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MSK exam 1 AP > Superficial and Deep back > Flashcards

Superficial and Deep back Flashcards

1
Q

how many back layers

A

6

superficial 1, 2
intermediate 4
deep back 4,5,6

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2
Q

layer 1 of back

A

trapezius

latissimus dorsi

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3
Q

layer 2 of back

A

rhomboideus major
rhomboideus minor
levator scapulae

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4
Q

layer 3 of back

A

serratous posterior superior

serratous posterior inferior

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5
Q

layer 4 of back

A

erector spinae which includes:
iliocostalis
longissimus
spinalis

splenius capitis AND cervicis

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6
Q

layer 5 of back

A

Transversospinalis which includes:
semispinalis
multifidus
rotatores

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7
Q

intersegmental muscles

A

interspinales

Intertransversarii

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8
Q

subocciptial muscles

A

rectus capitis posterior major
rectus capitis posterior minor
obliquus capitis superior
obliquus capitis inferior

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9
Q

what 5 muscles attach the scapula to the vertebral column

A 
trapezius
latissimus dorsi
levator scapulae
rhomboideus minor
rhomboideus major
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10
Q

triangle of ausculation borders

A

medial- trapezius
lateral- rhomboideus major
inferior- latissimus dorsi

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11
Q

trapezius

A

Origin–> external occiptial protuberance, superior nuchal line
via the nuchal ligment to the cervical/upper thoracic spinous processes to TV12

Insertion- lateral superior border of the clavicle
acromion and spine of the scapula

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12
Q

action of trapezius

A

superior fibers–> elevate scapula, assists in upward rotation of the glenoid cavity

middle fibers–> retraction of the scapula

inferior fibers–> upward rotation of glenoid cavity

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13
Q

innervation of trapezius

A

spinal accessory nerve (cranial nerv XI)

ventral rami of spinal nerves C3 to C4 (sensory)

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14
Q

what artery is found in the trapezius

A

transverse cervical artery

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15
Q

CN X( (spinal accessory nerve) and spinal nerves C3 and C4 form a network of nerves on the ventral surface of the trapezius known as…

A

subtrapezial plexus

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16
Q

how do you test the integrity of the spinal accessory nerve?

A

ask pt to shrug their shoulders against resistance

any change in strength on either side implied injury to spinal nerve (accessory) (CN XI)

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17
Q

latissimus dorsi (o )

A

o–> spinous processes T6-T12

via thoracolumbar fascia to all lumbar and sacral spinous processes

posterior one third of the crest of the ilium

outer surfaces of the ribs 9-12

inferior angle of the scapula

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18
Q

latissimus dorsi insertion

A

floor of the intertubercular groove of humerus

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19
Q

action of latissimus dorsi

A

adducts, extends, and medially rotates the humerus (swimmer doing the butterfly)

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20
Q

innervation of latissimus dorsi

A

thoracolumbar nerve

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21
Q

levator scapulae

A

Origin- transverse process of cervical vertebrae 1-4

insertion–> medial border of scapula from superior angle to root of spine

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22
Q

action of levator scapulae

A

elevates scapula

assists in downward roation of the glenoid cavity

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23
Q

innervation of the levator scapulae

A

dorsal scapular nerve (c5)

3rd and 4th cervical nerves

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24
Q

rhomboideus minor

A

superor the the rhomb. majory

origin–> spinous processes of C7 to T1

insertion–> medial border of scapula at root of scapular spine

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25
Q

rhomboideus minor action and innervation

A

action–> retracts scapula, downwardly rotaes the glenoid cavity

innervation–> dorsal scapular nerve

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26
Q

rhomboideus major

A

origin –> spinous process T2-T5

insertion–> medial border of scapula from root of spine to inferior angle

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27
Q

rhomboideus major action and innervation

A

retracts scapula, downwardly rotates glenoid cavity

innervation –> dorsal scapular nerve

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28
Q

what is the transverse cervical artery a branch of?

