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Anatomy Block 1 > Superficial back and spine objectives > Flashcards

Superficial back and spine objectives Flashcards

1
Q

Describe the organization of the vertebral column: How many cervical columns are there? Thoracic? Lumbar?

Define scoliosis, kyphosis, lordosis, spina bifida, and osteoarthritis

A

7, 12, 5

  • scoliosis is lateral curvature with rotation of the vertebrae
  • kyphosis is hunchback in THORACIC region
  • lordosis is swayback or increase in lumbar curvature, can be seen in pregnant women
  • spina bifida is neural tube defect characterized by failure of closure of the vertebral arch
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2
Q

Describe the curvatures of the vertebral column:

What are the primary curvatures in the spine?

What is the type of the primary curvature and why is it primary?

Secondary? Which is concave/convex?

A

Thoracic and sacral are primary. Cervical and lumbar are secondary. Primary is concave (thoracic and sacral) and secondary is convex (cervical and lumbar). (Think about spine). Remember: cavemen came first; hunchback of notre dame

kyphotic curvature in the fetal spine, called primary bc first and eventually develops into multiple curvatures later

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3
Q

What makes up the functional unit of the vertebral column. Give the functions/purpose.

A

2 adjacent posterior and anterior vertebrae including the intervertebral disk 
make up the functional unit of the vertebral column. The anterior includes the 
vertebral bodies. (4 things)

The anterior is weight bearing and the posterior is for movement



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4
Q

Describe a typical vertebrae. Which cervical vertebrae is not like the others and why?

A

C1 doesn’t have a spinous process nor a body. Typical vertebrae has (1) body, (2) vertebral arch, (3) vertebral foramen, (4) superior articular facet, (5) superior articular process, (6) transverse process, (7) inferior vertebral notch, (8) spinous process

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5
Q

What are the 2 components of the vertebral arch?

A

lamina and pedicle

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6
Q

What are the 5 regions of the vertebral column and how many movable vertebrae in each? How many movable vertebrae in all?

A

Cervical has 7; thoracic has 12; lumbar has 5; 24 movable in all. sacral has 5 fused; coccygeal has 3-5 fused (mean=4)

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7
Q

No disks between where? WHy not? Be specific

A

C1 and C2 ; this is the atlantodental joint which prevents rotation and allows us to say no with our head.

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8
Q

which joint lets us say no with our head. where is it located

A

atlantodental joint; located on C1

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9
Q

Where is most of the weight bearing part of the vertebrae?

Where are more of the neural influences in the vertebrae?

A

in the lumbar, increases as go down the spine

in Superior aspect, so as you go up the vertebrae with cervical having the most

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10
Q

What 2 things cause dehydration of the disc?

What percent of the height is the disk?

A

Daily, so as the day gets longer, we get shorter; age- so as we get older, we get shorter too.

25%

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11
Q

General height of the column? What about male and female?

A

a. 60-70 cm

b. women : 60cm ; men: 70cm

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12
Q

Where does the head articulate with the vertebrae inferiorly and superiorly?? How is this
joint different than the atlantodental joint?

A

At the atlantooccipital joint- superiorly at this joint, you can say yes.
Also articulates inferiorly with the coxae at the sacroiliac joint.

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13
Q

where does the head say yes

A

articulation at the atlantooccipital btwn dens of C2 and facet of dens of C1

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14
Q

How do you distinguish a cervical vertebrae?

A

Count 3 foramens because may have transverse foramen (This hole transmits the vertebral artery and vein along with a plexus of sympathetic nerves.)
b. SOme have bifid spinous process…except C3-6

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15
Q

How do you distinguish a thoracic vertebrae?

A

(1) Costal demifacets- on T1, T10-12→ areas of attachment where joints are formed btwn vertebrae and ribs
(2) long anteroinferior spinous process
(3) transverse facet

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16
Q

the spinal nerves exit the vertebral canal via the…

A

intervertebral foramina

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17
Q

How do you distinguish lumbar vertebrae

A

a. thicker body
b. mamillary processes ( rough posterior portion of the superior articular process)
c. also has smaller vertebral foramen

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18
Q

what is the C1 and C2 vertebrae called?

