Practical 2 Flashcards
(348 cards)
1
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- Acetabulum
- Acetabulum fossa
- Acetabular notch
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- Greater sciatic notch
- Lesser sciatic notch
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Arcuate line
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Ischiopubic ramus
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Pectineal line of pubis
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How can you tell if you are observing the left or right hip bone when in the anatomical position?
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Make sure of the following:
1. The symphysial surface of the pubis is vertical
2. The acetabulum faces inferolaterally
3. The obturator foramen faces inferomedial to acetabulum
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Fovea capitis femoris (fovea for the ligament of the head of femur)
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*Note: Anterior view
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What is the difference between the following:
Trochanteric fossa
Intertrochanteric crest
Intertrochanteric line
A
Trochanteric fossa = a depression on the medial surface of the greater trochanter
Intertrochanteric crest = a ridge between the greater and lesser trochanters on the POSTERIOR aspect of the femur
Intertrochanteric line = a ridge between the greater and lesser trochanters on the ANTERIOR aspect of the femur
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- Greater trochanter
- Lesser trochanter
- Quadrate tubercle
- Pectineal line (spiral line)
- Gluteal tuberosity
- Linea aspera
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a. Sacrotuberous ligament
b. Sacrospinous ligament
c. Inguinal ligament
d. Acetabular labrum
e. Ligamentum teres femoris
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What is the function of this?
A
Zona orbicularis:
A ligamentous band of circular fibers that surrounds the neck of the femur, that provides stability for the hip joint by reinforcing the joint capsule of the hip
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a. Iliofemoral ligament
b. Ischiofemoral ligament
c. Pubofemoral ligament
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What is the difference between the 'pelvic girdle' and the 'bony pelvis'?
Pelvic girdle = ilium, ischium and pubis
Bony pelvis = ilium, ischium, pubic, sacrum and coccyx
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What are the bones and articular surfaces of the following joints:
1. Sacroiliac joint
2. Pubic symphysis
3. Hip joint
1. Auricular surface of the sacrum & ilium
2. Medial surface of the left and right pubic bones
3. Head of the femur & acetabulum of the hip bone
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Classify each joint:
Sacroiliac joint
Pubic symphysis
Hip joint
Sacroiliac joint = synovial plane joint
Pubic symphysis = secondary cartilaginous joint (i.e. symphysis)
Hip joint = synovial ball-and-socket joint
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What are the movements possible at the hip joint?
Flexion
Extension
Abduction
Adduction
Internal (medial) rotation
External (lateral) rotation
Circumduction
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Gluteus maximus:
O = Posterior to the posterior
gluteal line of the ilium, dorsal surface of sacrum and coccyx and sacrotuberous ligament
I = Iliotibial tract and gluteal
tuberosity
NS = Inferior gluteal nerve
M = Extends thigh (especially from flexed position), assists in rising from sitting position, assists in lateral rotation
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Gluteus medius:
O = External surface of the ilium between anterior and posterior gluteal lines
I = Lateral surface of greater trochanter of femur
NS = Superior gluteal nerve
M = Abduct and medially rotate thigh, keeps pelvis level when opposite leg is raised
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Gluteus minimus:
O = External surface of the ilium between anterior and posterior gluteal lines
I = Anterior surface of the greater trochanter of femur
NS = Superior gluteal nerve
M = Abduct and medially rotate thigh, keeps pelvis level when opposite leg is raised
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Where does the iliotibial tract insert into?
Upper lateral part of the tibia (i.e. Gerdy tubercle)
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*Note: The obturator externus passes through the obturator foramen as opposed to going over it like the other deep gluteal muscles
(i.e the obturator externus is the deepest of the deep gluteal muscles)
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Piriformis:
O = Anterior surface of sacrum
I = Superior border of the greater trochanter
NS = L5, S1 and S2 anterior rami branches
M = Lateral rotation of the femur during hip extension and abducts the femur during hip flexion
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Superior gemelli:
O = Ischial spine
I = Medial surface of the greater trochanter
NS = Nerve to obturator internus
M = Lateral rotation of the femur during hip extension and abducts the femur during hip flexion
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Obturator internus (tendon):
O = Obturator membrane and surrounding bone
I = Medial surface of the greater trochanter
NS = Nerve to obturator internus
M = Lateral rotation of the femur during hip extension and abducts the femur during hip flexion
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Inferior gemelli:
O = Superior aspect of the ischial tuberosity
I = Medial surface of the greater trochanter
NS = Nerve to quadratus femoris
M = Lateral rotation of the thigh at the hip joint
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Quadratus femoris:
O = Lateral aspect of the ischial tuberosity
I = Quadrate tubercle on the intertrochanteric crest
NS = Nerve to quadratus femoris
M = Lateral rotation of the thigh at the hip joint
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1. Gluteus maximis (reflected)
2. Gluteus medius
3. Piriformis
4. Gemellus superior
5. Tendon of obturator internus
6. Gemellus inferior
7. Quadrator femoris
8. Sciatic nerve
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Biceps femoris:
O = Ischial tuberosity (long head), linea aspera and lateral supracondylar ridge (short head)
I = Lateral aspect of the fibular head
NS = Sciatic nerve (long head = tibial division, short head = common fibular division)
M = Flexes and laterally rotates the leg at the knee, and extends the thigh at the hip joint
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Semimembranosus:
O = Ischial tuberosity
I = Medial tibial condyle
NS = Tibial division of the sciatic nerve
M = Flexes and medially rotates the leg at the knee, and extends the thigh at the hip joint
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Semitendinosus:
O = Ischial tuberosity
I = Semitendinosus tendon attaches to the pes anserinus which inserts into the medial tibial condyle
NS = Tibial division of the sciatic nerve
M = Flexes and medially rotates the leg at the knee, and extends the thigh at the hip joint
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Femoral triangle?
