Ptha 1413 - Functional Anatomy - Mansfield And Neumann Book And Miele Lecture - Exam 3

Front 1

The entirety of upper limb function (shoulder girdle, shoulder joint, elbow joint, radio-ulnar joint, wrist joint) is directed toward ***

Back 1

hand function

Front 2

The joint and muscle structure of the upper limb offers both _______ and ______ to hand function, as well as optimizing the.... ***

Back 2

- stability, mobility

- length-tension of hand muscles (at the wrist)

Front 3

Degrees of freedom at each joint proximal to the hand, combined with the degrees of freedom within the hand allow... ***

Back 3

the hand a (practically) infinite number of positions from which to perform work

Front 4

Any loss of function at any aspect of the upper limb will decrease... ***

Back 4

the overall function of the hand (mainly because you can’t get the hand where you need it to go)

Front 5

The hand consists of ____ digits. ***

Back 5

5

(4 fingers and 1 thumb)

Front 6

The hand consists of ____ bones. Name them. ***

Back 6

19

- 5 metacarpals
- 14 phalanges

Front 7

Each digit of the hand has ___ metacarpal(s). ***

Back 7

1

Front 8

Fingers have ___ classifications of phalanges. Name them. ***

Back 8

3

- proximal
- middle
- distal

Front 9

How are metacarpals designated numerically? ***

Back 9

as 1 through 5, beginning on the radial (thumb) side

Front 10

Each metacarpal has what landmarks? ***

Back 10

- base
- shaft
- head
- neck

Front 11

Which metacarpal is the shortest and thickest? ***

Back 11

the first (thumb)

Front 12

Which metacarpal is generally the longest? ***

Back 12

the second (index finger)

(yes, even though the third/middle finger may be longer overall)

Front 13

The last three metacarpal bones ______ in length from the radial to ulnar portion of the hand. ***

Back 13

decrease

Front 14

How many joints comprise the hand? ***

Back 14

19 joints

5 carpometacarpal (CMC),
5 metacarpophalangeal (MCP),
4 proximal interphalangeal (PIP),
4 distal interphalangeal (DIP), and
1 interphalangeal (IP)

(and, conveniently, 19 bones)

Front 15

How many phalanges does the thumb contain? ***

Back 15

2

proximal and distal only
(which is why it only has an IP joint, not PIP/DIP)

Front 16

What four joints comprise digits 2-5 (index, middle, ring, and little fingers)? ***

Back 16

CMC
MCP
PIP
DIP

Front 17

What is the CMC joint? ***

Back 17

- carpometacarpal

- articulation between distal carpal row and bases of MCs 2-5 (this was how the notes were, but there is a CMC joint at the thumb, although the function and structure are very different)

Front 18

What type of joint is the CMC? ***

Back 18

- plane joint

(minimal to no movement)

Front 19

Motions of CMC joints ***

Back 19

- flexion/extension

- slight abduction/adduction

Front 20

What is the primary function of the CMC joints? ***

Back 20

palmar arching for cupping of the hand

Front 21

What are the MCP joints? ***

Back 21

- metacarpophalangeal joints

- articulation of heads of metacarpals with bases of proximal phalanges (knuckles)

Front 22

What type of joint are the MCP joints (at least 2-5)? ***

Back 22

- condyloid joints

- biaxial, 2 degrees of freedom

Front 23

Of what types and ranges of motion are the MCP joints (at least 2-5) capable? ***

Back 23

- flexion/extension
- abduction/adduction

- 90-110 degrees of flexion (2-5 MCP)

Front 24

What are the PIP joints? ***

Back 24

- proximal interphalangeal joints

- articulation of proximal phalanges with middle phalanges

Front 25

What type of joint are the PIP joints? ***

Back 25

- hinge joints

- uniaxial, 1 degree of freedom

Front 26

Of what types and ranges of motion are the PIP joints capable? ***

Back 26

- flexion/extension

- 80-90 degrees of flexion

Front 27

Which have greater range of motion in flexion, PIPs or DIPs? ***

Back 27

PIPs

Front 28

How many joints are in the thumb? ***

Back 28

3

- carpometacarpal
- metacarpalphalangeal
- interphalangeal

Front 29

Describe the CMC joint of the first digit. ***

Back 29

- thumb

- articulation of trapezium and base of first MC

- saddle joint, biaxial, 2 degrees of freedom

capable of:
- flexion/extension
- abduction/adduction
- permits some rotation which allows for circumduction: which facilitates opposition (a combination of flex/ext, ab/add)

Front 30

Describe the MCP joint of the first digit. ***

Back 30

- thumb

- articulation of first MC and proximal phalanx

- hinge joint
- uniaxial, one degree of freedom

- flexion/extension
- 50 degrees of flexion

Front 31

Describe the IP joint of the first digit. ***

Back 31

- thumb

- articulation between proximal phalanx & distal phalanx

- hinge joint
- 90 degrees of flexion

Front 32

Describe the motions of thumb flexion and extension. ***

Back 32

- flexion is movement of palmar surface of thumb in frontal plane across and parallel with palm (flexion is making 4)

- extension returns thumb back to anatomic position (sticking out)

Front 33

Describe the motions of thumb abduction and adduction. ***

Back 33

- abduction is forward movement of thumb away from palm in a sagittal plane

- adduction returns thumb to plane of hand

Front 34

Describe the retinacular system of the hand. ***

Back 34

- fibrous bands spanning the wrist/proximal hand region, medial-lateral

- located on volar surface (flexor retinaculum) and dorsal surface (extensor retinaculum)

- long finger flexor/extensor tendons pass under retinaculum

Front 35

What is the retinacular system of the hand designed to do? ***

Back 35

prevent bowstringing of flexor and extensor tendons

Front 36

Describe the flexor retinaculum ***

Back 36

- spans the wrist/carpal region to form a carpal tunnel

- structures such as the flexor tendons and median nerve pass through it

- when inflammation/edema occur in this area Carpal Tunnel Syndrome develops

Front 37

Describe the extensor retinaculum ***

Back 37

- spans dorsal wrist/carpal area

- long finger extensor tendons pass under it

Front 38

Describe the palmar aponeurois ***

Back 38

- triangular sheet of fibrous tissue covering the long flexor tendons

- protects underlying hand structures

- receives tendon of palmaris longus muscle

- shrinkage of aponeurosis results in Dupuytren’s contracture

Front 39

Describe the bursae in the hand ***

Back 39

- radial and ulnar bursa
- pad the flexor tendons

- flexor tendons pass beneath the flexor retinaculum
- decrease friction

Front 40

Describe the flexor (digital) tendon sheaths ***

Back 40

- synovial-like membrane wrapping/covering finger flexor tendons as they pass on to digits

- produce friction-free excursion of tendons

Front 41

Describe the annular pulleys of the hand ***

Back 41

- fibrous tunnels located intermittently on digits

- flexor tendons pass through

- prevent bowstringing of tendons during finger flexion

Front 42

Describe the extensor mechanism of the hand ***

Back 42

- expansion

- triangular shaped aponeurosis located on dorsum and sides of proximal phalanx of fingers

- not on the thumb

- finger extensor tendons, lumbricals, and muscles form an attachment to middle/distal phalanges via their attachment to expansion

- extensor tendons blend with connective tissue called extensor mechanism; proximally is the dorsal hood, and ultimately the extensor mechanism attaches to the dorsal side of the distal phalanges

- by way of attachments to this aponeurosis, these muscles are able to both flex MCP and extend PIP/DIPs to assume the functional position (lumbrical grip/puppet hand) of the hand (as in writing)

Front 43

How do the extrinsic extensors of fingers work with the extensor mechanism? ***

Back 43

- extensor tendons do not attach directly to phalanges but blend with extensor mechanism

- proximal end of extensor mechanism is the dorsal hood, which wraps completely around MCP joint

- extensor mechanism serves as primary distal attachment for both extensor muscle tendons and intrinsic muscles of fingers

Front 44

Describe the extrinsic muscles of the hand (in general) ***

Back 44

- extrinsic: muscle origins proximal to wrist

- insertions in hands

- assistive actions at wrist

- multijoint muscles

- exhibit active and passive insufficiency

Front 45

Describe the intrinsic muscles of the hand (in general) ***

Back 45

- intrinsic: muscles having both origins and insertions in hand

- responsible for fine motor control and precision movements of fingers and thumb

- fine motor skills take more stability

Front 46

Additional role of the finger flexors ***

Back 46

assist with wrist flexion

Front 47

Describe the flexor digitorum superficialis ***

Back 47

- divides into 4 tendons

- attaches to middle phalanx

- flexes MCP and PIP joints

Front 48

Describe the flexor digitorum profundus ***

Back 48

- runs deep to FDS

- divides into 4 tendons

- passes through split of FDS attaches to distal phalanx

- flexes all three finger joints

Front 49

Additional role of the extrinsic finger extensors ***

Back 49

assist with wrist extension

Front 50

Describe the extensor digitorum ***

Back 50

- divides into 4 tendons

- attaches to distal phalanges of fingers 2-5 via extensor expansion

- extends all three joints of fingers

Front 51

Describe the extensor indicis ***

Back 51

extends all joints of index finger

Front 52

Describe the extensor digiti minimi ***

Back 52

extends all joints of the little finger

Front 53

Describe the flexor pulleys ***

Back 53

- embedded within each fibrous digital sheath

- surround flexor tendons, providing them with nutrition and lubrication

- following tendon injury, adhesions may develop between tendon and adjacent digital sheath or between adjacent tendons

Front 54

List the thumb extrinsic muscles and their functions ***

Back 54

- abductor pollicis longus: abducts the thumb at CMC joint

- flexor pollicis longus: flexes all joints of thumb

- extensor pollicis longus: extends MCP and IP joints of thumb

- extensor pollicis brevis: extends MCP joint of thumb

Front 55

Describe the anatomical snuffbox ***

Back 55

- tendons of EPL,EPB, APL form the borders of the depression

- on dorsolateral aspect of hand at base of thumb when thumb extended

- floor of snuffbox is scaphoid bone

- radial artery passes through snuffbox

Front 56

What bone forms the floor of the anatomical snuffbox? ***

Back 56

scaphoid bone

Front 57

What artery passes through the anatomical snuffbox? ***

Back 57

radial artery

Front 58

List the three groups of intrinsic muscles of the hand. ***

Back 58

- thenar muscles - move thumb

- hypothenar muscles - move little finger

- palm muscles - located between thenar and hypothenar muscles

Front 59

Describe the functional position of the hand (a.k.a. lumbrical grip or "puppet hand"). ***

Back 59

combined action of the lumbricals and dorsal and palmar interossei flex the MCP joints and extend the PIP and DIP joints

Front 60

List and describe the thenar muscles. ***

Back 60

- opponens pollicis: thumb opposition

- abductor pollicis brevis: abduction of MCP joint

- flexor pollicis brevis: flexion of MCP joint

Front 61

List and describe the hypothenar muscles. ***

Back 61

- opponens digiti minimi: opposition of 5th finger

- abductor digiti minimi: abduction of MCP joint

- flexor digiti minimi: flexion of MCP joint

Front 62

List and describe the palm muscles. ***

Back 62

- adductor pollicis: adducts thumb

- interossei (dorsal and palmar):
--- abduction (dorsal) and adduction (palmar) of fingers
--- flex MCP joints and extend PIP/DIP joints

- lumbricales
--- have no bony attachment (start from the FDP)
--- originate on FDP and insert on extensor expansion
--- flex MCP joints and extend PIP/DIP joints

Front 63

How do the wrist and hand need to be manipulated for optimal length-tension of the extrinsic finger flexors/extensors? ***

Back 63

- the action of the extrinsic finger flexors/extensors depends upon position of the wrist for optimal length-tension

- the wrist needs to extend for maximal finger flexion or flex for maximal finger extension; if not, the muscles become actively insufficient

Front 64

How are the long finger flexors made
- actively insufficient?
- passively insufficient? ***

Back 64

- active insufficiency: wrist flexion and finger flexion

- passive insufficiency: wrist extension and finger extension

Front 65

How are the long finger extensors made
- actively insufficient?
- passively insufficient? ***

Back 65

- active insufficiency: wrist extension and finger extension

- passive insufficiency: wrist flexion and finger flexion

Front 66

What is tenodesis in the hand? ***

Back 66

- use of passive insufficiency of long finger flexors together with wrist extension to get hand flexion

- utilized by patients with SCI who have active wrist extension but no finger flexion

- creates a grip

Front 67

How is passive finger flexion achieved via "tenodesis action"? ***

Back 67

- extrinsic flexors of digits cross over anterior side of wrist, and wrist position alters amount of stretch placed on these muscles

- stretching multi-articular muscle at one joint creates passive movement at another joint and is referred to as tenodesis action of muscle

Front 68

List some common injuries and pathologies of the hands. ***

Back 68

- rheumatoid arthritis
- carpal tunnel syndrome
- Dupuytren’s contracture
- ruptured finger flexor/extensor tendons
- compression of neurovascular structures
- fractures of metacarpals or phalanges
- dislocations of MCP/PIP/DIP joints

Front 69

Describe rheumatoid arthritis effects on the hand(s). ***

Back 69

- inflammation of synovial membrane which erodes articulating joint surfaces
- affects hands bilaterally
- can be severely disabling

deformities include
- palmar dislocation of the MCP joint
- ulnar drift
- swan-neck deformity
- boutonniere deformity

Front 70

Describe the effects of carpal tunnel syndrome on the hand(s). ***

Back 70

- any inflammation that causes compression of the median nerve, including inflammation of flexor retinaculum

- due to repetitive movements of finger flexor tendons through tunnel

- leads to inflammation of structures contained within wrist

- edema and pressure on median nerve

- paraesthesia/pain in distal hand/fingers

- motor dysfunction of muscles innervated by median nerve

Front 71

Describe Dupuytren's contracture. ***

Back 71

- shrinkage of palmar aponeurosis resulting in 4th and 5th digits flexion contracture into palm

- etiology unknown

Front 72

What are the signs and symptoms of compression of neurovascular structures in the hand? ***

Back 72

- sensorimotor dysfunction
- deformities
- muscle atrophy
- distal necrosis of tissue

