1. How many spinal vertebrae are there?

2. How many spinal nerves?

3. How much of the spine is bone?

4. How much is not?

1. 30

2. 31

3. 3/4

4. 1/4

1. the shape of the vertebrae
2. strength of the vertebrae and the invertebral discs
3. strong ligaments
4. the surronding musculature

Primary Curves: thoracic and sacrococcygeal or "kyphotic" curves. Develop early in fetal growth to allow viscera growth.

Secondary Curves: cervical and lumbar or "lordotic" curves. Develop later in infancy to allow for head and body support. These curves develop as a result of differences in thickness between anterior and posterior invertebral discs. 

1. What is Scoliosis? 

2. What are potential causes of Scoliosis?

3. Term for "huntch back", pregnant woman

1. An abnormal curvature laterally where spinous processes also turn toward the curve cavity. 

2. Potential causes: 

• Asymetric weakness of back muscles (curves toward stronger side) 
• Failure of 1/2 of vertebrae to develop
• Leg length differences producing muscle contractures

3. Kyphosis,  Lordosis

1. What does the atlantooccipital joint include? 

2. What is the joint between C1 and C2 called? What type of joint is it?

3. Where are facet joints/zygapophyseal joints located?

4. What are symphysis joints between adjecent vertebral bodies called? Where do they run?

5. What are joints between vertebrae and ribs called?

6. What joint is between the sacrum/pelvis?

7. What are the 6 vertebral column joints?

-What kind of movement does the Atlantooccipital joint do?

-Name the parts of the atlas vertebre? 

-Biaxial movement/ its a condyloid/ ellipsoidal joint

- Articular processes, inferior articular facet, inferior articular process, transverse process, superior articular process, pedicle, vertebral foramen, vertebral body

1. End Plate

2. anulus fibrosus

3. nucleus pulposus 

1. What does the Anterior longitudinal ligament protect?
2. Are intervertebral discs symphysis joints?
3. Whats another name for symphasis joints?
4. Cartiliginious joints are ____
5. There is a Disc between C1 and C2. T or F
6. Where do Annuli insert?
7. What is the most inferior functional disc?
8. Intervertebral dics are ________ joints designed for what? They consist of  an ______ surrounding gelatinous ______.

1. Just the anterior
2. Yes
3. amphiarthrosis
4. synarthrosis/synchondrosis
5. FALSE 
6. On the rounded rims of vertebral bodies
7. L5/S1
8. fibrocartilaginous, designed for weight bearing and strength (allow movement) They consist of an annulus fibrosus, surrounding gelatinous nucleus pulposus.

Where and what do these connect:

1. Anterior longitudinal ligament

2. Posterior longitudinal ligament

3. Ligamentum Flavum

4. Interspinous Ligament

5. Supraspinous Ligament

1. Where does the Anterior Longitudinal Ligament span from? Describe it.
2. What is the Anterior Longitudinal Ligament's function?

1. Broad fibrous band extending from the anterior surface of the sacrum to the anterior tubercle of C1 and occipital bone anterior to the foramen magnum
2. To maintain stability of intervertebral joints and help to prevent hyperextension of the vertebral column

1. Describe the Posterior Longitudinal Ligament
2. What does it prevent/protect?
3. Where is it located?

1. Narrower, weaker, and within the vertebral canal but connects to intervertebral disks and vertebral bodies
2. Prevents hyperflexion and protects the discs
3. Extends from C2 to the sacrum

-The supraspinous Ligament is a ____ ligament that runs along the ________ surface of the spinous processes from the __ cervical vertebra to the ______

-What is its function?

-thin, posterior, 7th, sacrum

-Prevents hyperflexion

1. The Interspinous Ligament is big?
2. Where is it found?
3. Does it prevent hyperextention or hyperflexion?

1. False, small
2. Between the adjecent spinous processes of all vertebra from the 7th cervical vertebra to the sacrum
3. Hyperflexion

1. What does the Ligamentum Nuchae do?
2. Where is it located exactly?
3. Does it prevent hyperflexion or hyperextension?
4. Where does it extend from?

1. Replaces the Supr and Interspinous ligaments in the cervical spine
2. Loacted along the lamina
3. Prevents hyperflexion
4. Extends from the occiput to C7

1. Name 2 Dangerous injuries that happen to the vertebral column.

1. Anterior Flexion and hyperextension

1. How does Anterior flexion occur?
2. What causes this to damage in the vertebral column?

1. Occurs with sudden and forceful acceleration of the head/torso forward (head on collision)
2. Causes:

• Compression fracture of the vertebral boddies
• Fracture of the articular facets
• Rupture of the posterior longitudinal ligament
• Displacement of the superior vertebrae anteriorly over the inferior vertebrae
• Usually permanent damage of the spinal cord

1. How does Hyperextension occur?
2. What does it cause to the vertebral column?

1. Occurs with sudden and forceful acceleration of the head/torso backwards (rear ended)
2. Causes

• The destruction of part of or displacement of the vertebral arches
• Breaking of the transverse foramen (arteries are affected/maybe severed)
• Rupture of the anterior longitudinal ligament
• C1 is crushed between the occipital bone and C2 (more accelerating movement potential w/ hyperextension). If C2/C3 disk ruptures, this will sever cord. 

