Trunk Flashcards
1
Q
vertebrae
-classification
A
unfused -cervical: 7 -thoracic: 12 -lumbar: 5 fused -sacral: 5 (fused as sacrum) -coccygeal: 4 (may be 3 or 5)
2
Q
What 2 types of natural curvatures occur in the spine?
A
primary
secondary
3
Q
primary curvatures
- what are they?
- convex anterior or posterior?
- names
A
what -curvatures present embryologically -carried through during birth convex posteriorly -yield the curvature of the fetal position names -thoracic -sacral
4
Q
secondary curvatures
- what are they?
- result of…
- types
A
what -curvatures that develop postnatally result of neuromuscular development necessary for -head support -bipedal locomotion types -cervical -lumbar
5
Q
cervical curvature
- convex anterior or posterior
- purpose of development
A
convex anterior
develops to support the head
6
Q
lumbar curvature
- convex anterior or posterior
- purpose of development
A
convex anterior
develops to support the body for bipedal locomotion
7
Q
abnormal curvatures
-types
A
kyphosis
lordosis
scoliosis
8
Q
kyphosis
- what is it?
- commonly seen in…
- due to…
- Poliomyelitis infection
A
what
-exaggerated posterior curvature
commonly seen in elderly with an exaggerated thoracic curvature giving the impression of a “humpback”
due to changes that occur during aging that result in
-bone loss
-loss of turgidity of the nucleus pulposus
can also be seen as a response to muscular changes following recovery from Poliomyelitis infection
9
Q
lordosis
- what is it?
- commonly seen in…
A
what
-exaggerated anterior curvature
commonly seen in women during pregnancy
-response to shifting of weight
10
Q
scoliosis
- what is it?
- result of…
A
what
-abnormal lateral curvature
result of…
-incomplete formation of vertebrae (hemivertebrae)
OR
-unequal muscle tension exerted on one side of the vertebral column
11
Q
landmarks of a typical vertebrae (7)
A
body vertebral arch pedicles lamina spinous process transverse process articular processes (zygapophysis)
12
Q
body
- anterior or posterior aspect of vertebra?
- how does size change throughout spinal column?
- why are the inferior and superior surfaces marked by a roughened circumference (perimeter)?
- what is the smooth center composed of and why?
A
anterior aspect
size
-size increases inferiorly from cervical region through lumbar region
-size decreases from lumbar region through coccygeal region
roughened perimeter is a result of the attachment of the annulus fibrosus fibrocartilage of IV disc
smooth center
-composed of hyaline cartilage
-corresponds to position of nucleus pulposus
13
Q
vertebral arch
- encloses…
- what is the vertebral canal?
- arch formed by…
A
encloses the vertebral foramen
vertebral canal
-canal formed by all vertebral foraminae collectively
formed by
-pedicles and laminae as they join via the transverse and spinous processes
14
Q
pedicles
- span what distance?
- pedicle contains which two notches?
- purpose of notches
A
span distance between body and transverse processes
notches
-superior and inferior vertebral notches
purpose
-from the intervertebral foramen (spinal nerve passes through)
15
Q
lamina
-span what distance?
A
span distance between transverse process and spinous process
16
Q
spinous process
-projects…
A
projects posterior inferiorly
17
Q
transverse process
- projects…
- purpose
A
project posterolaterally and slightly superiorly
act as leverage for the attachment of the intrinsic muscles of the back
-specifically the intermediate and deep or transversospinalis layers of muscles
18
Q
articular processes (zygopophysis)
- most commonly referred to as…
- composed of what two structures?
- joint type
A
most commonly referred to as facet joints
composed of paired superior and inferior articular processes with an articular facet (face)
synovial planar joint
19
Q
superior articular facet face
- direction importance
- cervical direction (C3-C7)
- thoracic direction
- lumbar direction
A
direction importance
-used an an identifying characteristic of each level of vertebrae
*face points perpendicular to plane of articular process
-i.e. face of lumbar superior articular process points inward; plane of process is in sagittal plane
cervical direction
-posterosuperior
thoracic direction
-posterior
lumbar direction
-medial
20
Q
cervical vertebrae
- unique characteristics (3)
- what is the vertebra prominens?
