic
Emotion
33
Neuro-RIBS-Part 2
***MOSSY FIBERS--in CEREBELLUM via spinal cerebellum path.
**CLIMBING FIBER--originate in INFERIOR OLIVARY NUCLEUS
***GRANULE CELLS >>PARALLEL FIBERS SYAPSE ON PURKINJE CELLS AND THEN SEND TO DEEP CEREBELLAR NUCEI (DCN)
Sensory components of CN V
1--Main sensory – _________ discrimination
2--Spinal trigeminal – Light touch, pain, temperature
3-- Mesencephalic – Proprioceptive
Vibrotactile
34
Neuro-RIBS-Part 2
Medial longitudinal fasciculus (MLF) a mixed pathway carried by the VESTIBULAR NERVE
***involves the __________ ABDUCENS AND THE
___________ OCCULOMOTOR NUCLEUS
Head moves right...eyes move left.
CONTRALATERAL
IPSILATERAL
35
Neuro-RIBS-Part 2
Pyramidal Tract
Decussates (Mostly)
– 80% CROSSING OVER at caudal medulla
= “_______ corticospinal tract”
• Limbs, digits (stuff needing fine motor control)
– 20% continue ipsilateral DOES NOT CROSS OVER
• “________ or ventral corticospinal tract”
• Axial muscles
• Some of these will decussate some won’t
• These travel until thoracic spinal cord
Lateral
anterior
36
Neuro-RIBS-Part 2
Upper motor neuron control of lower motor neurons
```
A---• 4 brainstem pathways: related to posture: “_____________”
1– Vestibular (vestibulospinal)
2– Reticular (reticulospinal)
3– Red nucleus (rubrospinal)
4– Superior colliculus (tectospinal)
```
B--• 2 cortical pathways: related to limbs, facial muscles
1– Direct
2– Indirect
(via first synapsing in the brainstem---”__________”)
extrapyramidal
corticobulbar
37
Neuro-RIBS-Part 2
Typical signs of LOWER motor neuron damage
```
1--• Paralysis or paresis
2--• AREFLEXIA
– Loss of muscle tone (related to areflexia)
3--• ___________
– Due to denervation and disuse
4- • Twitching
```
Atrophy
38
Neuro-RIBS-Part 2
UPPER motor neuron damage
1--• _________ ________
– Toes point upward instead of downward due to loss of Upper motor neuron control
2--• Spasticity
– ___________ influences probably are somewhat inhibitory to the brainstem control of postural muscles---relaxes them a bit.
3--• Loss of fine motor control
– Due to corticospinal damage
Babinski’s sign
Corticospinal
39
Neuro-RIBS-Part 2
Where is the first synapse for ascending pain info of the face?
Which thalamic nucleus receives tactile information from hands and feet?
SPINAL TRIGEMINAL NUCLEUS
THE VPL
40
Neuro-RIBS-Part 2
Which pathway controls the vestibulo-ocular reflex?
What cerebellar pathway(s) carry unconscious prorpioceptive info about the upper half of the body?
THE MLF
THE CUNEAL ROSTRAL CEREBELLAR
41
Neuro-RIBS-Part 2
Paleospinothalmic pain information is carried ipsilaterally, bilaterally or contralaterally through the spinal cord?
BILATERAL
42
Neuro-RIBS-Part 2---last one
What are some examples of extrapyramidal pathways?
1--TECTO
2--VESTIBULO
3--RETICULO
43
Neuro-RIBS-Part 3
The neuroendocrine hypothalamus
1--• Nuclei involved in release of hormones through the hypophysis
2--• Neurohypophysis (_______ pituitary)
– Direct neuroendocrine release
3--• Adenohypophysis (________ pituitary)
– Release via a vascular link within the ant. pituitary
posterior
anterior. A = A tip
44
Neuro-RIBS-Part 3
Neurohypophysis
1--• 2 hypothalamic nuclei: supraoptic and paraventricular
– Magnocellular
2--• ______ (vasopressin)
– Water reabsorption
3--• ________ = Milk letdown reflex, uterine contractions
ADH
Oxytocin
45
Neuro-RIBS-Part 3
Signaling molecules through adenohypophesis
```
Releasing Hormone
CRH
TRH
GHRH
GnRH
Dopamine
```
```
Anterior Lobe Hormone
ACTH
Thyrotropin
Growth hormone
FSH/LH
Prolactin
```
Parvocellular neurons release the “__________ hormones”
releasing
46
Neuro-RIBS-Part 3
What’s the limbic system again?
