Trunk and Neck Clinical Conditions Flashcards
Locations of the 3 different types of hernias
o Indirect inguinal hernia occurs when abdominal content protrude through
the internal inguinal ring; occurs LATERAL to the epigastric vessels
o Direct hernia– protrusion of the abdominal contents through the
trasversalis fascia
o Femoral hernia – protrution into the femoral ring
Hasselbach’s Triangle Borders
- Indicates the location of direct hernias
- Borders:
Lateral: inferior epigastric vessels
Medial: rectus abdominal sheath
Inferior: inguinal ligament
What constitutes the femoral ring
lateral: femoral vein
medial: lacunar ligament
anterior: inguinal ligament
Posterior: superior ramus of the ilium and pectineal ligament
structures running in the inguinal canal
spermatic cord or round ligament, genital portion of the genitofemoral n, ilioinguinal ligament
structures running in the femoral ring
fat, lymph vessels, and lymph nodes
how is the inguinal canal formed?
external abdominal oblique aponeurosis wraps around and forms the anterior wall while the inguinal ligament and conjoint tendon from the posterior wall
origin and insertion of internal abdominal oblique
thoracolumbar fascia, ant 2/3 of iliac crest, lateral half of inguinal lig to inferior borders of 10th-12th ribs, linea alba, and pectin pubis via conjoint tendon
origin and insertion of external abdominal oblique
external surfaces of 5th -12th ribs to linea alba, pubic tubercle, and anterior half of iliac crest
During swinging motions (baseball, tennis, golf etc.) what other muscles assist in creating a forceful swing besides the obliques?
Rectus abdominus, spinal rotators, intercostal muscles
If someone batted right-handed (left side facing the pitcher) which direction
would they rotate when they hit the ball
- rotation of trunk to left
- L IO and R EO approximate
What muscles would eccentrically slow this motion at end range
opposite: R IO and L EO
The article found that 78% of pitchers and 70% of batter tended to experience strain of
the abdominal muscles contralateral to their dominant side. Explain which muscle is being injured and why
As the right-handed batter rotates to the left the left IO fires forcefully causing the
possible strain
Identify the structures susceptible to osseous injury is a strain is severe enough. Describe
the specific mechanism of this injury
Avulsion of the lower ribs (usually ribs 11 &10). This occurs specifically at the costal
chondral junction
what nerve lies within sub occipital triangle?
C1
where does C2 emerge?
inferior to the obliquus capitis inferior and pierces the semispinalis capitis muscle
what artery runs closely to C2 nerve?
Occipital artery
Arises as branch of external carotid a
if the (R) obliquus capitis inferior is in spasm which way will this muscle rotate the head
Area of triangle will decrease
- will allow less room for the C1 nerve and vertebral a
How might a patient present if there were a spasm in the R obliquus capitis inferior
- occlusion of the triangle can impair suboccupital n which innervates muscles of the triangle causing more issues
- compression of vertebral a can lead to lightheadedness/dizziness
- inferior oblique spams may irritate greater occipital n causing headache and sharp pain posteriorly
- compression of occipital a can cause hypoxic reaction creating more muscular issues
in the upper c- spine, the PPL is continuous with what other structure? at the AA and OA joint what is this structure continuous with?
tectorial membrane becomes PLL and is continuous with cruciate ligament
What other ligamentous structures of the spine may experience ossification?
ALL, interspinous ligament
- both can limit motion but do not encroach the spinal cord space
what motion does the PLL prevent?
-hyper-flexion
- protects encroachment into the spinal canal by the intervertebral discs and osteophytes
Who is most susceptible to ossification of PLL?
- older men present with n/t or dysthesia
- later disease the ligament thickens encroaching the spinal canal leading to spinal cord signs
origin and insertion of deep flexors of the neck
- longus capitis: transverse processes of C3-C6 to basil portion of occipital bone
- Longus colli: bodies of T3-C3 to bodies of C4-C3, tubercle of atlas and transverse processes of C5/6
What is primary role of deep neck flexors
stabilization and maintaining correct lordosis of C spine
forces that occur to longus Colli during a rear impact MVA
severe, sudden elongation of the muscle followed by very fast shortening and then again sudden elongation
patients with longus colli calcific tendonitis present with severe neck pain, sore throat, and hoarseness. Why?
the larynx sits superficial to these muscles and is likely affected by the injury and close proximity to the calcifications
Compartments involved in TOS
Interscalene triangle
Costoclavicular space
Subcoracoid space
Neurovascular structures affected in TOS spaces
- brachial plexus roots and trunks (mostly C7-T1 and middle/inf trunks)
- brachial plexus cord (mostly lateral)
- subclavian A and V
What structures/etiologies cause the closure of the spaces that cause TOS
- scalene tightness/inflammation
- midclavicular fractures with poor alignment
- first rib malalignment and or accessory rib
Special Tests for TOS
- Addson Test: mostly costoclavicular and inter scalene triangle
- ROOS: subcaracoid and costoclavicular
- ULTT: inter scalene triangle and costoclavicular
how is myelomeningocele different from meningocele?
Meningocele: meninges on outside but tissues intact
Myelomeningocele: meninges and tissues outside
Where is the conus medullaris located at birth for children with MMC?
- Usually lower than the usual L1/L2 area characterizing the tethering
In a tethered cord, what is the spinal cord tethered to?
scar tissue, fatty growth
- not usually directly attached to bone
Where is the wisdom tooth located
right at the curve of the ramus of the mandible
what neural and vascular structures may be affected by impaction of the third molar and/or fracture of the mandible from extraction?
- inferior alveolar n and a
- lingual n
- NOT LINGUAL A bc it is more inferior
what is the relationship between the chorda tympani and the lingual n?
Chorda tympani is from the facial n
Lingual n is from trigeminal n
chorda tympani merges with lingual n
what are the functions of the lingual n, chorda tympani, and inf alveolar n?
chorda tympani and lingual n give taste to ant 2/3 or tongue
- inf alveolar n gives sensation to the teeth
Special test for cervical nerve root compression/radiculopathy
Spurling
What nerve is typically impacted in trigeminal neuralgia?
Maxillary division of trigeminal n
Muscles in quiet inspiration
diaphragm
muscles in forced inspiration
- SCM, pecs, external intercostals, scalenes, serratus post sup and inf, quadratus lumborum, erector spinae, levator costorum, rhomboids, levator scap, upper traps
muscles in quiet expiration
passive rebound of diaphragm
muscles in forces expiration
internal intercostals, abs/all of core, pelvic floor, transverses thoracic, iliocostalis lumborum, lats