A
-larger vertebral foramen (spinal canal) - more nerves (axons) coming out of these areas
-foramen transversarium for passage of vertebral artery (may be diminished in C7)
-bifid spinous processes (C1 only has a posterior arch)
vertebra prominens
-spinous process of C7
21
Q
C1 and C2 characteristics
A
C1 -has no body, only an anterior ventral (posterior) arch C2 -has the odontoid process (dens) --formed from body of C1
22
Q
important cervical ligaments
A
cruciform ligament
alar ligaments
23
Q
thoracic vertebrae unique characteristics -costal facets --purpose --occur where --what type of facets are they and why? spinous process direction -purpose -rotation limited due to...
A
costal facets
-for articulation with ribs
where
-on side of vertebral body and transverse process of superior 10 ribs
-on pedicle for articulation with ribs 10-12
type
-demi- or hemifacets since articulation of head of the rib spans the intervertebral space
spinous processes are sloped posteroinferiorly
-restrict inferiorly
rotation limited due to true ribs
-more rotation in false and floating rib regions
24
Q
lumbar vertebrae special characteristics (2)
- why is L5 transverse process elongated
- spina bifida occulta results due to…
- spinous processes point…
A
massive bodies and lamina
no costal facets
L5 transverse process elongated for attachment of iliolumbar ligament
spina bifida occulta
-failure of closure of the posterior neuropore at L4
spinous processes point posteriorly
25
sacral vertebrae
- foraminae: number, purpose, and size difference
- sacral base articulates with...
- sacral hiatus
- sacral cornu
- sacral promontory
- auricular surface
- -articulates with...
- -type of joint
- -when does ossification occur?
```
foraminae
-4 dorsal pairs and 4 ventral pairs
-for exit of spinal nerves
-dorsal are smaller
base of sacrum articulates with body of L5
sacral hiatus
-inferior opening of spinal canal
-after S3 (due to lack of spinous process)
sacral cornu
-remnant of inferior articular process
-borders sacral hiatus
sacral promontory
-body of S1
auricular surface
-articular with ilium (SI joint)
-synovial planar joint (same as facet joints)
-ossifies following puberty in males; after menopause in females
```
26
coccygeal vertebrae
| -remain as...
remain as bodies only
27
primary vertebrae ossification sites
- how many?
- what?
3
- body (centrum)
- two lateral parts of the arch (pedicles?)
28
secondary vertebrae ossification sites
- how many?
- what?
5
-tips of the spinous and transverse processes along the superior and inferior rims of the body (future site of attachment of annulus fibrosus)
29
intervertebral joints
| -what type of joint?
secondary cartilaginous
| similar to symphyses
30
ligaments of the trunk (5)
```
anterior longitudinal ligament
posterior longitudinal ligament
ligamentum flavum
interspinous limgament
supraspinous ligament
```
31
```
anterior longitudinal ligament
-attached to...
-functions
only ligament that...
-supports...
-inderdigitates with...
```
attached to periosteum of the anterior side of body and intervertebral disc
functions
-stability of the joint
only ligament that limits extension (prevents hyperextension)
supports
-anterior and lateral aspects of vertebral body
inderdigitates with
-annulus fibrosus/fibrous capsule of disc
32
posterior longitudinal ligament
- attached to
- purpose
- strength and size compared to ALL
- continues into what?
- what structures does it move through and attach to inside the skull?
- where is the least supported region of the disc?
attached to
-posterior side of the body
purpose
-stability
-prevention of hyperflexion
-prevents direct posterior protrusion of the nucleus pulposus into vertebral canal
weaker, narrower, and thinner than the ALL
continues as tectorial membrane from C2 onto the inferior surface of the skull
moves through foramen magnum to the inside of the posterior cranial fossa
least supported region of is posterolateral region
33
ligamentum flavum
- attaches...
- color and composition
attaches lamina to lamina
yellow in color
made primarily of elastic connective tissue
34
interspinous ligament
| -connects...
connects successive spinous processes
35
supraspinous ligament
- connects
- also called the ____ in the _____ regions
- in humans, it is
continuous ligament connecting successive tips of each spinous process
also called the Ligamentum Nuchae in the upper thoracic and cervical region
mostly a fascial sheath in humans (most prominent in quadrupeds who need assistance extending the head)
36
intervertebral disc
- composition
- remnant of...