1. Where do verteral arteriest pass through on the cervial vertebrae?
2. Name the movements the cervical vertebral column can do
3. Name the movements the thoracic vertebral column can do
4. Name the movements the lumbar vertebral column can do
5. Name the movements the sacral column can do
6. Name the movements the coccygeal column can do

1. Through the transverse foramen
2. Flexion/extension, lateral flexion, rotation
3. Lateral flexion, rotation
4. Flexion/ extension, lateral flexion, rotation
5. Flexion/ extension, lateral flexion, rotation
6. Flexion/ extension. lateral flexion, rotation

NOTE: Flexion and extension- greatest in lumbar region, rotation and lateral flexion: greatest in thoracic

1. What are movements created by in the vertebral column?
2. What are movements limited by in the vertebral column?

1. Back muscles, anterolateral abdominal muscles, gravity
2. Thickness and flexibility/ compressibility of discs, muscle and ligament resistance, facet joints and their joint capsules, ribcage (in thoracic region)

Spinal Vasculature:

1. What arteries supply the head and neck?
2. What arteries supply the thorax, abdomin, and pelvis?
3. What spinal veins supply the vertebral column? Where do they drain?

1. Branches from the subclavian artery
2. Branches from the descending aorta
3. Venous plexuses extend throughout the vertebral column both inside and outside the vertebral canal. They drain to the azygos vein primarily. 

RULES:

-For joints that permit flexion/extension: 

-For joints that permit lateral flexion:

-For joints that permit rotation:

- If the action line crosses the anterior aspect of the joint, the muscle is a flexor; if the action line crosses the posterior aspect of the joint, the muscle is an extensor.

- If the action line is diagonal in anterior view, the muscle is likely a lateral flexor.

-If the action line is diagonal or horizontal in sagittal view, the muscle is likely a rotator

1. Name all the neck muscles (cervical):
2. Name Back/Trunk Muscles (thoracic and lumbar):

1. Suboccipital muscles, muscles of the mouth & hyoid bone, prevertebral muscles, sternocleidomastoid, scalenes, splenius muscles
2. Rectus abdominis, obliques, transversus abdominis, erector spinae muscles, transversospinalis muscles, interspinalis, intertransversarii, quadratus lumborum

1. Name the suboccipital muscles 
2. Name their actions

1. 1. Rectus capitis posterior minor 2. Obliquus capitis superior 3. Rectus capitis major 4. Obliquus capitis inferior
2. All act to extend the head

• Both Obliquus Capitis Inferior and Rectus Capitis Posterior Major also laterally flex and rotate the head to same side

1. What is the Superficial cervical muscle?

• What is its action?

1. Platysma

• Anterior: Draws lower lip down and out (pout), tensing
• Entire muscle: Wrinkles skin of neck obliquely 

1. What does the Suprahyoid consist of? 

• What is their action?

1. Diagastric, stylohyoid, mylohyoid, geniohyoid

• Elevate larynx (diagastric, stylohyoid, geniohyoid)
• depress mandible (diagstric, mylohyoid, geniohyoid)
• Elevate hyoid bone (mylohyoid) or retract it (geniohyoid)

1. What does the infrahyoid consist of?

• What are their actions?

1. Sternohyoid, sternothyroid, thyrohyoid, omohyoid

• Depress hyoid bone and larynx (omohyoid, sternohyoid, sternothyroid)
• Depress hyoid bone and elevate larynx (thyrohyoid)

1. What are the Prevertebral muscles? What are their actions?

1. Longus Coli, Longus Capitis: Unilaterall rotate head, Bilaterally: Flex the neck, limit hyperextension of head (longus only)
2. Rectus Capitis Anterior: Flexes the head
3. Rectus Capitis Lateralis: Laterally flexes the head

• What are the innervation points of the Sternocleidomastod?

• What are its actions?

• CN 11 and spinal nerve from C2 and C3
• Action: Unilateral: laterally flexes neck, rotates head to opposite side.Bilateral: Flexes neck while hyperextending head

1. Where do the Scalenes innervate

• What is their action?

1. Innervation: Lower cervical spinal nerves

• Unilateral: Laterally flex neck, rotate head to same side
• Bilateral: Flex neck and/or elevate ribs

What are the 2 splenius muscles?

Where do they innervate?