• Base of the ________—sits on top of ___________ structures...named ajer boundary or borders
cortex
subcortical
47
Neuro-RIBS-Part 3--last one
Papez circuit
1---• Original circuit tied to ________
• Cingulate gyrus— hippocampus— fornix—mammillary body—ant nuc. Thal.—cingulate gyrus
emotion
48
RIBS: SPINAL ANATOMY----START!!
SOME VERTEBRAL LEVELS
1--C3 = hyoid bone
2-- C4,5= Thyroid Cartilage
3-- ____ = cricoid cartilage
C6
49
RIBS: SPINAL ANATOMY
SOME VERTEBRAL LEVELS
4--C6,7, T1 = Thyroid gland
5--• T2 = superior angle of scapula
6--• ______ = base of spine of scapula standing and lying down
T3/4
50
RIBS: SPINAL ANATOMY
SOME VERTEBRAL LEVELS
7--T6/7 = inferior angle of scapula standing and lying down
8--• T4/5 IVD= trachea bifurcation and Sternal angle
9--• _____= xiphoid process
T10
51
RIBS: SPINAL ANATOMY
SOME VERTEBRAL LEVELS
10--T8, T10, T12= IVC, esophagus and aorta pierces diaphragm
11--• L4 = tubercle of iliac crest
12--• _____ = PSIS
S2
52
RIBS: SPINAL ANATOMY
SOME VERTEBRAL LEVELS
13--T4 dermatome = nipple line
14--____ dermatome = umbilicus
T10
53
RIBS: SPINAL ANATOMY
How many vertebra are there in an adult spine? Spinal column?
How many pairs of spinal nerves are there?
How many dermatomes are there?
```
ADULTS = 24.....26
KIDS = 33
```
31
30
54
RIBS: SPINAL ANATOMY
THE AXIAL SKELETON
1--Cranial bones, ossicles of inner ear, ribcage, and spinal column
Know
55
RIBS: SPINAL ANATOMY
THE AXIAL SKELETON
Spinal column
```
1- 24 true and 2 false vertebra (sacrum and coccyx)
2-23 IVDs
3- Begins between C2 & C3
4- Ends between L5 & S1
5-Named for the vertebrae _______
```
6- 31 pairs spinal nerves
7- Begins between Occiput & C1
8-Ends with Co1 at sacral hiatus at S5 segment
ABOVE
* **CERVICAL BULGE = ABOVE
* **LUMBAR BULGE = BELOW
56
RIBS: SPINAL ANATOMY
THE AXIAL SKELETON
Ribcage
1-6 true ribs (attach to sternum), 7-10 false (indirect attachment to sternum), 11 and 12 floating ribs (no attachment)
Sternum =
Manubrium
Body
Xyphoid process
KNOW THAT 11 AND 12 DO NOT HAVE COSTOTRANSVERSE FACETS...ALL OTHER THORACIC VERTEBRAE DOES!
57
RIBS: SPINAL ANATOMY
SPINAL NERVES
1--Cervical Spine: 8 pairs
-- Nerves exit ________ thru IVF, disc protrusion effects nerve ABOVE as it passes
2---Thoracic: 12 pairs
3-- Lumbar: 5 pairs
--Nerves exit ________ thru IVF, disc protrusion effects nerve BELOW as it passes
inferiorly
superiorly
58
RIBS: SPINAL ANATOMY
SPINAL NERVES
4--Sacrum: 5 pairs
5--Coccyx: 1 pair
6--ONLY ___ DERMATOMES (none for C1)
30
59
RIBS: SPINAL ANATOMY
Key phrases
C3,4,5 keeps the diaphragm alive./ NERVE = ____
L2,3,4 walks you out the door./NERVE =____&______
S2,3,4 keeps your “FUCKEN COCK” off the floor
NERVE = ____________
PHRENIC
FEMORAL AND OBTURATOR
PUDENDAL
60
REVIEW QUESTIONS
1-- What are the two plexuses that provide peripheral nerves to the upper and lower extremities?