1. Sartorius (lateral border)
2. Inguinal ligament (superior border)
3. Adductor longus (medial border)
4. Illiopsoas (lateral floor)
5. Pectineus (medial floor)
...
6. Femoral nerve
7. Femoral artery
8. Femoral vein
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From lateral to medial, identify the contents of the femoral triangle?
Lateral --> medial = NAVEL
1. Femoral nerve
2. Femoral artery
3. Femoral vein
4. Empty space
5. Lymph nodes
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Iliopsoas:
O = Transverse processes, bodies and discs of T12 to L5 vertebra (psoas major), iliac fossa (iliacus)
I = Lesser trochanter of the femur
NS = Anterior rami of L1-L3 nerves (psoas major), femoral nerve (iliacus)
M = Flexor of the thigh at the hip joint
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Sartorius:
O = Anterior superior iliac spine (ASIS)
I = Pes anserinus
NS = Femoral nerve
M = Assists in flexion of the thigh at the hip and the leg at the knee joint. It also abducts the thigh and laterally rotates (tailor’s position)
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Tensor fasciae latae:
O = Outer margin of the iliac crest, posterior to ASIS
I = Iliotibial tract
NS = Superior gluteal nerve
M = Stabilisers the knee and the hip joint
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Rectus femoris muscle (cut):
O = AIIS
I = Tibial tuberosity (via quadriceps femoris tendon and patellar ligament)
NS = Femoral nerve
M = Flexes thigh at the hip, extends leg at the knee
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Vastus intermedius:
O = Upper anterior and lateral femur
I = Tibial tuberosity (via quadriceps femoris tendon and patellar ligament)
NS = Femoral nerve
M = Extends the leg at the knee joint
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Vastus medialis:
O = Intertrochanteric line, linea aspera, medial supracondylar line
I = Tibial tuberosity (via quadriceps femoris tendon and patellar ligament)
NS = Femoral nerve
M = Extends the leg at the knee joint
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Vastus lateralis:
O = Intertrochanteric line, greater trochanter, gluteal tuberosity, linea aspera
I = Tibial tuberosity (via quadriceps femoris tendon and patellar ligament)
NS = Femoral nerve
M = Extends the leg at the knee joint
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Gracilis:
O = Pubic bone
I = Pes anserinus onto the medial proximal tibia
NS = Obturator nerve
M = Adducts the thigh at the hip joint and flexes the leg at the knee joint
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Pectineus:
O = Pecten pubis
I = Pectineal line of the femur
NS = Obturator nerve
M = Adduction of the thigh
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Adductor longus:
O = Anterior surface of the pubic bone
I = Linea aspera
NS = Obturator nerve
M = Adduction of the thigh
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Adductor brevis:
O = Body of the pubis
I = Upper linea aspera
NS = Obturator nerve
M = Adduction of the thigh
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Adductor magnus:
O = Ischiopubic ramus (adductor part), ischial tuberosity (hamstring part)
I = Linea aspera (adductor part), adductor tubercle (hamstring part)
NS = Obturator nerve (adductor part), sciatic nerve (hamstring part)
M = Adducts and medially rotates the thigh at the hip joint
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What is the femoral canal?
A small passage located at the medial aspect of the femoral vein within the femoral triangle of the thigh, and contains lymphatic vessels and lymph nodes
It is the most medial compartment of the femoral sheath, which also encloses the femoral artery and vein
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What is this passageway (1), function (2), where does it end (3), and boundaries (4)?
1. Adductor canal
2. Forms a passage for the femoral blood vessels and the saphenous nerve
3. Adductor hiatus
4. Anterior-laterally = vastus medialis
Medially = sartorius
Posteriorly = adductor longus and adductor magnus
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What is the relationship in position between the femoral sheath, femoral canal, femoral vein, femoral artery and femoral nerve?
The femoral sheath encases the femoral artery (lateral), femoral vein (medial), and femoral canal (most medial), while the femoral nerve is positioned outside and lateral to the sheath
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What is the clinical significance of the femoral canal and adductor canal?
Femoral canal = lymphatics pass through it
Adductor canal = femoral artery, femoral vein and saphenous vein pass through it
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How do you know if you are identifying the left or right femur?
1. The femoral head faces medially in the anatomical position
2. Make sure the distal condyles and popliteal surface are facing posteriorly
3. The medial condyle is larger and more prominent than the lateral condyle
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Is the soleus line or anteromedial surface of the tibia subcutaneous?
Soleus line = posterior
Anteromedial surface = subcutaneous, easily palpable and susceptible to injuries (i.e. tibial shaft fractures)
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How do you know if you are identifying the left or right tibia?
1. Tibial tuberosity faces anteriorly
2. Check where the medial malleolus is on the distal tibia
3. Check if the fibula is on the left or right of the tibia
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1. Styloid process of the fibula
2. Head of the fibula
3. Shaft of the fibula
4. Lateral malleolus
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How do you know if you are identifying the left or right fibula?
1. The styloid process faces superior-laterally
2. The lateral malleolus faces laterally
3. The malleolar fossa is medial to the lateral malleolus
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How do you know if you are identifying the left or right patella?
1. The base is the broad, superior portion
2. The apex is the pointed, inferior portion
3. Posteriorly, the medial fact for the medial femoral condyle is smaller than the facet for the lateral femoral condyle
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What three bones contribute to the articulating surfaces of the knee joint?
