smaller vertebral bodies

larger vertebral foramina

shorter spinous processes, w/bifurcation at tip

transverse processes contain a foramen transversarium

allows the most movement in all directions

C1

does not have a body

has anterior and posterior arches

part of the atlanto-occipital joint

(lateral masses of C1 with occipital condyles)

C2

has the dens (was the body of C1 that fused to C2 during development)

articulates with Atlas (atlantoaxial joint)

held by alar ligaments and cruciate ligament (transvers, super. and infer. longitudinal ligaments)

spinous processes are long and directed inferiorly over the next vertebrae below it

articulates with ribs at the costal facets: two costal facets on each side of vert body, and one costal facet on the transverse processes

body costal facets -> head of rib

transverse costal facet -> tubercle of rib

small forward flexion, lateral flexion, rotation

largest vertebral bodies

broad spinous processes, project posteriorly

no costal facets

flexion, extension, lateral flexion, no rotation

Trapezius:

level of muscle

origin

superficial back muscle

origin:

nuchal ligament

external occipital protuberance

spinous processes C7-T12

spinous process of C7

most prominent spinous process in cervical region

palpable on neck

Trapezius:

insertion

Insertions:

Superior part -> attached to later 1/3 of clavicle

middle -> to acromion and spine of scapula

inferior -> near medial end of spine of scapula

Trapezius:

function

Function:

superior part -> elevates scapula

middle -> retracts scapula

inferior -> depresses scapula

Trapezius:

vascular supply

vascular supply:

transverse cervical artery

Trapezius:

innervation

innervation:

accessory nerve (CN XI)  = motor

ventral primary rami of C3 and C4 = sensory

Latissimus dorsi:

level of muscle

Origin

superficial muscle

Origin:

spinous processes of T7-T12

thoracolumbar fascia

iliac crest

ribs 9-12 lateral to their angles

(all are proximal attachments)

Latissimus dorsi:

insertion

insertion:

floor of the intertubercular sulcus on the anterior side of the humerus (distal attachment)

Latissimus dorsi:

function

function:

extension, adduction, and medial rotation of humerus

Latissimus dorsi:

vascular supply

vascular supply:

thoracodorsal artery (on anterior surface near distal attachment)

Latissumus dorsi:

innervation

innervation:

thoracodorsal nerve (on anterior surface near distal attachment)

Rhomboids:

level of muscle

origin

superficial

origin:

minor -> nuchal ligament and C7 and T1 spinous processes

major -> T2-T5 spinous processes

Rhomboids:

insertion

insertion:

minor -> medial border of scapula at level of the spine of the scapula

major -> medial border of the scapula inferior to the level of the spine of the scapula

Rhomboids:

function

function:

minor -> retracts scapula, rotates scapula to depress glenoid cavity, fixes scapula to thoracic wall

major -> retracts scapula, rotates scapula to depress glenoid cavity, fixes scapula to thoracic wall

Rhomboids:

vascular supply

vascular supply:

minor and major -> dorsal scapular vessels (on deep surface  of both and course parallel to the medial border of the scapula)

Rhomboids:

innervation

innervation:

minor and major -> dorsal scapular nerve (C4 & C5)  (on deep surface of both muscles and courses parallel to the medial border or the scapula)

Levator scapulae:

level of muscle

origin

superficial

origin:

C1-C4 transverse processes

Levator scapulae:

insertion

insertion:

superior angle of the scapula

function:

elevates and rotates the scapula to depress the glenoid cavity

vascular supply:

dorsal scapular artery

innervation:

dorsal scapular nerve

bounded by latissimus dorsi, trapezius, and rhomboid major

within triangle, intercostal space 6 has no overlying muscles

well suited for auscultation

bounded by the latissimus dorsi, external oblique, and iliac crest

rare site for lumbar herniations

Serratus posterior superior:

level of muscle

origin

intermediate muscle

origin:

nuchal ligament

C7-T3 spinous processes

insertion:

superior borders of ribs 2 - 5

function:

respiratory muscles (elevates the ribs)

innervation:

ventral primary rami, intercostal nerves

intermediate muscle

origin:

T11-L2 spinous processes

insertion:

inferior borders of ribs 9 - 12

function:

respiratory muscles ( pulls ribs outward and downward, conteracting inward pull of the diaphragm)

innervation:

vetranl primary rami, intercostal nerves

Splenius capitis:

level of muscle

origin

deep muscle

origin:

nuchal ligament, C7-T6 spinous processes

(same as splenius cervicis)

insertion:

supieror nuchal line of occipital bone and mastoid process of temporal bone

function:

bilateral (w/cervicis) -> extend head and neck

unilateral -> laterally flex head and neck to side of contraction

innervation:

dorsal primary rami

origin:

nuchal ligament and C7-T6 spinous processes

(same as splenius capitus)

insertion:

C1-C4 transverse processes

function:

bilateral (w/ capitis) -> extension of head and neck

unilateral -> laterally bend head and neck to side of contraction

innervation:

dorsal primary rami

Erector Spinae:

composition

level of muscle

origin

composition:

spinalis, longissimus, iliocostalis (medial to lateral)

deep muscle of back

origin:

sacrum and ilium (all three are fused together at the origin)

insertion:

spinalis -> spinous processes of cervical, thoracic, lumbar vertebrae

longissimus -> transverse processes of cervical and thoracic lumbar

iliocostalis -> ribs

function:

bilateral (all three) -> extend vertebral column

unilateral -> bends vertebral column laterally toward side of contraction

innervation:

dorsal primary rami

Transversospinalis:

composition

level of muscle

origin

composition:

semispinalis (multifidus, rotators)

deep muscle of back

transverse and spinous processes

Transversospinalis:

function

function:

cause rotational and lateral bending movements between adjacent vertebra and stabilize the vertebral column

Semispinalis capitus:

level of muscle

origin

deep muscle

part of transversospinalis

origin:

transverse process of upper thoracic vertebrae

insertion:

between superior and inferior nuchal lines of the occipital bone

function:

extends head and rotates head, turning face to opposite side of contraction

innervation:

dorsal primary rami

suboccipital triangle:

boundaries

contents within triangle

boundaries:

obliquus capitis inferior (inferior boundary) , rectus capitus posterior major (medial), obliquus capitis superior (lateral)

contents within:

suboccipital nerve (dorsal ramus of C1) and vertebral artery

greater occipital nerve:

emerges

and passes through ____ muscle

Nerve C2

emerges between C1 and C2

passes through semispinalis capitis muscle (part of transversospinalis)

dural sac ends at ___

(vertebral level)

spinal cord ends at ___

(vertebral level)

conus medularis

(vertebral level)

aorta

pulmonary trunk

SVC

IVC

four pulmonary veins

outermost layer is fibrous pericardium, a collagen layer (no elastic fibers) with little ability to distend acutely, prevents excessive overfilling

two innermost layers are serous pericardium, the visceral (epicardium, innermost) and parietal layers

posterior (base)

apex

left (pulmonary)

right

inferior (diaphragmatic)

anterior (sternocostal)

posterior surface of the heart

what vertebral level

base surface

left atrium (receives blood from the pulmonary veins)

found at vertebral level T6-9

apex surface of the heart

what intercostal space

inferior lateral portion of the left ventricle

found at intercostal space 5 @ midclavicular line

where max pulsation of heart occurs

pulmonary surface

mainly the left ventricle

occupies the cardiac notch of the left lung

diaphragmatic surface

consists mainly of the left ventricle

related to the central tendon of the diaphragm

sternocostal surface

consists mainly of the right ventricle

right

left

inferior

superior

right atrium

SVC

IVC

left ventricle

left atrium

pulmonary trunk

aortic arch

right atrium

left atrium

SVC

ascending aorta

pulmonary trunk

deoxygenated blood from SVC and IVC and coronary sinus

right auricle

pectinate muscles (trabeculated part)

crista terminalis (internal)/sulcus terminalis (external)

sinus venarum (smooth part)

fossa ovalis

atrial septum

tricuspid valve (anterior, posterior, septal)

venous blood from the right atrium

trabeculae carneae (inflow track)

conus ateriosus (outflow track)

supraventricular crest

tricuspid valve (anterior, posterior, septal)

papillary muscles (anterior, posterior, septal)

cordae tendinae

interventricular septum

septomarginal trabecula (moderator band)

pulmonary semilunar valve (anterior, right, left)

receives oxygenated blood via the 4 pumlmonary veins (valveless)

left auricle

pectinate muscles

smooth part (sinus venarum?)