2-- What are the spinal nerve levels for each?
3-- What are the terminal branches of each?
BRACHIAL AND LUMBAR SACHRIAL PLEXUS
C5 TO T1
T12--S4
61
Study slide 7!!!
BRACHIAL PLEXUS (C5-T1)
Asap
62
BRACHIAL PLEXUS (C5-T1)
```
1-Musculocutaneus (C5- C6)
2-Median (C5-T1)
3- Ulnar (C8-T1)
4- _______ (C5-T1)
5- Axillary (C5-C6)
6- Phrenic (C3-5)
7- Long thoracic (C5-7)
8- Dorsal Scapular (C5-6)
9-Suprascapular (C6)
10- Subscapular
11- Upper (C5-7)
12-Middle (Thoracodorsal) (C6-8)
13- Lower (C5-7)
14- Medial Pectoral (C8-T1)
15- Lateral Pectoral (C5-7)
```
Radial
63
LUMBOSACRAL PLEXUS (T12-S4)
THE ASS AREA
- Iliohypogastric (T12,L1)
- Ilioilguinal (L1)
- Genitofemoral (L1,2)
- Lateral Femoral Cutaneous (L2,3)
```
1- Femoral (L2-4)
2- Obturator (L2-4)
>>Superior GLUTeal (L4-S1)
>>Inferior GLUTeal (L4-S1)
>>Sciatic (L4-S3)
3- Tibial (L4-S3)
4-Common Peroneal (L4- S2)
5- Deep Peroneal (L4- S2)
6- Superficial Peroneal (L4-S2)
>>Posterior Fermoral Cutaneous (S1-3)
>>_________ (S2-4)
```
Pudendal
64
What type of curves are the thoracic ??
--and sacral curves?
Cervical ??
--and lumbar?
```
T = Kyphotic / primary / accomodating
S = kyphotic and primary
```
```
C = LORDOTIC/SECONDARY/ COMPENSATORY
L = LORDOTIC/"/"--A BACKWARD "C"
```
65
TYPES OF VERTEBRAL CURVES
1--Kyphotic / primary / accomodating
A. Thoracic: bodies are ________ posterior
B. Discs are _______ height
thicker
equal
66
TYPES OF VERTEBRAL CURVES
```
2--Lordotic / secondary / compensatory
A. Cervical: bodies are equal _______
-- Discs are wedged, greater anteriorly
B. Lumbar: varies
--Discs are wedged, greater ________
```
height
anteriorly
67
TYPES OF VERTEBRAL CURVES
Vertebral canal (spinal canal) = __+ vertebral foramen in a row
2
68
Which vertebra are typical in the cervical spine?
Atypical?
***What are the characteristics of a typical cervical vertebra?
C3>>>C6
C1...C2..C7
***SEE NEXT SLIDE
69
TYPICAL CHARACTERISTICS: CERVICAL
1--C3-C6
2--Oval body, triangular vertebral foramen
3-- Facets: 45 degrees off horizontal, NO medial lateral rotation
4-- Uncinate processes
5--Anterior/Inferior (A/I) ______
6-- Costotransverse lamellae
---true and false transverse processes (ant/post tubercles)
lipping
70
TYPICAL CHARACTERISTICS: CERVICAL
```
7--Bifid SPs
8-- Transverse Foramen
9-- Key concepts:
A. Vertebral artery travels in transverse foramen C6-C1 thru posterior vertebral groove
B. Ligamentum nuchae: EOP to _____
```
C7
71
ATYPICAL: CERVICAL
1--C1 atlas
A. Fovea dentalis, lateral masses, groove for vertebral artery
2--C2 Axis (___________)
A. Dens (_________), pivot joint with C1, first AI lipping
3--C7 (typical vertebral prominence)
A. Uncinates but no AI lipping, no bifid SP.
4--Normal ADI
- - .5 to 3mm in adults
- - 3 to 5mm in children
epistopheus
odontoid
72
Which vertebra are typical in the thoracic spine? Atypical?