Femur: Medial and lateral femoral condyles
Tibia: Medial and lateral tibial condyles
Patella: Posterior surfaces of the patella articulate with the medial and lateral femoral condyles
*Note: Fibula does not contribute to the articulating surfaces of the knee joint
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1. Medial collateral ligament of the knee
2. Lateral collateral ligament of the knee
3. Medial meniscus
4. Lateral meniscus
5. Transverse ligament of the knee (or transverse meniscal ligament)
6. Anterior cruciate ligament
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1. Lateral meniscus
2. Medial meniscus
3. Posterior meniscofemoral ligament
4. Posterior cruciate ligament
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a. Ligamentum patellae
b. Oblique popliteal ligament
c. Arcuate popliteal ligament
d. Transverse meniscomeniscal ligament
e. Posterior meniscofemoral ligament
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a. Anterior inferior tibiofibular ligament
b. Posterior inferior tibiofibular ligament
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*Note: The inferior transverse tibiofibular joint is essential for integrity of the ankle joint
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What are the articular surfaces for the following joint:
Knee joint
Proximal tibiofibular joint
Distal tibiofibular joint
Knee joint = medial and lateral femoral & tibial condyles, and the posterior surface of the patella
Proximal tibiofibular joint = lateral condyle of the tibia and the fibula head
Distal tibiofibular joint = fibular notch of the tibia and the distal end of the fibula
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Classify the following joints:
Knee joint
Proximal tibiofibular joint
Distal tibiofibular joint
Knee joint = modified hinge synovial joint
Proximal TF joint = synovial plane joint
Distal TF joint = fibrous syndesmoses joint
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List the movements possible for the following joints:
Knee joint
Proximal tibiofibular joint
Distal tibiofibular joint
Knee joint = flexion, extension, limited medial and lateral rotation
Proximal TF joint = gliding movements of the fibula against the tibia
Distal TF joint = no active movement, but can accommodate small gliding movements of the ankle joint
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1. Biceps femoris muscle
2. Iliotibial tract
3. Quadriceps tendon
4. Patella
5. Patellar ligament
6. Pes anserinus
7. Sartorius
8. Tendon of gracilis
9. Tendon of semitendinosus
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1. Biceps femoris (superolateral border)
2. Semimembranosus (superomedial border)
3. Semitendinosus (superomedial border)
4. Medial head of the gastrocnemius (inferomedial border)
5. Lateral head of the gastrocnemius (inferolateral border)
6. Sciatic nerve
7. Tibial nerve (branch from the sciatic nerve)
8. Common fibular nerve (branch from the sciatic nerve)
9. Popliteal vein
10. Popliteal artery
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1. Tibialis anterior
2. Extensor hallucis longus
3. Extensor digitorum longus
4. Tendons on extensor digitorum longus
5. Tibialis posterior
6. Fibularis (peroneus) tertius
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Tibialis anterior:
O = Lateral tibial condyle and proximal 2/3 of anterolateral surface of the tibia
I = Inferior surface of medial cuneiform and base of the 1st metatarsal
NS = Deep fibular nerve
M = Foot inversion at the subtalar joint and dorsiflexion at the ankle joint
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Extensor digitorum longus:
O = Proximal medial half of the fibula, lateral tibial condyle and interosseous membrane
I = Base of the middle and distal phalanges of lateral 4 digits
NS = Deep fibular nerve
M = Dorsiflexion at the ankle joint, foot eversion at the subtalar joint and extension of the lateral 4 toes metatarsophalangeal and interphalangeal joints
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Extensor hallucis longus:
O = Middle and medial third of the fibula and Interosseous membrane
I = Base of distal phalanx of digit 1
NS = Deep fibular nerve
M = Extensor of big toe at the metatarsophalangeal and interphalangeal joint of the 1st digit and dorsiflexion at the ankle joint
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6?
Fibularis (peroneus) tertius:
O = Medial and distal third of the fibula and interosseous membrane
I = Base of the 5th metatarsal bone
NS = Deep fibular nerve
M = Dorsiflexion at the ankle joint and foot eversion at the subtalar joint
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1. Fibularis (peroneus) longus
2. Fibularis (peroneus) brevis
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1?
Fibularis (peroneus) longus:
O = Head of fibula, proximal 2/3 of fibula and interosseous membrane
I = Medial cuneiform and base of the 1st metatarsal
NS = Superficial fibular nerve
M = Foot eversion at the subtalar joint, plantarflexion at the ankle joint and supports longitudinal and transverse foot arches
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2?
