1
Q
cardiac muscle
A
- only in the heart
- involuntary
- striated
2
Q
smooth muscle
A
- walls of hollow organs
- involuntary contractions
- causes secretion and peristalsis
- smooth
3
Q
walls of artery VS vein (deep to superficial)
A
- endothelium (+valves in veins)
- basement membrane
- internal elastic lamina (only artery)
- smooth muscle (thick in artery)
- external elastic lamina (only artery)
- tunica externa
4
Q
skeletal muscle
A
- voluntary contraction
- movement at joints
- striated
- insertions / origins
5
Q
insertion VS origin
A
I moves toward O during contraction (decrease angle)
6
Q
4 muscle categories for movement
A
agonists = main thrust of movement
antagonist = resist main movement
synergists = help to agonist
stabilizers = stabilization
7
Q
LIST
superficial (extrinsic) muscles of the back
A
- trapezius (CN XI)
- latissimus dorsi
- rhomboid major
- rhomboid minor
- levator scapulae
- anterior rami
8
Q
LIST
intermediate (extrinsic) muscle of the back
A
- serratus posterior superior
- serratus posterior inferior
- anterior rami
9
Q
LIST
deep (intrinsic) muscles of the back
A
- spinotransversales muscles
- erector spinae muscles
- transversospinalis muscles
- all are in groups
- posterior rami
10
Q
trapezius
A
- O: external occipital protuberance, ligamentum nuchae, spinous processes C7-T12
- I: lateral clavicle, acromion, scapula spine
- nerve: CNXI - spinal accessory
- actions: elevate/adduct/depress scapula
11
Q
latissimus dorsi
A
- O: spinous processes T8-L5, sacrum, iliac crest, ribs 10-12
- I: humerus (floor of intertubercular sulcus)
- nerve: thoracodorsal nerve (C6-C8) (ant rami)
- actions: extend/adduct/medially rotate humerus
12
Q
levator scapulae
A
- O: transverse processes C1-C4
- I: medial scapula border
- nerve: dorsal scapular nerve (C4, C5)
- action: elevate scapula
13
Q
rhomboid minor
A
- O: spinous processes C7-T1
- I: medial scapular border (above spine)
- nerve (shared): dorsal scapular nerve (C4, C5)
- action (shared): adduct shoulders and elevate scapula
14
Q
rhomboid major
A
- O: spinour processes of T2-T5
- I: medial scapular border (below spine)
- nerve (shared): dorsal scapular nerve (C4, C5)
- action (shared): adduct shoulders and elevate scapula
15
Q
serratus posterior superior
A
- O: spinous processes C7-T3, lower lig nuchae, supraspinous ligaments
- I: upper border ribs 2-5
- nerve: anterior rami of upper thoracic nerves (T2-T5)
- action: elevates ribs 2-5
16
Q
serratus posterior inferior
A
- O: spinous processes T11-L3, supraspinous ligaments
- I: lower border ribs are 9-12
- nerve: antior rami of lower thoracic nerves (T9-T12)
17
Q
spinotransversales
A
muscles of the neck
18
Q
erector spinae
A
keep straight back
3 types, long fibres run length of back
19
Q
transversospinales
A
tiny fibres, need to remove these to see vertebral arch
20
Q
LIST
layers of muscles of thoracic wall
A
- Intercostal muscles (external, internal, innermost)
- subcostal muscles
- transversus thoracis
21
Q
external intercostal muscles
A
- most superficial, 11 PAIRS
- O: lower edge of rib above
- I: upper edge of rib below
- nerve: intercostal nerves T1-T11
- actions: most active during inspiration, raise ribs and support ribs
- fiber direction: inferior and anterior
22
Q
internal intercostal muscles
A
- 11 pairs, run opposite way to external ones
- O: upper edge of rib below
- I: lateral edge of costal groove of rib above
- nerve: intercostal nerves T1-T11
- actions: most active during expiration, lowers ribs, support ribs
- fiber direction: superior and anterior
- note: intercostal nerve/artery/vein run in costal groove BETWEEN internal and innermost layers of muscle – intercostal space
23
Q
innermost intercostal muscles
A
- runs same way as internal
- O: upper edge of rib below
- I: medial edge of costal groove of rib above
- nerve: intercostal nerves T1-T11
- action: most active during expiration, lower ribs, support ribs (same as internal)
- fiber direction: superior and anterior
24
Q
subcostal muscles
A
- along the back of the ribcage
- O: internal surface of lower rib
- I: internal surface of rib 2-3 above
- nerve: intercostal nerve
- actions: may depress ribs
25
transversus thoracis
* superhero badge, behind sternum
* O: inferior part of body/xiphoid process
* I: inferior margin and internal surface of ribs 2-6
* nerve: related intercostal nerve
* action: **may depress costal cartilages**
26
intercostal space
* space beteeen ribs
* filled with intercostal muscles
* **costal groove** is at inferior margin of internal rib surface
* order (superior-inferior): post/ant vein, post/ant artery, nerve
27
intercostal veins - blood flow
* front: anterior intercostal vein, drains into internal thoracic vein - goes to heart
* back: posterior intercostal vein, drains into Azygos vein - goes to heart
28
intercostal arteries - blood flow
* front: from internal thoracic artery (from aorta branch), into anteior intercostal artery OR anterior perforating branches (goes to skin)