A

thyrocervical trunk (1st portion of the subclavian artery)

divides into superficial and deep branch

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29
Q

where is the superficial branch of the transverse cervical artery?

A

descends in company with the spinal accessory nerve on the deep surface of the trapezius

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30
Q

where is the deep branch of the transverse cervical artery?

A

run deep to the levator scapulae and the rhomboid muscles

accompanies the dorsal scapular nerve and participates in the scapular anastomosis

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31
Q

from what does the dorsal scapular artery arise from?

A

arises from the 2nd or 3rd portion of the subclavian artery and courses posteriorly between portions of the brachial plexus and neck musculature

this artery then follows the path described above by the deep branch of the transverse cervical artery

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32
Q

thoracodorsal artery

A

a branch of the subscapular artery (3rd portion of the axillary artery)

accompanies the thoracodorsal nerve on the ventral surface of the latissimus dorsi muscle

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33
Q

what do some texts also refer the deep branch of the transverse cervicalartery as?

A

descending or dorsal scapular nerve

see buck book pg 30

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34
Q

nerves that innervate the muscles of the upper limb and superficial back are derived from what?

A

ventral rami of spinal nerves associated with the brachial plexus

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35
Q

what innervates the superficial muscles of the back?

A

ventral primary rami of cervical spinal nerves

AND for the trapezius only the spinal accessory nerve which is cranial nerve XI

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36
Q

what innervates the intermediate muscles of the back? and what are the intermediate muscles of the back?

A

ventral primary rami of thoracic spinal nerves
(intercostal nerves)

serratous posterior superior and inferior

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37
Q

what is the primary function of the deep muscles of the back?

A

extend, sidebend, and rotate the spine

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38
Q

what are the muscles groups of the deep muscles of the back?

A 
splenius
erector spinae (no rotation)
transversospinal group
intersegmental muscles
muscles of the subocciptial triangle
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39
Q

serratous posterior superior (intermediate)

A

origin–> nuchal ligament and spinous processes of CV7-TV3

Insertion–> posterior surface of ribs 2-5 lateral to the angle

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40
Q

action of serratous posterior superior

A

elevates ribs during inspiration

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41
Q

innervation of serratous posterior superior

A

intercostal nerves T1-T4

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42
Q

origin of serratous posterior inferior

A

spinous process TV11-LV2 via thoracolumbar fascia

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43
Q

insertion of serratous posterior inferior

A

posterior surface of ribs 9-12 lateral to the angle

SAME INSERTION AS latissimus dorsi

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44
Q

action of serratous posterior inferior

A

depresses lower four ribs allowing diaphragm to act during inspiration (stabilizes the diaphragm)

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45
Q

innervation of the serratous posterior inferior

A

intercostal nerves T9-T11 AND subcostal nerve (underneath last rib)

46
Q

fascia

A

continuous layer extending from skull to the sacrum

possesses regionally named divisions

  • nuchal
  • throacolumbar fascia (thorax and lumbar regions)
47
Q

superficial lamina (fascia) attachments

A

attachaed medially to the nuchal ligament, supraspinal ligament, tips of all spinous processes, median crest of the sacrum

48
Q

deep (anterior) (fascia) lamina attachment

A

attached medially to the base of the skull below the superior nuchal line, to the tips of cervical and lumbar transverse processes and in the thoracic region to the angles of the ribs

49
Q

NOTE about fascia

A

laterally the two layers of the nuchal fascia blend to become continuous with the prevertebral fascia

laterally the anterior and posterior laminae of the thoracolumbar fascia blend with the fascias of the anterolateral abdominal musculature

50
Q

splenius capitis et cervicis origin

A

spinous process of CV7 - TV6

51
Q

insertion of splenius capitis

A

lateral portion of the superior nuchal line and mastoid process

52
Q

insertion of splenius cervicis

A

posterior tubercles of transverse processes of CV1 to CV3

53
Q

action of capitis splenius

A

extends head

rotates and side bends the head and neck to the same side

54
Q

action of cervicis splenius

A

extends and rotates neck to the same side

also binds deeper musculature

55
Q

innervation of splenius capitis and cervicis

A

dorsal rami of C2-C5

56
Q

erector spinae muscle group

A

occupies vertebral costal groove

extends the full length of the vertebral column

inferiorly it attaches via a strong aponeurotic tendon to the iliac crest, sacrum, lumbar spinous process and supraspinal ligament