Fibularis (peroneus) brevis:
O = Distal 2/3 of the lateral fibula and interosseous membrane
I = Tuberosity of the 5th metatarsal bone
NS = Superficial fibular nerve
M = Foot eversion at the subtalar joint and plantarflexion at the ankle joint
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Medial & lateral heads of gastrocnemius:
O = Medial and lateral femoral condyles
I = Posterior surface of the calcaneus via the calcaneal (achilles) tendon
NS = Tibial nerve
M = Flexion of the leg at the knee joint and foot plantarflexion at the ankle joint
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Soleus:
O = Soleal line, medial border of the tibia, head of fibula, and posterior border of the fibula
I = Posterior surface of the calcaneus via the calcaneal (achilles) tendon
NS = Tibial nerve
M = Foot plantarflexion at the ankle joint
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Plantaris:
O = Lateral supracondylar line of the femur, oblique popliteal ligament of the knee
I = Posterior surface of the calcaneus via the calcaneal (achilles) tendon
NS = Tibial nerve
M = Weak flexion of the leg at the knee joint and foot plantarflexion at the ankle joint
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1. Tendon of tibialis posterior
2. Tendon of flexor digitorum longus
3. Muscle + tendon of flexor hallucis longus
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Popliteus:
O = Lateral femoral condyle
I = Posterior surface of the proximal tibia - superior to the soleal line
NS = Tibial nerve
M = Prevent hyperextension of the knee joint by unlocking it and laterally rotates the femur on the tibia
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Tibialis posterior:
O = Interosseous membrane and the proximal surface of the posterior tibia and fibula
I = Tuberosity of navicular bone and medial cuneiform bone
NS = Tibial nerve
M = Foot inversion at the subtalar joint, plantarflexion at the ankle joint and supports medial longitudinal foot arches
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Flexor digitorum longus:
O = Posterior surface of the tibia (inferior to the soleal line)
I = Base of the distal 4 lateral phalanges
NS = Tibial nerve
M = Flexion of the lateral 4 digits at the metatarsophalangeal and interphalangeal joints
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Flexor hallucis longus:
O = Interosseous membrane and the distal 2/3 of the posterior surface of the fibula
I = Base of the distal phalanx of the great toe
NS = Tibial nerve
M = Foot plantarflexion at the ankle joint, foot inversion at the subtalar joint and flexion of the great toe at the 1st metatarsophalangeal and interphalangeal joint
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Name and identify what action do the muscles that cross the knee joint anteriorly have in common?
Quadriceps femoris muscles (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius) = EXTENDING THE KNEE
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Name and identify what action do the muscles that cross the knee joint posteriorly have in common?
Hamstring muscles (short and long head of biceps femoris, semitendinosus, semimembranosus) = FLEXING THE KNEE
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Name the muscles which cross both the hip joint and the knee joint?
Sartorius
Rectus femoris
Biceps femoris
Semitendinosus
Semimembranosus
Gracilis
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Medial longitudinal arch of the foot (plantar view)?
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Transverse arch of the foot (plantar view)?
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What ligaments make up the inferior tibiofibular joint?
Anterior inferior tibiofibular ligament
Posterior inferior tibiofibular ligament
Transverse tibiofibular ligament
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Where are the peroneal and flexor retinacula located around the ankle?
Peroneal retinacula = lateral side of the ankle
Flexor retinaculum = medial side of the ankle
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What are the names of these joints?
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What is the name of this joint?
Transverse tarsal joint (calcaneocuboidal and talonavicular part of talocalcaneonavicular joint)
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What is the name of this joint?
Tarsometatarsal joint
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Name the articular surfaces for the following joints:
Ankle joint
Subtalar joint
Transverse tarsal joint (calcaneocuboidal part)
Tranverse tarsal joint (talonavicular part)
Tarsometatarsal
Metatarsophalangeal
Interphalangeal
Ankle joint = distal tibia (medial malleolus), distal fibula (lateral malleolus) and the trochlea of the talus
Subtalar joint = inferior surface of the talus and the superior surface of the calcaneus
Transverse tarsal joint (calcaneocuboidal part) = anterior surfaces of the calcaneus and posterior surface of the cuboid
Transverse tarsal joint (talonavicular part) = head of the talus and proximal surface of the navicular
Tarsometatarsal = distal surfaces of the cuboid, medial/intermediate/lateral cuneiforms with the proximal row of the 1st-5th metatarsals
Metatarsophalangeal = distal heads of the metatarsals and base of the proximal phalanges
Interphalangeal = head of the 'proximal' phalanx with the base of the 'more distal' phalanx
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Classify the following joints:
Ankle joint
Subtalar joint
Transverse tarsal joint (calcaneocuboidal part)
Tranverse tarsal joint (talonavicular part)
Tarsometatarsal
Metatarsophalangeal
Interphalangeal
Ankle joint = synovial hinge joint
Subtalar joint = synovial plane joint
Transverse tarsal joint (calcaneocuboid part) = synovial saddle joint
Transverse tarsal joint (talonavicular part) = synovial ball-and-socket
Tarsometatarsal = synovial plane joint
Metatarsophalangeal = synovial condyloid joint
Interphalangeal = synovial hinge joint
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List the movements possible at the following joints?
Ankle joint
Subtalar joint
Transverse tarsal joint (calcaneocuboidal part)
Tranverse tarsal joint (talonavicular part)
Tarsometatarsal
Metatarsophalangeal
Interphalangeal
Ankle joint = dorsiflexion and plantarflexion
Subtalar joint = inversion and eversion
Transverse tarsal joint (calcaneocuboidal part) = inversion and eversion
Tranverse tarsal joint (talonavicular part) = inversion and eversion
Tarsometatarsal = dorsiflexion, plantarflexion, inversion and eversion
Metatarsophalangeal = dorsiflexion and plantarflexion
Interphalangeal = flexion and extension
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Explain the relative position of the extensor digitorum brevis and the extensor hallucis brevis?
Both muscles are deep to the tendons of the extrinsic leg/foot muscles but are superficial to the deeper interossei muscles
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Extensor digitorum brevis:
NS = Deep fibular nerve
M = Extension of the distal 2-4 phalanges at their interphalangeal joints
Extensor hallucis brevis:
NS = Deep fibular nerve
M = Extension of the great toe at the 1st metatarsophalangeal joint
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1. Tendon of tibialis anterior
2. Deltoid ligament
3. Tendon of tibialis posterior
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1. Calcaneofibular ligament
2. Anterior talofibular ligament
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What is the red space joint outlined and what is its function?
