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Anatomy Block 1 > 1b.Superficial back and posterior shoulder part II > Flashcards

1b.Superficial back and posterior shoulder part II Flashcards

1
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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2
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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3
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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4
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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5
Q

what is the cause of odontoid fractures?

A

usually falls and motor vehicle accidents (C2)

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6
Q

what is a type II odontoid fracture?

A

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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7
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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8
Q

Which C spine injuries are the worst?

A

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

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9
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 rotation
symptoms: pain and inability to actively move neck, sensation of instability so patients may present holding thier head
clinical findings range: quadriplegia w/ respiratory center problems or minimal sensory/motor deficits
c.

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10
Q

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

A

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

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11
Q

Know xray for hangman’s fraction/ presentations

A

broken bilateral pedicles forward displacement of C1

speration of upper cervical spine from lower cervical spin

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12
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)

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13
Q

How do you repair a hangman’s fracture?

A

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

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14
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

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15
Q

why 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

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16
Q

what are the 2 types of cartilaginous joints?

A

1) Primary cartilaginous joints: (synchondrosis): In this subtype the bones are united by a plate of hyaline cartilage so that the joint is immovable and strong. These joints are temporary in nature because after a certain age the cartilaginous plate is replaced by the bone. Examples of this type of joints are joint between the epiphyses and diaphysis of a growing long bone, the costochondral joint and the first chondrosternal joint.
2) Secondary cartilaginous joints: (symphysis): These are also known as fibro-cartilaginous joints. There articular surface is covered by a thin layer of hyaline cartilage and the bones are united by fibro-cartilage. These joints are permanent and persist throughout the life of an individual. Typically the secondary cartilaginous joints occur in the median plane of the body and permit limited movements because of compressible pad of cartilage in them. The thickness of the fibro-cartilage in these joints is directly related to the range of movement the joint offers. Examples of this type of joints are; symphysis pubis, manubrio-sternal joint and intervertebral joints between the vertebral bodies.

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17
Q

Describe the zygapophyseal joint. what type is it?

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

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18
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)

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19
Q

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

A

disc controls AMOUNT of movement whereas joint controls DIRECTION of movement
in 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

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20
Q

what are the ligmental supports?

A

posterior longitudinal= NARROW band from sacrum to C2 on posterior vertebral bodies and discs

ligamentum favum= runs from lamina to lamina from axis to sacrum

anterior longitudinal= WIDE band from sacrum to occiput on anterior vertebral bodies and discs

facet joint capsule

interspinous 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 C7

nuchal= thickened continuation of supraspinous ligament from C7 to occiput

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21
Q

what are the 3 region specific joints in the cervical region?

A

uncovertebral
atlantodental
atlantoccipital

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22
Q

where is the uncovertebral joint and what does it do

A

it prevents lateral translation and is at the uncinate procces (edge of the body) and the one above

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23
Q

what type of joint is the atlantodental?

A

synovial/diarthrotic joint of the pivot type (move in one plane about vertical axis). artculation btwn dens and posterior facet of anterior tubercle
rotation: just say no! (antlantoaxial),

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24
Q

what type of joint is the atlantooccipital?

A

synovial/diathrotic, of the condyloid type, superior articular facets of c1 articulate with the occiptal condyles on the occiptal bone of the skull

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25
Q

what is a condyloid joint

A

here articular surfaces consist of two distinct condyles in which one is convex surface (called the male surface) fitting into a concave surface (called the female surface) of the other bone. These joints mainly permit the movement in plane around a transverse axis. Example of this type of joints is knee joint.

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26
Q

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

A

transverse ligament

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27
Q

DIffrence btwn pivot joint and condyle joint?

A

pivot joint allows movement in only 1 plane- transverse; while condyle joint allows sagittal and frontal plane movement. so this joint allows you to laterally flex but also to say yes

28
Q

what is a demifacet?

A

partical facet; demifacet of neighboring vertebrae have rotaiton with both vertebrae

29
Q

which don’t have transverse costal facets?

A

T11 and T12

30
Q

Costovertebral joint? what region is this in?

A

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

31
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

32
Q

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

A

1) superficial muscles/ extrinsic : they act on upper limb

2) deep/intrinsic muscles act on vertebral column

33
Q

What is the function of the trapezius

A

superior elevation, midline retraction, and inferior depression at the shoulder girdle (not a joint)

34
Q

what is the function of the throracolumbar fascia

A

suppors secondary curvature

35
Q

what is the function of the latissimus dorsi?

A

extends, medial rotation, and adduction at the shoulder

36
Q

what is the neuromuscular bundle

A

vein, artery, nerve

37
Q

what is the trapezius innervated by?