- between which vertebrae is a disc missing?
composition
-outer ring of fibrocartilage (annulus fibrosus)
-internal part primarily composed of water (nucleus pulposus)
remnant of the embryological notochord
no discs
-occiput and atlas (C0C1)
-atlas and axis (C1C2)
last intact disc is between sacrum and L5
37
annulus fibrosus
- made of...
- how is the fibrocartilage oriented
- where is it thicker?
- supporeted by which ligament?
- where is it thinner and less supported?
made of concentric rings of fibrocartilage
each layer of fibrocartilage is oriented about 90 degrees differently for strength
thicker on the anterior side
supported more heavily by the anterior longitudinal ligament
thinner and less supporeted posteriorly
more logical direction of herniation of the internalized nucleus pulposus
38
nucleus pulposus
- contact with...
- location
- purpose
contact with hyaline cartilage
located centrally on the superior and inferior faces of the body of the vertebrae
purpose
-forms cushion
39
facet joint
- technical name for joint
- joint type
- what do all joint of this type have?
```
zygapophysial joint
synovial joint (of the planar type)
all synovial joints have hyaline cartilage on their articular surfaces
```
40
```
movement allowed at cervical joints (rough)
-flexion/extension
lateral bending
--C1C2
Axial rotation
--C1C2
--total
```
```
flexion/extension
-7-20
lateral bending
-3-10
-0 at C1C2
Axial rotation
-around 10
-47 at C1C2
-around 90 total
```
41
movement allowed at thoracic joints
- flexion/extension
- lateral bending
- axial rotation
```
flexion/extension
-7-20
-more in T10-L1 - false and floating ribs
lateral bending
-5-10
axial rotation
-8-10
-less in T9-L1
```
42
movement allowed at lumbar joints
- flexion/extension
- lateral bending
- axial rotation
```
flexion/extension
-12-20
lateral bending
-around 10
axial rotation
-3-5
```
43
what are the primary part of the rib (3)
head
neck
tubercle
44
ribs
- head of each rib has 2 _____ to match the _____ of the vertebrae
- -exceptions to this rule
- -why are these exceptions present
head of each rib has 2 demifacets to match the demifacets of the vertebrae
exception
-ribs 1, 11, and 12
-ribs 11 and 12 don't have an articular surface on the tubercle since they don't articulate with the transverse processes of vertebrae T11 and T12
45
movement of the vertebral column
- how are ribs situated and what effect does this have on movement?
- lumbar articular facet orientation effect on movement
- flexion/extension ability at C-spine
- flexion/extension at lumbar level
- ribs are anchored rostrally (couldn't find a great definition) to the sternum and thus make the thoracic region less flexible than the cervical or lumbar region
- articular facet orientation in the lumbar region allows for flexion/extension
- flexion good at cervical region
- extension compromised at cervical region due to the overlapping spinous processes
- lumbar region: greatest mobility is in extension and then in flexion
- lumbar flexion is limited due to the massive size of the bodies
46
bones of the pelvis
| -combine to form...
ilium
ischium
pubis
-combined to form the coxal bone or os coxae (not coccyx)
47
ilium
- Ala contains..
- superior margin components
- tubercle of crest located at...
- SI joint type
- iliac tuberosity is an anchor point for...
- where is the greater sciatic notch
-ALA (wing-like portion) contains iliac fossa
-superior margin: iliac crest, bordered by anterior and posterior superior iliac spines (ASIS, PSIS)
-tubercle at superior end of anterior gluteal line
SI joint
-synovial planar joint
-matching auricular surfaces
iliac tuberosity is an anchor point for the iliolumbar and anterior sacroiliac ligaments
greater sciatic notch is below PIIS
48
ischium
- location
- body and ramus articulate with...
- landmarks (3)
```
posteroinferor 1/3 of hip
body articulates with ilium
ramus articulates with pubis
landmarks
-ischial tuberosity
-ischial spine
-ischiopubic ramus
```
49
ischial spine
- what is below this?
- what defines the greater sciatic foramen above?
- what defines the lesser sciatic foramen?
- lesser sciatic notch is below
- sacrospinous ligament defines the greater sciatic foramen above (by closing the greater sciatic notch)
- sacrotuberous ligament defines the lesser sciatic foramen (by closing the lesser sciatic notch)
50
ischiopubic ramus
| -these define the...
articulation of ischial and inferior pubic rami define the obturator foramen
51
pubis
- components
- inferior ramus articulates with...
- superior ramus articulates with...