What are their actions?

Splenius Capitis:

• Innervation: middle and lower cervical spinal nerves
• Action: Unilateral: laterally flexes neck and rotates to same side. Bilaterally: extend neck and head

Splenius Cervicis:

• Innervation: Middle and lower cervical spinal nerves
• Action: Unilateral: Laterally flexes neck and rotates to same side. Bilateral: Extend nack and head

What innervates the intercostal nerves 7-12?

What flexes the spine, compresses abdomen, depresses ribs?

• What are the innervation points of the External  Abdominal obliques?
• What are the External Abdominal obliques actions?

• What are the innervation points of the internal Abdominal obliques?
• What are the Internal abdominal obliques actions?

• Innervation: Intercostal nerves 8-12, iliohypogastric and ilioinguinal nerves
• Unilateral: laterally flex trunk to same side, rotate to opposite side Bilateral: Flex trunk, compress abdomen, depress ribs 
• Innervation: same as external, 
• Unilateral: Laterally flex trunk and rotate to same side                Bilaterally: Flex trunk, compress abdomen, depress ribs

-Where does the Transversus abdominis innervate?

-Action?

- Innervation: Intercostal nerves 7-12, iliohypogastric and ilioinguinal nerves

-Action: Compresses abdomin

-What innervates the dorsal rami of spinal nerves?

-Describe this muscle's actions?

-Erector Spinae muscles (Spinalis, Longissimus, Iliocostalis)

-Action: Unilateral: Laterally flex neck and/or trunk to same side, rotate to same side (longissimus and iliocostalis only)

Bilateral: Extend neck and/or trunk

- Name the Transversospinalis muscles?

• Innervation of these muscles?

• Action of these muscles?

- Semispinalis, Multifidus, Rotatores

• Innervation: Dorsal rami of spinal nerves

• Action: Bilaterally: Extend the neck and trunk

Unilaterally: Rotate neck and trunk to opposite side, Laterally flex to same side

1. What innervates the interspinalis muscle?
2. What is the interspinalis muscle's actions?

1. Dorsal Rami of spinal nerves
2. Extends neck and/or trunk (CANT ROTATE, CANT LATERALLY FLEX)

-What does the intertransversarii muscle innervate?

-What is its action?

-Dorsal rami of spinal nerves

-Laterally flexes neck and/or trunk

-What does the Quadrarus Lumborum innervate?

-What are its actions?

- Innervation: T12, L1 spinal nerves

- Laterally flexes trunk

Elevates pelvis unilaterally (if trunk is fixed)

-How many metacarpal bones do humans have?

-Name the segments of the upper extremity

- What does the pectoral/ shoulder girdle include?

-What does the subcomponent of the shoulder complex include?

- What movements and existence of the clavicle and scapula help to provide?

- 5

-Pectoral/ Shoulder girdle, Arm, Forearm, wrist, hand

-Clavicle, scapula

-The shoulder girdle, the sternum, the humerus, the ridcage, all of the joints/articulations between these structures 

- Position of the shoulder joint (increases ROM), stability for the arm movement, Attachment sites for muscle that serve to move the upper extremity

-What is the venous drainage of the trunk and upper limbs?

- What is the Lymphatic drainage of the upper limb?

-Cephalic, Basilic, Median cubital

-Axillary lymph nodes, Cubital lymph nodes

- What is the purpose of the clavicle?

- What does the sternoclavicular joint include?

- It serves to keep the upper extremity away from the thorax, providing maximum mobility. Dissipates the shock from the upper limb to the axial skeleton. 

- Pectoral girldle connected to the axial skeleton where the clavical meets the sternum (specifically at manubrium)

Describe the Scapula.

-Processes, what it protects, how its connected

Processes (scapular spine, acromion, coracoid process) protect glenohumeral joint

Not connected to axial skeleton by joints or ligaments

connected by muscles

scapulo-thoracic articulation is therefore not a true joint

- What is the long bone of the arm (brachium)?

-What is the glenohumeral joint?

-What are the 3 articulating surfaces of the distal end of the humerus?

-humerus

-Humeral head articulates with the scapula at the glenohumeral joint

- Anteriorly: capitulum- articulates with the head of the radius, Trochlea: articules with the ulna trachlear Posteriorly: olecranon process of the ulna articulates into the olecranon fossa

-The Forearm is also called what?

-What 2 long bones does it have?

- The proximal articulating surfaces of the Ulna?

-Distal articulating surfaces of the Ulna?

- Antebrachium

- Ulna and radius

- the olecranon process articulates with the olecranon fossa of the humerus posteriorly. The coronoid process articulates anteriorly around the trochlea of the humerus. Lateral to the coracoid process is the radial notch for the radioulnar joint articulation.