A

atlas is C1 and axis is C2

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19
Q

describe the anatomical position

A

body erect, feet together arms at the sides and palms facing FORWARD

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20
Q

Objective 1) Describe the body wall in terms of tissue layers

A
  1. epidermis- stratified squamos epithelial
  2. dermis- dense, irrigular connective tissue
  3. hypodermis / superficial fascia- loose connective tissue with cutaneous vessels and nerves
  4. deep fascia- dense irregular connective tissue with muscles and deep structures
  5. muscle, bone, connective tissue
  6. deep fascia
  7. loose connective tissue- endothoracic fasci in thorax; extraperitoneal tissue in abdomen
  8. parietal serous membrane- pleura in thoracic and peritoneum in abdominopelvic cavity
  9. body cavity
  10. visceral serous membrane - adherent to surface of viscera
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21
Q

Describe the unique characteristics of c1. what does the dens articulate with?

A

no spinous process or vertebral body; anterior tubercle, FACET for dens, posterior and anterior tubercle, transverse foramen, superior articular facet. *dens is anterior and articulates with occipital condyle and the dens of the C2 or axis

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22
Q

describe unique characteristics of c2, what is it called?

A

c2 is the axis and the dens is posterior here. dens articulates with C1 at the facet for dens on C1

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23
Q

what is a jefferson fracture? what is it caused by?

A

burst fracture of the atlas (C1) ; often caused by blow to the top of the head. arch broken in one or more places

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24
Q

what is a type 1 fracture of the c2?

A

type I is an oblique fracture through the upper part of the odontoid process. avulsion fraction (fragment of bone tears away from major bone) this is mechanically stable but associated with life threatening atlantooccipital dislocation. incidence is very low at <5%. treat: hard collar immobilization for 6-8 weeks. caused by motor vehicle accidents and falls

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25
Q

what is the cause of odontoid fractures?what is a type II odontoid fracture?

A

usually falls and motor vehicle accidents (C2) type 2- 60% incidence; occurs at base of the densrequire halo immobilization of 12-16 weeks; internal fixation (screw dens parts back together); posterior atantodental arthrodesis may be required.

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26
Q

what is a type 3 c2 fracture?

A

type 3- 30% (more frequeent that type 1 but also rare) ; halo immobilization, internal fixation; c1/c2 arthrodesis= where you have clamps, screws or wire bolting the parts together and leaves 50% rotation/mobility

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27
Q

Which C spine injuries are the worst?

A

the higher or more superior, the higher the morbidity and mortality; craniocervicaljunction injiries are the deadliest

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28
Q

What are symptoms, mechanism of injury and clincial findings of c-spine injuries?

A

a. b.mechanism of injury: combination of flexion, extension, and rotationsymptoms: pain and inability to actively move neck, sensation of instability so patients may present holding thier headclinical findings range: quadriplegia w/ respiratory center problems or minimal sensory/motor deficitsc.

29
Q

Describe cause hangmans fracture; where is the fulcrum? What type of extension?

A

both pedicles are brokenbeing hanged, falls, or motor vehicle accidents: momentum carries body forward into windshield and rebound movement or whiplash, causes forceful hyperextension that breaks the pediclesforced hyperextension with cervical spine as fulcrum

30
Q

Know xray for hangman’s fraction/ presentations

A

broken bilateral pedicles forward displacement of C1speration of upper cervical spine from lower cervical spin

31
Q

how does fusion happen

A

Lateral mass screws and pedicle screws go at an angle and then stablize with fusion rods to connect between. This is called a fusion. Laminectomy is sometimes coupled with this (spinous process being removed therefore need stabilization)

32
Q

How do you repair a hangman’s fracture?

A

intervention: c2 pedicle arthrodesis: lateral mass screws in c1 and pedicle screws inc2 and 2 plates for stabilization

33
Q

describe vertebral subluxation

A

displacement of vertebrae that can stress spinal cord and nervous system causes: poor posture and sleeping posture, mva, slips/ falls, strenous excercise,can cause impinged nerve

34
Q

what kind of joint is the anterior intervertebral joint?

A

synarthrosis joint: specifically a secondary cartilagenous, also known as a syphysis type joint where the bodies of adjacent vertebrae would articulate with the intervertebral disc located betwen them

35
Q

Describe the zygapophyseal joint. what type is it?

