Practical #2 (Trail Guide) Flashcards
Rectus Abdominis
O: Pubic symphysis and crest
I: Xiphoid process, Costal cartilage 5-7
N: Thoracoabdominal nerves (T7-12 APRs)
A: Flexes trunk (lumbar vertebrae), compress abdominal viscera
External Oblique
O: External surface ribs 5-12
I: Linea alba, pubic tubercle, anterior half of iliac crest
N: Thoracoabdominal nerves (T7-12 APRs); Subcostal nerve (T12)
A: Compress + support ab viscera flex + contralateral rotation
Internal Oblique
O: Lateral inguinal ligament, iliac crest, thoracolumbar fascia
I: Internal surface of lower three ribs, rectus sheath to linea alba
N: Thoracoabdominal nerves (T7-T12), Iliohypogastric/Ilioinguinal (L1), ventral rami
A: (Unilaterally) -Laterally flex vertebral column to the same side; Rotate the vertebral column to the same side
(Bilaterally) - Flex the vertebral column; Compress abdominal contents
Transverse Abdominal
O: Lateral inguinal ligament, iliac crest, thoracolumbar fascia, and internal surface of lower six ribs
I: Rectus sheath to linea alba
N: T7-T12, L1, iliohypogastric/ilioinguinal (L1), ventral divisions
A: Compress + support abdominal contents
Diaphragm
O:
(Costal attachment): Inner surface of lower 6 ribs
(Lumbar attachment): Upper two or three lumbar vertebrae
(Sternal attachment): Inner part of xiphoid process
I: Pericardium to the Central Tendon
N: Phrenic nerve (C3-C5)
A: Draw down the central tendon of the diaphragm; Increase the volume of the thoracic cavity during inhalation
External Intercostals
O: Inferior border of the rib above
I: Superior border of the rib below
N: Thoracic Spinal Nerves, Intercostal Nerves (powerpoint)
A: Draws ribs superiorly (increasing space of the thoracic cavity) to assist with inhalation
Internal Intercostals
O: Inferior border of the rib above
I: Superior border of the rib below
N: Thoracic Spinal Nerves, Intercostal Nerves (powerpoint)
A: Draw the ribs inferiorly (decreasing the space of the thoracic cavity) to assist with exhalation.
Multifidus
O: Sacrum and transverse processes of lumbar through cervical vertebrae
I: 2-4 vertebrae up of spinous processes to 2nd cervical vertebrae
N: Spinal Nerves
A: (Unilaterally) - Rotate the vertebral column to the opposite side
(Bilaterally) - Extend the vertebral column
Rotatores
O: Transverse processes of lumbar through cervical vertebrae
I: 1-2 vertebrae up of spinous processes, lumbar through second cervical vertebrae
N: Spinal Nerves
A: (Unilaterally) - Rotate the vertebral column to the opposite side
(Bilaterally) - Extend the vertebral column
Erector Spinae Group (Spinalis, Longissimus, Iliocostalis)
O: Common tendon (thoracolumbar fascia) that attaches to the posterior surface of sacrum, iliac crest, spinous processes of the lumbar, and last two thoracic vertebrae
I: Various attachments at the posterior ribs, spinous and transverse processes of thoracic and cervical vertebrae, and mastoid process of temporal bone
N: Spinal Nerves
A: (Unilaterally) - Laterally flex vertebral column to the same side
(Bilaterally) - Extend the vertebral column
Spinalis
O: Spinous processes of upper lumbar and lower thoracic vertebrae (thoracis);
Ligamentum nuchae, spinous process of C7 (cervicis)
I: Spinous processes of upper thoracic (thoracis);
Spinous processes of cervicals, except C1 (cervicis)
N: Spinal Nerves
A: (Unilaterally) - Laterally flex vertebral column to the same side
(Bilaterally) - Extend the vertebral column
Longissimus
O: Common tendon (thoracis); Transverse processes of upper five thoracic vertebrae (cervicis and capitis)
I: Lower nine ribs and transverse processes of thoracic vertebrae (thoracis); r
Transverse processes of cervical vertebrae (cervicis);
