The Back and Vertebral Column Flashcards
Where can you palpate the spinalis part of the erector spinae muscles?
They are the hills on back just lateral to the midline
At what spinal level does the scapular spine fall?
T3
At what spinal level does the inferior angle of the scapula fall?
T7 or T8
At what spinal level do the iliac crests fall?
L4
The ASIS should align with each other in the horizontal plane and with the ________ in the vertical plane
pubic symphysis
At what spinal level do the PSIS fall?
S2 (indicated by dimples)
What joint is located at S2?
sacroiliac joint
Which vertebral regions are the most flexible and why?
The cervical and lumbar regions are more mobile than the thoracic region because the cervical and lumbar vertebrae do not have ribs attached to them
The Atlantooccipital Joint allows for the movement of nodding ___ whereas the Atlantoaxial Joint allows for movement of nodding __.
Yes
No
In the cervical and upper thoracic spine, side bending is coupled with axial rotation in the ____ direction.
same
With left side bending the cervical and upper thoracic spinous processes move in what direction?
right
In the middle and lower thoracic spine, lateral bending is coupled with axial rotation in the _____ direction when lateral bending is the first movement
opposite
In the middle and lower thoracic spine, lateral bending is coupled with axial rotation in the _____ direction when rotation is the first movement
same
In the lumbar spine, side bending is coupled with axial rotation in the ____ direction.
opposite
With left side bending the lumbar spinous processes move in what direction?
left
What 3 things allow for a vertebral segment to move?
intervertebral disk joint and two posteriorly positioned facet joints (one right and one left)
In the Occipital-Atlanto-Axial Complex rotation and side bending of the head occurs in the ____ direction.
opposite
When the head rotates right, C1 side bends ___.
left
What fills the majority (1/3 to 1/2) of the intervertebral foramina?
cervical nerves
What does the vertebral artery test test for?
vertebral artery blood flow
A reduction in vertebral artery blood flow results in what?
transient ischemic attack (TIA)
What is a transient ischemic attack?
Occurs when blood flow to a part of the brain stops for a brief period of time which in turn will lead to a stroke
During coupled axial rotation and side bending is there more motion from the spine of C7 or T1?
C7
The first rib is attached to the clavicle via what ligament?
costoclavicular ligament
How many true ribs are there?
7 (ribs 1-7)
How many false ribs are there?
5 (ribs 8-12)
Of the false ribs, how many are floating?
2 (ribs 11 and 12)
What is the sternal angle?
The location where the manubrium and sternum meet
What rib articulates at the sternal angle?
rib #2
How many facet joints does each vertebrae have in total?
4
What is the function of a facet joint?
stabilize the spine, and prevent excessive bending and translation between adjacent vertebrae
What is the orientation of the articular surfaces of cervical facet joints?
midway between a frontal and horizontal plane (35-45 degrees)
What 4 motions do the cervical facet joints allow for?
flexion, extension, rotation, and lateral flexion
What is the orientation of the articular surfaces of thoracic facet joints?
mostly in the frontal plane (60 degrees)
What is the primary motion allowed at the thoracic facet joints?
axial rotation
What is the orientation of the articular surfaces of lumbar facet joints?
mostly in the sagittal plane (90 degrees)
What 2 motions do the lumbar facet joints allow for?
flexion and extension
What are the 2 types of nerve endings found in the nerves that innervate the facet joints?
mechanoreceptors and nociceptors.
Mechanoreceptors react to what type of stimuli?
proprioceptive
Nociceptors react to what type of stimuli?
pain sensations
2 functions of intervertebral discs
- Forms a fibrocartilaginous joint to allow slight movement of the vertebrae
- Acts as a ligament to hold the vertebrae together
How are the layers of the annulus fibrosus arranged?
the fibrocartilage fibers of each layer are distributed in different directions (like layers of plywood)
How many IVDs are there?
23 discs in the human spine:
6 in the cervical region
12 in the thoracic region
5 in the lumbar region
Is there a direct blood supply to the IVDs?
NO
Before the age of 40 approximately __% of people show evidence of DJD
25
After the age of 40 approximately __% of people show evidence of DJD
60
What changes occur in the nucleus pulposus of IVDs during aging?
The nucleus pulposus begins to dehydrate and the concentration of proteoglycans in the matrix decreases, thus limiting the ability of the disc to absorb shock
What changes occur in the annulus fibrosis of IVDs during aging?
It becomes weaker and has an increased risk of tearing
What branch of spinal nerves innervate the meninges, vertebrae, and spinal ligaments?
Meningeal branch (aka sinuvertebral nerves)
What do the dorsal primary rami supply?
motor and sensory innervation of the skin and muscles of the back as well as the facet joints
What do the ventral primary rami supply?
the ventral and lateral skin and muscles of the trunk
The ventral primary rami in the upper and lower thoracic regions form what kinds of nerves?
Upper form intercostal nerves
Lower form thoracoabdominal nerves
What do the remainder of the primary ventral rami form?
the nerve plexuses (cervical, brachial, lumbar, sacral, and coccygeal plexuses)
The posterior aspects of the lumbar intervertebral discs are supplied by what nerves?
the sinuvertebral nerves (meningeal branches of the spinal nerves)
What supplies the posteriolateral aspects of the lumbar intervertebral discs?
The branches of the adjacent ventral primary rami and the grey rami communicantes near their junction with the ventral primary rami
What innervates the lateral aspects of the lumbar intervertebral discs?
branches from the rami communicantes
What innervates the anterior aspects of the lumbar intervertebral discs?
recurrent branches of rami communicantes
The cervical intervertebral discs are supplied by what nerves?
sinuvertebral nerves
What are the 4 types of nerve endings found in joints?
- Free nerve endings
- Golgi type endings
- Ruffini endings
- Paciniform endings
Where are free nerve endings found?
in the joint capsule and connective tissue surrounding a synovial joint
What activates free nerve endings?
extreme mechanical or chemical irritation
Where are Golgi type nerve endings found?
in the ligaments of the joint
What activates Golgi type nerve endings?
ligament stretch
Where are Ruffini nerve endings found?
in the joint capsule
What activates Ruffini nerve endings?
stretching and tactile stimulation
Where are Paciniform nerve endings found?
in the periosteum near the articular attachments
What activates Paciniform nerve endings?
active at onset and termination of movement, they signal movement velocity and acceleration
Describe the basic idea behind the gate control theory
Non-painful input closes the gates to painful input by activating inhibitory interneurons which prevent the pain sensation from traveling to the CNS
The gate theory was the rationale behind the production and use of what modality?
transcutaneous electrical nerve stimulation (TENS)
Proprioception involves both ____ sense and _____ sense.
position
motion
Where are nociceptors located in a joint?
Throughout it. In the capsule, ligaments, menisci, periosteum and subchondral bone.
Pain afferents are ____ diameter neurons, whereas mechanoreceptors are _____ diameter neurons.
small
large
The perception of pain is dependent upon what?
The balance of activity in large [mechanoreceptor] and small [nociceptive] afferents
What supplies the sensation for the facet joints (zygapophyseal joints)?
The medial branch of the dorsal primary ramus above and below the level it is on
What 4 things does the xiphisternal plane mark?
1) Anterior and inferior limit of the thoracic cavity
2) Superior surface of the liver
3) Diaphragm
4) Inferior border of the heart
At what vertebral level does the xiphisternal plane fall?
T9
What is the supracristal plane and what does it mark?
It is the highest point on the iliac crest (L4) and marks the bifurcation of the aorta
How many joints does each vertebrae have?
12
2 IVDs
4 facet joints
2 for costal transverse processes
4 for the ribs