A

spinal accessery nerve 11, ascending transverse cervical vein and artery

38
Q

what is the latissimus dorsi innovated by?

A

thoracodorsal v, a, n (aka middle subscapular v,a,n

39
Q

what is the rhomboid maj/min innervated by?

A

dorsal scapular v, a, n (descnding transverse cervical v, a, n)

40
Q

what is the legator scapulae innervated by?

A

dorsal scapular v, a, n

41
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

42
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

43
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

44
Q

all joint actions are at the shoulders. which are they?

A

deltoid: abduction, axilary nerve and posterior humerus circum

triceps brachii: lateral H, LH, profunda branch, radial nerve

45
Q

what does the supraspinatus do?

A

initaites and ends abduction at the shoulder joint; supra scapular n/a

46
Q

what does the infraspinatus do?

A

lateral rotation at he shoulder joint and supra scapular n/a

47
Q

what does the trees minor do?

A

lateral rotation at the shoulder joint and axillary n (posterior branch) and scapular circumflex

48
Q

teres major

A

medial rotation of humerus; abduction at the shoulder joint; lower sub scapular n, scapular circumflex

49
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 dorsi
all 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/

50
Q

trapezius

A

a) adducts (aka retraction) of scapula; upper portion elevates and lower portion depresses
b) innervated by spinal accessory nerve or cranial 11
c) axio appendicular : meaning it goes from spinal portion of skeleton to limb portion of skeleton
d) has upper component which wraps around clavicle, a middle component which wraps spine and scapula and inferior that wraps to root of spine of scapula.
e) elevation, retraction or depression of shoulder

51
Q

latissimus dorsi

A

adducts (aka protraction) humerus
and medially rotates humerus
-innervated by thoracodorsal nerve (middle sub scapular n or n to lats dorsi)

52
Q

levator scapula

A
  • elevates scapula

- innervated by dorsal scapular nerve

53
Q

rhomboid minor and minor; where do they attach?

A

minor comes from above the root of the spine of the scapula
* both attach to spinous processes of cervical vertebrae (not the transverse process like the legator does

both adduct scapula
-innervated by dorsal scapular nerve

54
Q

supraspinatus and infraspinatus

A

supraspinatus:
initiates abduction of shoulder for deltoid
innervated by supra scapular nerve

infraspinatous:
lateral rotator of humerus
innervated by supra scapular nerve

55
Q

teres minor and major

A

major: medial rotator and adductor of humerus
innervated by lower sub scapular nerve

minor: lateral rotator of humurus
innervated by axillary nerve

56
Q

rotator cuff

A

supraspinatus, infraspinatus, teres minor and subscapularis

support head of humerus in glenoid

57
Q

location of supra scapular nerve and artery?

A

on posterior view:

navy over
army under

58
Q

quadrangular space

A

axillary nerve

posterior humeral circumflex artery

59
Q

triangular space

A

br of scapular circumflex artery

rearrange space

60
Q

triangular interval

A

radial nerve

profunda brachii arteyr

61
Q

quadrangular space syndrome

A

hypertrophy of quadrangular space muscles or fibrosis of muscle edges may impinge on axillary nerve

could 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

62
Q

intermediate layer of posterior back has:

why can the intermediate layer still be included?

A
  1. accessory muscles for respiration
  2. 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

63
Q

movements of the lumbar vs thoracic and cervical

A

both can do lateral flexion, flexion and extension, but only the thoracic/cervical can do rotation

64
Q

list all the diarthrosis/synarthrosis/amphiarthrosis joints discussed so far

A

diarthrosis:

1) atlantodental (pivot)
2) atlantooccipital (pivot)

3) zygophophyseal (plane)
4) costovertebral (plane)
5) costotransvere (plane)

synathrosis:

1) anterior intervertebral
2) sacroiliac jt

65
Q

differentiate these terms/locations:

scapular circumflex artery
supraspinatous
supraspinous
suprascapular nerve and artery
dorsal scapular nerve
A

scapular circumflex artery:
muscles of scapula- teres minor and major

supraspinatous:
muscles of scapula- supraspinatous initiates abduction and is enervated by the supra scapular nerve

supraspinous:
ligament of vertebrae, connects tips of spinous processes

suprascapular nerve:
muscles of scapula, innervates supraspinatous and infraspinatous

suprascapular nerve/artery: navy over, army under

dorsal scapular nerve:
extrinsic back muscles, innervates rhomboid major/minor and levaetor scapula

66
Q

on the back, the skin is innervated by ___

but the muscles are innervated by ___ except ___

A

skin innervated by dorsal rami

muscles innervated by ventral rami, excel the trap which is innervated by cranial nerve 11

67
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.

Anatomy Block 1 (16 decks)

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