Front 73

Cause and result of ruptured finger flexor/extensor tendons ***

Back 73

- trauma

- results in deformities and dysfunction

Front 74

Joints of the hand are organized into three sets of articulations: ***

Back 74

- carpometacarpal
- metacarpophalangeal
- interphalangeal

Front 75

MCP joints form: ***

Back 75

the base of each digit

Front 76

IP joints are capable of only what types of motion? ***

Back 76

- flexion and extension

(other potential planes of motion are blocked by bony fit of joint and by periarticular connective tissues)

Front 77

Simultaneous extension of all three joints of fingers requires: ***

Back 77

coordinated interplay among muscles

Front 78

What is the most-used joint in the body? ***

Back 78

the TMJ (temporomandibular joint)
- chewing
- talking
- swallowing

Front 79

The TMJ opens and closes the mouth ______ times/day ***

Back 79

1500-2000

Front 80

Describe the articulation of the TMJ. ***

Back 80

- articulation of mandibular condyle of mandible with mandibular fossa of temporal bone; right and left sides of jaw anterior to ear lobes

- each articulation contains an intra-articular disc separating joint space into two distinct compartments: upper and lower

Front 81

The intraarticular disc of the TMJ divides the joint into... ***

Back 81

two distinct compartments
- upper/superior
- lower/inferior

Front 82

What type of joint(s) make up the TMJ? ***

Back 82

- it is a synovial joint
- the upper is a plane joint
- the lower is a hinge joint
(each has their own separate synovial lining)

Front 83

Describe the TMJ capsule. ***

Back 83

- both the upper and lower joints are enclosed in the same capsule

- the capsule is thin and loose anteriorly (more joint dislocations occur anteriorly for this reason)

Front 84

Of what are the articulating surfaces of the TMJ comprised? ***

Back 84

- no hyaline cartilage on the bony articulating surfaces

- fibrocartilage is present instead, as it is necessary to withstand the TMJ's repeated high-stress forces

Front 85

Are the articular surfaces of the TMJ congruent? ***

Back 85

no, they are incongruent and the joint goes off-course frequently

Front 86

What assists in making the incongruent TMJ more congruent? ***

Back 86

the articular disc

Front 87

What is the role of the ligaments comprising the TMJ? ***

Back 87

- provide ligamentous support for stability

- attach the mandible to skull and guide movement of mandible against base of skull under the influence of muscular activity

- prevent excursion of the mandible

Front 88

What are the three major ligaments of the TMJ? ***

Back 88

- lateral temporomandibular ligament (lateral surface)

- sphenomandibular ligament (medial surface)

- stylomandibular ligament (posterior)

Front 89

Of what motions is the TMJ capable? ***

Back 89

- depression (mouth opening – normal ROM is 3 fingerwidths)
- elevation (mouth closing)

- protrusion/protraction (jutting chin forward)
- retrusion/retraction (sliding teeth backward)

- lateral deviation (sliding teeth to either side)

Front 90

What is the normal ROM for TMJ depression? ***

Back 90

3 fingerwidths

Front 91

What do the muscles of the TMJ provide? ***

Back 91

- power (chewing) and

- intricate control (talking) movement for jaw

Front 92

What muscles act at the TMJ and what do they do? ***

Back 92

- digastric – depression of jaw

- temporalis – elevation and assists protrusion of jaw with posterior fibers

- masseter – elevation of jaw and assists only initiation of protrusion

- medial and lateral pterygoids – protrusion, lateral deviation, and assists elevation of jaw

Front 93

What issues can cause TMJ disorders? ***

Back 93

- C-spine problems - poor cervical posture (forward head) often directly affects the TMJ

- poor dentition - (teeth positioning, presence/absence of teeth) can result in malocclusions and asymmetrical bite patterns which can cause dislocation of disc, unstable joint

- grinding (bruise) and clenching of teeth - can cause tightness of surrounding muscles and muscle spasms, increasing compression of TMJ

- injuries or trauma/blows to jaw can cause TMJ dislocation

- RA can cause inflammation of the joint capsule and eventual degeneration of the disc and articulating surfaces

- OA of TMJ results in degeneration of bony condyle (usually unilateral, usually due to loss of posterior teeth)

Front 94

What are some signs and symptoms associated with TMJ disorders? ***

Back 94

- crepitation, clicking of TMJ (slipping of condyle under/out from under disc during opening and closing)
- jaw pain

- decreased range of motion of jaw
- asymmetrical opening/closing of mouth
- closed or open locking of jaw

- tinnitus (ringing in ears)
- dizziness
- headaches

Front 95

What is the thorax? ***

Back 95

the portion of the trunk between the neck and abdomen

Front 96

What are the three components of the thorax? ***

Back 96

- ribcage
- diaphragm
- abdomen

Front 97

What comprises the ribcage? ***

Back 97

consists of:
- sternum (manubrium, body, xiphoid process)
- ribs/costal cartilages
- thoracic vertebrae

Front 98

How many ribs does the typical person have, and how are they attached? ***

Back 98

12 pairs of ribs (1-7 true, 8-10 false, 11-12 floating)

ribs attach to sternum anteriorly and
thoracic vertebrae posteriorly (this greatly reduces thoracic spine movements)

Front 99

Why is movement in the thoracic spine restricted? ***

Back 99

because of the attachment of the ribs to the vertebrae

Front 100

What joints does the ribcage have and of what type are they? ***

Back 100

anteriorly – ribs attach to sternum via cartilage:
- costochondral joints--ribs to cartilage (synarthrodial) and
- chondrosternal joints--cartilage to sternum (synovial)

posteriorly – costovertebral, costotransverse (synovial plane joints)

Front 101

What are the two types of movements by the ribcage during respiration? ***

Back 101

- bucket-handle movement

- pump-handle movement

Front 102

Describe bucket-handle movement during respiration. ***

Back 102

- elevation of lateral aspect of rib cage up and out

- increases mediolateral diameter of thoracic cavity

Front 103

Describe pump-handle movement during respiration. ***

Back 103

- elevation of sternal end of ribs

- increases anterioposterior diameter of thoracic cavity

Front 104

What is the diaphragm? ***

Back 104

dome-shaped, thin musculotendinous sheath which composes the muscular floor of thoracic cavity

Front 105

How does the diaphragm support respiration? ***

Back 105

- actively contracts during inspirations

- moves caudally, descends or flattens, thereby increasing thoracic cavity space of lung expansion

- passively recoils during expirations

- ascends into thorax, forming dome shape

Front 106

Name the muscles of the abdominal wall. ***

Back 106

- transverse abdominis
- internal/external obliques
- rectus abdominis

Front 107

What are the functions of the abdominal muscles during respiration? ***

Back 107

Two functions:
- increase in muscle tension just before inspiration which increases intra-abdominal pressure (IAP) which forces diaphragm cranially, places it on a slight stretch and insures a stronger diaphragmatic contraction upon inspiration

- abdominals also assist during forced expiration

Front 108

1 inspiration + 1 expiration =
_________ ***

Back 108

1 respiration

Front 109

Describe the inspiration process. ***

Back 109

- elevation of ribs and increase in size of thoracic cavity due to descent of diaphragm and expansion of thoracic wall

- pressure within thorax decreases (below atmospheric pressure), air rushes into the lungs

- two phases: quiet and forced

Front 110

Describe the expiration process. ***

Back 110

- depression of ribs causing decrease in size of thoracic cavity

- pressure in thorax increases air is forced out of lungs

- two phases: quiet and forced

Front 111

What is "quiet inspiration" and what muscles are involved? ***

Back 111

- inspiration with resting or sitting quietly

- diaphragm and external intercostals

Front 112

What is "quiet expiration" and what muscles are involved? ***

Back 112

- passive action occurring through relaxation of diaphragm
- elastic recoil of thoracic wall and lungs
- results in depression of ribs

- no muscle action is occurring, but external intercostals are involved

Front 113

What is "forced inspiration" and what muscles are involved? ***

Back 113

- occurs when an individual is working very hard and needs a great deal of oxygen (“air hunger”)

- uses muscles of quiet inspiration plus accessory muscles

Front 114

What is "forced expiration" and what muscles are involved? ***

Back 114

- occurs when an individual is working very hard or lacks elastic recoil mechanism due to disease process

- uses accessory muscles to aid in forcing air out of lungs

Front 115

What are the accessory muscles of respiration? ***

Back 115

- muscles which attach to rib cage, shoulder girdle, or vertebral column

- muscles that can assist with inspiration/expiration during situations of stress/forced respirations (exercise, disease)

- but not used during quiet respiration

Front 116

What are the accessory muscles of inspiration? ***

Back 116

- those muscles that stabilize and/or elevate shoulder girdle, which indirectly elevate the ribcage, thereby increasing the size of the thoracic cavity

- serratus posterior superior
- levator scapula
- upper trapezius
- rhomboids
- pectoralis minor
- SCM

Front 117

What are the accessory muscles of expiration? ***

Back 117

those muscles that depress/pull down on ribs
- internal intercostals
- serratus posterior inferior

those muscles that compress abdomen and force diaphragm upward
abdominal muscles
- transverse abdominis
- external/internal obliques
- rectus abdominus

Front 118

What are some effects of aging on respiratory structures? ***

Back 118

ossification of articular cartilages
- fusion of articulation
- decreases mobility of rib cage

decreased abdominal tone
- decreases function of abdominal muscles during forced expiration

increased kyphotic posture
- decreases overall thoracic cavity space for lung expansion

Front 119

What are some effects of musculoskeletal changes/scoliosis on respiratory structures? ***

Back 119

scoliosis
- abnormal lateral curvature of spine resulting in twisting of the vertebral column

rotation of vertebral column
- ribs are rotated in thoracic region = ribcage mobility restricted
- thoracic cavity space decreased

Front 120

How many bones and intervertebral discs does the vertebral (spinal) column have? ***

Back 120

- 33 (26) short, irregular bones forming long, multijointed rod
(7 cervical, 12 thoracic, 5 lumbar, 5 (fused into 1) sacral, 4 (fused into 1) coccygeal

- 23 intervertebral discs

Front 121

What is the function of the vertebral (spinal) column? ***

Back 121

- base of support for head and internal organs

- base for attachment of ligaments, muscle, bones

- link between UE/LE

- encases and protects spinal cord

Front 122

What are the five regions of the vertebral column? ***

Back 122

1. cervical (7 bones)
2. thoracic (12 bones)
3. lumbar (5 bones)
4. sacral (5 bones, fused)
5. coccygeal (4 bones, fused)

Front 123

How do vertebrae increase and decrease in size? ***

Back 123

- vertebrae increase in size from cervical to lumbar region

- vertebrae decrease in size from sacral to coccygeal region

Front 124

What types of curves are seen in the spinal column? ***

Back 124

- posterior convexity present at birth

- kyphotic curves (thoracic)

- lordotic curves (cervical and lumbar)

Front 125

Why is beneficial to have curvature of the spine? ***

Back 125

- curved configuration provides strength and resilience to vertebral column

- 10 times stronger than if straight

Front 126

The vertebral column behaves as a _____ kinematic chain. ***

Back 126

closed

Front 127

How does being a closed kinematic chain affect the spine? ***

Back 127

- curves are interdependent

- changes in the position of any one segment will result in changes in position of adjacent vertebral joints

- not all posture variances are correctable

Front 128

How does the spine achieve its great ROM? ***

Back 128

- motion at the juncture of any two vertebrae is extremely limited and consists of a small amount of movement (some have more than others)

- compound effects of small motions produce a large range of motion for vertebral column as a whole

Front 129

Of what types of motion is the spinal column capable, and in which planes? ***

Back 129

- flexion/extension/hyperextension: sagittal plane

- lateral flexion/bending: frontal plane

- rotation: transverse plane

Front 130

What are the major components of a vertebra? ***

Back 130

- body
- neural (vertebral) arch
- vertebral foramen

Front 131

What are the characteristics of the body of a vertebra? ***

Back 131

- anterior portion is cylindrical portion

- major weight bearing structure of vertebral column

- increase in size cervical to lumbar due to increased load

- central portion covered with hyaline cartilage (cartilaginous or vertebral endplates)

- spinal roots pass through intervertebral foramina

- nutrients pass from cancellous bone through here to cartilaginous intervertebral discs

Front 132

How are the bodies of C1 and C2 formed and how do they articulate? ***

Back 132

- body is absent in C1, poorly formed in C2

- spinous processes are bifid (2-pronged)

- they are structurally weak in the anterior portion and fracture

- C1 (atlas/yes) - atlantooccipital joint (AO joint)

- C2 (axis/no) - atlanto-axial joint (AA joint) dens/odontoid process

Front 133

Describe the neural (vertebral) arch. ***

Back 133

- posterior portion of vertebra, has many parts

- 2 pedicles projecting from body; have inferior/superior vertebral notches which form intervertebral foramina (PNS)

- 2 laminae which unite in spinous process

- 2 inferior and 2 superior articular processes (facets); form facet joints; orientation of facets determines type of motion occurring at that joint

Front 134

What is a pedicle? ***

Back 134

- structures that project from body of vertebra

- have inferior/superior vertebral notches which form intervertebral foramina (PNS)

Front 135

What is the vertebral foramen? ***

Back 135

- large opening formed by joining of body and neural arch

- spinal cord passes through

Front 136

What passes through the vertebral foramen? ***

Back 136

spinal cord

Front 137

Characteristics of cervical vertebrae ***

Back 137

- smallest group of vertebrae

- body is small oval; transverse diameter is greater than A/P diameter

- vertebral foramen is large

- transverse processes have foramina for vertebral artery (if I remember A&P correctly, only the cervical vertebrae have foramina in the transverse process--helps to ID)

- spinous process short, bifid

- C1 (atlas/yes) has no spinous process or body -- it is shaped like a ring

Front 138

Characteristics of thoracic vertebrae ***

Back 138

- intermediate size vertebrae

- body is squared-off oval

- has equal transverse and A/P diameters

- vertebral foramen is small

- transverse process has facets for rib articulation (big clue for identifying thoracic vertebrae)

- spinous process is long, slender, points inferiorly (thus limiting extension); overlap adjacent vertebra

Front 139

Characteristics of lumbar vertebrae ***

Back 139

- largest (greatest amount of force applied in this region of the spinal column)

- body is massive oval with transverse diameter greater than entire diameter (helpful in identifying lumbar vertebrae)

- 5th lumbar has a wedge shaped body for articulation with sacral segment (S1)

- vertebral foramen is intermediate

- spinous process thick, broad, point posteriorly (horizontally)