* back: from thoracic aorta, to posterior intercostal artery (also provides oxygenation to skin)
29
nerves of the ribs
* nerve originates posteriorly and wraps around front
* **anterior rami of spinal nerves = intercostal nerve** from T1-T11 (travels in costal groove)
* T123 = **subcostal nerve**
* lateral branches of intercostal nerve = superficial to ribs (skin)
30
knnervation of back: spinal cord
* spinal nerves exit at intervertebral foramen
* rootlets join spinal cord at posterolateral/anterolateral sulcus (dorsal/ventral rootlets) , joint into a root, then into a spinal nerve
* spinal nerve only exists briefly in intervertrbral foramen, then split into rami
* central "H" is collection of nerve cell bodies
* only thorax has intermediate horn (bump) in H, and have dorsal (wings) and ventral horns
31
posterior rami
* motor innervation to intrinsic (DEEP) muscles of back
* sensory innervation to small area of skin over vertebral column
* so posterior = mostly motor (1 lane highway)
32
anterior rami
* does everything else!
* motor to ALL other skeletal muscles in trunk and limbs, AND sensory to most remaining skin (except some of the head)
* motor = away from SC, sensory = towards SC
33
cauda equina
at level L1 the solid column ends (conus medularis), turns into fibrws that are stretched rootlets
34
autonomic VS sensory ganglia
sensory ganglia = pseudo-unipolar neurons (dorsal root)
autonomic ganglia = multipolar neurons
35
cranial nerves VS spinal nerves
* 12 pairs VS 31 pairs
* CN = somatic and visceral
36
schwann cell
unmyelinated = one cell wraps many axons
myelinated = ONE cell on ONE axon segment
37
functional organization of NS
38
the ANS
* visceral motor (efferent)
* divided into SNS and PSNS
* pre-gang neuron begins in CNS (spinal cord), have peripheral synapse ganglia, with post-gang to effector organ
39
SNS
* sympathetic chain (T1-L2 origin, but goes above/below)
* begin with cell body in grey matter of spinal cord in INTERMEDIATE horn of T1-L2 spinal cord
* short pre-gang, LONG post-gang
* want to turn it all on at once (fight/flight)
40
PSNS
* cranio-sacral
* rest and digest
* LONG pre-gang, short post-gang
41
sympathetic chain
* begin at int. horn, motor OUT the front (ventral root)
* white ramus = ENTER chain (myelinated)
* grey ramus = EXIT chain (unmyelinated)
* at levels above/below **T1-L2** there is NO WHITE RAMUS, there is no "on-ramp" -- motor neurons can only exit
42
pathways in sympathetic chain
1. peripheral (cutaneous) sympathetic innervation = level of origin (sweat glands, erector pilli, blood vessel SM) **T1-L2**
2. peripheral sympathetic innervation = above/below origin (out grey ramus)
3. sympathetic innervation of thoracic and cervical viscera (enter chain at level, exit at same level without going back into anterior rami through grey ramus)
4. sympathetic innervation to abdominal/pelvic viscera = several levels, enter into white ramus and exit anteriorly = splanchnic nerves
43
visceral sensory (afferent)
* info travels from nerve right through ganglion, through WHITE ramus, and snyapse at dorsal root ganglion
* travel in the same path as motor but opposite direction
44
prevertebral plexus divisions
celiac
aortic
superior hypogastric
45
layers in abdominal cavity
* superficial - deep
* skin
* superficial fascia (fatty), superficial fascia (membranous)
* external oblique
* internal oblique
* transversus abdominus
* transversus fascia
* extraperitoneal fascia
* patietal peritoneum (contact with wall)
* visceral peritoneum (contact with organ)
46
intraperitoneal organs
surrounded (suspended) by visceral peritoneum
47
retroperitoneal organs
between back wall and visceral peritoneum
48
diaphragm openings
* separates thoracic and abdominal cavities
* I ate 10 eggs at noon
* Inferior vena cava = T8
* Esophageal hiatus = T10
* Aortic hiatus = T12
49
pelvic cavity
* separated from abdominal cavity superiorly by **pelvic inlet**
* males = heart shaped, lower angle, projecting ischial spines
* females = circular, wide angle, non-projecting spines
50
solid joints
* connective tissue, more rigid
* fibrous connection = sutures, syndesmosis
* cartilage connection = symphysis (vertebral plates)
51
RED FLAGS
1. motor/sensory loss at ANY level
2. Cauda equina syndrome
3. significant trauma (high energy, advanced age, osteoporosis)
4. **done immediately, emergent**
52
cauda equina syndrome
* urinary retention
* fecal incontinence
* bilateral leg pain
* saddle anesthesia
53
YELLOW FLAGS
1. risk factors of infection (weight loss, fever, HIV, cancer, IV drugs/steroids, new/progressive pain
2. widespread neurological signs
3. patient over 50 with first episode of severe back pain
**urgent**
54
low back pain
* very common, 97% idiopathic (won't show on imaging)
* medical imaging could help determine underlying cause
* primary goal = don't miss red/yellow flags, otherwise premanent neurological damage
55
acute low back pain (no red/yellow flags):
NO TEST IS APPROPRIATE
do nothing
56
# ****
if they have 1+ red OR yellow flags...