Mastoid process of temporal bone (capitis)
N: Spinal nerves
A: (Unilaterally) - Laterally flex vertebral column to the same side
(Bilaterally) - Extend the vertebral column
Iliocostalis
O: Common tendon (Lumborum); Posterior surface of ribs 1-12 (thoracis and cervicis)
I: Transverse processes of lumbar vertebrae 1-3 and posterior surface of ribs 6-12 (Lumborum);
Posterior surface of ribs 1-6 (thoracis);
Transverse processes of lower cervicals (cervicis)
N: Spinal nerve
A: A: (Unilaterally) - Laterally flex vertebral column to the same side
(Bilaterally) - Extend the vertebral column
Quadratus Lumborum
O: Posterior iliac crest
I: Last rib and transverse processes of L1-L4)
N: Lumbar plexus (T12-L3)
A: (Unilaterally) - Laterally tilt (elevate) the pelvis); Laterally flex the vertebral column to the same side
(Bilaterally) - Fix the last rib during forced inhalation and exhalation; Assist to extend the vertebral column
Psoas Major
O: Bodies of T12-L5; transverse processes of lumbar vertebrae L1-L5
I: Lesser trochanter
N: Lumbar plexus (L1-L4)
A: (With the origin fixed)
Flex hip (coxal joint); May laterally rotate the hip (coxal joint)
(With the insertion fixed)
Flex the trunk toward the thigh; Tilt pelvis anteriorly
(Unilaterally)
Assist to laterally flex the lumbar spine
Iliacus
O: Iliac fossa
I: Lesser trochanter
N: Femoral nerve (L1-L4); L2-L3 (in our last unit)
A: (With the origin fixed)
Flex hip (coxal joint); May laterally rotate the hip (coxal joint)
(With the insertion fixed)
Flex the trunk toward the thigh; Tilt pelvis anteriorly
Splenius Capitus
O: Inferior 1/2 of ligamentum nuchae and spinous processes of C7-T4
I: Mastoid process and lateral portion of superior nuchal line
N: Cervical nerves
A: (Unilaterally)
Rotate head/neck to the same side
Laterally flex the head and neck to the same side
(Bilaterally)
Extend the head and neck
Splenius Cervicis
O: Spinous processes of T3-T6
I: Transverse processes of C1-C3
N: Cervical Nerves
A: (Unilaterally)
Ipsilateral Rotation of head/neck
Ipsilateral Lateral flexion
(Bilaterally)
Extend the head and neck
Anterior Scalene
O: Transverse processes of C3-C6 (anterior tubercles)
I: First rib
N: Cervical Spinal Nerves C4-C8
A: (Unilaterally)
With the ribs fixed, ipsilateral lateral flexion
Contralateral rotation of head/neck
(Bilaterally)
Elevate the ribs during inhalation (all)
Flexion of head/neck
Middle Scalene
O: Transverse processes of C2-C7 (posterior tubercles)
I: First rib
N: Cervical Spinal Nerves C4-C8
A: (Unilaterally)
With the ribs fixed, ipsilateral lateral flexion
Contralateral rotation of head/neck
(Bilaterally)
Elevate the ribs during inhalation (all)
Flexion of head/neck
Posterior Scalene
O: Transverse processes of C6-C7
I: Second rib
N: Cervical Spinal Nerves C4-C8
A: (Unilaterally)
With the ribs fixed, ipsilateral lateral flexion
Contralateral rotation of head/neck
(Bilaterally)
Elevate the ribs during inhalation (all)
Flexion of head/neck
Rectus Capitis Posterior Major
O: Spinous process of axis (C2)
I: Inferior nuchal line of the occiput
N: Suboccipital
A: Rock and tilt head into extension, ipsilateral rotation
Rectus Capitis Posterior Minor
O: Tubercle of Posterior arch of atlas (C1)
I: Inferior nuchal line of the occiput
N: Suboccipital
A: Rock and tilt head into extension
Obliquus Capitis Superior
O: Transverse process of atlas (C1)
I: Between the nuchal lines of the occiput
N: Suboccipital
A: Extends head, Ipsilateral lateral flexion of head
Obliquus Capitis Inferior
O: Spinous process of axis (C2)
I: Transverse process of atlas (C1)
N: Suboccipital
A: Ipsilateral rotation of head
Sternocleidomastoid
O: (Sternal head) - Top of manubrium