- Narrower, rounded head and styloid process. posterior- medially

The Radius:

Proximally-

- The disc- like head articulates in the _______ of the ulna (rotates) in ___________.  The _____ articulates with the capitulum of the humerus in _______.

Distally-

Ulnar- notch medially -_____moves around and anterior to the ____ in pronation articulation with the head of the ulna, while reversing motion in ________.

Proximally:

1. radial notch, pronation-supination, head, flexion- extension

Distally:

2. The ulnar notch medially- radius moves around and anterior to the ulna in pronation articualtion with the head of the ulna, while reversing motion in supination

-What is another name for the wrist?

-How many carpal bones are there?

- Which of the 2 carpal bones articulate laterally with the radius and what joint is formed?

- The carpals are posteriorly ______ and anteriorly ______

- Carpus

-8

-Scaphoid and Lunate, synovial joint is formed between the forearm and wrist.

- concave, convex

-What does the carpal tunnel contain?

-What is it bounded by?

- Tendons of Flexor Pollicus Longus, Flexor Digitorum Superficialis, and Digitorum Profundus and the MEDIAN nerve.

- Transverse Carpal Ligament (aka Flexor retinaculum) superiorly; the scaphoid and trapezium laterally and the pisiform and hammate medially

What is Carpal Tunnel Syndrome caused by?

What are the symptoms?

Caused by chronic entrapment of median nerve leading to inflammation

Often activity-related, but other factors contribute

obesity, fluid retention, genetic susceptibility

Symptoms:

Numbness, tingling, and/or pain in regions served by median nerve

In severe cases, weakness and atrophy of muscles innervated by median nerve

-What does RSI stand for?

- What are management and treatment options for RSI and Carpal Tunnel Syndrome?

-What are more options for more severe cases of Carpal Tunnel and RSI?

-What can be done if nerve degeneration or muscular atrophy occurs?

-What do the metacarpals do?

-How many phalanges does each digit have? Is it the same for all digits?

-Connects the carpus to the phalanges (metacarpo-phalangeal joints)

- 3, No, the first digit only has 2

-Simple Fracture

- Compound Fracture or Open Fracture

-Partial Fracture

- Complete Fracture

- Colles' Fracture

- The bone does not break through the skin

- The bone is exposed to the outside

- The bone is partially broken

- The bone is split into 2

- A fracture at the distal end of the radius

What do most fractures of the upper extremity include?

-Where does the Cephalic vein run? What does it turn into? Where does it drain?

-Where does the Besilic vein run?

- What does the Median cubital vein do? What usually happens here?

- Starts at superficial fascia of lateral border of wrist and passes antero-laterally up the arm. It joins axillary vein after passing between the pectoralis major and deltoid muscle. It drains the superficial portion of the hand and forearm on the radial side and then continues up the lateral side of the arm.

- Runs in the superficial fascia on the medial side of the forearm and distal arm. It then goes deep to run continulously to the axillary vein. 

- Allows for communication between the basilic and cephalic veins at the anterior elbow (cubital fossa). Blood draws

-Where do superficial lymphatic vessels arise?

-What do superficial lymph vessels ascend with?

- Some superficial lymph vessels drain to ______ lymph nodes, while most drain to _____ lymph nodes.

- ____ lymphatic vessels follow in the same direction as deep arteries to drain in ______ nodes.

- From lymphatic plexi in the digits, palm, and dorsum of the hand

- Superficial veins

- Cubital, axillary

- Deep, axillary 

-What is in superficial fascia that is not in deep fascia?

- Where is pectoral fascia located? Is it superficial or deep?

-Is the brachial fascia deep or superficial?

-What two compartments does the brachial fascia form?

-What is fascia in the forearm called?

- What is the deep fascia at the wrist (posteriorily) in a transverse band called?

What is the deep fascia at the wrist anteriorly thickening called?

- What is the deep fascia in the hand?

- What is the deep fascia in the hand continuous with? What is the central part called?

- Adipose tissue

- Invests the pectoralis major muscle, it is deep- forms armpit.

-Deep, it encloses the extremity extending to the humeral epicondyles and the olecranon of the ulna

- Anterior flexor and posterior extensor

- antebrachial fascia (attaches to olecranon)

- extensor retinaculum

-flexor retinaculum

-Palmar retinaculum

- Continuous with the retinacula, central part: palmar aponeurosis

Axilla:

Anterior wall

Posterior wall

Lateral Wall

Medial wall

What is the axillary artery a continuation of?

What does the axillary vein become?

Anterior wall: Pec. major (and minor)

Posterior wall: Scapula, subscapularis, and latissimus dorsi

Lateral wall: biceps brachii and coracobrachialis

Medial wall: rib 1-4 and serratus anterior

The subclavian artery, when it passes the pec. minor is becomes the brachial artery

Subclavian Vein