***primarily an EXTENSORS and side bender of the spine AND POSTURAL Muscles NOT FOR ROTATION

57
Q

iliocostalis divisions

A

lumborum
thoracis
cervicis

part of erector spinae muscle

58
Q

origin of iliocostalis

A

crest of ilium and sacrum

posterior surface of ribs at angle

59
Q

insertion of ilocostalis

A

angle of ribs

transverse processes lower cervical vertebrae

60
Q

proximal attachment versus distal attachment

A

proximal–> usually the origin

distal –> usually the insertion

61
Q

innervation of ilocostalis AND spinalis

A

dorsal rami of spinal nerves from vertebral segments covered by muscle

62
Q

division of longissimus

A

thoracis, cervicis, capitis

63
Q

origin of longissimus

A

transverse process below

64
Q

insertion of longissimus

A

transverse process above

capitis portion inserts on mastoid process deep to splenius and sternocleidomastoid muscles

65
Q

action of longissimus

A

extends vertebral column

lateral flexion to same side

capitis portion*** extends skull and rotates it to the same side

66
Q

origin of spinalis

A

part of erector spinae muscles

divided into thoracis, cervicis, capitis

***the capitis portion is usually blended/fused with a deeper muscle, the semispinalis capitis

origin—>spinous process below

67
Q

insertion of spinalis

A

spinous processes above

68
Q

action of spinalis

A

extends vertebral column, lateral flexion to same side

capitis portion extends the skull

69
Q

general movements of transversospinal group (5th layer) if acting on one side

A

rotate vertebrae above to opposite side

side bend the vertebral column to the same side

70
Q

general movements of transversospinal group (5th layer) if acting with both sides

A

extends the vertebral column

71
Q

origins of transversospinal groups

A

on transverse process below

72
Q

insertions of transversospinal groups

A

on spinous process one to six segments above depending on specific subdivision

73
Q

innervation of transversospinal groups

A

dorsal rami of spinal nerves of vertebral segments covered by muscle

74
Q

divisions of transversospinal group

A

semispinalis– subdivision spanning 4-6 vertebrae

multifidus- subdivisions spanning 2-4 vertebrae

rotatores-subdivisions spanning 1-2 vertebrae

75
Q

semispinalis thoracis

A

continuous with semispinalis cervicis

76
Q

semispinalis cerviscis

A

ends at spinous process of CV2 (first bifid spinous process)

77
Q

semispinalis capitis

A

largest muscle of the posterior neck

extends from mid thoracic and lower cervical vertebrae to the skull

covers semispinalis cervicis

78
Q

multifidus

A

extends the length of the vertebral column from sacrum to CV2

most well developed in lumbar area

***important in extension and minimal rotatory component

79
Q

semispinalis general info

A

extends one half of vertebral column from lower thoracic to upper cervical levels

80
Q

rotatores

A

each subdivision spans one to two vertebrae

81
Q

note on movement of rotatores and multifidus

A

since these span fewer vertebral segments compared to semispinalis they function more as stabilizers between individual vertebral segments than as prime movers

82
Q

intersegmental deep back muscles 6th layer general info

A

lcoated deep to transversospinal muscles

consists of short muscles that span one vertebral segment

stabilizers***

high concentration of stretch receptors allow them to feedback on postural spinal muscles

innervated by dorsal rami of regional spinal nerves EXCEPT for levatores costarum

83
Q

interspinales

A

paired muscles (left and right) that span adjacent spinous processes of cervical and lumbar vertebrae

local adjustors*** constantly keeping spine straight b/c they are filled with proprioceptor fibers

84
Q

intertransversarii

A

paired muscles (anterior and posterior)

span adjacent transverse processes of cervical and lumbar vertebrae

85
Q

what is the anterior portion of the intertransversarri innervated by ?