Malleolar mortise (a type of joint space), enclosed by the medial malleolus by the tibia and lateral malleolus by the fibula)
Function:
Forms a socket where the talus can fit, allowing ankle movement
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What forms the lumbar plexus?
Ventral rami of L1-L4
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What forms the sacral plexus?
Ventral rami of L4-S4
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1. Obturator nerve
2. Femoral nerve
3. Lateral cutaneous nerve of the thigh
4. Genitofemoral nerve
5. Ilio-inguinal nerve
6. Iliohypogastric nerve
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Lateral cutaneous nerve of the thigh
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Genitofemoral nerve
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Pudendal nerve
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1. Superior gluteal nerve
2. Inferior gluteal nerve
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List the changes in arteries in the lower limb?
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1. Superior gluteal artery
2. Inferior gluteal artery
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List the arteries originating from the internal iliac artery?
Internal iliac artery --> superior and inferior gluteal arteries
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List the arteries originating from the external iliac artery?
External iliac artery --> passes underneath the inguinal ligament --> femoral artery --> reaches the popliteal fossa --> popliteal artery --> anterior tibial artery and tibioperoneal artery
*Note: The femoral artery has a profunda femoral artery that has its own branches 3-4cm below the inguinal ligament
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List the arteries continuing from the anterior tibial artery and tibioperoneal artery?
Anterior tibial artery --> passes underneath the extensor retinacula at the ankle --> dorsali pedis artery
Tibioperoneal artery --> branches into the posterior tibial artery and the fibular (peroneal) artery
*Note: The posterior tibial artery passes underneath the flexor retinaculum into the foot and divides into the medial and lateral plantar arteries
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Describe the venous drainage of the great saphenous vein?
Dorsal venous arch --> great saphenous vein (on the medial side of the foot) --> travels along the medial aspect of the leg (accompanied by the saphenous nerve) --> travels along the medial thigh --> drains into the femoral vein just below the inguinal ligament
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Describe the venous drainage of the small saphenous vein?
Dorsal venous arch --> small saphenous vein (on the lateral side of the foot) --> passes posterior to the lateral malleolus --> passes posterior and superficial to the gastrocnemius (accompanied by the sural nerve) --> drains into the popliteal vein --> the popliteal vein drains into the femoral vein (after exiting the popliteal fossa and passing the adductor hiatus)
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What are the curvatures of the spine?
Primary (concave anteriorly) = thoracic and sacral region
Secondary (concave posteriorly) = cervical and lumbar region
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What mainly accounts for, or causes the secondary (compensation) curvature?
Develops after birth to help shift the weight of the baby to a permit upright position when learning how to sit upright, stand and walk
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Define kyphosis, lordosis, scoliosis?
Kyphosis = excessive outward curvature of the thoracic vertebrae
Lordosis = excessive inward curvature of the lumbar vertebrae
Scoliosis = sideways curvature of the spine
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Compare the width of the vertebral bodies?
The vertebral bodies increase in size from the cervical to the lumbar region, accommodating the increasing load as you move downward along the spine
Cervical = small, wider side-to-side bodies
Thoracic = larger and heart-shaped with facets for rib articulation
Lumbar = largest, kidney-shaped bodies to support more weight
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Compare the size of the intervertebral disc of the vertebrae?
Intervertebral discs also become thicker, especially from the thoracic to the lumbar region, to support the increased mechanical stress and weight bearing
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Compare the size and shape of the spinous processes and transverse processes in the vertebrae?
Cervical = smaller, bifid spinous processes (except C7) and transverse processes, containing the transverse foramen in between both processes
Thoracic = longer, downward-angled spinous processes suited for increasing the surface area for muscle attachment, and long, prominent transverse processes containing a costal facet for articulating with the costal cartilage
Lumbar = massive, short, and thick spinous and transverse processes for muscle attachment and weight support
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Compare the size and orientation of the superior and inferior articular processes in the vertebrae?
The size of the articular facets increases from cervical to lumbar regions, adapting to the differing movements and loads.
Cervical = flat to facilitate a wide range of motion
Thoracic = vertical orientated anteriorly to restrict flexion and extension while allowing some rotation
Lumbar = vertical and medially/lateral facing to primarily allow flexion and extension and limit rotation
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Compare how the vertebrae articulate with each other?
The amount of articulation between vertebras decreases as you move down the vertebral column
Cervical = high degree of flexion, extension and rotation in all directions
Thoracic = limited flexion, extension and rotation due to rib attachments, emphasising limited rotational movements
Lumbar = primarily allow flexion and extension with limited rotation to support body weight
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Compare the size of the intervertebral foramina between each pair of vertebrae on either side?
Intervertebral foramina are smallest in between the cervical vertebrae (because cervical spinal nerves are smaller and fewer) and the largest in between the lumbar vertebrae (typically larger to prevent the compression of larger spinal nerves passing through them)
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What passes through the intervertebral foramina?
Spinal nerves, dorsal root ganglion, spinal artery, and communicating veins between the internal and external vertebral venous plexuses
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Which movement decreases the size of the intervertebral foramina?
Extension (generally narrows these openings, potentially compressing the nerves that pass through them) and lateral flexion
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Compare the vertebral arch made up of pedicles and lamina, surrounding the vertebral foramen?
Cervical = large triangular vertebral foramen for the passage of the cervical spinal cord
Thoracic = smaller and circular
Lumbar = triangular but smaller than in the cervical area
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What is the function of each of the cervical, thoracic, and lumbar vertebrae?