(Clavicular head) - Medial one-third of the clavicle
I: Mastoid process of temporal bone and the lateral portion of superior nuchal line of occiput
N: Spinal accessory (XI) nerve, C2-C3
A: (Unilaterally)
Ipsilateral lateral flexion of head/neck
Contralateral rotation of head/neck
(Bilaterally)
Flex the neck
Assist to elevate the rib cage during inhalation
Masseter
O: Zygomatic arch
I: Angle and ramus of mandible
N: Trigeminal (V) nerve (mandibular division)
A: Elevate the mandible (temporomandibular joint); May assist to protract the mandible (TM joint)
Temporalis
O: Temporal fossa and fascia
I: Coronoid process and anterior edge of ramus of the mandible
N: Trigeminal (V) nerve (mandibular division)
A: Elevate the mandible (temporomandibular joint); Retract the mandible (TM joint)
Longus Capitis
O: Transverse processes of C3-C6
I: Inferior surface of occiput
N: Cervical nerves C1-C4
A: (Unilaterally)
Ipsilateral lateral flexion of head/neck
Ipsilateral rotation of head/neck
(Bilaterally)
Flex the head and neck
Longus Colli
O: Bodies of C5-T3, transverse processes of C3-C5
I: Tubercle on anterior arch of the atlas (C1); bodies of C2-C4; transverse processes of C5-C6
N: C2-C6 (C7)
A: (Unilaterally)
Ipsilateral (same side) Lateral flexion of head/neck
Ipsilateral (same side) Rotation of head/neck
(Bilaterally)
Flexion of head/neck
Suprahyoids (Geniohyoid, Mylohyoid, Stylohyoid)
O: (Geniohyoid, Mylohyoid) - Underside of mandible
(Stylohyoid) - Styloid process
I: Hyoid Bone
N: Geniohyoid - Nerve to Geniohyoid (C1-C2)
Mylohyoid - Trigeminal (V) nerve
Stylohyoid - Facial (VII) nerve)
A: Elevate hyoid and tongue; Depress mandible (temporomandibular joint)
Infrahyoids (Sternohyoid, Sternothyroid, Thyrohyoid, Omohyoid)
O: (Sternohyoid and Sternothyroid) - Top of manubrium
(Thyrohyoid) - Thyroid cartilage
(Omohyoid) - Superior border of the scapula
I: (Sternohyoid, thyrohyoid, and omohyoid) - Hyoid bone
(Sternothyroid) - Thyroid cartilage
N: (Sternohyoid, Sternothyroid, and Omohyoid) - ansa cervicalis (C1-C3)
(Thyrohyoid) - C1, C2
A: Depress the hyoid bone and thyroid cartilage
Iliohypogastric nerve
L1
Course: Runs along the crest of the ilium toward the midline
Supply: To the skin over the hypogastric (pubic bone) region, upper thigh, and lateral gluteal region
Powerpoint: Emerges from Psoas Major, in front of QL, behind Kidneys, goes into TA near iliac crest, splits into Lat Cutan. and Ant. Cutan. Branches between TA and IO
Subcostal nerve
T12
Supply: Transversus abdominis, internal abdominal oblique, and external abdominal oblique. The skin of the abdominal wall and skin of the lateral gluteal region.
Powerpoint: Lower 12th rib, in front of QL, passes between the TA and IO
Ilioinguinal nerve
L1
Sensory: Internal abdominal oblique muscles. Sensory innervation from the scrotum and root of penis, or labium majus (females)
Powerpoint: Emerges from lateral border of Psoas Major, passes between QL and iliacus, goes into TA near ant. part of iliacus then goes into IO and accompanies spermatic cord/round ligament to anterior groin, upper/med thigh
Lateral Femoral Cutaneous Nerve
L2-L3
Sensory: Cutaneous sensation over inferior buttock, posterior thigh and popliteal fossa
Pathway:
- Lateral border of psoas major, courses laterally around iliac fossa on ant. surface of iliacus, pass next to inguinal ligament, medial to ASIS, splits into Ant/Post branches
Femoral nerve
Origin: Lumbar Plexus (L2-L4)
- Starts L2-L4
- Moves below inguinal ligament, lateral to femoral artery
- Runs between iliacus and psoas
- Splits into ant/post divisions
Sciatic Nerve
Origin: L4-S3
Course: Enters gluteal region through greater sciatic foramen, beneath piriformis.
