Back Flashcards
(147 cards)
1
Q
What line separates the sides of the back?
A
midaxillary line
2
Q
Where is the suboccipital located?
A
inferior part of occipital bone on the back wall of the pharynx
3
Q
What is the main component of the axial skeleton?
A
the back
4
Q
List the back structures from superficial to deep:
A
skin, subcutaneous tissue, deep fascia, muscles, ligaments, vertebrae, ribs, spinal cord and meninges, spinal nerves, and blood vessels
5
Q
What is the deep fascia of the back called?
A
thoracolumbar fascia (diamond shaped fascia)
6
Q
Where the manubrium meets the sternum is called what?
A
angle of Louis (sternal angle)
7
Q
The recess along the midline of the back is called what?
A
posterior median furrow (overlies vertebral spinous processes)
8
Q
What spinous process is easily mistaken for C7?
A
T1
9
Q
The vertebra prominent is visible in what region?
A
C7
10
Q
T/F the thoracic spinous process always corresponds to the vertebral body level:
A
FALSE
11
Q
What overlies the cervical spinous processes of C2-C6?
A
thick nuchal ligament
12
Q
The superior angle of the scapula typically corresponds to what spinous process level?
A
T1/T2
13
Q
The inferior angle of the scapula lies at what level?
A
T7/T8
14
Q
What spinous process lies at the iliac crest?
A
L4
15
Q
What is an important landmark for lumbar punctures?
A
the iliac crest @ L4
16
Q
How many sacral spines can be palpated?
A
the first 3 fused segments
17
Q
A small dimple can be visualized at the level of the S2 spinous process, what does this represent?
A
posterior superior iliac spine
18
Q
Which region of vertebral column has ribs?
A
thoracic
19
Q
What plane crosses the L4 spinous process?
A
supracristal plane
20
Q
What two vertebral columns are fused?
A
sacral and coccygeal
21
Q
How many vertebras do we have?
A
33
22
Q
Name the vertebral columns of the spine and indicated how many vertebras they have in each column
A
- 7 cervical
- 12 thoracic
- 5 lumbar
- 3-5 coccygeal
23
Q
What are vertebrae separated by?
A
fibrocartilaginous intervertebral discs
24
Q
What is the function of the vertebral columns?
A
protect the spinal cord and spinal nerves and support body weight superior to the pelvis
25
Where does spinal motion occur?
superior to the sacral level
26
Spinal motion includes what?
extension, flexion, lateral side-bending, rotation, and circumduction
27
What is the vertebral arch formed by?
two pedicles that project posteriorly from the body and two laminae
(think of the vertebral arch as a house)
28
What cervical vertebras are short and bifid? What does bifid mean?
C3-C5
bifid = divided into two parts
29
Another name for C1 is what? What does it articulate with?
atlas - articulates w occipital condyles through two lateral masses & anterior facet that articulates with the dens of C2
30
What is another name for dens? (hint: relates to C2)
dens = odontoid process
31
Another name for C2 is what? What does it articulate with?
axis - projects superiorly to articulate with C1
32
C2 projects superiorly to articulate with C1, what type of synovial joint is this?
pivot joint
33
Which foramen transmit vertebral arteries traveling up to the head?
foramen transversarium
34
Which foramen accommodates the cervical enlargement of the spinal cord?
triangular vertebral foramen of the cervical region
35
The costal facets of the thoracic vertebrae articulate with what?
rib tubercles
36
Describe the structure of the lumbar vertebrae:
large, kidney-shaped bodies and large, triangular vertebral foramina
37
Where is the mammillary process located?
on the superior articular process
38
Why is motion in the thoracic region limited?
bc each thoracic vertebra has 12 joint structures
39
The facet orientation of the zygapophyseal (facet) joint in the thoracic region is in what plane?
frontal plane
40
The facet orientation of the zygapophyseal (facet) joint in the lumbar region is in what plane? What does this plane permit?
in the sagittal plane - permits flexion/extension and minimal rotation
41
The sacral vertebrae is a fused, wedge-shaped bone that is _____ anteriorly and ______ posteriorly
concave anteriorly & convex posteriorly
42
The Ala of the coccyx is latin for what word?
wing
43
Why is the articular surface of the coccyx sometimes called the auricular surface?
because it resembles an ear
44
The intervertebral discs are arranged between all presacral vertebra except for between what structures?
occiput, atlas, & axis
45
In adults, the intervertebral discs constitute for how much of the total length of the spine?