What are the characteristics of a typical thoracic vertebra?
SEE NEXT SLIDE! =)
73
TYPICAL CHARACTERISTICS: THORACIC
1---T___ to T____
2--______ = body, _______ = vertebral foramen
3--Facet orientation: 60 degrees off horizontal, 20 degrees lateral
4--4 demifacets (body), 2 costotransverse facets (TPs), costovertebral joints, costotransverse joint
T2--T8
Heart
circular
74
TYPICAL CHARACTERISTICS: THORACIC
Keys concepts:
1--Ribs named after vertebra ______ (except Rib 1,10-12)
A. Ex: 5th rib HEAD articulates with inf demifacet of T4 and sup demifacet T5 and the RIB TUBERCLE with TP of T5
B. Radiate ligaments covers the costovertebral joint
BELOW
75
ATYPICAL: THORACIC
1---T1
A. 2 full facets, 2 inferior demifacets, 2 costotransverse facets
2--- T9
A. 2 superior demifacets, no inferior demifacets, 2 costotransverse facets
3--T10
A. 2 full facets, 2 costrotransverse facets
4--T11 , T12
A. 2 full facets, NO _________ facets
costrotransverse
76
Which vertebra are typical in the lumbar spine?
Atypical?
What are the characteristics of a typical lumbar vertebra?
SEE NEXT SLIDE
TWO SLIDES FROM HERE
NEXT SLIDE
77
TYPICAL CHARACTERISTICS: LUMBAR
```
1-- L1-4
2--Facet orientation: 90 degrees off horizontal, 45 degrees med
3-- Mamillary processes (multifidii)
4-- Accessory processes
5-- ________ vertebral foramen
6-- ________ shaped body
```
Triangular
Kidney
78
ATYPICAL: LUMBAR
1-L5
2-Shorter SP points more ______
3- Inferior APs face almost in the coronal plane to articulate with the sacrum
4-Larger and ________
horizontal
Wider
79
The lateral sacral crest is made by the fusion of what component of the vertebra?
SACRAL GROOVE = LAMINAE
80
TYPICAL CHARACTERISTICS: SACRUM AND COCCYX
1--Sacrum
A. __ ______ vertebra (adult)
B. Base, apex, ala, anterior and posterior sacral foramen, cornu, hiatus,
median (SP)/intermediate(AP)/lateral(TP sacral crests, sacral groove (lamina)
5 fused
81
TYPICAL CHARACTERISTICS: SACRUM AND COCCYX
B. Coccyx
1-__fused vertebra
2-Base, apex, cornu
***study slide 24!! Look now!!
4
Do it!!
82
OSSIFICATION CENTERS VERTEBRAE
```
1-- Primary ossification
A. Cervical and Thoracic (__)
--1 VB, 1 each Vertebral arch
B. Lumbar (5)
-- Gets an extra one for each mamillary process.
C. Atlas (__)
-- each lateral mass and anterior arch
D. Axis (__)
--1VB, 1 each vertebral arch, 2 odontoid
```
2-- Secondary ossification (5)
A. 1 each epiphyseal plate
B. 1 each TP
C. 1 each SP
3
3
5
83
THE CLAVICLE IS THE FIRST BONE TO BEGIN OSSIFICATION AT 7 ______ POSTOVULATORY
WEEKS
84
IVFS
1-- Cervical
A. __________
B. Angles laterally and anterior
2--Lumbar
A. ___________
B. Face laterally (as do thoracics)
3. Boundaries: vertebral bodies, vertebral notches (pedicles), facets, IVDs.
4. Contents: spinal nerve trunk, dorsal root ganglion, spinal artery, radicular and intervertebral veins, recurrent meningeal nerves, lymphatics, adipose.
5. Recurrent ________ nerves: sensory innervation to the posterior aspect of the annulus fibrosus, PLL, and the ant dura matter
Smallest
Largest
meningeal
85
BONES OF THE SKULL x 14
SKULL X 6
1--_____ bone (1): bone between the orbits, nasal cavity (superior and middle conchae).
2--Frontal bones--(2): roof of the orbit, anterior part of the cranial floor.