Front 140

Characteristics of intervertebral discs ***

Back 140

- fibrocartilaginous discs located between each vertebral body of cervical, thoracic, lumbar regions (except C1)

- make up approx 20-33% of length of vertebral column (this is where we lose height when we age)

- thickest in lumbar region (9mm) thinnest in thoracic

- no independent blood supply; gets nutrients from vertebral endplates covering superior/inferior vertebral surfaces

- composed of nucleus pulposis and annulus fibrosis

Front 141

What is the nucleus pulposus? ***

Back 141

- central semi-gelatinous substance

- fluid-filled ball which acts a pivot for intervertebral joints

- able to undergo great distortions with loading forces

- high water content (80% at birth, < 60% at 60 y/o-- this is why older people get shorter)

- can vary morning to night depending on amount of vertebral column loading

- people tend to have problems where there is motion (cervical discs and lumbar discs, not generally thoracic

Front 142

How much of the length of the vertebral column is due to the height of the intervertebral discs? ***

Back 142

20 - 33%

Front 143

Easy ways to distinguish
- cervical vertebrae
- thoracic vertebrae
- lumbar vertebrae? ***

Back 143

- transverse foramina
- facets for rib attachment
- size

Front 144

Why do people shrink as they age? ***

Back 144

as we age our intervertebral discs (which comprise 20-33% of the height of our vertebral column) contain less water and compress

Front 145

What is the anulus fibrosis? ***

Back 145

- outer portion of intervertebral disc

- fibrocartilaginous rings

- enclose nucleus pulposus and keep it under pressure

- concentrically arranged

- thicker anterio-laterally, thinner posteriorly (why it tends to rupture posteriorly)

Front 146

In which direction do intervertebral discs typically rupture, and why? ***

Back 146

- typically posteriorly

- they are thicker anterio-laterally

Front 147

What are the functions of the intervertebral discs? ***

Back 147

- absorb and transmit shock or forces

- increase motion/flexibility of vertebral column

- amount of motion at any one disc joint determined by height ratio of disc-- the greater the height the more motion; reduced height reduces ROM

- discs height decreases with disc rupture and aging = decreased joint ROM

Front 148

When the intervertebral discs are compressed due to aging/loss of water content, what also happens in addition to compression and loss of height? ***

Back 148

loss of range of motion

(taller discs can bend further and have greater ROM)

Front 149

Name the joints of the vertebral column. ***

Back 149

- atlanto-occipital (AO joint - yes)
- atlanto-axial (AA joint – no)

- intervertebral joints
- facet joints (zygapophyseal joints)

Front 150

What is another name for a facet joint? ***

Back 150

zygapophyseal joint

Front 151

What is the atlanto-occipital (AO) joint? ***

Back 151

- articulation between occipital condyles of the skull and C1 vertebra

- synovial, condyloid biaxial joint (flex/ext, lat flex)

- supports the weight of the head
- protects the spinal cord

- many strong ligaments to reinforce the joint, give stability for support of head, protection of SC

Front 152

What is the atlanto-axial (AA) joint? ***

Back 152

- articulation between C1 (atlas/yes) and C2 (axis/no)

- dens (odontoid process) of axis (C2) articulates with anterior arch of atlas (C1) and transverse ligament (posteriorly)

- synovial, pivot joint (rotation); 50% cervical rotation

Front 153

What contributes 50% of the total cervical rotation of the neck in each direction? ***

Back 153

- the atlanto-axial (AA) joint between C1 and C2

- it contributes 50% and the other joints combine to make up the rest

Front 154

What are the intervertebral joints? ***

Back 154

- articulation between vertebral bodies (except C1-2, sacral)

- weight-bearing joint of vertebral column

- intervertebral discs each joint

- cartilaginous, non-synovial joints

- each produces a small amount of movement, cumulatively enable great ROM

- in vertebral column: the intervertebral joints primarily determine amount of motion and the facet joints primarily determine direction of motion

Front 155

Describe the facet (zygapophyseal) joints. ***

Back 155

- articulation between superior and inferior facets of adjacent vertebrae

- all levels except sacral

- synovial plane joints, direction of movement is determined by the orientation of facets

- lumbar processes in sagittal plane (primarily flexion/extension)

- thoracic processes in frontal plane (primarily lateral bending, some rotation, minimal flexion/extension due to rib attachment and long spinous processes

- cervical processes diagonally directed, with motion in all 3 planes

- cervical spine is the most mobile--allows for freedom of movement for head/neck

Front 156

At what level(s) of the spinal column are there no facet (zygapophyseal) joints? ***

Back 156

sacral

Front 157

What is the primary motion permitted by the facet joints at the
- lumbar spine?
- thoracic spine? ***

Back 157

- lumbar - primarily flexion/extension in the sagittal plane

- thoracic - primarily lateral bending in the frontal plane, some rotation and flexion/extension, but limited by rib attachment and long spinous processes

- in vertebral column: the intervertebral joints primarily determine amount of motion and the facet joint primarily determine direction of motion

Front 158

Of all the spinal regions, which is the most mobile/has the most freedom of movement? ***

Back 158

cervical (motion is permitted in all three planes)

Front 159

What impact may compression forces have on the vertebral column? ***

Back 159

abnormal axial compression forces though long axis of spine primarily affect:
- discs (ruptures),
- end plates (fxs)

Front 160

What impact may tensile forces have on the vertebral column? ***

Back 160

abnormal stretching/elongation on structures results in tears of:
- discs,
- ligaments,
- muscles around vertebral column

Front 161

What impact may shear forces have on the vertebral column? ***

Back 161

abnormal amount of sliding between 2 vertebrae affects
- discs (tears) and
- joint spaces/angles (subluxes)

occurs primarily at L-S angle and shearing increases as pelvis tilts anteriorally and L-S angle increases

Front 162

What impact may bending over have on the vertebral column? ***

Back 162

- causes compression and tensile (stretching) forces on structures opposite each other

with forward flexion,
- anterior structures (discs, ligaments, bones) subject to compression forces and
- posterior structures (annulus fibroses, ligaments, muscles) subject to tensile forces

Front 163

What impact may torsion have on the vertebral column? ***

Back 163

- axial rotation, twisting (the worst)

- result in tensile forces which cause stretching and tearing

- risk of rupture of disc fibers is increased when torsion, heavy axial compression, and bending are combined

Example: lifting a heavy patient in a flexed, twisted posture

Front 164

What is one of the worst things you can do to your spinal column? ***

Back 164

simultaneously twist and bend, then lift something heavy

Front 165

What is the lumbar-pelvic rhythm? ***

Back 165

- complete lumbar flexion is a coordinated activity of lumbar vertebral flexion and flexion of pelvis (acetabulum) on femur (anterior pelvic tilt)

- as trunk flexes, first portion of lumbar flexion occurs in lumbar intervertebral joint

- last portion of flexion occurs as a result of anterior pelvic tilt (hip flexion)

- this is the only way the trunk can flex enough to touch fingers to toes

Front 166

What is the sacroiliac joint? ***

Back 166

- articulation between ilia and fused S1,2,3

- part synovial/part fibrous joint; reinforced by strong, massive ligaments

- very little motion/mobility; will expand during pregnancy; often fuses in old age

Front 167

Describe the cervical region of the spinal column. ***

Back 167

- most flexible region; movement in all planes

- 50% cervical rotation at atlanto-axial (AA) joint

- head nod primarily at atlanto-occipital (AO) joint

- greatest amount cervical flex/ext ROM at C4-C6

- stability essential (especially AO and AA) to support of head and protect CC

- many muscles/ligaments in C1-C2 region to offer stability

Front 168

What is a cervical facet impingement and how do you treat it? ***

Back 168

"crick in the neck" (mainly due to the loose facet joint capsules in the region)

- flex neck and rotate 45 degrees in the opposite direction to release

Front 169

Where is the greatest amount of cervical flexion/extension ROM? ***

Back 169

C4-C6

Front 170

Describe the thoracic region of the spinal column. ***

Back 170

less mobility than cervical region due to
- rib cage
- inferior orientation of spinous processes
- taut facet joint capsules

- primary movement is lateral flexion, but some rotation, minimal flex/ext

Front 171

Describe the lumbar region of the spinal column. ***

Back 171

- primary function is to provide support for weight of upper body (HAT – head, arms, trunk)

- primary movement flex-ext

- L-S angle: horizontal L5 vertebra articulating with angled S1; the greater the angle the greater the lordosis
-- increases with anterior pelvic tilt
-- decreases with posterior pelvic tilt

- produces increased shearing forces as angle increases

Front 172

Describe the sacral region of the spinal column. ***

Back 172

- fused sacral vertebrae

- designed for
-- stability
-- supporting loads and
-- transmitting forces of HAT (head, arms, & trunk) from vertebral column to hip joint/LE

- minimal movement at sacroiliac joint; strong massive ligaments for reinforcement of joint

Front 173

What is the role of trunk flexor muscles during erect posture? ***

Back 173

- flexors: located anteriorally and laterally

- not active during normal erect standing

- forward flexion in standing does not require flexors (due to gravity pulling torso down)

- lie parallel to vertebral column and this exerts a large compression force during contraction (stability)

Front 174

What is the role of trunk extensor muscles during erect posture? ***

Back 174

- extensors: located posteriorly

- maintain stability of vertebral column in erect posture

- control forward flexion in erect posture (eccentric lowering)

- lie parallel to vertebral column

- exert a large compression force on vertebral column during contraction (stability)

Front 175

What are the general effects of aging and injury on the vertebral column? ***

Back 175

- most common structures affected with aging/injury to vertebral column
-- vertebral bodies (compression fx)
-- discs (ruptures)
- ligaments (tears, especially PLL)

Front 176

How does the CKC and interrelatedness of spinal column structures affect the structure when one part is damaged? ***

Back 176

deformation of one structure leads to deformation of others

(e.g., decreased disc height due to aging or injury results in:

- closer proximity of vertebral bodies, facet joints, spinous processes = loss of mobility

- decreased shock absorbency = increased compressive stresses on vertebral body (compression fx)

- loss of height of SC = slackened anterior longitudinal ligament (ALL – runs down front)/PLL = decreased stability of SC = Hypermobility of SC)

- usually kyphotic posture)
--------------------------------------------------------
(e.g., bulging disc due to excessive forces results in:

- overstretching of PLL = creep = eventual ligament tissue fails (tearing) = spilling of disc contents into vertebral canal = impingement on spinal nerves)

Front 177

Describe the ligaments of the vertebral column and list the primary ligaments. ***

Back 177

- vertebral column is virtually surrounded by ligaments
- need lots of stability

Primary ligaments:
- Anterior longitudinal ligament (down front)
- Posterior longitudinal ligament (down back)

Front 178

Describe the ALL. ***

Back 178

Anterior longitudinal ligament

- runs down entire vertebral column on anterior surface of vertebral bodies

- becomes stretched during extension

- limits excessive extension and reinforces intervertebral discs anteriorally

- is twice as strong as PLL

Front 179

Describe the PLL. ***

Back 179

Posterior longitudinal ligament

- runs down entire vertebral column on posterior surface of vertebral bodies adjacent to spinal cord

- becomes stretched in flexion; limits excessive flexion

- reinforces intervertebral discs posteriorly

- weaker than ALL

- thick in Cx region/thin in Lx region

- often tears in lumbar region = possible disc herniation

Front 180

List some of the other ligaments of the vertebral column located in the vertebral arch regions. ***

Back 180

- supraspinal ligament
- interspinous ligament
- ligamentum nuchae (nuchal ligament - name for supraspinal ligaments in the cranial/cervical region)
- ligamentum flavum
- transverse or intertransverse ligament

Front 181

What is the supraspinal ligament? ***

Back 181

extends from C7 to sacrum along tips of spinous processes (tip to tip)

Front 182

What is the interspinous ligament? ***

Back 182

runs between spinous processes

Front 183

What is the ligamentum nuchae? ***

Back 183

(nuchal ligament)

- extension of supraspinal and interspinous ligaments in the cervical region

Front 184

What is the ligamentum flavum? ***

Back 184

connects adjacent lamina anteriorly

Front 185

What is the transverse or intertransverse ligament? ***

Back 185

ligament that runs between two transverse processes

Front 186

What is often overlooked in therapy in cases of unexplained reduced ROM in thumb?

Back 186

the 1st CMC joint

Front 187

Which of the following statements is (are) true regarding the normal curvatures of the vertebral column? ***
a. the cervical and lumbar regions are both normally lordotic
b. the thoracic and lumbar regions are both normally kyphotic
c. the cervical and sacral areas are both normally kyphotic
d. the lumbar region is the only region of the spine that is normally lordotic

Back 187

a. the cervical and lumbar regions are both normally lordotic

Front 188

The central fluid-filled portion of the intervertebral disc is called the: ***
a. vertebral end plate
b. nucleus pulposus
c. annulus fibrosis
d. pedicle

Back 188

b. nucleus pulposus

Front 189

Which of the following vertebrae possess transverse foramina? ***
a. cervical
b. thoracic
c. lumbar

Back 189

a. cervical

Front 190

Which of the following terms is used to describe the second cervical vertebra? ***
a. cauda equina
b. pedicle
c. atlas
d. axis

Back 190

d. axis

Front 191

The lumbar region allows the most motion in the: ***
a. frontal plane
b. sagittal plane
c. horizontal plane

Back 191

b. sagittal plane

Front 192

The craniocervical region allows the most motion in the: ***
a. frontal plane
b. sagittal plane
c. horizontal plane

Back 192

c. horizontal plane

Front 193

Which motion of the lumbar spine results in a posterior migration of the nucleus pulposus of an intervertebral disc? ***
a. lateral flexion
b. rotation
c. flexion
d. extension

Back 193

c. flexion

Front 194

An anterior pelvic tilt is naturally accompanied by: ***
a. increased lordosis of the lumbar spine
b. decreased lordosis of the lumbar spine
c. strong activation of the abdominals
d. near maximal elongation of the hip flexors

Back 194

a. increased lordosis of the lumbar spine

Front 195

Which of the following motions decreases the diameter of the intervertebral foramen? ***
a. flexion
b. extension

Back 195

b. extension

Front 196

Which of the following statements best describes an anterior spondylolisthesis? ***
a. reduced flexion of the cervical vertebrae
b. elongation of the ligamentum flavum
c. anterior slippage, or translation, of one vertebra relative to another
d. simultaneous elongation of the anterior longitudinal ligament and the rectus abdominis muscle