atrial septum

mitral valve ( anterior, posterior)

receives oxygenated blood from the left atrium

trabeculae careae (inflow track)

aortic vestibule (outflow track)

mitral valve (anterior, posterior)

chordea tendineae

papillary muscles (anterior, posterior)

aortic semilunar valve (posterior, right, left)

trabeculated part of the right and left ventricles

(inflow or outflow track)

trabeculae carneae

inflow tracks

conus arteriosus -> right ventricle

aortic vestibule -> left ventricle

outflow tracks

anterior

posterior

septal

anterior

posterior

anterior

right

left

posterior

right

left

right and left aortic sinuses

(there is no posterior coronary artery)

sinoatrial nodal artery

conus branch

right marginal artery

atrioventricular nodal artery

posterior interventricular artery (right side dominance)

septal branches

left circumflex artery

intermediate ramus (variable branch)

anterior interventricular artery

posterior interventricular artery (left-side dominance)

great cardiac vein travels along with: the anterior interventricular artery (that is a branch off of the left main coronary artery)

middle cardiac vein travels along with: the posterior interventricular artery (usually a branch off of the right coronary artery)

small cardiac vein travels along with: the right marginal branch (that is a branch off of the right coronary artery)

bridge the atrioventricular sulcus between the right atrium and right ventricle

the drain the anterior wall of the right ventricle directly into the right atrium

they pass superficial to the right coronary artery

three branches off of the aorta

(in order of the arch from ascending to descending side)

braciocephalic trunk

(divides into a common carotid and subclavian artery)

common carotid artery

subclavian artery

ligamental attachment between the inferior border of the aortic arch and the superior border of the pulmonary trunk

what used to be the ductus arteriosus

superior

inferior

middle

superior

inferior

right lung -> middle and inferior

left lung -> superior and inferior

right lung -> superior and middle lobes

left lung -> superior lobes

right lung -> superior lobe

left lung -> superior lobe

right lung -> inferior lobe (the uppermost part of posterior surface is the superior lobe)

left lung -> inferior lobe (the uppermost part of the posterior surface is the superior lobe)

the division of the parietal pleura

and two main recesses (total of 4)

costal, mediastinal, diaphragmatic, cervical

costodiaphragmatic recess

costomediastinal recess

most inferior part of the superior lobe of the left lung

it is the homolog of the middle lobe of the right lung

cardiac notch

arch of the aorta

thoracic (descending) aorta

esophagus

cardiac notch (smaller impression)

SVC

arch of azygos vein

right lung -> right main bronchus, right pulmonary artery, two pulmonary veins

left lung -> left main bronchus, left pulmonary artery, two pulmonary veins

separated from inferior mediastinum at sternal angle (T4)

trachea

esophagus

thymus

phrenic n

azygos v

SVC

brachiocephalic a/v

aortic arch

left common carotid a

left subclavian a

thoracic duct

anterior

middle

posterior

between the sternum and pericardium

thymus fat

lymph nodes

connective tissue

between the anterior and posterior mediastinums

pericardium

heart

roots of the great vessels (coming out of the heart)

phrenic nerves

lies posterior to the pericardium and anterior to vertebral bodies T5-12

descending aorta

esophagus

thoracic duct

azygos and hemiazygos v.s

thoracic splanchnic n

vagus n

plexuses that innervate the lungs

sympathetic and/or parasympathetic?

anterior and posterior pulmonary plexuses

these plexuses contain both symp and parasympathetic nerve fibers

sympathetic motor nerve fibers of the lungs (direction of travel)

preganglionic and postganglionic

preganglionic motor starts in the IML cell column and synapse in the paravertebral chain ganglion at the cervical and thoracic (T1-4) levels with the cell bodies of the postgang.

postgang leave these ganglia and terminate on smooth muscle of blood vessels within the lung -> vasoconstriction

postgangs also terminate on postgang parasympathetic (modulate broncho activity -> bronchodilation)

cell bodies found in the dorsal root ganglion around the C7-8 and T1-4 spinal cord levels

peripheral process -> to lungs

central process -> to spinal cord

pain sensation

parasympathetic motor fiber of lungs (direction of travel)

pregang and postgang

pregang cell bodies found in the dorsal motor nucleus of vagus, CN X, and nucleus ambiguus of medulla

pregang travel through the pulmonary plexuses and synapse with postgang within the lung, postgangs terminate on smooth muscle of bronchial airways -> bronchoconstriction and increased glandular secretion

cell bodies located in the inferior (nodose) ganglia of CN X

peripheral process -> to the lungs via CN X

central process -> solitary nucleus in the brain

touch and stretch sensation

phrenic nerve

(ventral primary rami of C3,4,5, motor and sensory)

intercostal nerves (sensory to the periphery)

muscles of the thorax

(within the intercostal space)

external intercostal

internal intercostal

innermost intercostal

external, internal, innermost intercostal muscles

superior attachment

inferior border of ribs

external intercostal muscle -> the muscle is angled from inferior border to medial direction