~25%
46
Each intervertebral disc consists of an outer and inner what?
outer annulus fibrosis & inner nucelus pulposus
47
The strong outer annulus of the intervertebral discs are made up of how many fibrocartilaginous rings (lamellae)?
6-10
48
The inner nucleus pulpous of the intervertebral discs is a gel-like connective tissue structure that contains what content?
water (has high water content)
49
Collectively, the outer annulus and the inner nucleus pulpous of the intervertebral discs do what?
permit spinal movement & transmit loads across each vertebral segment (also bind vertebral bodies together)
50
Regionally, intervertebral discs range in thickness for what purpose? What regions are discs thicker?
thickness = to permit different ranges of motion
thicker in cervical and lumbar regions
51
Tears in the annulus fibrosis allow for herniation of what?
nucleus pulpous out into the spinal canal
52
Gel-like nucleus pulpous contains what percentage of water at the time of birth and what percentage by the time an individual turns 60 y/o?
birth = 80% water
60+ = <70% water
53
List the four distinct spinal curvatures:
primary, secondary, cervical, & lumbar
54
The primary spinal curvatures are found in what region(s)? When are they developed and what is their shape?
thoracic & sacral (concave anteriorly)
develop during fetal period
C SHAPE
55
The secondary spinal curvatures are found in what region(s)? When are they developed and what is their shape?
cervical & lumbar (concave posteriorly)
develop as infant begins to hold head and walk
INDENTED C
56
Name the 4 spinal curvatures of the spinal regions:
cervical (lordosis)
thoracic (kyphosis)
lumbar (lordosis)
sacral (kyphosis)
57
The back musculature can be divided into what two muscle groups?
intrinsic and extrinsic
58
Extrinsic muscles are found in what groups?
found in superficial & intermediate groups
59
Intrinsic muscles make up what group?
make up the deep group
60
What muscle is an exception to the intrinsic and extrinsic muscle of the back?
trapezius
61
The trapezius is innervated by what cranial nerve?
accessory nerve (XI)
62
Superficial back muscles originate from the spine and insert onto the upper back limb, this group comprises what two layers?
1st layer - latissimus dorsi & trapezius muscle
2nd layer - rhomboid major/minor & elevator scapulae muscles
63
Intermediate back muscles function to assist respiration and proprioception and to receive ____ _____ & ______?
segmental innervation (anterior rami) & vascularization
64
What are the three back muscle groups?
superficial (2 layers)
intermediate
deep (3 layers)
65
What does it mean that deep back muscles are "native" to the back?
meaning during development, they originated posteriorly & remains in position
66
What are the deep back muscles innervated by?
segmental posterior rami
67
What are the layers of the deep back muscles?
superficial, intermediate, & deep layers
(same as back muscle groups but deep back muscles have these subgroups as well)
68
The intermediate layer of the deep muscle group of the back contains what collection of muscles?
erector spinal muscles
69
The intermediate layer of the deep muscle group of the back contains a collection of three muscles. Name the 3 muscles:
spinalis, longissimus, iliocostalis
70
The deep layer of the deep muscle group of the back contains what muscle group?
transversospinales muscle group
71
What is the function of the transversospinales muscle group of the deep layer of the deep muscle group of the back?
acts as spinal stabilizers
72
Name the muscles that make up the transversospinales muscles (deep layer of deep muscle group of back):
semispinalis (capitis), multifidus, rotatores
73
Testing trapezius function is a quick way to assess the integrity of which cranial nerve?