Back 196

c. anterior slippage, or translation, of one vertebra relative to another

Front 197

Forward flexion of the lumbar spine involves: ***
a. elongation of the anterior longitudinal ligament
b. increased diameter of the intervertebral foramen
c. posterior migration of the nucleus pulposus
d. b and c
e. all of the above

Back 197

d. b and c

Front 198

Torticollis is typically caused by: ***
a. tightness of the lumbar erector spinae muscles
b. tightness of the sternocleidomastoid
c. excessive lateral flexion of the thoracic and lumbar spine
d. weakness of the quadratus lumborum

Back 198

b. tightness of the sternocleidomastoid

Front 199

Which of the following statements is true regarding the external oblique muscle? ***
a. activation of the right external oblique produces rotation to the left
b. activation of the right external oblique produces rotation to the right
c. bilateral activation of the external obliques can produce a posterior pelvic tilt
d. a and c
e. b and c

Back 199

d. a and c

Front 200

Which of the following muscles or muscle groups is involved with producing an anterior pelvic tilt? ***
a. erector spinae
b. hip flexors
c. rectus abdominis
d. a and b
e. b and c

Back 200

d. a and b

Front 201

Which of the following statements is (are) true regarding scoliosis? ***
a. scoliosis refers primarily to a frontal-plane deviation
b. scoliosis is named by the concave side of the spinal curve
c. scoliosis is named by the convex side of the spinal curve
d. a and b
e. a and c

Back 201

e. a and c

Front 202

Which muscle is part of the transversospinal muscle group? ***
a. multifidus
b. internal oblique
c. iliocostalis
d. transverse abdominis

Back 202

a. multifidus

Front 203

Lateral flexion of the cervical spine occurs in the: ***
a. frontal plane
b. sagittal plane
c. horizontal plane

Back 203

a. frontal plane

Front 204

Performing a full sit-up requires strong activation of the: ***
a. quadratus lumborum and erector spinae
b. iliocostalis and transversospinal muscles
c. iliopsoas and rectus abdominis
d. scalenes and suboccipital muscles

Back 204

c. iliopsoas and rectus abdominis

Front 205

The right quadratus lumborum is able to: ***
a. rotate the lumbar spine to the left
b. "hike" the left side of the pelvis
c. "hike" the right side of the pelvis
d. laterally flex the trunk to the left

Back 205

c. "hike" the right side of the pelvis

Front 206

Thoracic outlet syndrome is often the result of tightness or excessive hypertrophy of the: ***
a. iliopsoas muscle
b. anterior and middle scalenes
c. external obliques
d. foramen magnum

Back 206

b. anterior and middle scalenes

Front 207

Which of the following muscles is referred to as the corset muscle owing to its primary function of increasing intraabdominal pressure? ***
a. quadratus lumborum
b. erector spinae
c. transversus abdominis
d. splenius capitis and splenius cervicis

Back 207

c. transversus abdominis

Front 208

A posterior pelvic tilt involves activation of the abdominal muscles? ***
a. true
b. false

Back 208

a. true

Front 209

The dens is a bony projection found on the first cervical vertebra? ***
a. true
b. false

Back 209

b. false

it is found on the 2nd cervical vertebra (axis)

Front 210

The amount of lateral flexion that occurs in the thoracic region is largely limited by the articulation of the ribs with the thoracic vertebrae. ***
a. true
b. false

Back 210

a. true

Front 211

The cervical vertebrae have the widest, thickest bodies of all the vertebrae. ***
a. true
b. false

Back 211

b. false

the lumbar vertebrae have the widest, thickest bodies

Front 212

An individual with an anterior spondylolisthesis in the lumbar region would likely perform hyper-extension exercises as part of a therapeutic regimen. ***
a. true
b. false

Back 212

b. false

extension would be very bad for anterior spondylolisthesis

Front 213

About one half of the rotation available to the head and neck occurs from motion at the atlanto-axial (AA) joint. ***
a. true
b. false

Back 213

a. true

Front 214

The facet (apophyseal) joint surfaces of most lumbar vertebrae are oriented largely in the frontal plane. ***
a. true
b. false

Back 214

b. false

they are typically oriented in the sagittal plane, although at the caudal end they do return to frontal orientation (e.g., L5-S1)

Front 215

A posterior pelvic tilt typically results in a decreased diameter of the lumbar intervertebral foramina. ***
a. true
b. false

Back 215

the answer given is "true," however, on page 203 it states that a posterior pelvic tilt:
- flexes the lumbar spine
- decreases lumbar lordosis
- shifts the nucleus pulposus posteriorly
- INCREASES the diameter of the intervertebral foramina

Front 216

The spinal nerves exit the vertebral column through the transverse foramina. ***
a. true
b. false

Back 216

b. false

the transverse foramina are conduits for vertebral arteries

Front 217

The craniocervical region typically allows 90 degrees of axial rotation to each side. ***
a. true
b. false

Back 217

a. true

Front 218

The cervical, thoracic, and lumbar regions of the vertebral column allow what types of movement?

Back 218

they each allow movement in all three planes;
- flexion/extension
- lateral flexion
- horizontal rotation

Front 219

The amount of motion allowed at any point of the vertebral column depends upon:

Back 219

shapes and functions of local bony, muscular, and ligamentous structures

Front 220

What can lead to neuromuscular and musculoskeletal problems?

Back 220

- disease
- trauma
- aging

Front 221

Type of curvature in the
- cervical region
- thoracic region
- lumbar region
- sacrococcygeal region?

Back 221

- lordosis
- kyphosis
- lordosis
- kyphosis

Front 222

What does the anterior concavity of the thoracic and sacral regions provide?

Back 222

space for vital organs of chest and pelvis

Front 223

What do the normal curvatures of the spine provide?

Back 223

strength and stability to the entire axial skeleton

Front 224

Why can a curved vertebral column support more compressive force than a straight one?

Back 224

- curves allow compressive forces to be shared through the tension in the stretched connective tissue and muscles on the convex side of each curve

- they also allow the vertebral column to "give" slightly under a load, rather than support large forces statically

Front 225

What can lead to exaggeration (or reduction) of normal spinal curvature?

Back 225

- disease
- trauma
- genetically loose ligaments
- habitual poor posture

Front 226

Through which points does the line of gravity pass on a person with ideal posture?

Back 226

- mastoid process
- anterior to 2nd sacral vertebra
- slightly posterior to hip
- slightly anterior to knee and ankle
(just to the concave side of each vertebral region's curvature)

Front 227

How does gravity help maintain spinal curvature?

Back 227

in ideal posture, gravity produces a torque that helps maintain optimal shape of each spinal curvature, allowing one to stand at ease with minimal muscular activation and minimal stress on surrounding connective tissues

Front 228

Why do people have poor posture?

Back 228

- muscular tightness/weakness
- trauma
- poor habits
- body-fat distribution
- disease
- heredity

Front 229

Extension of the vertebral column ______ cervical and lumbar lordosis but _____ thoracic kyphosis.

Back 229

- increases lordosis

- decreases kyphosis

Front 230

Flexion of the vertebral column ______ cervical and lumbar lordosis but _____ thoracic kyphosis.

Back 230

- decreases lordosis

- increases kyphosis

Front 231

Clinicians who treat people with back and neck pain often attempt to correct _______ as a primary component of the rehabilitation process.

Back 231

faulty posture

Front 232

Name five types of faulty posture.

Back 232

- relaxed faulty posture
- kyphosis lordosis
- sway back
- flat back
- round back

Front 233

What structures form the atlanto-occipital joint?

Back 233

- occipital condyles

- atlas (C1)

Front 234

What is the primary weight-bearing structure of the vertebral column?

Back 234

body of the vertebra

Front 235

What is the function of the intervertebral disc?

Back 235

shock absorber

Front 236

What is the interbody joint?

Back 236

formed by the junction of two vertebral bodies and the interposed intervertebral disc

Front 237

What is the vertebral canal?

Back 237

the hole through each vertebra, through which the spinal cord passes

Front 238

What are pedicles?

Back 238

- short, thick projections of bone that connect the vertebral body to the transverse process

(the "sides/walls" of the vertebral canal between the body and transverse process; they form notches for the intervertebral foramina)

Front 239

What are laminae?

Back 239

- thin plates of bone that form the posterior wall of the vertebral canal, connecting each transverse process to the base of the spinous process

(the "sides/walls" of the vertebral canal between the transverse and spinous processes)

Front 240

What are the superior and inferior articular processes and facets?

Back 240

- points at which the vertebrae articulate

- the inferior facet of the upper disc articulate with the superior process of the disc below it

Front 241

What do the articular processes and facets form?

Back 241

apophyseal joints

(a.k.a. facet joints)

Front 242

How are the intervertebral foramina formed, and what is their function?

Back 242

- they are formed by the superior and inferior notches on the pedicles and the superior and inferior articular facets)

- they serve as passageways for nerve roots entering or exiting the vertebral column

Front 243

Why does the diameter of the intervertebral foramina sometimes change?

Back 243

because they are formed between two vertebrae (at the pedicles), thus spinal movement (especially flexion and extension) can significantly alter the diameter

Front 244

What types of forces are intervertebral discs extremely important in absorbing and transmitting?

Back 244

- shear

- compression

Front 245

What three structures comprise an intervertebral disc?

Back 245

- nucleus pulposus
- annulus fibrosus
- vertebral end plate

Front 246

Approximately how much of the nucleus pulposus is comprised of water?

Back 246

70-90%

Front 247

How many rings typically comprise the annulus fibrosus?

Back 247

10-20 concentric rings of fibrocartilage oriented in a crisscross fashion

Front 248

How are intervertebral discs supposed to function?

Back 248

- two vertebrae are compressed from the pressure of body weight or muscular forces

- the nucleus pulposus of the disc in between them is squeezed outward, producing tension within the annulus fibrosus

- this tension stabilizes the spongy disc, converting it into a stable weight-bearing structure

Front 249

What is the function of the vertebral end plate?

Back 249

- connects the intervertebral disc to the vertebrae above and below

- also helps provide the disc with nutrition

Front 250

How are spinal nerves numbered?

Back 250

- cervical spinal nerves exit ABOVE their respective cervical vertebrae (thus there is a C8)

- thoracic and lumbar nerves exit BELOW their respective vertebrae

Front 251

What is a costal facet?

Back 251

a place for rib attachment, and only on the thoracic vertebrae

Front 252

What is a costotransverse joint?

Back 252

point where a rib articulates with a transverse process (only thoracic)

Front 253

What is a costovertebral joint?

Back 253

point where a rib articulates with the vertebral body (only thoracic)

Front 254

Atlas (C1)
- body?
- spinous process?
- vertebral canal?
- transverse processes?

Back 254

- no body
- no spinous processes
- triangular, largest of cervical region
- largest of cervical region

Front 255

Axis (C2)
- body?
- spinous process?
- vertebral canal?

Back 255

- tall with vertical projecting dens
- largest spinous process; bifid
- large and triangular

Front 256

C3-C6
- bodies?
- spinous processes?
- vertebral canal?

Back 256

- wider than deep
- bifid
- large and triangular

Front 257

C7
- body?
- spinous process?

Back 257

- wider than deep

- large and prominent, easily palpable (thus often called vertebral prominens)

Front 258

T2-T9
- body?
- spinous processes?
- vertebral canal?
- other features?

Back 258

- equal width and depth
- long, pointy, slant inferiorly
- smaller than cervical
- costal facets for ribs

Front 259

T1, T10-12
- body?
- spinous processes?
- vertebral canal?
- other features?

Back 259

- equal width and depth; T1 has full costal facet for rib 1 and partial for rib 2
- long, pointy, slant inferiorly
- smaller than cervical
- costal facets for ribs, although T10-T12 may lack costal facets

Front 260

L1-L5
- body?
- spinous processes?
- vertebral canal?

Back 260

- wider than deep; L5 is slightly wedged (taller anteriorly than posteriorly)
- stout and rectangular
- triangular; contain cauda equina

Front 261

How are the facet joints oriented in the
- cervical spine?
- thoracic spine?
- lumbar spine?

Back 261

- generally about halfway between horizontal plane and frontal plane (45 degrees)

- closest to the frontal plane

- upper lumbar are primarily in the sagittal plane but lower lumbar vertebrae transition toward frontal plane

Front 262

Which are the most mobile vertebrae?

Back 262

cervical

Front 263

Which vertebrae contain transverse foramina? What are they for?

Back 263

- cervical

- passage for vertebral arteries

Front 264

What are the uncinate processes?

Back 264

articulations on the superior posterio-lateral side of cervical vertebrae

(those points that look like vampire fangs)

Front 265

What are the superior facets of C1 for?

Back 265

articulating with the occipital condyles of the skull to form the AO joint

Front 266

Why do intervertebral discs degenerate/become dehydrated?

Back 266

due to
- excessive wear
- arthritis
- advanced age

Front 267

What happens when an intervertebral disc degenerates/dehydrates?

Back 267

- bone on bone compression (esp. of uncinate processes of cervical vertebrae)

- compression stimulates growth of osteophytes (bone spurs) which may impinge nerves

Front 268

What is Wolff's Law?

Back 268

a law governing development of osteophytes, which states that, "bone is laid down in areas of high stress and reabsorbed in areas of low stress"

Front 269

The apophyseal/facet joints of the thoracic vertebrae are oriented.....

Back 269

in the frontal plane, thus promoting lateral flexion primarily

Front 270

The apophyseal/facet joints of the lumbar vertebrae are oriented.....

Back 270

- primarily in the sagittal plane in the upper lumbar region, thus promoting flexion and extension

- lower (around L5-S1) the orientation switches to frontal, likely to prevent the lower vertebrae from sliding forward

Front 271

What is the role of the sacrum?

Back 271

transmit weight of the vertebral column to the pelvis

Front 272

What is the sacral promontory?

Back 272

the portion of the sacrum which articulates with L5, forming the lumbosacral junction

Front 273

What is the lumbosacral junction?

Back 273

the point where L5 articulates with the sacral promontory

Front 274

What is the sacral canal, and what does it protect?

Back 274

- the vertebral canal of the sacrum

- protects the cauda equina

Front 275

What are the dorsal sacral foramina?

The ventral sacral foramina?

Back 275

- four pairs of holes that allow passage of the dorsal rami of sacral nerves

- four pairs of holes which allow passage of the ventral rami of spinal nerves that form much of the sacral plexus

Front 276

What is the articulation of the sacrum and coccyx called?