How do zygapophyseal joints prevent movement? Difference btwn disc and joint? Describe regional differences

A

has superior and infereior facets- the superior articulates with the inferior one above it, forming a diarthrosis joint (plane) therefore movements are gliding or sliding. Intervertebral formaina is between adj vertebrae and allows for spinal nerves

disc controls AMOUNT of movement whereas joint controls DIRECTION of movementin cervical region- 45 degrees; transverse to frontal plane allows rotation, flexion, and extension in throacic region- 60 degrees; front plate has sets that permit rotation in lumbar is 90 degrees (sagittal place); sagittal plane only permits extension and flexion

36
Q

in facet joint degeneration, what do we see at L4/5? from what view?

A

coronal view we see severe bilateral facet joint degeneration at L4/5 with air in the joints (show as gaps on X-ray)

37
Q

what are the ligmental supports?

A

posterior longitudinal= NARROW band from sacrum to C2 on posterior vertebral bodies and discsligamentum favum= runs from lamina to lamina from axis to sacrumanterior longitudinal= WIDE band from sacrum to occiput on anterior vertebral bodies and discs facet joint capsuleinterspinous and intertransverse= goes from spinous processes to spinous process and the intertransverese goes from transverse to transverse supraspinous= continuous attachment to tips of spinous process from sacrum to C7nuchal= thickened continuation of supraspinous ligament from C7 to occiput

38
Q

what are the 3 region specific joints in the cervical region?describe actions and what type of joints they are

A

uncovertebral-it prevents lateral translation and is at the uncinate procces (edge of the body) and the one aboveatlantodental-synovial/diarthrotic joint of the pivot type (move in one plane about vertical axis). artculation btwn dens and posterior facet of anterior tuberclerotation: just say no! (antlantoaxial), atlantoccipital-synovial/diathrotic, of the condyloid type, superior articular facets of c1 articulate with the occiptal condyles on the occiptal bone of the skull

39
Q

at the atlantodental joint, the dens is held in place by

A

transverse ligament

40
Q

which don’t have transverse costal facets?

A

T11 and T12

41
Q

Costovertebral joint? what region is this in?

A

plane joint therefore just permits linear movement of articulating surfaces past one anotherribe is wedge shaped so that each side can articulate with each demifacetarticulation btwn tubercle of rib with transverse costal facet; lateral and supiror cosotransverse ligaments support this joint. thoracic region

42
Q

what is the region specific joint of the sacral region? what type of joint is it/

A

sacroiliac joint is a synarthrosis type joint; auricular suface on coxa with auricular surface (resembles ear) on sacrum. with bilateral erosion of bony surfaces

43
Q

what are the 2 muscle layers of the back? what is their function

A

1) superficial muscles/ extrinsic : they act on upper limb2) deep/intrinsic muscles act on vertebral column

44
Q

trapezius

A

origin: superior nuchal line, external occipital protuberance, ligamentum nuchae, spinous processes of vertebrae C7-T12

insertion: clavicle, medial side of acromion, upper crest of the scapular spine, tubercle of the scapular spine
innervation:

  • motor:spinal accessory nerve 11
  • proprioception: C3-C4

blood supply: ascending transverse cervical artery

fx:
- elevates and depresses the scapula
- rotates the scapula superiorly
- retracts scapula

45
Q

what is the function of the throracolumbar fascia

A

supports secondary curvature

46
Q

what is the neuromuscular bundle

A

vein, artery, nerve

47
Q

what are the cutaneous nerves of the back?

A

sensory to skin, motor to sweat glands and erector pili muscles anterior aspect of trapezius muscle: dorsal rami (come every 2 inches apart and send cutaneous innervation to the skin) , sensory to skin, motor to sweat glands & motor to erecto pili muscles that generate tension when you get scared and hair stands on end

48
Q

Describe nerve distribution to the body wall

A

spinal cord supplies the cord. can see dorsal root ganglion and spinal nerve which distributes its dorsal ramus through the back muscle to the skin which it supplies and ventral ramus supplies most of the rest of the body wall

49
Q

dermatome vs cutaneous

A

dormatome is a strip of skin that is innervated bya pair of spinal nerves. cutaneous: areas of skin innervated by cutaneous nerve

50
Q

what are the superficial layer muscles of the extrinsic back (hypaxial) muscles? where do they all act?

A

trapezius, levator scapulae, rhomboideus, and latissimus dorsiall act on the scapula or humerus and associated with movements of the upper limb and respiration http://www.anatomyguy.com/essential-anatomy-series-back-muscle-basics-2/

51
Q

location of supra scapular nerve and artery?