accessory nerve (XI) - ask pt to shrug shoulders & test muscle strength
74
What space allows for respiratory sounds to be heard clearly because of thinning of back musculature?
triangle of auscultation (ask pt to fold arms across chest and flex forward for better reveal)
75
What can be the root cause of lumbar lordosis?
psoas muscle tightness
76
Which lumbar group is important for posture?
erector spinae group
77
Which lumbar group provides increased stabilization to the spinal column?
transversospinalis group
78
Joints of the vertebral column include what type of articulations?
synovial & symphysis
79
Anteriorly in the vertebral column, adjacent vertebral bodies are joined by ____ _____ ___.
interposed intervertebral discs (symphysis type)
80
T/F symphysis type allows for weight bearing and contributing to the strength of the spine:
TRUE
81
Posteriorly in the vertebral column, _____ ____ occur between the articular process bilaterally.
zygapophyseal joints (synovial type)
82
T/F in synovial type, orientation of the articular facets dictate regional type and range of motion:
TRUE
83
Craniovertebral joints join in what two places?
the base of skull and cervical spine
84
Synovial plane joints are supported by what, which allows for what?
an articular capsule (allows for gliding in different places)
85
Cervical spine synovial joints are between what two planes allowing for a wide range of motion?
horizontal (transverse) & frontal (coronal) planes
86
The lumbar facet joints are oriented in what plane allowing for spinal flexion and extension?
sagittal plane
87
Posteriorly, zygapophyseal joints occur between what two articular processes on either side of the vertebral arch?
superior and inferior articular processes
88
The craniovertebral joints include what two joints?
atlanto-occipital joint & atlantoaxial joint
89
The atlanto-occipital joint is between what two structures?
the occipital condyles and C1 (atlas)
90
The atlantoaxial joint is between what two structures?
C1 and C2 (axis)
91
The atlantoaxial joint permits what movement?
head rotation ("no" movement)
92
The atlanto-occipital joint permits what movement?
head nodding ("yes" movement)
93
Where does rotation at the atlantoaxial joint occur?
around the axis of the dens of C2
94
T/F the vertebral column is supported by a series of ligaments that limit excessive spinal motion:
TRUE
95
The anterior longitudinal ligament spans from where to where?
from the occipital tubercle to the sacral over the anterior and lateral surfaces of the vertebral bodies and discs
96
What ligament is wide and strong and prevents hyperextension of the spine?
anterior longitudinal ligament
97
The posterior longitudinal ligament runs from where to where?
along the posterior surface of the vertebral bodies and discs from the axis to the scare and coccyx
98
What ligament is thin and provides little resistance to disc herniation, especially in the lumbar region? (hint: prevents hyperextension)
posterior longitudinal ligament
99
The location on the vertebra that connects adjacent laminae is called what?
location of ligament flavum
100
In an adult, the spinal cord spans from what to what?
the foramen magnum to approx. L2
101
The spinal cord in the CNS serves as what and conducts what?
serves as a reflex center and conducts motor + sensory signals between brain & body
102
The spinal cord has what shape?
cylindrical
103
Distally, the spinal cord tapers and ends where?
at L2 as the conus medullaris
104
Multiple spinal nerve rootlets emerge from the distal spinal cord and _____ _____ to exit the vertebral column:
conus medullaris
105
The nerve rootlets that emerge from the distal spinal cord and conus medullaris to exit the vertebral column is collectively called what?
cauda equina (latin for horse tail)
106
The spinal nerves exit above corresponding vertebrae in the cervical region and begin in the ____, ____, and ____ regions:
thoracic, lumbar, and sacral regions
107
In a cross section, the spinal cord has an "H"-shape core made up of cell bodies. What is this called?
gray matter (continuous)
108
What is peripheral white matter (saltatory) made up of?
nerve fibers (axons)
109
Gray matter is organized into ____ and ____ horns, which contain motor and sensory body cells:
anterior & posterior
110
The thoracolumbar region is at what vertebral levels?