Back 276

sacrococcygeal joint

Front 277

What is the ligamentum flavum?

Back 277

- ligaments that attach between anterior surface of one lamina and the posterior surface of the lamina below

- limits flexion

- lies just posterior to spinal cord

- thickest in lumbar region

Front 278

What are the supraspinous and intraspinous ligaments?

Back 278

- ligaments between adjacent spinous processes from C7 to the sacrum

- limit flexion

- called ligamentum nuchae in the cervical and cranial region

- midline structure for muscle attachments and passive support for the head

(supraspinous seem to run straight down the back of the spinous processes, while intraspinous seem to run along the lateral sides of the spinous processes)

Front 279

What are the intertransverse ligaments?

Back 279

- those between adjacent transverse ligaments

- limit contralateral lateral flexion

- few in the cervical region, in the thoracic are combined with muscle, in the lumbar are thin and membranous

Front 280

What is the PLL?

Back 280

- posterior longitudinal ligament

- from C2 to sacrum, along posterior surfaces of the vertebral bodies

- just anterior to spinal cord

- stabilizes vertebral column, limits flexion, reinforces annulus fibrosus

Front 281

What is the ALL?

Back 281

- anterior longitudinal ligament

- between base of occipital bone to the sacrum

- along anterior surface

- adds stability, limits extension or excessive lordosis in cervical/lumbar

Front 282

What is the cauda equina?

Back 282

- "horse's tail"

- end of spinal cord

Front 283

What can damage to the cauda equina do?

Damage to the spinal cord?

Back 283

- may cause muscle paralysis, atrophy, altered sensation, and hyporeflexia

- may cause paralysis, altered sensation, spasticity, and hyper-reflexia

Front 284

Where does the adult spinal cord typically end?

Back 284

L1-L2

Front 285

From what aspect is movement in the spinal column defined?

Back 285

it is described by the direction of motion of a point on the anterior side of the vertebrae

Front 286

Movements of a particular spinal region are guided primarily by the....

Back 286

spatial orientation of the surfaces within the facet joints

Front 287

Flexion and extension
- plane
- axis of rotation

Back 287

- sagittal

- medial-lateral

(bending forward and backward)

Front 288

Lateral flexion to right or left
- plane
- axis of rotation

Back 288

- forntal

- anterior-posterior

(bending from side to side)

Front 289

Axial rotation to right or left
- plane
- axis of rotation

Back 289

- horzontal

- longitudinal/ vertical

(twisting, rotating)

Front 290

A vertebra naturally moves in the direction of _____ bony resistance, which is strongly dictated by .....

Back 290

- least

- the articular surfaces of the facet joints

Front 291

The superior facets of C2 are oriented closest to the ____ plane and thus the freest motion is ______.

Back 291

- horizontal

- rotation along the transverse axis

Front 292

The facet surfaces of C3-C7 are oriented ____ and thus the freest motion is ______.

Back 292

- halfway between the horizontal and frontal planes

nearly equal between
- lateral flexion along the anterior-posterior axis, and
- horizontal rotation along the transverse axis

Front 293

The facet surfaces of the thoracic vertebrae are oriented closest to the ____ plane and thus the freest motion is ______.

Back 293

- frontal

- lateral flexion along the anterior-posterior axis (although ROM is limited by ribs)

Front 294

The facet surfaces of the upper lumbar vertebrae are oriented closest to the ____ plane and thus the freest motion is ______.

Back 294

- sagittal

- flexion and extension along a medial-lateral axis

Front 295

The facet surfaces of the lower lumbar vertebrae are oriented closest to the ____ plane and thus the freest motion is ______.

Back 295

- frontal

- lateral flexion along the anterior-posterior axis
(this may be for the "hip hiking" motion needed to walk or run; it also keeps lower lumbar vertebra from sliding anteriorly)

Front 296

Flexion ROM:
- AO joint
- AA joint
- C2-C7

Back 296

- 5 degrees
- 5 degrees
- 35 degrees
(total of about 45-50 degrees)

Front 297

Extension ROM:
- AO joint
- AA joint
- C2-C7

Back 297

- 10 degrees
- 10 degrees
- 70 degrees
(values are double that of flexion)
(total about 85 degrees)

Front 298

Full cervical ROM for flexion and extension?

Back 298

about 130-135 degrees

Front 299

Axial rotation ROM:
- AO joint
- AA joint
- C2-C7
- total

Back 299

- negligible
- 40-45 degrees
- 45 degrees
(total about 90 degrees)

Front 300

Lateral flexion ROM:
- AO joint
- AA joint
- C2-C7
- total

Back 300

- about 5 degrees
- negligible
- 35 degrees
(total about 40 degrees)

Front 301

How do the roll and slide work at the AO joint?

Back 301

opposite directions

(convex on concave)

Front 302

How much of total cervical sagittal plane motion occurs at AO and AA joints?

Back 302

25%

Front 303

Because of the orientation of the cervical facet joints at C2-C7, what occurs during cervical rotation?

Back 303

the rotation is coupled with a slight amount of cervical lateral flexion

Front 304

Because of the orientation of the cervical facet joints at C2-C7, what occurs during cervical lateral flexion?

Back 304

the lateral flexion is coupled with a slight amount of cervical rotation

Front 305

What is full ROM in both directions (combined) for cervical rotation?

Back 305

about 180 degrees

(about 90 degrees each left and right)

Front 306

What does the addition of 150-160 degrees of horizontal plane motion of the eyes do for cervical rotation?

Back 306

enables us to approach 360 degrees of visual field without moving the trunk

Front 307

The AA joint is responsible for about ____ the rotation in the craniocervical region.

Back 307

half

(about 45 of the 90 degrees)

Front 308

Does the head rotate without atlas?

Back 308

no

(the AO joint strongly resists rotation, thus the AA joint is where it happens)

Front 309

How does flexion affect the size of the intervertebral foramina? Extension?

Back 309

- flexion increases the diameter

- extension decreases the diameter

Front 310

What is one of the most commonly observed faulty postures of the craniocervical region?

Back 310

- "forward-head" posture

- [head is protracted by flexing lower cervical vertebrae and (hyper)extending the upper craniocervical region]

Front 311

How is forward head posturing commonly treated?

Back 311

chin tucks

(retraction of the head)

Front 312

Flexion ROM:
- thoracic
- lumbar
- total

Back 312

- 30-40 degrees
- 50 degrees
- (about 85 degrees)

Front 313

Extension ROM:
- thoracic
- lumbar
- total

Back 313

- 20-25 degrees
- 15 degrees
- (about 35-40 degrees)

Front 314

What is the total thoracolumbar sagittal ROM (flexion and extension combined)?

Back 314

about 120-125 degrees

Front 315

The five lumbar vertebrae provide about 50 degrees of flexion. How is this possible? What is the downside?

Back 315

it is due to the near-sagittal plane orientation of the facet joints

(this freedom of motion, however, may also be the cause of the lumbar vertebrae's high incidence of HNP)

Front 316

What limits extension in the thoracic region?

Back 316

- the inferiorly pointing spinous processes of the thoracic vertebrae, and

- the tension in the ALL

Front 317

Rotation ROM:
- thoracic
- lumbar
- total

Back 317

- 30 degrees
- 5 degrees
- about 35 degrees

Front 318

Lateral flexion ROM:
- thoracic
- lumbar
- total

Back 318

- 25 degrees
- 20 degrees
- about 45 degrees

Front 319

Why is rotation of the lumbar vertebrae so limited?

Back 319

because of the near-sagittal plane orientation of the lumbar apophyseal/facet joints

Front 320

What are the four categories of disc herniation?

Back 320

- protrusion
- prolapse
- extrusion
- sequestration

Front 321

What is a protrusion?

Back 321

displaced nucleus pulposus remains within the annulus fibrosus but may create a pressure bulge on the neural tissues

Front 322

What is a prolapse?

Back 322

displaced nucleus pulposus reaches the posterior edge of the disc, but remains confined within the outer layers of the annulus fibrosus

Front 323

What is an extrusion?

Back 323

annulus fibrosus ruptures, allowing the nucleus pulposus to completely escape from the disc into the epidural space

Front 324

Because the nucleus pulposus is mostly fluid, it tends to migrate ____ from the compressed regions of adjacent vertebrae.

Back 324

away

(generally moves opposite spinal motion)

Front 325

Where are HNPs most common?

Back 325

- in the lumbar region

- posteriorly (toward the spinal cord or cauda equina)

Front 326

In which position does the least amount of pressure occur on a lumbar HNP?

Back 326

while lying down

Front 327

Since treatment of HNPs is often based on mechanics of spinal motion, how are posterior HNPs often treated?

Back 327

with extension exercises to help push the nucleus pulposus anteriorly back toward the center of the disc and away from the spinal elements

Front 328

What does "scoliosis" mean?

Back 328

curvature

Front 329

What is scoliosis?

Back 329

deformity of the vertebral column, primarily characterized by abnormal frontal plane curvatures in the thoracolumbar region

Front 330

Because the motions of the spine are mechanically coupled, scoliosis typically also involves....

Back 330

abnormal curvatures in the horizontal plane and, to a lesser extent, in the sagittal plane

Front 331

What is the most common pattern of scoliosis?

Back 331

- a single lateral curve, with an apex in the T7-T9 region

- many other patterns involve a compensatory curve, most often in the lumbar region

Front 332

How is the type of scoliosis defined?

Back 332

by the apex of convex side of the curve

Front 333

In cases of structural (fixed) scoliosis, a characteristic _____ is often evident on forward flexion as a result of the ribs being forced to follow the unwanted rotation of the thoracic vertebrae.

Back 333

"rib hump"

Front 334

How is scoliosis typically treated?

Back 334

- stretching of the tissues on the shortened (concave) side of each curve

- strengthening of the muscles on the convex side

- bracing

- soft tissue mobilization

- postural education

- surgery, when conservative treatment does not arrest progression of the deformity

Front 335

What is an anterior pelvic tilt?

What effect does it have on the lumbar spine?

Back 335

- a short-arc anterior rotation of the (top/anterior crest of the) pelvis about the hip joints, with the trunk held upright and stationary

- it extends the lumbar spine and increases lumbar lordosis

- tends to shift the nucleus pulposus anteriorly and decrease the diameter of the intervertebral foramina

Front 336

What is a posterior pelvic tilt?

What effect does it have on the lumbar spine?

Back 336

- a short-arc posterior rotation of the (top/anterior crest of the) pelvis about the hip joints, with the trunk held upright and stationary

- it flexes the lumbar spine and decreases lumbar lordosis

- tends to shift the nucleus pulposus posteriorly and increase the diameter of the intervertebral foramina

Front 337

What is the lumbosacral junction? What occurs here?

Back 337

- the articulation of L5-S1

- the weight of the entire HAT is transferred to the pelvis at this point

Front 338

What is the configuration of the lumbosacral junction? What is this angle called?

Back 338

- aligned so the base of the sacrum is inclined forward about 40 degrees from horizontal

- sacrohorizontal angle

Front 339

Why are the facet joints of L5-S1 oriented close to the frontal plane?

Back 339

to help prevent the lower spine from translating "downhill" in a forward direction relative to the sacrum (anterior spondylolisthesis)

"spondylo" - spine
"listhesis" - to slip

Front 340

What forms the SI joints?

Back 340

- articulation between the sacrum and both iliac bones

Front 341

What is the function of the SI joints?

Back 341

to allow the sacrum to transfer forces of body weight to the pelvis and LE

Front 342

How much motion do the SI joints allow?

Back 342

- very little

- the rigidity promotes stability, which is required to transfer large forces adequately, such as when walking or running

Front 343

How is the SI joint stabilized?

Back 343

- by many thick ligaments and roughened articular surfaces

- also by muscles such as the piriformis, hamstrings, and abdominals

Front 344

What is the most common pathology causing anterior spondylolisthesis?

Back 344

fracture of the pars interarticularis, a section of the vertebrae midway between the superior and inferior articular processes

Front 345

What movements are contraindicated for a person with anterior spondylolisthesis?

Back 345

- any exercises promoting full extension or hyperlordosis

- extreme anterior pelvic tilts

Front 346

What are some of the ligaments of the SI joint?

Back 346

- short posterior SI ligaments
- long posterior SI ligaments
- sacrospinous ligaments
- sacrotuberous ligament

Front 347

What is the typical rotational ROM at the SI joint? Translational distance?

Back 347

- 2 degrees or less

- usually less than 2 mm

Front 348

What is nutation? Counternutation?

Back 348

- means "to nod" (referencing the anterior edge of the sacrum)

- anterior rotation of the sacrum relative to the ilia

- posterior rotation of the sacrum relative to the ilia

Front 349

How are the SI joints typically injured? What effects can this have on overall posture?

Back 349

- by a fall on the hip or coccyx

- SI joints become misaligned, which destabilizes the pelvis and results in pain or significant postural compensation

Front 350

Once a spinal nerve exits an intervertebral foramen, it quickly ______.

Back 350

divides into a ventral or dorsal ramus

Front 351

What are dorsal rami?

Back 351

- form short nerves that innervate most muscles of the posterior neck and posterior trunk

- muscle tissue on the posterior aspect of the vertebral column that courses between T6 and T12 is likely innervated by multiple dorsal rami from spinal nerves T6-T12

Front 352

What are ventral rami?

Back 352

- form the cervical, brachial, and lumbosacral plexuses

- innervate most of the muscles of the anterior-lateral trunk and neck

- muscle tissue of the anterior-lateral trunk spanning T6-T12 would likely be innervated by nerves of the ventral rami of the T6-T12 region (called intercostal nerves)

Front 353

The muscles of the craniocervical region can be divided into what two groups?

Back 353

- anterior

- posterior

Front 354

What motions do anterior craniocervical muscles perform?

Posterior craniocervical muscles?

Back 354

- flex the head/neck

- extend the head/neck

(and nearly every muscle in this region also has some potential to laterally flex or rotate the craniocervical regions in the horizontal plane)

Front 355

Name the superficial muscles of the anterior craniocervical region.

Back 355

- sternocleidomastoid
- anterior scalenes
- middle scalenes
- posterior scalenes

Front 356

What are the functions of the superficial anterior craniocervical muscles?

Back 356

- flex, laterally flex, contralaterally rotate head/neck

- act as "guy wires" to stabilize the region

Front 357

What does the ventral nerve root do?