- pubis, ilium, and ischium all articulate within...
- bodies of the pubi? articulate with each other via...
- pubic crest location
- pubic tubercle location
- what attaches on pubic tubercle?
- composed of body and 2 rami
- inferior ramus articulates with ischial ramus
- superior ramus articulates with the ilium
- pubis, ilium, and ischium all articulate within the acetabular fossa
- bodies articulate via pubic symphysis (fibrocartilage)
- pubic crest on superior border of body
- pubic tubercle on lateral end of body
- inguinal ligament attaches on pubic tubercle
52
joints of pelvis
| -name and joint type
SI joints
-synovial planar joints
-some books say both surfaces are of hyaline cartilage
-some say the sacral side is fibrocartilage
pubic symphysis
-fibrocartilaginous joint
53
SI joint supporting ligaments
anterior SI ligament
posterior SI ligament
iliolumbar ligament
-stretches from iliac tuberosity to transverse process of L5
54
extrinsic muscles of the back
- overall purpose
- names and individual purpose
overall purpose
-movement of the upper extremity and ribs
most superficial
-trapezius and latissimus dorsi
--act upon the upper extremity
deep to these
-serratus posterior, superior, and inferior
--involved in respiration due to their attachments and orientation
55
thoracolumbar fascia
- another name
- where is it attached?
- formed by
- number of layers and names
- purpose
-also called thoracodorsal fascia
-formed from aponeurotic (flattened tendinous attachment) connections of the abdominal muscles attaching to the lumbar vertebrae and iliac crest
3 layers
-posterior, middle, anterior
posterior and middle layers encase the deep back muscles (intrinsic muscles of the back)
anterior fascial layers form the rectus sheath, which encases the abdominis muscle
56
intrinsic muscle purpose
maintain posture
assist with flexion, extension, lateral flexion and rotation of the vertebral column
-head to a lesser extent
57
abdominal muscles
- functions
- function in upright posture
- activation when...
functions
-compress abdomen
-major function in flexion of the trunk against gravity
relatively inactive in upright posture
activated against gravity as in sit-ups
in rotational movements against gravity
-external abdominal oblique and contralateral internal abdominal oblique are active together
58
transverse abdominis
| -purposes
involved in the stabilization of the lumbar spine to the pelvis
stabilizes lumbar vertebrae during training to prevent lower back pain
59
names of layers of intrinsic back muscles
superficial
intermediate
deep
60
superficial intrinsic back muscle names
| -located where?
splenius cervicis
splenius capitis
only located at cervical region
61
intermediate intrinsic back muscles
- broad name
- extend to...
- muscles move...
erector spinae group
extend to base of skull
muscles move superolaterally
62
erector spinae muscle names (3)
iliocostalis
longissimus
spinalis
63
iliocostalis muscle names
lumborum
thoracis
cervicis
64
longissimus muscle names
thoracic
cervicis
capitis
65
spinalis muscle names
thoracic
cervicis
capitis
-spinalis cervicis and capitis are usually indistinguishable from semispinalis cervicis and capitis
66
common broad tendon
- importance
- where does it originate?
```
all erector spinae muscles originate from this
originates on...
-lumbar spinous processes
-median sacral crest
-PSIS
-posterior 1/3 of iliac crest
```
67
deep muscles names
transversospinalis (broad name)
- semispinalis
- multifidus
- rotatores
68
transversospinalis (general characteristic)
| -move from where to where and in what direction?
move from transverse process superomedially to spinous process
69
semispinalis
- span what distance?
- names
```
span about 6 vertebrae
names
-thoracic
-cervicic
-capitis
```
70
multifidus
| -span what distance?
3-4 vertebrae
| most visible in lumbar and cervical regions
71
rotatores
| -span what distance?
brevis: 1 segment
longus: 2 segments
most visible in thoracic region
72
actions of deep muscles compared to intermediate muscles
extension and ipsilateral lateral flexion
| contralateral transverse rotation
73
other muscles that play a role in the movement or stability of the vertebral region and the head
```
interspinales
intertransversarii
levator costarum (some books describe as modified intertransversarii muscles)
```
74
generalities of intrinsic back muscles
- superficial and intermediate muscle groups performs what movements?
- -why these movements
- deep muscle groups perform what movements?