A

on posterior view:navy over army under

52
Q

nerves of quadrangular spacetriangular spacetriangular interval

A

axillary nerveposterior humeral circumflex artery-br of scapular circumflex artery(rearrange space) -radial nerveprofunda brachii arteyr

53
Q

quadrangular space syndrome

A

hypertrophy of quadrangular space muscles or fibrosis of muscle edges may impinge on axillary nervecould produce weakness even atrophy in muscles it supplies-deltoid muscle-teres minor muscle===> more common could affect control that rotator cuff muscles exert on glenohumeral joint

54
Q

intermediate layer of posterior back has:why can the intermediate layer still be included?

A
  1. accessory muscles for respiration2. serratus posterior inferior (deep to latissimus dorsi) and superior (level with clavicle, deep to rhomboid) intermediate layer of muscle but can also be included in superficial back because supplied by ventral rami or 11th cranial nerve (like in the case of the trapezius
55
Q

on the back, the skin is innervated by ___ but the muscles are innervated by ___ except ___

A

skin innervated by dorsal ramimuscles innervated by ventral rami, excel the trap which is innervated by cranial nerve 11

56
Q

The primary action at the atlanto-axial joint is:

A

The atlanto-axial joint is a complex joint with multiple articulations between the atlas (C1 vertebra) and the axis (C2 vertebra). The primary action at this joint is rotation of the head on the neck.

57
Q

describe unique characteristics of c2, what is it called?

A

c2 is the axis and the dens is posterior here. dens articulates with C1 at the facet for dens on C1

58
Q

deltoid

A

innervation: axillary nerve (C5, C6)

blood supply: posterior circumflex humeral artery

origin: lateral 1/3 of clavicle, acromion, lower lip of the crest of the spine of the scapula
insertion: deltoid tubersoity of the humerus

fx:
-adduct arm
flex and medially rotate arm
laterally rotate arm

59
Q

levator scapula

A

innervation: dorsal scapular nerve (C5)
blood: dorsal scapular artery
origin: transverse processes of C1-C4
insertion: medial border of the scapula to the from superior angle to the spine
fx: elevates scapula

60
Q

latissimus dorsi

A

innervation: thoracodorsal nerve (C7,8)
blood: thoracodorsal artery
origin: vertebral spines form T7 to the sacrum, lower 3 or 4 ribs
insertion: floor of the inter tubercular groove
fx: extends the arm and rotates the arm medially (think rock climbing)

61
Q

rhomboideus major

A

inn: dorsal scapula nerve (C5)
blood: dorsal scapular artery

origin: spines of vertebrae T2-T5
insertion: medial border of the scapula inferior to the spine of the scapula
fx:
retracts, elevates, and rotates the scapula inferiorly

62
Q

rhomboideus minor

A

inn: dorsal scapular nerve
blood: dorsal scapular a
origin: inferior end of the ligamentum nuchae, spines of C7 and T1
insert: medial border of the scapula at the root of the spine
fx: retracts, elevates, and rotates the scapula inferiorly

63
Q

teres major

A

inn: lower sub scapular nerve from the posterior cord of the brachial plexus
blood: circumflex scapular a

origin: dorsal surface of the inferior angle of the scapula
insert: crest of the lesser tubercle of the humerus

fx: adducts the arm, medially rotates the arm, assists in arm extension

64
Q

infraspinatus

A

inn: suprascapular n
blood: suprascapular a
origin: infraspinatous fossa
insertion: greater tubercle of the humerus (middle facet)
fx: laterally rotates the arm

65
Q

subscapularis

A

inn: upper and lower sub scapular nerves
blood: subscapular a
origin: medila 2/3 of the scapula
insert: lesser tubercle of the humerus
fx: medially rotates the arm; assists in extension

66
Q

supraspinatous

A

inn: suprascapular nerve
blood: suprascapular a
origin: supraspinatous fossa
insert: greater tubercle of the humerus (highest facet)
fx: initiates abduction

67
Q

teres minor

A

inn: axillary nerve
blood: circumflex scapular a
origin: upper 2/3 of the lateral border of the scapula
insert: greater tubercle of the humerus (lowest facet)
fx: laterally rotates the arm

68
Q

triangle of auscultation

A

triangular gap for examining posterior segments of the lungs with a stethoscope

borders: trapezius, rhomboid major and latissimus dorsi

Anatomy Block 1 (16 decks)

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