Back 357

contains primarily outgoing (efferent) axons that provide motor signals to muscle

Front 358

What does the dorsal nerve root do?

Back 358

- contains mostly incoming (afferent) dendrites that carry sensory information to the spinal cord from the periphery

Front 359

What are spinal nerves?

Back 359

composed of dorsal and ventral nerve roots

Front 360

What is a dorsal ramus?

Back 360

posterior branches from the spinal nerve that innervate the deeper posterior musculature of the trunk and craniocervical regions

Front 361

What is a ventral ramus?

Back 361

- anterior branches from the spinal nerve that innervate the anterior-lateral musculature of the trunk and craniocervical regions

- also form the cervical, brachial, and lumbosacral plexus

Front 362

Sternocleidomastoid OAIN

Back 362

O - sternal head - super manubrium
clavicular head - medial 1/3

I - mastoid process

N - Cranial nerve XI (spinal accessory)

A - bilateral - flex head/neck
unilateral - rotation of head to opposite side; lateral flexion

Front 363

What is torticollis?

Back 363

- a.k.a. wryneck

- tightness of a SCM which results in the head and neck becoming positioned into all of the actions of the SCM (flexion, lateral flexion, contralateral rotation)

- typically seen in young children, treated conservatively with stretching and ST mobilization

Front 364

Anterior scalene OAIN

(1413 Ex3)

Back 364

O - transverse processes C3-C7

I - first rib

N - ventral rami (C3-C7)

A - bilateral - flexion of neck; assist inspiration
unilateral - lateral flexion

Front 365

Middle scalene OAIN

(1413 Ex3)

Back 365

O - transverse processes C2-C7

I - first rib

N - ventral rami (C3-C7)

A - bilateral - flexion of neck; assist inspiration
unilateral - lateral flexion

Front 366

Posterior scalene OAIN

(1413 Ex3)

Back 366

O - transverse processes C5-C7

I - external surface of second rib

N - ventral rami (C3-C7)

A - bilateral - assist inspiration
unilateral - lateral flexion

Front 367

How do scalenes assist inspiration?

Back 367

by elevating the ribs

Front 368

Who may have hypertrophied scalenes?

Back 368

COPD patients, from using them to assist with labored breathing

Front 369

If either the anterior or middle scalene is significantly tight, what may happen?

Back 369

the patient may experience thoracic outlet syndrome

Front 370

What passes between the anterior and middle scalenes?

Back 370

- brachial plexus
- subclavian artery

(thus if either muscle is tight, they could pinch one of the above and cause thoracic outlet syndrome)

Front 371

Name the deep anterior craniocervical muscles and their function

Back 371

- longus colli
- longus capitis
- rectus capitis anterior
- rectus capitis lateralis

- flex neck and head, dynamically stabilize the craniocervical region

Front 372

Longus colli OAIN

Back 372

O - bodies and transverse processes of C3-T3

I - transverse processes and bodies of C1-C6

N - ventral rami C2-C8

A - flexion of the neck

Front 373

Longus capitis OAIN

Back 373

O - transverse processes of C3-C6

I - anterior to foramen magnum

N - ventral rami C1-C3

A - bilateral: flexion of the head and neck

Front 374

Rectus capitis anterior OAIN

Back 374

O - transverse processes of C1

I - just anterior to occipital condyles

N - ventral rami C1-C2

A - flexion of the head (AO joint only)

Front 375

Rectus capitis lateralis OAIN

Back 375

O - transverse processes of C1

I - just lateral to occipital condyles

N - ventral rami C1-C2

A - unilateral: lateral flexion of the head (AO joint only)

Front 376

Name the deep posterior craniocervical muscles.

What is their function?

Back 376

suboccipital muscles
- rectus capitis posterior major
- rectus capitis posterior minor
- obliquus capitis superior
- obliquus capitis inferior

- fine control of movements in the AO and AA joints for positioning the head for vision, hearing, and vestibular functions

Front 377

With what is tightness of the suboccipital muscles often associated?

Back 377

"forward head" posture

Front 378

Rectus capitis posterior major OAIN

Back 378

O - spinous process of C2

I - lateral aspect of inferior nuchal line

N - suboccipital nerve (dorsal ramus C1)

A - bilateral: extension of AA/AO joints;
unilateral: lateral flexion of AO joint, rotation to same side at AA joint

Front 379

Rectus capitis posterior minor OAIN

Back 379

O - posterior tubercle of C1

I - medial aspect of inferior nuchal line

N - suboccipital nerve (dorsal ramus C1)

A - bilateral: extension of AO joint

Front 380

Obliquus capitis superior OAIN

Back 380

O - transverse process of C1

I - lateral aspect between superior and inferior nuchal lines

N - suboccipital nerve (dorsal ramus C1)

A - bilateral: extension of AO joint;
unilateral: lateral flexion of AO joint

Front 381

Obliquus capitis inferior OAIN

Back 381

O - apex of spinous process of C2

I - inferior margin of the transverse process of C1

N - suboccipital nerve (dorsal ramus C1)

A - bilateral: extension of AA joint;
unilateral: same-side rotation of AA joint

Front 382

Name the superficial cervical extensors.

What are their function?

Back 382

- splenius capitis
- splenius cervicis

- work together to extend, laterally flex, and rotate the head and neck to the same side

Front 383

Splenius capitis OAIN

Back 383

O - lower half of ligamentum nuchae and spinous processes of C7-T3

I - mastoid process and lateral 1/3 of superior nuchal line

N - dorsal rami (C2-C8)

A - bilateral: extension of head and neck
unilateral: lateral flexion of head and neck, ipsilateral rotation of head and neck

Front 384

Splenius cervicis OAIN

Back 384

O - spinous processes of T3-T6

I - transverse processes of C1-C3

N - dorsal rami (C2-C8)

A - bilateral: extension of neck
unilateral: lateral flexion of neck, ipsilateral rotation of neck

Front 385

What is whiplash?

Back 385

result of uncontrolled acceleration of head and neck into flexion, extension, or both

Front 386

Which type of whiplash generally causes greater strain on muscles and soft tissues?

Back 386

whiplash associated with hyperextension

(partially because maximum extent of cervical flexion is blocked by the chin striking the chest

Front 387

What muscles are particularly vulnerable to hyperextension-associated whiplash?

Back 387

- longus colli

- longus capitis

Front 388

What signs and symptoms does a person with hyperextension whiplash display?

Back 388

- marked tenderness and
- protective spasm in the region of the longus colli/capitis

Front 389

What can a cervical hyperextension (whiplash) injury lead to?

Back 389

- cervical instability

- difficulty shrugging shoulders

- without stabilization provided by longus colli and other flexors, upper trapezius loses its stable cranial attachment and thus loses its effectiveness at elevating the shoulder girdle

(as part of the upper trapezius, lower trapezius, serratus anterior upward rotation force couple, as well as with the levator scapula and rhomboids in pure elevation, I assume; weakness of upper trapezius also may lead to depressed and downwardly rotated scapula, superior dislocation of the SC joint, and subluxation of the GH joint)

Front 390

Ample control of the head and neck is essential for coordinated alignment of the ________.

Back 390

eyes and ears

(neurologically, many muscles of the head and neck are closely linked to the visual and vestibular systems of the brain)

Front 391

What is the primary function of the deeper craniocervical muscles?

Back 391

- to fine-tune movements of the head and neck

- these muscles (e.g., suboccipitals) are effective at neutralizing secondary (and often undesired) actions that are otherwise dictated by the plane of the facet joint

Front 392

Name the anterior-lateral muscles of the trunk.

Back 392

- rectus abdominis
- external oblique
- internal oblique
- transverse abdominis

Front 393

What is the main purpose of the anterior-lateral trunk muscles?

Back 393

- provide mobility and stability to the trunk

Front 394

What does contraction of the abdominal muscles do, and why is this important?

Back 394

- increases intra-abdominal and intrathoracic pressures

- helps in stabilizing the lumbar spine during lifting, coughing, defecation, and childbirth

Front 395

When contracting bilaterally, the abdominal muscles decrease the distance between the _____ and the _____.

Back 395

- xiphoid process of sternum

- pubic bone

Front 396

Bilateral contracting of abdominals is expressed by either _____ or ______ (or ______.)

Back 396

- flexing the thoracic region ("crunches")

- posteriorly tilting the pelvis

- or both actions simultaneously

Front 397

Why is the ability to posteriorly tilt the pelvis so important?

Back 397

- it is necessary to neutralize the strong anterior tilting potential caused by contraction of the hip flexor muscles

- this is why clinicians often promote abdominal activation prior to any strong activation of hip flexors (such as straight leg raises) to prevent unwanted lumbar lordosis

Front 398

What is the thoracolumbar fascia?

Back 398

- an extensive, dense sheet of connective tissue that attaches to the spinous processes of all lumbar vertebrae, posterior sacrum, and posterior ilium

- this tissue tightly wraps around several muscles, including the erector spinae, quadratus lumborum, and latissimus dorsi

Front 399

How can contraction of the abdominal muscles help support the lower back?

Back 399

- contraction of the abdominal muscles increases the tension in the thoracolumbar fascia

- this allows the abdominal muscles to transfer force to mechanically support the lower back (maybe why we instinctively contract our abs and hold our breath just prior to a lift)

Front 400

How do we over-stretch the thoracolumbar fascia?

Back 400

- slumped sitting with overly flexed lower back for long period of time

- may reduce the stiffness in the tissue and reduce the effectiveness of the force transfer from the abs and lower back

Front 401

Rectus abdominis OAIN

(1413 Ex3)

Back 401

O - crest of pubis

I - xiphoid process and cartilage of ribs 5-7

N- intercostal nerves (T7-T12)

A - flexion of trunk, posterior pelvic tilt, increases intra-abdominal and intrathoracic pressure

two halves separated by tendinous sheath called linea alba, which mechanically links left and right sets of abdominal muscles; also has three tendinous intersections, which help produce the "six pack"

Front 402

External oblique OAIN

(1413 Ex3)

Back 402

O - lateral side of ribs 4-12

I - iliac crest, linea alba

N- intercostal nerves (T8-T12)

A - bilateral: flexion of trunk, posterior pelvic tilt, increases intra-abdominal and intrathoracic pressure; unilateral: contralateral trunk rotation; lateral flexion

largest of lateral abdominal muscles; fibers travel inferior-medial (as your hands travel when putting them into front pockets)

primary contralateral rotator of the trunk

Front 403

Internal oblique OAIN

(1413 Ex3)

Back 403

O - iliac crest, inguinal ligament, and thoracolumbar fascia

I - ribs 9-12, linea alba

N- intercostal nerves (T8-T12)

A - bilateral: flexion of trunk, posterior pelvic tilt, increases intra-abdominal and intrathoracic pressure, increases tension in thoracolumbar fascia; unilateral: lateral flexion of the trunk, ipsilateral rotation of trunk

deep to the external oblique; courses superior medial (iliac crest to sternum) nearly perpendicular to the external oblique

primary ipsilateral rotator of the trunk

Front 404

Transverse abdominis OAIN

(1413 Ex3)

Back 404

O - iliac crest, thoracolumbar fascia, cartilages of ribs 6-12, and inguinal ligament

I - linea alba

N- intercostal nerves (T7-T12)

A - increases intra-abdominal pressure, increases tension in thoracolumbar fascia

deepest abdominal muscle; a.k.a. "corset muscle," reflecting its primary function of increasing intra-abdominal pressure; as with internal oblique, contraction pulls on the thoracolumbar fascia, and the resulting tension helps stabilize the lumbar region during lifting activities

Front 405

Other functionally associated muscles (not considered muscles of the trunk, but strongly associated with movement and stability of lumbar region).

Back 405

- iliopsoas (iliacus and psoas major)

- quadratus lumborum (anatomically a muscle of the posterior abdominal wall)

Front 406

Functions of the iliopsoas in the lumbar region

Back 406

- primary hip flexor

- dominant role in other motions of the trunk and pelvis (e.g., sit-ups, anterior pelvic tilt)

Front 407

Functions of the quadratus lumborum in the lumbar region

Back 407

- bilateral activation results in extension of the lumbar spine

Front 408

Iliopsoas OAIN

Back 408

O - (psoas) transverse processes of T12-L5; (iliacus) iliac fossa

I - lesser trochanter of femur

N- femoral nerve

A - hip flexion, trunk flexion, anterior pelvic tilt

abdominals produce posterior pelvic tilt, while iliopsoas produces anterior pelvic tilt; these muscles can be activated together to firmly stabilize the pelvis within the sagittal plane

Front 409

Quadratus lumborum OAIN

Back 409

O - crest of ilium

I - transverse processes of L1-L4 and 12th rib

N- ventral rami (T12-L3)

A - bilateral: extension of the lumbar region; unilateral: lateral flexion of trunk

clinically, the muscle is known as a "hip-hiker, describing its ability to elevate one side of the pelvis; patients with weak or paralyzed hip flexors can be taught to contract their QL to elevate one side of the pelvis, helping clear the foot from the ground as it is advanced forward during gait

Front 410

What are the two phases of a sit-up?

Back 410

- trunk flexion phase - abdominals (primarily rectus abdominis) bring xiphoid to pubis and flatten lordotic curve of lumbar spine; phase concludes when scapulae clear the surface, however abdominal muscles remain active throughout entire sit-up

- hip flexion phase - hip flexors rotate pelvis and attached trunk anteriorly, drawing the chest closer to the knees

Front 411

How will a person with weak abdominals compensate during a sit-up?

Back 411

- strong contraction of hip flexors, which immediately take over the action

- noted by exaggerated anterior pelvic tilt and increased lumbar lordosis as pelvis and trunk are rotated forward and upward

Front 412

Name the muscles of the erector spinae group.

Back 412

- spinalis (capitis, cervicis, thoracis)
- longissimus (capitis, cervicis, thoracis)
- iliocostalis (cervicis, thoracis, lumborum)

Front 413

As a group, the erector spinae....

Back 413

extend and stabilize the entire vertebral column and craniocervical region

Front 414

The inferior parts of the erector spinae share what common attachment?