Cervical = support the head's weight and its movement, protects the cervical part of the spinal cord and allow a high degree of flexion, extension and rotation for nodding and turning the head
Thoracic = attachment point for the ribs, protects vital organs and allow less mobility
Lumbar = bear the majority of the body's weight by absorbing and distributing immense forces during strenuous activities, and allow flexion and extension
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How does the centrum (aka vertebral body) and neural arch (aka vertebral arch) relate to these vertebral parts?
Centrum = main weight-bearing structure, absorb shock, and provide a strong platform for the intervertebral disc
Neural arch = formed by the pedicles and lamina to form the vertebral foramen that encloses and protects the spinal cord. Neural arch also serves as an attachment point for muscles and ligaments via the superior and inferior articulation points, transverse and spinous processes
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Typical cervical vertebrae?
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C1 atlas --> atypical cervical vertebra?
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C2 axis --> atypical cervical vertebra?
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C2 axis --> atypical cervical vertebra?
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a. Typical cervical vertebra
b. Typical thoracic vertebra
c. Typical thoracic vertebra
d. Typical lumbar vertebra
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Typical thoracic vertebra?
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Typical thoracic vertebra?
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Typical lumbar vertebra?
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Typical lumbar vertebra?
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What are the typical and atypical vertebrae of the cervical and thoracic region?
Cervical typical = C3-C6
Cervical atypical = C1 (atlas), C2 (axis), C7 (vertebra prominens)
Thoracic typical = T2-T8
Thoracic atypical = T1, T9-T12
Lumbar typical = L1-L4
Lumbar atypical = L5
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The thoracic vertebrae articulates with a separate rib. How is the costal element incorporated into the cervical, lumbar and sacral vertebrae?
Cervical = transverse foramina is believed to be a remnant of a previous more extensive rib-like structure
Lumbar = costal processes are thought to be remnants of ribs that have become fused to the transverse processes during evolution
Sacral = ala (lateral parts of the sacral wings) are fused remnants of the ribs that were associated with the original sacral vertebrae before fusing into one combined vertebrae
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What is the function of the transverse foramen found only in the cervical vertebrae?
Facilitates the passage and protection of the vertebral artery, vertebral vein, and accompanying sympathetic nerve fibres
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Explain the movement possible at the different vertebrae and explain why?
Cervical = flexion, extension, rotation and some lateral flexion (greatest ROM because of the relative thickness of IV discs, nearly horizontal articular facets and the small amount of surrounding body mass)
Thoracic = limited flexion, extension and lateral flexion, but great degree of rotation (because of the attachment of the rib cage, the vertical orientation of the articular facets, and overlapping spinous processes)
Lumbar = high degree of flexion, lateral flexion and limits rotation (because of the large thickness of the IV discs, and the vertical articular facets permitting mainly forward and backward flexion/extension)
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a. Intervertebral joint
b. Sacrococcygeal joint
c. Zygapophysial joint
d. Uncovertebral joint
e. Sacroiliac joint
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Classify the following joints:
Intervertebral joint
Sacrococcygeal joint
Zygapophysial joint
Uncovertebral joint
Sacroiliac joint
Intervertebral joint = secondary cartilaginous joint/symphyses
Sacrococcygeal joint = secondary cartilaginous joint/symphyses
Zygapophysial joint = synovial plane joint
Uncovertebral joint = synovial plane joint
Sacroiliac joint = synovial plane joint
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Three joint complex:
The combination of an intervertebral disc and a pair of zygapophysial joints in C2/3 to L5/S1
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During movement, what is the function of the:
Anterior longitudinal ligament
Posterior longitudinal ligament
Anterior longitudinal ligament = limits hyperextension of the spine (i.e. can resist backward bending)
Posterior longitudinal ligament = limits hyperflexion of the spine (i.e. can resist forward bending)
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What is the strongest elastic ligament in the body, and what is its function in the vertebral column?
Ligamentum flavum
Helps to preserve the normal curvature of the vertebral column and assists with straightening of the vertebral column after flexing
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1. Annulus fibrosus
2. Nucleus pulposus
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a. Atlanto-occipital joint (between the occipital condyles and superior facets of the atlas)
b. Median atlanto-axial joint (dens of the axis and the anterior arch of the atlas)
c. Lateral atlanto-axial joint
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Classify the following joints:
Atlanto-occipital joint (median & lateral)
Atlanto-axial joint (median)
Atlanto-axial joint (2 lateral)
Atlanto-occipital joint (median & lateral) = synovial condyloid joint
Atlanto-axial joint (median) = synovial pivot joint
Atlanto-axial joint (2 lateral) = zygapophyseal (synovial plane) joint
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a. Ligamentum flava (yellow ligaments between the laminae of adjacent vertebrae)
b. Interspinous ligament
c. Supraspinous ligament
d. Intertransverse ligament
e. Ligamentum nuchae (thick ligament that covers the spinous processes of the cervical vertebrae)
f. Anterior longitudinal ligament
g. Posterior longitudinal ligament
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What are the boundaries of the thoracic inlet (or superior thoracic aperture)?
Anterior = superior border of the manubrium
Posterior = first thoracic vertebrae
Lateral = First ribs and their costal cartilages
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What are the boundaries of the thoracic outlet (or inferior thoracic aperture)?
Anterior = xiphoid process of the sternum
Posterior = 12th thoracic vertebrae
Medial-lateral = ribs 7-10 costal cartilages
Lateral = 12th pair or ribs
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Parts of the sternum?
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Joints of the sternum?
Manubriosternal joint = sternal angle
Xiphisternal joint = infrasternal angle
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Rib 1?