internal intercostal muscle -> the muscle is angled from inferior border to lateral direction

external, internal, innermost intercostal muscles

inferior attachment

superior border of the ribs below

external intercostal muscle -> the muscle is angeled from inferior border of rib to medial direction

 internal intercostal muscle -> the muscle is angeled from inferior border of rib to lateral direction

external, internal, innermost intercostal muscles

innervation

innervation:

ventral primary rami of T1-11 -> intercostal nerves

run in the costal groove

intercostal nerves run between the internal and innermost intercostal muscles

ventral primary rami of T12 -> subcostal nerve

external, internal, innermost intercostal muscles

function

external -> elevate ribs during forced inspiration (exercise, lung disease)

internal -> assist active expiration (exercise, lung disease)

innermost -> assist with internal (active expiration)

two anterior intercostal arteries per intercostal space

branch off of internal thoracic artery in intercostal spaces 1-6

branch off of musculophrenic artery in intercostal spaces 7-9

subcostal artery is a branch of the thoracic (descending) aorta

(courses along inferior border of rib 12)

costocervical trunk of the subclavian artery -> superior intercostal artery -> posterior intercostal arteries of intercostal spaces 1 and 2

thoracic aorta -> posterior intercostal arteries of intercostal spaces 3-11

posterior intercostal veins (1/space) drain into the hemiazygos and azygo vein.

the right posterior intercostal veins drain into the azygos vein

the left posterior intercostal veins drain into the hemiazygos vein

hemiazygos vein drains into azygos which drains into SVC

skin

superficial fascia: fatty layer (camper's fascia) and membranous layer (scarpa's fascia)

external oblique

internal oblique

transversus abdominus

transversalis fascia

extraperitoneal fascia

parietal peritoneum

superficial layer: camper's fascia, composed entirely of fat

deep layer: scarpa's fascia, fibrous connective tissue, containing relatively little fat

lies deep to the transversus abdominus and superficial to the peritoneum

inferior portion makes part of posterior boundary of inguinal canal

inferior to the arcuate line -> 1 layer of rectus sheath; the aponeuroses of all three muscle layers (external oblique, internal oblique, transversus abdominus) run anterior to the rectus abdominus

superior to the arcuate line -> 2 layers of rectus sheath; the aponeurosis of the external oblique runs anterior to rectus abdominus; the aponeurosis of internal oblique splits and anterior half runs anterior to and the posterior half run posterior to the rectus abdominus; the aponeurosis of transversus abdominus run posterior to rectus abdominus

the aponeuroses of the three flat abdominal muscles

superior to arcuate line -> has an anterior and posterior layer with the rectus abdominus in between

inferior to arcuate line -> has one anterior layer

external oblique muscle:

layer of abdominal wall, and course the fibers travel

origin

layer of abdominal wall:

 superficial muscle layer

fiber course:

from superolateral to inferomedial

origin:

 external surfaces of ribs 5-12

external oblique muscle:

insertion

insertion:

linea alba

pubic tubercle

anterior half of iliac crest

(the coiled lower border makes the inguinal ligament)

external oblique muscle:

innervation

innervation:

thoracoabdominal nerves T7-11

subcostal nerve T12

external oblique muscle:

function

function:

not really found anywhere, but netter's says: bilateral contraction -> flexion of vertebral colum/trunk; unilateral contraction -> vertebral column bends laterally and rotates it, bringing shoulder of same side forward

internal oblique muslce:

layer of abdominal muscles

origin

layer:

middle layers, lies deep to external oblique

origin:

thoracolumbar fascia, iliac crest, lateral half of the inguinal ligament

internal oblique muslce:

insertion

insertion:

inferior borders of ribs 10-12

linea alba

pubic crest

pecten pubis (via conjoint tendon)

forms part of superior part/roof of inguinal canal

internal oblique muslce:

innervation

innervation:

thoracoabdominal nerves -> ventral primary rami of T6-12

first lumbar nerves

internal oblique muslce:

function

function:

flexes and rotates trunk

compresses and supports abd viscera

transversus abdominus muscle:

layer of abdominal muscles

origin

layer:

third layer of abd mucsles, lies deep to internal oblique muscle

origin:

internal surfaces of the 7-12 costal cartilages

thoracolumbar fascia

iliac crest

lateral third of inguinal ligament

transversus abdominus muscle:

insertion

insertion:

linea alba

pubic crest

pecten pubis

(conjoint tendon attaches to pubic crest and pecten pubis)