Back 414

to the common tendon
- a broad, thick tendon just superficial to the sacrum
- blends with the more superficial part of the thoracolumbar fascia

Front 415

spinalis (capitis, cervicis, thoracis) OAIN

Back 415

O -
capitis - blends with semispinalis capitis
cervicis - ligamentum nuchae and spinous processes of C7-T1
thoracis - common tendon

I -
capitis - blends with semispinalis capitis
cervicis - spinous process of C2
thoracis - spinous processes of T1-T6

N- dorsal rami of adjacent spinal nerves

A - bilateral: extension

Front 416

longissimus (capitis, cervicis, thoracis) OAIN

Back 416

O -
capitis - transverse processes of T1-T5 and near facet joints C3-C7
cervicis - transverse processes of T1-T4
thoracis - common tendon

I -
capitis - mastoid process
cervicis - transverse processes of C2-C6
thoracis - transverse processes of T1-T12

N- dorsal rami of adjacent spinal nerves

A - bilateral: extension; unilateral: lateral flexion

Front 417

iliocostalis (cervicis, thoracis, lumborum) OAIN

Back 417

O -
cervicis - angle of ribs 3-7
thoracis - angle of ribs 6-12
lumborum - common tendon

I -
cervicis - transverse processes of C4-C6
thoracis - angle of ribs 1-6
lumborum - angle of ribs 6-12

N- dorsal rami of adjacent spinal nerves

A - bilateral: extension; unilateral: lateral flexion

Front 418

Name the transversospinal muscles

Back 418

- semispinalis
- multifidus
- rotators

Front 419

Where are the transversospinal muscles located?

Back 419

- deep to the erector spinae

- run obliquely from transverse processes of one vertebra to the spinous processes of more superior vertebrae

Front 420

How are the transversospinal muscles similar? Different?

Back 420

- similar fiber direction

- length and number of vertebral segments they cross

Front 421

Where are the transversospinal muscles particularly well developed? What is the benefit?

Back 421

- lumbar and craniocervical areas

- extra stability

Front 422

Function of all transversospinal muscles

Back 422

- extend the vertebral column

- oblique fiber direction also gives them a favorable line of pull to produce contralateral rotation

Front 423

The more horizontal (and shorter) the transversospinal muscle, the greater the potential to...

Back 423

produce horizontal plane rotation

Front 424

How do the transversospinal muscles work with the oblique abdominal muscles?

Back 424

- during trunk rotation

(e.g., rotation to the left is driven primarily by the right external and left internal obliques and reinforced by the right transversospinal muscles

Front 425

Semispinalis (capitis, cervicis, thoracis) OAIN

Back 425

O - transverse processes of C4-T12

I - spinous process 6-8 vertebral segments above the origin;
semispinalis capitis attaches just above inferior nuchal line

N- dorsal rami of adjacent spinal nerves (C1-T12)

A - bilateral: extension;
unilateral: rotation to opposite side

Front 426

Multifidus OAIN

Back 426

O - transverse processes of T1-T12
mamillary processes of L1-L5
sacrum

I - spinous process 2-4 vertebral segments above the origin;

N- dorsal rami of adjacent spinal nerves (C4-S3)

A - bilateral: extension;
unilateral: rotation to opposite side

Front 427

Rotators OAIN

Back 427

O - transverse processes of all vertebrae

I - spinous process 1-2 vertebral segments above the origin;

N- dorsal rami of adjacent spinal nerves (C4-L4)

A - bilateral: extension;
unilateral: rotation to opposite side

Front 428

What comprises the short segmental group?

Back 428

- intertransversarus muscles

- interspinales muscles

Front 429

Intertransversarus muscles attachment and action

Back 429

- attach between consecutive transverse processes

- unilaterally: laterally flex spine

Front 430

Interspinalis muscles attachment and action

Back 430

- attach between consecutive spinous processes

- extend the spine

Front 431

At what are the intertransversarus and interspinalis muscles particularly effective?

Back 431

- the paired, segmental nature of these muscles allows them to control movement at individual intervertebral junctions, enabling them to provide fine control over the vertical stability of the vertebral column in both sagittal and frontal planes

- they also provide a rich source of sensory feedback, essential for subconscious control of postural alignment

Front 432

The muscles of the posterior trunk have an important function in....

Back 432

- vertically stabilizing the vertebral column

- each muscle group does so in a different manner

Front 433

Which are the most superficial of the posterior trunk muscles?

Back 433

erector spinae

Front 434

Because of their parallel path, the erector spinae are often referred to as the ______.

Back 434

paraspinals

Front 435

Each muscular column of the erector spinae crosses many intervertebral segments and is therefore only capable of

Back 435

furnishing gross control over extension and lateral flexion

Front 436

The transversospinal muscles course obliquely (from nearly vertical to nearly horizontal) across relatively few intervertebral segments, thus...

Back 436

they can exert more refined, multidirectional control over the alignment of the vertebral column

Front 437

The deep (short) segmental muscles cross only one intervertebral segment, thus...

Back 437

can provide the most precise control over vertical stability

Front 438

Bending over to touch the toes requires adequate flexibility in both ______ and _____

Back 438

- hips

- low back

Front 439

When observing someone attempting (but unable) to touch their toes, how would tight hamstrings manifest in the lumbopelvic rhythm?

Back 439

- little movement at/flexion of the hip

- excessive lumbar flexion

Front 440

When observing someone attempting (but unable) to touch their toes, how would tight lower back muscles manifest in the lumbopelvic rhythm?

Back 440

- little movement at/flexion of the back

- excessive hamstring flexion

Front 441

What effects can forward flexion compensations (of either the hamstrings or low back) in the lumbopelvic rhythm have?

Back 441

- tightness in one area can place large demands on the other, possibly inducing stress-related pathology

- this is why it's important to visually isolate the components of a particular movement to help determine the origin of a particular limitation

Front 442

Lifting even moderately sized objects can generate large _____ and _____ forces throughout the body, and especially in the base of the spine.

Back 442

compression, shear

Front 443

Optimal lifting technique allows the forces on the low back to be shared by muscles of the _____, _____, and ______

Back 443

arms, legs, trunk

Front 444

What are the two sources of stability in the spinal column?

Back 444

- active muscle force (primary)

- ligaments, connective tissue (secondary)

Front 445

What is a neutral spine?

Back 445

- proper spinal alignment with the normal curvatures intact

Front 446

Core stabilization exercises for the abdominals and posterior trunk are often integral components of ____ rehab programs.

Back 446

back

Front 447

Core stabilization exercises challenge both _____ and _____ muscular stabilizers.

Back 447

- intrinsic (transversospinal and short segmental groups - attach within the vertebral column to provide fine motor/precise stabilization)

- extrinsic (abdominals, erector spinae, quadratus lumborum, psoas major - attach outside vertebral column to provide gross motor stabilization/movement)

Front 448

What is typically involved in a core stabilization program?

Back 448

- work on extrinsic and intrinsic muscles

- holding a neutral or optimally positioned lumbar spine and pelvis while simultaneously performing movements or dynamic posturing

Front 449

What are the three major requirements of the thoracolumbar region?

Back 449

- protect the organs
- function as a mechanical chamber for breathing
- core stability

Front 450

Core stability establishes:

Back 450

- firm base of support for extremities

- mechanical support for vulnerable lumbar/lumbosacral region

Front 451

The most inferior end of the vertebral column is specialized for what two functions?

Back 451

- lumbosacral junction and SI joints must transfer large forces from body weight and activated muscle through the pelvis to the lower extremities

- interacting mechanically with the hip joints (pelvis or femurs) to maximize movement of the trunk

Front 452

Pain with limited ROM anywhere within the vertebral column can originate from:

Back 452

- tight/weak muscles
- torn ligaments
- herniated discs
- bone spurs compressing nerve roots
- inflamed joints
- combination of any/all of the above

Front 453

When lifting, why should one attempt to maintain the external load as close to the body as possible?

Back 453

to minimize the external moment arm, thereby reducing the torque and force demands on back muscles

Front 454

Where is it ideal (although not always possible) to hold the load while lifting?

Back 454

between the knees

Front 455

Why should one attempt to lift with the lumbar spine as close as possible to a neutral lordotic posture (avoiding extreme flexion and extension)?

Back 455

- vigorous contraction of back extensors with the lumbar spine maximally flexed can damage intervertebral discs

- vigorous contraction of back extensors with the lumbar spine maximally extended may damage facet joints

Front 456

What can lifting with minimal-to-moderate flexion in the lumbar spine do?

Back 456

possibly reduces force demands on extensor muscles

Front 457

What can lifting with minimal-to-moderate extension in the lumbar spine do?

Back 457

places the apophyseal joints nearer to their close-packed position, providing greater stability

Front 458

When lifting, what muscles should be used to minimize the force demands on the low back muscles

Back 458

hip and knee extensors

Front 459

Why should one avoid twisting while lifting?

Back 459

torsional forces on the vertebrae can lead to HNP

Front 460

Why should one lift slowly and smoothly?

Back 460

to reduce the large peak force generated in the muscles and connective tissues

Front 461

Why should one lift with a wide base of support?

Back 461

to increase stability and reduce chance of falling or slipping

Front 462

Which of the following terms best describes anterior translation of the jaw? ***
a. lateral excursion
b. elevation
c. protrusion
d. retrusion

Back 462

c. protrusion

Front 463

Which of the following bones forms the upper jaw? ***
a. mandible
b. maxillae
c. sphenoid
d. temporal

Back 463

b. maxillae

Front 464

Which of the following muscles is primarily involved with opening the mouth? ***
a. temporalis
b. masseter
c. medial pterygoid
d. lateral pterygoid (inferior head)

Back 464

d. lateral pterygoid (inferior head)

Front 465

Widely opening the mount requires ____ of the mandibular condyle. ***
a. anterior translation (protrusion)
b. posterior translation (retrusion)
c. little movement
d. lateral excursion

Back 465

a. anterior translation (protrusion)

Front 466

Activation of the right medial pterygoid and right lateral pterygoid will cause: ***
a. lateral excursion of the mandible to the right
b. lateral excursion of the mandible to the left
c. simultaneous activation of the infrahyoid muscles
d. the hyoid bone to drop 1-2 inches toward the sternum

Back 466

b. lateral excursion of the mandible to the left

Front 467

Which of the following muscles attaches proximally to the zygomatic arch? ***
a. medial pterygoid
b. lateral pterygoid
c. masseter
d. temporalis

Back 467

c. masseter

Front 468

Which of the following bones make up the lower jaw? ***
a. sphenoid
b. mandible
c. maxillae
d. zygomatic

Back 468

b. mandible

Front 469

The total volume of air that can be moved in and out of the lungs on maximal forced inspiration and maximal forced expiration is called: ***
a. tidal volume
b. vital capacity
c. expiratory reserve volume
d. inspiratory reserve volume

Back 469

b. vital capacity

Front 470

Which of the following is considered the most important muscle of inspiration? ***
a. internal intercostals
b. diaphragm
c. scalenes
d. external intercostals

Back 470

b. diaphragm

Front 471

Persons with chronic obstructive pulmonary disease (COPD) often have a barrel-chested appearance because: ***
a. air becomes trapped in the lungs at the end of quiet or forced expiration
b. of significant hypertrophy of the abdominal obliques
c. of excessive calcium buildup within the rib cage
d. of paralysis of the diaphragm

Back 471

a. air becomes trapped in the lungs at the end of quiet or forced expiration

Front 472

According to Boyle's law, as the volume of a system increases: ***
a. the pressure within that system increases proportionally
b. the pressure within that system decreases proportionally
c. the pressure within that system remains constant

Back 472

b. the pressure within that system decreases proportionally

Front 473

The scalenes are able to assist with inspiration: ***
a. by depressing the upper ribs and superior aspect of the sternum
b. by elevating upper ribs and sternum
c. by depressing the lower ribs and lower aspect of the sternum
d. by lowering the floor of the thoracic cavity

Back 473

b. by elevating upper ribs and sternum

Front 474

Which of the following statements is true? ***
a. quiet expiration is primarily driven by the elastic recoil of the ribs and surrounding connective tissues
b. forced expiration involves active contraction of the abdominal muscles
c. any muscle that increases intrathoracic volume can be considered a muscle of inspiration
d. a and b
e. all of the above

Back 474

e. all of the above

Front 475

Expiration is the result of a decrease in intrathoracic volume. ***
a. true
b. false

Back 475

a. true

Front 476

The temporalis muscle is primarily involved with depression of the mandible. ***
a. true
b. false

Back 476

b. false

elevation

Front 477

Contraction of the diaphragm expands intrathoracic volume in three diameters: vertical, medial-lateral and anterior-posterior. ***
a. true
b. false

Back 477

a. true

Front 478

The volume of air moved in and out of the lungs during each ventilation cycle is called the tidal volume. ***
a. true
b. false

Back 478

a. true

Front 479

Retrusion describes an anterior translation of the mandible. ***
a. true
b. false

Back 479

b. false

protrusion is anterior, retrusion is posterior

Front 480

The masseter, medial pterygoid, and temporalis muscles are all involved with the action of closing the mouth. ***
a. true
b. false

Back 480

a. true

Front 481

Reduction of the intrathoracic volume will cause air to be drawn into the lungs. ***
a. true
b. false

Back 481

b. false

Reduction of volume would increase pressure and push air out; reduction of intrathoracic pressure will cause air to be drawn in

Front 482

What is mastication?

Back 482

the process of chewing, tearing, and grinding food with the teeth

Front 483

Each jaw is equipped with ____ of TMJs.

Back 483

a pair/two

Front 484

Pain originating in the TMJ is often referred to other areas and perceived as:

Back 484

headache or neck pain

Front 485

Which is the largest facial bone?

Back 485

mandible

Front 486

How is the mandible attached to the cranium?

Back 486

it is suspended by muscles, ligaments, and the TMJ capsule

Front 487

What muscles attach at the angle of the mandible?

Back 487

- masseter
- medial pterygoid

Front 488

Which two structures articulate to form the TMJ?

Back 488

- mandibular condyle of mandible

- mandibular fossa of the temporal bone

Front 489

Does the mandible articulate with the maxilla?

Back 489

nope, with the temporal bone

Front 490

What two processes form the zygomatic arch?

Back 490

the zygomatic process of the temporal bone and the temporal process of the zygomatic bone (cheek bone)

Front 491

How is the maxilla formed?

Back 491

by the union of the left and right maxillae

Front 492

The hyoid bone is located at the base of the throat, just anterior to the....

Back 492

third cervical vertebra

Front 493

What is the purpose of the hyoid bone, and what is unique about it?