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1. What does the tubercle of the first rib articulate with?
2. What is the scalene tubercle an attachment for?
3. What is the position of the groove for the subclavian artery and subclavian vein
1. Transverse process of T1
2. Attachment for scalene anterior
3. Artery = superior surface of the 1st rib and posterior to the scalene tubercle, vein = superior surface of the 1st rib and anterior to the scalene tubercle
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Where is the costal groove located on ribs 3-7 (typical ribs) and what is located on the groove?
Found on the inferior side of the inner surface of the shaft
For intercostal veins, artery and nerve
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What is the vertebral level of the sternal angle and the infrasternal angle, and the rib that articulates with the sternum at these two angles?
Sternal angle = T4/T5 intervertebral disc, and hyaline cartilage for ribs 1
Infrasternal angle = inferior to T12 and connected hyaline cartilage for ribs 7-10
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a. Sternochondral joint
b. Costochondral joint
c. Costotransverse joint
d. Costovertebral joint
e. Interchondral joint
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a. Radiate ligament
b. Lateral costotransverse ligament
c. Costotransverse ligament
d. Superior costotransverse ligament
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Classify the joints found in the thoracic cage:
Intervertebral joint
Sternoclavicular joint
Manubriosternal joint
Xiphisternal joint
Sternochondral joint
Interchondral joint
Costochondral joint
Costovertebral joint
Costotransverse joint
Intervertebral joint = secondary cartilaginous (symphysis) joint
Sternoclavicular joint = secondary cartilaginous (symphysis) joint
Manubriosternal joint = secondary cartilaginous (symphysis) joint
Xiphisternal joint = secondary cartilaginous (symphysis) joint
Sternochondral joint = fibrocartilaginous joint (1st rib), and synovial plane joint (remaining ribs)
Interchondral joint = synovial plane joint
Costochondral joint = primary cartilaginous (synchondrosis) joint)
Costovertebral joint = synovial plane joint
Costotransverse joint = synovial plane joint
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What is the costal margin?
It is the medial margin formed by the cartilages of ribs 7-10
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What are the muscle groups of the back?
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What are the intrinsic muscles of the back?
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What are the extrinsic muscles of the back?
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What nerves supply the extrinsic back muscles?
Anterior rami of the spinal nerves
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What is the main, general function of the extrinsic back muscles?
Moving the upper limb
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TRAPEZIUS
O = Superior nuchal line & nuchal ligament spinous processes of C7-T12
I = Lateral ⅓ of the clavicle, acromion and spine of the scapula
NS = CN XI accessory nerve (motor fibres) & C3 and C4 nerve (sensory)
M = Elevates the scapula (descending fibres), retracts the scapula (middle fibres) & depresses the scapula (ascending fibres)
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LATISSIMUS DORSI
O = Spinous processes of T7-T12, thoracolumbar fascia, iliac crest, lower 4 ribs
I = Bicipital groove
NS = Thoracodorsal nerve
M = Extension, adduction and medial rotation of the humerus & raises the body to the arms during climbing
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LEVATOR SCAPULAE
O = Transverse process of C1-C4
I = Superior angle (or superior border) of the scapula
NS = Dorsal scapular nerve
M = Elevates the scapula
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RHOMBOID MINOR
O = Spinous processes of the 7th cervical vertebrae & 1st thoracic vertebrae
I = Medial border of the scapula (level of the spine)
NS = Dorsal scapular nerve
M = Retracts the scapula & rotate the scapula to tilt the glenoid cavity inferiorly
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RHOMBOID MAJOR
O = T2-T5 spinous processes
I = Medial border of the scapula (inferior to the spine)
NS = Dorsal scapular nerve
M = Retracts the scapula & rotate the scapula to tilt the glenoid cavity inferiorly
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SERRATUS POSTERIOR SUPERIOR:
NS = Intercostal nerves
M = Elevates the ribs, and acts as an accessory muscle of inspiration
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SERRATUS POSTERIOR INFERIOR:
NS = Intercostal nerves
M = Depresses the ribs, and prevents elevation of the ribs when the diaphragm contracts
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What nerves supply the intrinsic back muscles?
Posterior rami of the spinal nerves
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Spinotransversales?
1. Splenius capiticis
2. Splenius cervicis
M = lateral flexion and rotation of the head and neck to the same side (unilateral contraction), extends the head and neck (bilateral contraction)
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Erector spinae?
1. Spinalis (capitis, cervicis, thoracis)
2. Longissimus (capitis, cervicis, thoracis)
3. Iliocostalis (cervicis, thoracis, lumborum)
M = lateral/ipsilateral flexion of the spine (unilateral contraction), extension of the spine (bilateral contraction)
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Transversospinalis?
a. Semispinalis --> 5-6 vertebrae/fibre
(capitis, cervicis, thoracis)
b. Rotatores -->1-2 vertebrae/fibre
(cervicis, thoracis-most dominant, lumborum)
c. Multifidus --> 2-3 vertebrae/fibre
(cervicis, thoracis, lumbar-most dominant, sacral)
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What are the movements of the muscles in the transversospinalis muscle group?
Semispinalis = Ipsilateral flexion of the neck and spine with contralateral rotation of the head (unilateral contraction), draws the head posteriorly, extension of the neck and thoracic spine (bilateral contraction)
Rotatores = Contralateral rotation of the trunk (unilateral contraction), extension of the vertebral column (bilateral contraction)
Multifidus = Ipsilateral flexion and contralateral rotation of the vertebral column (unilateral contraction), extension of the vertebral column at all levels (bilateral contraction)
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Segmental?
a. Levator costarum
b. Interspinalis
c. Intertransversaris
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What are the movements of the muscles in the segmental muscle group?