Branches: Tibial and common fibular nerve
Tibial Nerve
- Splits above and passes into popliteal fossa
- Runs deep and between heads of gastrocnemius
- Dives into soleus and enters deep
- Runs posterior to medial malleolus
- Divides into Med/Lat Plantar Nerves
Common Fibular Nerve
- Splits at upper section of popliteal fossa
- Runs lateral to fossa, around medial border (Biceps Femoris)
- Wraps around neck/head of fibula, goes into Fib. Longus
- Divides into superficial and deep Fibular Nerve
Superior Gluteal Nerve
Origin: L4-S1
Course: From sacral plexus through greater sciatic foramen superior to piriformis.
Inferior Gluteal Nerve
Origin: L5-S2
Course: Through greater sciatic foramen to inferior portion of glute to Gluteus Maximus
Suboccipital nerve
Emerges from posterior ramus of C1
Inguinal Ligament
Location: Superficial band stretching between the ASIS and pubic tubercle
Palpation:
1. Partner supine. Soften the surrounding tissue of the ligament by bolstering your partner’s knee.
2. Locate the ASIS and slide diagonally in the direction of the pubic tubercle.
3. Strum gently across the slender ligament, feeling its cordlike quality
Anterior Longitudinal Ligament
Runs down the anterior surface of the spine to the sacrum
Posterior Longitudinal Ligament
Runs from 2nd cervical vertebrae down to sacrum, adjacent to spinal cord
Sacrospinous Ligament
Sacrotuberous Ligament
Location: Between the ischial tuberosity and the edge of the sacrum. Deep to gluteus maximus, it is still distinctly palpable and might feel like a span of bone.
Palpation:
1. Partner prone. Locate the ischial tuberosity. Locate the edge of the sacrum
2. Slide your fingertips off the tuberosity toward the edge of the sacrum. Using firm pressure, palpate through the gluteus maximus belly and strum broadly across the ligament
Iliolumbar Ligament
Located: Between the transverse processes of the 4th and 5th vertebrae and the posterior iliac crest. Deep to thoracolumbar fascia, thick multifidi, and and quadratus lumborum.
Action: Stabilizes L4 and L5
Palation:
1. Partner prone. Locate the PSIS
2. Slide your thumb straight superior from the PSIS to the level of L4 and L5. Your thumb should be between the iliac crest and the transverse processes of the lumbar vertebrae.
3. Using firm pressure, sink into the dense muscles of the low back and attempt to roll vertically across the ligament’s taut fibers
Nuchal Ligament
Location: Finlike sheet of connective tissue that runs along the sagittal plane from the external occipital protuberance to the spinous process of C7 in the neck.
Function: Stabilizes the head and neck, attachment site for superficial muscles of the posterior neck, such as the trapezius and splenius capitis.
Palpation:
1. Supine. Locate the external occipital protuberance and the spinous process of C7.
2. Palpate between these landmarks along the midline of the neck. Be sure you are superficial to the spinous processes. It might help to access the ligamentum nuchae if you roll your fingertips across the its fiber direction and explore what may feel like a flap of soft rubber.
3. Slowly and passively flex and extend the head, rolling your fingers across the fibers of the ligamentum nuchae. Note the changing degree of tension in the ligament as the head is moved.
Heart Areas (Apex of Heart, Aortic Area, Pulmonic Area, Tricuspid Area, Mitral Area)
Apex: 5th Left intercostal space
Aortic Area: (Ausculatatory area) Right 2nd intercostal space
Pulmonic Area: Left 2nd intercostal space
Tricuspid Area: 4th Left intercostal space (just left of sternum)
Mitral Area: 5th Left intercostal space
Heart Areas
Intercostal Nerve
Emerges from T1-T11
Bony Landmarks
Some reference points to find