Back 493

- it serves as an attachment for several muscles involved with moving the tongue, swallowing, and opening the jaw

- it is the only bone in the body that doesn't articulate with any other bone

Front 494

What is the function of the articular disc of the TMJ?

Back 494

- provides joint stability
- reduces joint contact pressure
- helps safely guide the condyle across the rough articular eminence of the temporal bone

Front 495

What are the primary motions of the TMJ?

Back 495

- protrusion (protraction)
- retrusion (retraction)
- lateral excursion
- elevation
- depression

Front 496

For what is lateral excursion of the TMJ important?

Back 496

for grinding food between teeth

Front 497

What provides stability to the TMJ during chewing motions?

Back 497

- fibrous joint capsule and

- lateral ligament

Front 498

How far, on average, can an adult open his/her mouth?

Back 498

slightly more than 2 inches

[given as 3 knuckles (PIP joints)]

Front 499

Fully depressing the mandible requires....

Back 499

- extreme anterior translation (protrusion) of each mandibular condyle relative to its mandibular fossa

- normally the articular disc translates anteriorly along with each mandibular condyle, helping to properly guide the motion

Front 500

What are the primary muscles of the TMJ?

Back 500

- masseter
- temporalis
- medial pterygoid
- lateral pterygoid

Front 501

What is the shared innervation of all TMJ muscles?

Back 501

cranial nerve V (Trigeminal)

Front 502

Masseter OAIN

Back 502

O - zygomatic arch

I - external mandible between angle and coronoid process of ramus

N - cranial nerve V (trigeminal)

A - bilateral: elevation of mandible (closing the mouth)
unilateral: ipsilateral excursion

Front 503

Temporalis OAIN

Back 503

O - temporal fossa

I - coronoid process and anterior edge of ramus of mandible

N - cranial nerve V (trigeminal)

A - bilateral: elevation of mandible (closing the mouth), retrusion
unilateral: ipsilateral excursion

Front 504

Medial pterygoid OAIN

Back 504

O - medial surface of lateral pterygoid plate

I - internal surface of the angle and ramus of mandible

N - cranial nerve V (trigeminal)

A - bilateral: elevation of mandible (closing the mouth)
unilateral: contralateral excursion

Front 505

Lateral pterygoid OAIN

Back 505

O - superior head: greater wing of sphenoid
inferior head: lateral surface of lateral pterygoid plate

I - near mandibular condyle; superior head also attaches to articular disc of TMJ

N - cranial nerve V (trigeminal)

A - bilateral: depression of mandible (opening the mouth--inferior head only); protrusion of the mandible
unilateral: contralateral excursion

Front 506

Together, how much biting force can the medial pterygoid and masseter produce?

Back 506

almost 100 lbs

Front 507

Name the suprahyoid muscles

Back 507

- digastric
- geniohyoid
- mylohyoid
- stylohyoid

Front 508

Name the infrahyoid muscles

Back 508

- omohyoid
- sternohyoid
- thyrohyoid
- sternothyroid

Front 509

What are the secondary muscles of mastication?

Back 509

- suprahyoids

- infrahyoids

Front 510

Function of the suprahyoid muscles?

Back 510

depression of mandible

Front 511

Function of infrahyoid muscles?

Back 511

stabilization of hyoid bone

Front 512

Digastric O, I

Geniohyoid O, I
Mylohyoid O, I

Stylohyoid O, I

Back 512

- anterior belly: internal surface of mandible; posterior belly: mastoid process

- midline of internal mandible
- internal surface of body of mandible

- styloid process of temporal bone

all insert on the hyoid

Front 513

Omohyoid O, I

Sternohyoid O, I
Sternothyroid O, I

Thyrohyoid O, I

Back 513

- superior border of the scapula, near scapular notch

- manubrium and medial clavicle
- manubrium

- thyroid cartilage

all attach to hyoid, except sternothyroid (thyroid cartilage)

Front 514

Conservative treatments for TMD

Back 514

- exercise and postural correction
- biofeedback/relaxation
- use of cold/heat
- patient education
- joint mobilization
- ultrasound
- behavioral modification
- intraoral appliances (splints)

Front 515

Opening the mouth involves:

Back 515

- contraction of inferior head of lateral pterygoid (protrusion)

- assisted by gravity and the suprahyoids (depression)

Front 516

Closing the mouth involves:

Back 516

- strong forces from masseter, medial pterygoid and temporalis

Front 517

Lateral excursion involves:

Back 517

- masseter (ipsilateral)
- temporalis (ipsilateral)
- medial pterygoid (contralateral)
- lateral pterygoid (contralateral)

Front 518

What is the average total lung capacity for a normal adult?

Back 518

5 1/2 liters of air

(most of this capacity is unused during normal breathing)

Front 519

What is the average tidal volume for a normal adult?

Back 519

1/2 liter

Front 520

What is inspiratory reserve volume?

Back 520

the amount of air that can be taken into the lungs (above the tidal volume) upon forced inspiration

Front 521

What is the expiratory reserve volume?

Back 521

the amount of air that can be pushed out of the lungs (beyond the tidal volume) upon forced expiration

Front 522

What is vital capacity?

Back 522

the total volume of air that can be moved into and out of the lungs

Front 523

What is Boyle's law?

Back 523

- the law behind much of the physics governing inspiration and expiration

- states that volume and pressure of a gas are inversely proportional

(e.g., larger volume = lower pressure, and vice versa; thus when the ribcage expands, the larger volume forces a drop in pressure and the lungs fill)

Front 524

Is quiet expiration an active or passive process?

Back 524

passive, carried out by the decrease in intrathoracic volume caused by the elastic recoil of the lungs, thorax, connective tissues, etc.

Front 525

Is forced expiration an active or passive process?

Back 525

active; involves active contraction of expiratory muscles such as the abdominals for coughing, sneezing, forcefully exhaling, etc.

Front 526

Is quiet inspiration an active or passive process?

Back 526

both quiet and forced inspiration are active processes

Front 527

How is the intrathoracic volume increased?

Back 527

- elevation of ribs
- elevation and forward expansion of sternum
- increasing vertical diameter of the thorax, caused by contraction of the diaphragm

Front 528

What muscles contribute to forced expiration?

Back 528

any that assist with
- depression of the ribs
- depression and pulling in on the sternum
- decreasing the vertical diameter of the thorax

Front 529

What are the primary muscles of inspiration? Why are they considered primary?

Back 529

- diaphragm
- scalenes
- intercostals

because they are active during all intensities of breathing (quiet or forced)

Front 530

Diaphragm OAIN

(1413 Ex3)

Back 530

O - inner surfaces of ribs 6-12, posterior xyphoid process, bodies of L1-L3

I - central tendon near dome

N - phrenic nerve (C3-C5)

A - primary muscle of inspiration

Front 531

External intercostals OAIN

Back 531

O & I - inner surfaces of ribs, originating on inferior borders; inserting on superior border of rib below--run obliquely toward midline

N - intercostal nerves (T2-T12)

A - assist with inspiration by elevating ribs and expanding thorax

Front 532

Internal intercostals OAIN

Back 532

O & I - inner surfaces of ribs, originating on superior borders; inserting on inferior border of rib above; deep to external intercostals and run perpendicular to them

N - intercostal nerves (T2-T12)

A - assist with forced expiration by depressing ribs

Front 533

How do the anterior, middle, and posterior scalenes assist with respiration?

Back 533

they assist inspiration by elevating the upper ribs

Front 534

What components are incorporated into COPD?

Back 534

- chronic bronchitis
- emphysema
- asthma

Front 535

What are the symptoms of COPD?

Back 535

- chronic inflammation and narrowing of the bronchioles
- chronic cough
- mucus-filled airways, with over-distention and destruction of alveolar walls

Front 536

What is a significant complication of COPD?

Back 536

- loss of natural elastic recoil within the lungs and collapse of the bronchioles

- as a result, air remains trapped in the lungs at the end of quiet/forced expiration, causing hyperinflation of the lungs and often giving a barrel-chested appearance

Front 537

Persons with COPD often depend upon _____ _____ to breathe.

Back 537

accessory muscles (e.g., scalenes, sternocleidomastoid, pectoralis minor)

Front 538

What are the muscles of forced expiration?

Back 538

- the four abdominal muscles
- internal intercostals

Front 539

Which of the following joints are most proximal within the hand? ***
a. MCP joints
b. PIP joints
c. DIP joints
d. CMC joints

Back 539

d. CMC joints

Front 540

Which of the following statements is true regarding abduction of the index finger? ***
a. this motion occurs in the frontal plane
b. this motion describes the index finger moving away from the middle finger (toward the thumb)
c. this motion describes the index finger moving toward the middle finger
d. a and b
e. b and c

Back 540

d. a and b

Front 541

Flexion of the thumb: ***
a. occurs in the sagittal plane
b. occurs in the frontal plane
c. occurs in the horizontal plane
d. occurs about a longitudinal axis of rotation
e. c and d

Back 541

b. occurs in the frontal plane

Front 542

Which of the following joints can perform flexion and abduction? ***
a. CMC joint of the thumb
b. DIP joints of digits 2 to 5
c. MCP joints of digits 2 to 5
d. a and b
e. a and c

Back 542

e. a and c

Front 543

The motion of touching the thumb to the other fingertips is called: ***
a. abduction
b. hypothenar flexion
c. opposition
d. reposition

Back 543

c. opposition

Front 544

The tendons of the extrinsic finger extensors: ***
a. all course posterior to the medial-lateral axis of rotation of the MCP joints
b. all course anterior to the medial-lateral axis of rotation of the wrist
c. all blend with a special set of connective tissues called the extensor mechanism
d. a and b
e. a and c

Back 544

e. a and c

Front 545

Which of the following muscles is not part of the hypothenar eminence? ***
a. flexor digiti minimi
b. abductor digiti minimi
c. opponens pollicis
d. opponens digiti minimi

Back 545

c. opponens pollicis

Front 546

The primary function of the muscles of the thenar eminence is: ***
a. curl the ulnar border of the hand such as when cupping
b. position the thumb in varying amounts of opposition to facilitate grasping
c. extend the thumb and ulnarly deviate the wrist
d. flex the MCP joints of digits 2 to 5

Back 546

b. position the thumb in varying amounts of opposition to facilitate grasping

Front 547

Which of the following is not an action of the lumbrical muscles? ***
a. flexion of the MCP joints of the fingers
b. extension of the DIP joints of the fingers
c. flexion of the PIP joints of the fingers
d. extension of the PIP joints of the fingers

Back 547

c. flexion of the PIP joints of the fingers

Front 548

The primary function of the dorsal interossei muscles is: ***
a. abduction of the fingers
b. adduction of the fingers
c. flexion of the PIP and DIP joints
d. flexion of the DIP joints

Back 548

a. abduction of the fingers

Front 549

Injury or paralysis of the ulnar nerve will significantly affect the muscles of the hypothenar eminence. ***
a. true
b. false

Back 549

a. true

Front 550

Basilar joint osteoarthritis refers to arthritis of the CMC joint of the thumb. ***
a. true
b. false

Back 550

a. true

Front 551

Injury or paralysis to the median nerve will likely result in an inability to oppose the thumb. ***
a. true
b. false

Back 551

a. true

Front 552

An individual without functional finger flexors may perform a tenodesis grip through activation of the wrist extensors. ***
a. true
b. false

Back 552

a. true

Front 553

Paralysis of the radial nerve will primarily result in an inability to oppose the thumb. ***
a. true
b. false

Back 553

b. false

median nerve

Front 554

The structure of the CMC joint of the thumb is that of a hinge joint. ***
a. true
b. false

Back 554

b. false

saddle

Front 555

Hyperextension of the MCP joints of the fingers is primarily limited by tension in the palmar (volar) plates. ***
a. true
b. false

Back 555

a. true

Front 556

A strong pinching activity such as when cutting with scissors involves strong activation of the adductor pollicis muscle. ***
a. true
b. false

Back 556

a. true

Front 557

Extrinsic muscles of the hand have their proximal attachments on the forearm or arm, but attach distally to a structure within the hand. ***
a. true
b. false

Back 557

a. true

Front 558

Without activation of the lumbricals and interossei muscles, contraction of the extensor digitorum results in clawing of the fingers. ***
a. true
b. false

Back 558

a. true

Front 559

What is a ray?

Back 559

a metacarpal bone and its associated phalanges

Front 560

What is a common site of fracture in the hand?

Back 560

neck of the metacarpal

Front 561

How does the position of the thumb's metacarpal differ from that of the other metacarpals?

Back 561

- the thumb's metacarpal is oriented in a different plane

- it is rotated almost 90 degrees medially relative to the other digits; palmar surface faces toward midline of the hand

- it is also more anteriorly positioned, which allows it to sweep freely across the palm

Front 562

How do the sides of the thumb face?

Back 562

- dorsal surface faces laterally
- palmar surface faces medially
- radial surface faces anteriorly
- ulnar surface faces posteriorly

Front 563

Which phalanges have heads?

Tuberosities?

Back 563

- proximal and middle phalanges

- distal phalanges only

Front 564

What structures support the arched curvature of the palmar surface of the hand?

Back 564

- proximal transverse arch (distal row of carpal bones; carpal tunnel)

- distal transverse arch (through MCPs)

- longitudinal arch (2nd and 3rd rays)

Front 565

How is abduction and adduction described with respect to digits 2-5?

Back 565

as motion away from or toward the middle digit

Front 566

How are flexion, extension, abduction, and adduction described with respect to the thumb?

Back 566

- palmar surface in frontal plane across palm
- back towards anatomical position
- forward movement away from palm
- back to anatomical position

Front 567

Where does the basis for all movements within the hand start?

Back 567

CMC joints

Front 568

What pathology of the hand receives more surgical attention than any other osteoarthritis-related condition of the upper limb?

Back 568

basilar joint osteoarthritis

(common among needlepointers and cow milkers)

Front 569

Supporting structures of the MCP joints

Back 569

- capsule

- radial and ulnar collateral ligaments - cross MCP in oblique palmar direction; limit abduction and adduction, become taut on flexion

- fibrous digital sheaths - form tunnels or pulleys for extrinsic finger flexors; contain synovial sheaths to help lubrication

- palmar (volar) plates - thick fibrocartilage ligaments that cross palmar side of each MCP; limit hyperextension of MCPs

- deep transverse metacarpal ligaments - 3 ligaments that merge into a wide, flat structure that interconnects and loosely binds metacarpals 2-5