forms part of superior part/roof of inguinal canal

transversus abdominus muscle:

innervation

innervation:

thoracoabdominal nerves -> ventral primary rami of T6-12

first lumbar nerves

transversus abdominus muscle:

function

function:

compresses and supports abdominal viscera

rectus abdominus muscle:

origin

origin:

pubic symphysis

pubic crest

rectus abdominus muscle:

insertion

insertion:

costal cartilages of ribs 5-7

(COA says xiphoind process)

rectus abdominus muscle:

innervation

innervation:

thoracoabdominal nerves -> T7-12

(enter laterally)

rectus abdominus muscle:

function

function:

flexion of the trunk

deep inguinal ring:

made by what structure

location

break through the transversalis fascia (the inner surface of the abd muscles) due to testes traveling down/passing through fascia during development

found superior to the midpoint of the inguinal ligament

found lateral to the inferior epigastric vessels

it is the coiled lower border of the external oblique

medial attachment to the pubic tubercle, and to the pectin pubis via the lacunar ligament

lateral attachment to the anterior-superior iliac spine

superficial inguinal ring:

made by what structure

location and components

triangular defect of the external oblique muscle aponeurosis

located lateral to the pubic tubercle

lateral (inferior) crus -> portion of external oblique aponeurosis that forms lateral margin of ring, attached to the pubic tubercle

medial (superior crus) -> portion of the external oblique aponeurosis that forms the medial margin of ring, attached to the pubic crest

deep -> deep inguinal ring

superficial -> superficial inguinal ring

anterior -> aponeurosis of external oblique muscle

inferior (floor) -> inguinal ligament and lacunar ligament

superior (roof) -> arching fibers of internal oblique and transversus abdominis muscles

posterior -> transversalis fascia, reinforced medially by conjoing tendon

some of the small intestine exiting the abdominal cavity medial to the inferior epigastric vessels

follows a direct course through the abdominal wall

found within the inguinal (Hasselbach's) triangle

common in older men

exits the abdominal cavity through the deep inguinal ring, course through the inguinal canal, possibly passing through superficial inguinal ring into the scrotum

protrudes lateral to the inferior epigastric vessels

protrudes above and medial to pubic tubercle

common in young men

protrudes through femoral canal below the inguinal ligament

protrudes below and lateral to pubic tubercle

protrudes medial to the femoral vein

more common in women on the right side

prone to early strangulation

iliohypogastric nerve

vertebral level, found where, innervates what

L1 nerve

runs parallel and superior to ilioinguinal nerves

innervates internal oblique, transversus abdominus, skin, and upper hypogastric region

ilioinguinal nerve

vertebral level, found where, innervates what

L1 nerve

 runs parallel and inferior to the iliohypogastric

courses through the inguinal canal, emerges from superficial inguinal ring

innervates internal oblique, transversus abdominus, skin of lower inguinal region, anterior scrotum/labium majus, and medial aspect of thigh

fusion of the aponeurosis of internal oblique and the aponeurosis of the transversus abdominis

medial to the superficial ring

found attached to pubic crest, spine of pubis and iliopectineal line (which pectin pubis is part of this line)

found on anterior surface of psoas muscle

the motor nerve to the cremaster muscle

lies on lateral side of psoas major

passes deep to the inguinal ligament

motor and sensory branches to anterior thigh

deep and medial to genitofemoral (almost within psoas muscle)

motor and sensory innervation to medial thigh

superior epigastric is a branch from the internal thoracic artery

inferior epigastric artery is a branch from the external iliac artery

they anastomose above the arcuate line, posterior to the rectus abdominus, between the posterior and anterior layers of the rectus sheath

jejunum -> long vasorecta and very few arcades

ileum ->  short vasorecta and many arcades

Iliocolic artery (inferior portion of ascending colon)

right colic artery (superior portion of ascending colon to hepatic flexure)

middle colic (1st branch off of superior mesenteric, mostly transverse colon, up to splenic flexure)

(also has many branches the supply the small intestine)

left colic artery (starting distal to splenic flexure of transverse colon, mostly upper portion of descending colon)

sigmoidal artery (rest of descending colon)

superior rectal artery (terminal end of inferior mesenteric artery)

common hepatic artery is part of the celiac trunk that comes off of abd aorta

gastroduodenal artery

proper hepatic artery

cystic artery (comes off of proper hepatic)

right gastric artery (left is part of celic trunk coming off of aorta)

left and right hepatic arteries (branches of proper hepatic)