3--_______ bone (1): posterior and inferior part of the cranium.
Ethmoid
Occipital
86
BONES OF THE SKULL x 14
SKULL X 6
4--_______ bones (2): sides and roof of the cranial cavity.
5--________ bone (1): part of the floor of the anterior, middle, and posterior cranial fossae; KEYSTONE of the cranial floor because it articulates with all the other cranial bones.
6-- Temporal bones--- (2): contains the organs of hearing.
Parietal
Sphenoid
87
BONES OF THE SKULL x 14
FASCIAL X 8
1---Inferior Nasal Conchae (2)
2--- _________ bone (2): medial wall of the orbit
3--- _______ (1): largest and strongest bone of the face
4---Maxillae (2): upper jawbone, articulate with every bone of the face except the ________!
5--- Nasal bones (2): fusion forms the superior part of the bridge of the nose.
Lacrimal
Mandible
mandible
88
BONES OF THE SKULL x 14
FASCIAL X 8
6---Palatine bones (2): posterior part of the hard palate
7---_______ (2): forms the inferior and posterior of the nasal septum.
8---Zygomatic bones (2)
Vomer
89
THE CALVARIUM X 8
1--________ suture: joins parietal bones
2-- ________ suture: joins frontal and parietal bones
3-- _______ suture: joins parietal bones and occipital bone
4-- _______________ sutures (2): joins parietal bone and temporal bone
.
Sagittal
Coronal
Lambdoidal
Parietomastoidal
90
THE CALVARIUM X 8
5--___:INTERSECTION of the sagittal and coronal sutures
6--___: INTERSECTION of sagittal and lambdoid suture
7-- __________ : 4 bones articulate: frontal, parietal,temporal, and sphenoid
--- Weakest part of the skull
---- Ant branch of middle meningeal artery runs under it
8--ASTERION: at END of parietomastoid suture
BREGMA
LAMBDA
PTERION
91
BASE OF THE CRANIUM X 5
1-- _____ Bone
-- Foramen Cecum: emissary vein to sagittal sinus
2-- ________ Bone
-- Cribiform Plate: olfactory nerve bundles
3-- _________ Bone
- - Sella turcica/hypophyseal fossa: Pituitary gland
- - Foramen rotundum: maxillary nerve
- - Foramen ovale: mandibular nerve, accessory meningeal artery, lesser petrosal nerve
- - Foramen spinosum: middle meningeal artery and vein, meningeal branch of mandibular nerve
- - Optic canal: optic nerve, opthlamic artery
Frontal
Ethmoid
Sphenoid
92
BASE OF THE CRANIUM X 5
4-- ___________ Bone
- Carotid canal: internal carotid artery and nerve plexus
- External auditory meatus and internal acoustic meatus: facial nerve, vestibulocochlear nerve
- Groove for occipital artery
- Greater and lesser petrosal nerve
- Jugular foramen: glossopharyngeal nerve, vagus nerve, Spinal accessory nerve, posterior
meningeal artery, internal jugular vein
5--_________ Bone
- Hypoglossal canal: hypoglossal nerve
- Foramen magnum: vertebral arteries, medulla oblangata
Temporal
Occipital
93
CRANIAL NERVES X 12 ( O-O-O-T-T-A-F-V-F-V-S-H )
1-- Olfactory- _________ plate
2-- Optic- optic canal
3-- Oculomotor- _________ orbital fissure
4--Trochlear- Superior orbital fissure
5-- Trigeminal- X 3
V1: Superior orbital fissure
V2: Foramen Rotundum
V3: Foramen Ovale
cribiform
Superior
94
CRANIAL NERVES X 12 ( O-O-O-T-T-A-F-V-F-V-S-H )
6--Abducens- Superior orbital fissure
7--Facial -Internal Auditory Meatus>>> ______ Foramen
8-- Vestibulocochlear- Internal Auditory Meatus
9-- Glossopharyngeal- Jugular Foramen
10-- Vagus- _________ Foramen
11-- Spinal accessory - Jugular Foramen
12-- Hypoglossal- Hypoglossal Canal
Stylomastoid
Jugular
95
CRANIAL FOSSA
1--- Anterior
- Bordered by _________ wing of sphenoid and optic chiasm
- Formed by frontal, ethmoid, and sphenoid bone
2--- Middle
- Separated from posterior by clivus and petrous crest
- Contains _______ lobes of the brain
3-- Posterior
- Located between tentorium cerebelli and foramen
magnum
- Contains ________ and cerebellum
lesser
temporal
brainstem
96
What does the ALL become?