Levator costarum = Elevate the ribs and facilitate inspiration during breathing
Interspinalis = Stabilise the adjoining vertebrae and assist with extension of the cervical and lumbar spine
Intertransversaris = Assist in lateral flexion and stabilisation of the cervical spine, aid in ipsilateral lateral flexion of the lumbar spine, and stabilise the spine
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Suboccipital?
a. Rectus capitis posterior major muscle
b. Rectus capitis posterior minor muscle
c. Obliquus capitis inferior muscle
d. Obliquus capitis superior muscle
M = Extensors & lateral flexors of the head
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Suboccipital?
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Name the prevertebral and lateral vertebral muscles?
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1. Quadratus lumborum
2. Psoas minor
3. Psoas major
4. Iliacus
5. Sartorius
6. Tensor fascia lata
7. Pectineus
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What are the muscles of the trunk divided into?
Thoracic muscles
Abdominal wall muscles
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Name & function of the extrinsic thoracic muscles?
1. Neck muscles (SCM, scalene)
2. Upper limb muscles (pec major, pec minor, serratus anterior)
3. Abdominal muscles (external abdominal oblique, rectus abdominis)
...
--> Movement of the upper limb, neck or trunk
--> Accessory breathing muscles (elevate/depress the ribs during deep inspiration or forced expiration)
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Nerve supply & movement of the 2 muscle groups?
Sternocleidomastoid muscle:
NS = Spinal root of CN XI (motor), C2/C3 nerves (proprioception and pain)
M = Lateral flexion and rotation of the neck (unilateral contraction), flexion of the neck (bilateral contraction)
Scalene:
NS = Anterior rami of the cervical spinal nerves
M = Elevates ribs 1 (anterior and middle) and ribs (posterior), lateral flexion and neck rotation
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*Note: Pectoralis minor is deep to the pectoralis major
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Name & function of the intrinsic thoracic muscles?
1. External/internal/innermost intercostal muscle
2. Transversus thoracis muscle
3. Subcostal muscle
4. Thoracic diaphragm
5. Levator costarum muscle
--> Primarily moves the thoracic wall during breathing
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a. External intercostal muscle (yellow), internal intercostal muscle (white)
b. Innermost intercostal muscle
c. Intercostal vein, intercostal artery, intercostal nerve (Superior to inferior –> VAN)
d. Transverse thoracis muscle
e. Subcostal muscle
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Levator costarum muscle
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Name & function of the abdominal wall muscles?
Anterolateral abdominal wall muscles --> flex the trunk, support abdominal viscera, and increase the intra-abdominal pressure:
--> External oblique abdominis, internal oblique abdominis, transverse abdominis, rectus abdominis
Posterior abdominal wall muscles --> assist with lateral flexion of the trunk or hip flexion:
--> Psoas major (+ psoas minor present in 50% of the population), quadratus lumborum, iliacus
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Posterior abdominal wall muscles?
1. Quadratus lumborum
2. Psoas minor
3. Psoas major
4. Iliacus
5. Sartorius
6. Tensor fascia lata
7. Pectineus
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What is the function of the thoracolumbar fascia?
Plays an important role in posture, load transfer, respiration and is in a position to assist with maintaining the integrity of the lower lumbar spine and the sacroiliac joint
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Name the muscles that form the medial, lateral and inferior borders of the suboccipital triangle. What are the contents of this triangle?
Medial border = Rectus capitis posterior major muscle
Lateral border = Obliquus capitis superior muscle
Inferior border = Obliquus capitis inferior muscle
Contents:
Suboccipital nerve (dorsal rami of C1), 3rd part of the vertebral artery (V3), and the suboccipital venous plexus
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1. Central tendon
2. Muscular part (mostly costal)
3. Right crura
4. Left crura
5. Median arcuate ligament
A. Caval hiatus
B. Oesophageal hiatus
C. Aortic hiatus
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1.Aortic hiatus
4.Central tendon
6.Muscular part (sternal, costal)
11.Caval hiatus
12.Left crura
14.Median arcuate ligament
15.Oesophageal hiatus
18.Right crura
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What are the vertebral level of the hiatuses passing through the diaphragm?
Caval (IVC) = T8
Oesophageal = T10
Aortic = T12
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What structures pass through the hiatuses in the diaphragm?
Caval hiatus:
Inferior vena cava
Terminal branches of the right phrenic nerve
Oesophageal hiatus:
Oesophagus
Left and right vagus trunks
Oesophageal branches of the gastric vessels
Lymph vessels
Aortic (IVC) hiatus:
Aorta
Thoracic duct
Azygos vein
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What is the position of the hiatuses in the diaphragm?
Caval = muscular part of the diaphragm, near the right crus
Oseophageal = muscular part of the diaphragm, near the right crus
Aortic = between the crura at the level of T12
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314
315
316
317
318
319
320
321
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Disc herniation between L4/L5
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Dermatome innervation?
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Cutaneous nerve innervation?
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337
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Varicose veins
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*Note: Spinous process ≠ level (slope)
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Palpating of arterial pulses?
a. Femoral artery pulse
b. Popliteal artery pulse
c. Posterior tibial artery pulse
d. Dorsalis pedis artery pulse
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Which peripheral nerves are tested with each of these reflexes?
a. Patellar tendon reflex for femoral nerve (L2-L4 spinal root)
b. Achilles tendon reflex for tibial nerve (S1 spinal root)