IMAGING REQUIRED
CT or MRI
CT = good for bones
MRI = really good for soft tissues
neither can do it alone... need to combine to be most effective
**US or XRay very bad for this...don't use**
*CT best for suspected fracture!!*
57
cervical spine pain: causes
* **most common = mechanical**
* 1. spondylosis
* 2. acute nerve compression (trauma)
* 3. spinal stenosis
traumatic injury of cervical spine more common than in lumbar (less sturdy, heavy head)
**looking for same flags, + CT/MRI only
58
what 3 components of inflammatory response have radiology correlates
1. heat
2. redness
3. swelling
**due to vasodilation/blood flow, increased permeability**
59
contrast on CT/MRI imaging
* contrast can show inflammation
* goes to site of inflammation, leaks out of capillaries, increase contrast of that area
* MRI = STIR or post-contrast
60
2 ways you can get osteomyelitis
1. hematological spread (bloodstream)
2. direct innoculation (penetrating injury, direct depositing of bacteria, or diabetic ulcers)
61
Radiograph imaging and osteomyelitis
* early stage = won't show on radiograph (normal bone)
* advanced stage = see bony destruction
* **see it when it's too late ... **
62
CT and osteomyelitis
* BEST for bone! but ...
* early stage = doesn't destroy bone, won't see it yet (but sooner than Xray) **early bony destruction**
* advanced stage = will see it...but too late again
* will see inflammation, more dense than fat
* serious stage = gas inside bone (black spots/air - dead)
63
MRI and osteomyelitis
* soft-tissue imaging modality! most sensitive since osteomyelitis begins in soft tissue..
* BEST for early-stage detection of osteomyelitis
* **STIR = Inflammation detector
* Post-Contrast = Inflammation detector**
64
ultrasound and osteomyeltisis
* CAN'T see the bone.. but can see on top of bone
* swelling, abcess, inflammation
* helps guide THERAPY without seeing osteomyelitis directly
* shows increased vascularity
* shows inflammatory process is THERE, but NOT the CAUSE
65
3 phase bone scan
* nuclear medicine scan that is EQUALLY as good as MRI for detecting osteomyelitis
* total body study (can see if spread to multiple locations)
* initial injection of isotope, pooling phase (blood settles in area) and late phases if it penetrates deeper into structures
* **looking for ASYMMETRIC darkness on bone scan = inflammation**
66
describing fracture on radiograph:
1. bone involved
2. fracture type
3. location
4. displacement
5. angulation
67
types of fractures
1. simple (single fracture, 1 break)
2. communated (more than 1 place bone is fractured)
68
displacement of fracture
how far apart are fracture fragments
*if bone is shortened (fragments overlap), need to pull apart, need edges together for fracture to fully heal*
69
angulation of fracture
how bent are the fracture fragments
70
thoracocolumbar outflow
* sympathetic chain
* T1-L2
* white=in, grey=out to ramus
* intermediate horn ONLY T1-L2 cell bodies
* going to viscera = splanchnic nerve
* going to other = anterior ramus
71
craniosacral outflow
* parasympathetic
* S2-S4
72
lumbar cistern
* L1/L2 - S2
* subarachnoid space CSF
73
somatic vs visceral sensory
somatic sensory = synapse in dorsal root ganglion
visceral sensory = synapse in sympathetic chain ganglion
ITM
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