Trunk and Neck Clinical Conditions

Question 1

Locations of the 3 different types of hernias

Answer 1

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

Question 2

Hasselbach’s Triangle Borders

Answer 2

• Indicates the location of direct hernias
• Borders:
  Lateral: inferior epigastric vessels
  Medial: rectus abdominal sheath
  Inferior: inguinal ligament

Question 3

What constitutes the femoral ring

Answer 3

lateral: femoral vein
medial: lacunar ligament
anterior: inguinal ligament
Posterior: superior ramus of the ilium and pectineal ligament

Question 4

structures running in the inguinal canal

Answer 4

spermatic cord or round ligament, genital portion of the genitofemoral n, ilioinguinal ligament

Question 5

structures running in the femoral ring

Answer 5

fat, lymph vessels, and lymph nodes

Question 6

how is the inguinal canal formed?

Answer 6

external abdominal oblique aponeurosis wraps around and forms the anterior wall while the inguinal ligament and conjoint tendon from the posterior wall

Question 7

origin and insertion of internal abdominal oblique

Answer 7

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

Question 8

origin and insertion of external abdominal oblique

Answer 8

external surfaces of 5th -12th ribs to linea alba, pubic tubercle, and anterior half of iliac crest

Question 9

During swinging motions (baseball, tennis, golf etc.) what other muscles assist in creating a forceful swing besides the obliques?

Answer 9

Rectus abdominus, spinal rotators, intercostal muscles

Question 10

If someone batted right-handed (left side facing the pitcher) which direction
would they rotate when they hit the ball

Answer 10

• rotation of trunk to left
• L IO and R EO approximate

Question 11

What muscles would eccentrically slow this motion at end range

Answer 11

opposite: R IO and L EO

Question 12

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

Answer 12

As the right-handed batter rotates to the left the left IO fires forcefully causing the
possible strain

Question 13

Identify the structures susceptible to osseous injury is a strain is severe enough. Describe
the specific mechanism of this injury

Answer 13

Avulsion of the lower ribs (usually ribs 11 &10). This occurs specifically at the costal
chondral junction

Question 14

what nerve lies within sub occipital triangle?

Answer 14

C1

Question 15

where does C2 emerge?

Answer 15

inferior to the obliquus capitis inferior and pierces the semispinalis capitis muscle

Question 16

what artery runs closely to C2 nerve?

Answer 16

Occipital artery
Arises as branch of external carotid a

Question 17

if the (R) obliquus capitis inferior is in spasm which way will this muscle rotate the head

Answer 17

Area of triangle will decrease
- will allow less room for the C1 nerve and vertebral a

Question 18

How might a patient present if there were a spasm in the R obliquus capitis inferior

Answer 18

• 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

Question 19

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?

Answer 19

tectorial membrane becomes PLL and is continuous with cruciate ligament

Question 20

What other ligamentous structures of the spine may experience ossification?

Answer 20

ALL, interspinous ligament
- both can limit motion but do not encroach the spinal cord space

Question 21

what motion does the PLL prevent?

Answer 21

-hyper-flexion
- protects encroachment into the spinal canal by the intervertebral discs and osteophytes

Question 22

Who is most susceptible to ossification of PLL?

Answer 22

• older men present with n/t or dysthesia
• later disease the ligament thickens encroaching the spinal canal leading to spinal cord signs

Question 23

origin and insertion of deep flexors of the neck

Answer 23

• 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

Question 24

What is primary role of deep neck flexors

Answer 24

stabilization and maintaining correct lordosis of C spine

Question 25

forces that occur to longus Colli during a rear impact MVA

Answer 25

severe, sudden elongation of the muscle followed by very fast shortening and then again sudden elongation

Question 26

patients with longus colli calcific tendonitis present with severe neck pain, sore throat, and hoarseness. Why?

Answer 26

the larynx sits superficial to these muscles and is likely affected by the injury and close proximity to the calcifications

Question 27

Compartments involved in TOS

Answer 27

Interscalene triangle
Costoclavicular space
Subcoracoid space

Question 28

Neurovascular structures affected in TOS spaces

Answer 28

• brachial plexus roots and trunks (mostly C7-T1 and middle/inf trunks)
• brachial plexus cord (mostly lateral)
• subclavian A and V

Question 29

What structures/etiologies cause the closure of the spaces that cause TOS

Answer 29

• scalene tightness/inflammation
• midclavicular fractures with poor alignment
• first rib malalignment and or accessory rib

Question 30

Special Tests for TOS

Answer 30

• Addson Test: mostly costoclavicular and inter scalene triangle
• ROOS: subcaracoid and costoclavicular
• ULTT: inter scalene triangle and costoclavicular

Question 31

how is myelomeningocele different from meningocele?

Answer 31

Meningocele: meninges on outside but tissues intact
Myelomeningocele: meninges and tissues outside

Question 32

Where is the conus medullaris located at birth for children with MMC?

Answer 32

• Usually lower than the usual L1/L2 area characterizing the tethering

Question 33

In a tethered cord, what is the spinal cord tethered to?

Answer 33

scar tissue, fatty growth
- not usually directly attached to bone

Question 34

Where is the wisdom tooth located

Answer 34

right at the curve of the ramus of the mandible

Question 35

what neural and vascular structures may be affected by impaction of the third molar and/or fracture of the mandible from extraction?

Answer 35

• inferior alveolar n and a
• lingual n
• NOT LINGUAL A bc it is more inferior

Question 36

what is the relationship between the chorda tympani and the lingual n?

Answer 36

Chorda tympani is from the facial n
Lingual n is from trigeminal n
chorda tympani merges with lingual n

Question 37

what are the functions of the lingual n, chorda tympani, and inf alveolar n?

Answer 37

chorda tympani and lingual n give taste to ant 2/3 or tongue
- inf alveolar n gives sensation to the teeth

Question 38

Special test for cervical nerve root compression/radiculopathy

Answer 38

Spurling

Question 39

What nerve is typically impacted in trigeminal neuralgia?

Answer 39

Maxillary division of trigeminal n

Question 40

Muscles in quiet inspiration

Answer 40

diaphragm

Question 41

muscles in forced inspiration

Answer 41

• SCM, pecs, external intercostals, scalenes, serratus post sup and inf, quadratus lumborum, erector spinae, levator costorum, rhomboids, levator scap, upper traps

Question 42

muscles in quiet expiration

Answer 42

passive rebound of diaphragm

Question 43

muscles in forces expiration

Answer 43

internal intercostals, abs/all of core, pelvic floor, transverses thoracic, iliocostalis lumborum, lats