- -why these movements
superficial and intermediate muscle groups
- laterally flex and rotate trunk to same side
- muscle fibers travel superiorly and laterally from origin to insertion
- deep muscle groups rotate the column to the opposite side
- muscle fibers travel superiorly and medially from origin to insertion
75
suboccipital triangle
- composed of what four muscles
- purpose
rectus capitis posterior major (superomedial)
-spinous process of C2 to base of skull
rectus capitis posterior minor (medial to RCP major)
-C1 to base of skull
obliquus capitis superior
(superolateral)
obliquus capitis inferior (inferolateral)
purposes
-stabilization of C1, C2, and skull
-maintain relationship between these three structures
76
suboccipital triangle contents
-dorsal ramus of spinal nerve C1
-dorsal rami of C2
-vertebral artery
-greater occipital nerve
-lesser occipital nerve
if this area of the body becomes impinged, the brain and brain stem begins to lose blood supply
77
dorsal rami of spinal nerve C1
no cutaneous sensory component
| only goes to the suboccipital muscles
78
dorsal rami C2 purpose
dermatome innervation of the posterior part of the head
79
vertebral artery
| -identified where?
identified exiting the transverse foramen of C1
| crosses anterosuperiorly to wrap to the anterior side of the brainstem and enter foramen magnum
80
greater occipital nerve
-initial location and purpose
-ending location
combination of...
crosses over suboccipital triangle to reach the posterior surface of the head
-provides sensory innervation
once it reaches back of head, it lies along side of the occipital artery (branch of external carotid artery)
combination of dorsal rami of C2-3
81
lesser occipital nerve
- purpose
- composed of...
provides sensory innervation to the lateral side of the neck
| combination of the ventral rami of C2-3
82
muscles that cause posterior movement of the trunk and head
```
splenius muscles
erector spinae
transversospinales
suboccipitals
segmental muscles (interspinalis, intertransversarii)
```
83
muscles that cause anterior movement of the trunk and head
```
suboccipital muscles
longus colli and capitis
scalenes
sternocleidomastoid
abdominas
psoas major
```
84
superficial muscles that cause lateral movement of the trunk and head
```
scalenes
sternocleidomastoid
quadratus lumborum
psoas major
internal oblique
```
85
stabilization of the vertebrae
- posterior muscle functions
- -examples
- psoas major
- -location
- purpose
posterior muscles have vectors of pull that would allow for extension, rotation and lateral bending, but they work synergistically (some common actions while other are opposite and negated) with other muscles to effect actual motion
-rotation through the abdominal region - external and internal oblique muscles vs. erector spinae and transversospinalis
-side bending - lateral abdominals and quadratus lumborum vs. erector spinae and transversospinalis
psoas major
-anterior muscle of the trunk (posterior abdominal wall)
-prime mover and stabilizer of the trunk
-supports the trunk from falling posteriorly in unsupported setting
86
forward bending
| -which muscles control movement and how?
eccentric contraction of hamstrings and erector spinae occur to control hip flexion and forward bending across trunk
concentric contractions return the trunk to upright posture
87
parts of a spinal nerve
dorsal and ventral root
spinal nerve
dorsal and ventral primary rami
dorsal and ventral division of primary rami
88
deep back muscle innervation
done by segmental dorsal rami of spinal nerves from the cervical, thoracic, and lumbar regions
segmental nerve stay segmental without joining other nerve segments
different organization than the larger ventral rami that form plexi (cervical, brachial, lumbosacral)
89
innervation exceptions
intertransversarii receive segmental branches of the ventral rami near their separation from the dorsal rami (just lateral to the intervertebral foramen)
90
lumbosacral plexus
- formed from...
- emerges through and around...
- innervated trunk muscles
-formed from ventral rami of lumbar and sacral spinal nerves
-emerges through and around posterior abdominal and pelvic walls, respectively
muscles
-psoas major
-QL
-muscles of the anterior abdominal wall
-intertransversarii
91
lateral raphe
- what is it?
- purpose
where
-deep to latissimus dorsi
-location where fascia of ext. oblique, int. oblique, and TA fuse
purpose
-assists with lumbar stabilization
-assists with maintenance of the lumbar lordotic curve (can alleviate lower back pain)
92
gluteal lines
- names
- attachments
posterior gluteal line: gluteus maximus
posterior to anterior: gluteus medius
anterior to inferior: minimum
93
quadratus lumborum
lateral flexor of trunk