What does the PLL become?
What does the Supraspinatus ligament become?
SEE NEXT SLIDE
97
SYNDESMOLOGY OF AXIAL SKELETON X 9
1---- Ligamentum nuchae (EOP to C7) > suprapinous >>
superficial posterior sacrococcygeal
2--- ______ __________ (STARTS at body of axis)
= Posterior longitudional (PLL) >>>deep posterior sacrococcygeal
3-- Anterior longitudinal (ALL) >>> anterior __________
4-- Ligamentum flavum (C2 to S1): elastic
Tectorial membrane
sacrococcygeal
98
SYNDESMOLOGY OF AXIAL SKELETON X 9
5--_________ ________: surrounds facet joints
6--Intertransverse and interspinous
7-- Atlantoaxial and Atlanto-occipital
8--___________: b/w C1 and C2
9-- Alar: check ligaments (check rotation) around dens to the foramen magnum
Capsular ligaments
Cruciate
99
ARTHROLOGY OF THE AXIAL SKELETON
CLASSIFICATION BY------------------ MATERIAL-------------
1-----______________
Sutures
Usually synarthrotic
2---- ___________ (fibrocartilage or hyaline)
Manubrium/sternal joint
Syncondroses, symphysis
Amphiarthrotic
3---- __________
Capsule filled with lubricating synovial fluid and joint
surfaces covered with hyaline cartilage
Fibrous
Cartilaginous
Synovial
100
ARTHROLOGY OF THE AXIAL SKELETON
CLASSIFICATION BY-------- MOVEMENT--------------
```
1------__________
- Immovable
- Most are Fibrous joints
- Gomphosis (teeth), synostoses (cranial bones fused),
synchondrosis (growth plates)
```
2----__________
- Slightly movable
- Symphysis (IVD and pubic symphysis) and syndesmosis
3----______________
- Very mobile
- Synovial joints (hinge, spheroid, pivot, etc)
Synarthoritic
Amphiarthrotic
Diarthrotic
101
ARTHROLOGY OF THE AXIAL SKELETON
SYNOVIAL JOINTS X 6
1. Ball and socket/_______: all movements
- Ex: GH, hip
2. ________: 2 planes of motion
- Ex: C0C1, metacarpophalange
3. _____:2 planes of motion
- Ex: carpometacarpal, SC
spheroid
Condyloid
Saddle
102
ARTHROLOGY OF THE AXIAL SKELETON
SYNOVIAL JOINTS X 6
4. Hinge/ _________: 1 plane of motion
- Ex: Humeral-ular
5. Pivot/ ________: 1 plane of motion
- Ex: radial-ulnar, atlanto-axial
6. Planar/________: 1 plane of movement
- Ex: Z-joints, AC, carpals
ginglymus
trochoid
GLIDING
103
IVD
1--- 25% height spinal column
```
2--- 3 parts
A. Annulus fibrosus
-- ________ fibers attach annulus to vertebral bodies
--Mostly Type I collagen
B. _____ pulposus
-- Mostly Type II collagen, proteoglycans and GAGs
C. Vertebral endplates (cartilage)
-- Allow nutrition to IVD thru ________
```
3---Bulge, Protrusion, Extrusion, Sequestration
***SEE SLIDE 41
Sharpeys
Nucleus
IMIBIBITION
104
MAIN MOTIONS
1--- CO-C1 = _______
--Occipital condyles roll anterior and slide posterior during flexion and vice versa for extension