A

anterior innervated by ventral rami

86
Q

what is the posterior intransversarri divided into and what innervates each part?

A

divided into medial and lateral portions

medial innervated by dorsal rami

lateral innervated by ventral rami

87
Q

what is the lateral muscle group (of the 6th layer) that is located in the thoracic region only

A

the lateral posterior intertransversarri which are called the LEVATOR COSTARUM

88
Q

levator costarum general info

A

extend from transverse processes ABOVE to ribs (medial to angle) one and two segments BELOW

89
Q

function of levator cost arum??

A

elevate ribs during inspiration

90
Q

what innervates the levator costarum?

A

innervated by corresponding VENTRAL RAMI of spinal nerves

91
Q

location of subocciptial triangle

A

deep to semispinalis capitis

92
Q

function of subocciptial triangle

A

extend the skull and rotate the skull and atlas to the same side

93
Q

innervation of suboccipital muscles

A

dorsal ramus of cervical nerve C1 (suboccipital nerve)

94
Q

rectus capitis posterior major

A

origin spinous process of CV2

insertion inferior nuchal line and occipital bone below

95
Q

action of rectus capitis posterior major (x3)

A

extension and lateral flexion of the skull

minimal rotation to the same side

96
Q

rectus capitis posterior minor

A

more medial than the rectus capitis posterior major

origin–> posterior tubercle of atlas

97
Q

insertion of rectis capitis posterior minor

A

medial portion of inferior nuchal line and occipital bone between inferior nuchal line and foramen magnum

may also attach to dura between CV1 and occiput

98
Q

obliquus capitis inferior

A

origin –> spinous process of CV2

insertion–> transverse proces of atlas

***only muscle that turns the head but does not attach to the head

99
Q

action of obliquus capitis inferior

A

rotates skull and atlas on odontoid process to the same side

100
Q

obliquus capitis superior

A

origin–> transverse process of atlas

insertion–> occipital bone between super and inferior nuchal lines

101
Q

action of obliquus capitis superior

A

extends and sidebends the skull to the same side

102
Q

lateral superior border of the suboccipital triangle

A

obliquus capitis superior

103
Q

lateral inferior border of the suboccipital triangle

A

obliquus capitis inferior

104
Q

medial border of the suboccipital triangle

A

rectus capitis posterior major

105
Q

roof and floor of the suboccipital triangle

A

roof–> semispinalis capitis

floor–> posterior atlantooccipital membrane and the posterior arch of the atlas

106
Q

vertebral artery

A

traverses the transverse cervical foramen of atlas and turns medially along the groove in the posterior arch of the atlas and pierces the posterior atlantoccipital membrane to gain the foramen magnum

107
Q

suboccipital nerve (C1-dorsal ramus)

A

pierces the atlantoocciptal (posterior) membrane between the posterior arch of the atlas and the vertebral artery

passes through the sub occ triangle and distributes to all sub occ muscles

108
Q

greater occiptial nerve (C2-dorsal ramus)

A

emerges from beneath the obliquus capitis inferior

turns upward to cross that muscle and the subocc triangle and pierces the semispinalis capitis and trapezius

innervates the posterior scalp as far forward as the vertex of the skull

109
Q

what is the cause of tension headaches?

A

passage of the greater occipital nerve through the substance of the semispinalis capitis places the nerve in a position where after prolonged extension of the neck CONTINUED TRACTION of the nerve results in the headache

110
Q

vessels of deep back usually are what ?

A

dorsal branches of specific arteries

111
Q

how is venous return accomplished in the deep back ?

A

venae comitantes of the arterial supply

tributaries to occipital, ascending cervical, vertebral, posterior intercostal, lumbar, iliolumbar, lateral sacral veins, most of which have continuity with the vertebral venous plexus

MSK exam 1 AP (7 decks)

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