T1-L2/L3
111
The thoracolumbar region features a what?
lateral horn
112
The lateral horn in the thoracolumbar region features a lateral horn that contains preganglionic sympathetic cell bodies organized into what?
intermediolateral cell column
113
Peripheral white matter is organized into specific tracts, what are they and are they sensory or motor?
ascending (sensory) & descending (motor) tracts
114
If a word has 'spino' at the beginning, does this indicate its afferent or efferent?
afferent (sensory)
115
If a word has 'spino' at the end, does this indicate its afferent or efferent?
efferent (motor)
116
White matter is ______ (saltatory) while gray matter is _____ (continuous).
white = myelinated (saltatory), gray = unmyelinated (continuous)
117
T/F the majority of nerves decussate:
TRUE
118
How many paired spinal nerves exit the vertebral column through the intervertebral foramina or sacral foramina at each vertebral level?
31
119
Anterior and posterior rootlets of the spinal nerves arise from the spinal cord laterally, representing what fibers?
motor (anterior) and sensory (posterior) fibers
120
The spinal nerve rootlets converge to form nerve roots, which contain autonomic and somatic motor or sensory components. What are these roots called, respectively?
- anterior root = autonomic & somatic motor
- posterior root = sensory
121
Pseudounipolar sensory neurons are housed where?
the spinal ganglion (posterior root ganglion)
122
Multipolar motor neuron cell bodies are found where? Their axons form what room?
- found in the anterior horn of the spinal cord
- axons form the anterior root
123
Once the spinal nerve has exited the vertebral column, it splits into what?
an anterior & posterior ramus
124
Is the general sensory afferent (GSA) system somatic or visceral? Where does it distribute to?
- somatic
- discriminative touch, proprioception, pain and temp from the skin, joints, and muscles
125
Where does the general visceral afferent (GSA) system convey?
sensation from the viscera
126
The general somatic efferent (GSE) system carries motor impulses to where?
skeletal muscles
127
The general visceral efferent (GVE) projects motor neurons to what?
viscera
128
What houses cell bodies for somatic and autonomic sensory neurons?
spinal ganglion
129
What anchors spinal cord inferiorly to the coccyx?
film terminale (pia)
130
What do the spinal meninges include?
dura mater, arachnoid mater, pia mater
131
Deep to the dura mater is the _____ _____, a delicate, web-like layers creates a subarachnoid space filled with CSF.
arachnoid mater
132
T/F is the subdural space considered a true space?
no, it shouldn't be visible unless bleeding occurs
133
Where does the lumbar cistern lie and what does it contain?
within the dural sac and contains CSF & caudal equina
134
What meningeal layer is closely adhered to the spinal cord?
pia mater
135
_____ ______ are extensions of pia that project laterally at each vertebral foramen level and anchor into the inner surface of the dura matter, separating anterior and posterior rootlets.
denticulate ligaments
136
What is an extension of pia from the tip of the conus medullaris that extends inferiorly to attach on the coccyx, acting as a caudal anchor for the spinal cord?
filum terminale
137
What artery serves the lower 2/3 of the spinal cord and is the largest of the medullary arteries?
great anterior segmental medullary artery (artery of Adamkiewicz)
138
T/F the radicular arteries anastomose with spinal arteries:
FALSE - they do not anatomies w spinal arteries
139
The radicular arteries supply what?
meningeal coverings and spinal nerve roots
140
The periostea and equatorial branches supply arterial blood to the _____ column:
vertebral
141
Where does the venous drainage of the vertebral column arise from?
spinal veins
142
There are 20-22 pairs of denticulate ligaments that line the spinal canal and help to do what?
anchor the spinal cord laterally
143
The conus medullaris terminates at what interspace?
L1-L2
144
The caudal equina consists of the posterior and anterior root from ____ to _____ vertebral levels, and descend below the level the conus medullaris:
L3 to coccygeal
145
What anchors the spinal cord inferiorly to the coccyx?
filum terminale
146
When performing a lumbar puncture, the needle should be inserted below the level at which the spinal cord ends. What area is this called?
conus medullaris
147
What joint has a dual innervation?
synovial