2--- C1-C2 = ______
-- ~____ % of total C/S rotation occurs here
-- From C2/3 to C5/6 the amount of available flexion/ext increases
3-- Thoracic = Rotation
--Movement increases at top and bottom of T/S
4-- Lumbar = Flexion/extension
Greatest mobility b/w L4 and S1
Nodding
Rotation
55
105
MYOLOGY OF AXIAL SKELETON
1--- Layer 1: latissmus dorsi, trapezius, levator
2--- Layer 2-4: rhomboids, serratus posterior
inf/sup, splenius capitus/cervicis, quadratus
lumborum
3--- Deep layers
A. Erector Spinae = Layer 5: -----------I love spaghetti!!!
I= Iliocostalis: lumborum, thoracics, cervicis
LOVE = Longissmus: thoracis, cervicis, capitis
SPAGHETTI = Spinalis: thoracis, cervicis, capitis
B. Interspinalii, intertransversarii, levator costarum
C. Layer 6: More Red Sauce
MORE = Multifidi (christmas trees),
RED = Rotators,
SAUCE = semispinalis
MEMORIZE LAYER 5 AND 6 WITH RHYMES ETC
106
SUBOCCIPITAL TRIANGLE
Border X 3
1-- Rectus capitis posterior major - above and ____
2-- Obliquus capitis superior - above and ______
3---Obliquus capitis inferior - _____ and laterally
medially
laterally
below
107
SUBOCCIPITAL TRIANGLE
Contents X 3
1--third part of _______ artery
2-- dorsal ramus of nerve C1-___________ NERVE
3--Suboccipital venous plexus
vertebral
SUBOCCIPITAL
108
DORSAL AND VENTRAL PRIMARY RAMI
1--- DORSAL primary rami, ALWAYS only innervate the ____ of the back, and the _____ muscles of the back!
2---- VENTRAL Primary Rami innervate everything else, except the ______&______
Ex: brachial plexus, lumbar plexus
skin
deep
head and neck.
109
This nerve provides articular branches to the
elbow and wrist joints and motor innervation to
the majority of the muscles of the anterior
forearm.
a. Ulnar
b. Radial
c. Median
d. axillary
c. Median
110
```
Which nerve roots unite to form the ansa
cervicalis of the cervical plexus?
a. C1 and C5
b. C2 and C3
c. C3 and C4
d. C4 and C5
```
b. C2 and C3
111
These nerves innervate the structures located on
the anterior aspect of the vertebral canal.
a. Lateral braches of the posterior primary
divisions
b. Recurrent meningeal nerves
c. Anterior primary divisions
d. Medial braches of the posterior primary
divisions
b. Recurrent meningeal nerves
112
A 28 year old woman sustains an injury to the left
arm during a fall off of her bicycle. Radiographs
done at your clinic show an oblique fracture
through the mid shaft of the humerus. Which
nerve is most likely to be injured by the mid shaft
fracture of the humerus?
a. Radial nerve
b. Median nerve
c. Musculocutanous nerve
d. Ulnar nerve
a. Radial nerve
113
You perform your exam and find that the patient has
sustained a lateral traction injury to the superior
roots of the brachial plexus. Which of the following
signs would you NOT expect to find in this patient?
a. Dropped left shoulder
b. Left scapula that falls laterally
c. Inability to rotate the humerus medially
d. Paresis of muscles of the anterior aspect of the
left arm
c. Inability to rotate the humerus medially
114
Exam reveals a contusion around the head and
neck of the fibula. Which nerve is susceptible
to direct injury by a compression force applied
to the lateral aspect of the head and neck of
the fibula?
a. Common peroneal nerve
b. Tibial nerve
c. Obturator nerve
d. Saphenous nerve
a. Common peroneal nerve
115
Choose the incorrect statement with regard to the brachial
plexus.
a. The flexors of the upper extremity are innervated by the
terminal branches of the medial and lateral cords
b. The cords of the brachial plexus are named according
to their relationship to the axillary artery
c. The brachial plexus is derived from dorsal rami of C5,
C6, C7, C8 and T1
d. The posterior cord is formed by the posterior divisions
of all 3 trunks
c. The brachial plexus is derived from dorsal rami of C5,
| C6, C7, C8 and T1
116
```
Spinal nerve C7 exits the IVF located between
which 2 of the following vertebrae?
a. C4, C5
b. C5, C6
c. C6, C7
d. C7, C8
```
c. C6, C7
