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322 Cards in this Set
- Front
- Back
pedicle |
1st part of vertebral arch after body; transmits tension and bending forces from posterior elements to body; increase in size cervical to lumbar |
|
lamina |
extends pedicle to form vertebral arch; transmits force from vertebral arch to pedicle |
|
superior articular process |
connects inferior articular process of bone above it to form facet joint |
|
spinous process and transverse process |
important sites for muscle attachment |
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pars interarticularis |
part of lamina between superior and inferior articular process of same vertebra; part of lamina that takes on most bending forces, therefore susceptible to fx; hypermobile athletes athletes susceptible to fx; spondylosis = fx |
|
vertebral canal |
holes through foramen referring to whole spine |
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interbody joint |
where 2 bodies connect; cartilagenous (symphysis) joint; accepts a lot of weight/force |
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facet joint/zygoapophyseal joint |
superior and inferior articular processes come together; synovial joint (synovial fluid, capsule, disk) |
|
uncovertebral joint/joints of Von Lushka |
only exist in cervical spine; start forming after age of 9; form on body on posterior-lateral surface; holds disk in so doesn't protrude into spinal cord; form b/c of wolf's law |
|
intervertebral foramen |
where nerves exit from spinal cord and travel into periphery; dorsal root ganglia live here; superior and inferior articular processes and disk make up intervertebral body |
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intervertebral disk |
20-25% of height of spinal column; made up of water, allows for fair amount of movement of spine; height of disks determine size of intervertebral foramen; good for shock absorption |
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1st intervertebral disk in btw |
C2 and C3 |
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anulus fibrosus |
outer ring of disk, made of fibrocartilage, concentric lamellae (layers) which resist tension outward; firmly attached to bone; thinner on posterior aspect than anterior; more common to herniate posteriorly; outer 1/3 = only part of disk that receives sensory innervation, poor vascular supply inside disk; annular tear = one of most painful experiences person can feel |
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innervation of intervertebral disk |
sinuvertebral/recurrent meningeal nerve |
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nucleus pulposus |
core of intervertebral disks; 88% water; more cartilaginous than fibrosis, more malleable, changes shape depending on forces put through it; when compressed = nucleus gets broad; when stretched/tensed = thinner; sits more posterior; can move anterior and posterior depending on forces |
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vertebral end plate |
sandwich for disk, covers superior and inferior portions of disk, made of cartilage, separates nucleus pulpous from vertebral body |
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lordosis curve |
convex from anterior portion; lumbar, cervical |
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kyphosis curve |
convex from posterior portion; thoracic, sacral |
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primary curves |
thoracic and sacral kyphosis, have when we are babies |
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secondary curves |
form from fxn and position over time; cervical and lumbar lordosis (cervical from crawling, lumbar from walking, crawling) |
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cervical spine characteristics |
intervertebral disks thin, ratio from disk height to body height = one of greatest in whole spine (1:1); bifid spinous process (2 tails) |
|
cervical spine facet joints |
horizontal (superior and inferior articular processes) moving to 45 degrees above horizontal; btw superior and inferior articular processes |
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foramen transversarium |
characteristic of c vertebrae; hole w/in transverse processes of spine aka transverse foramen; vertebral artery and veins go through it; vertebral artery goes to circle of willis |
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anterior and posterior tubercle on transverse process of c-spine |
important attachment for levator scapula and scalenes |
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C6 |
anterior tubercle called carotid tubercle where you would compress if someone was bleeding; on transverse process |
|
C1 |
atlas |
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C2 |
axis |
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thoracic spine characteristics |
transition zone for areas above and below |
|
costal facets of thoracic spine |
attachment points for ribs, on transverse process |
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T1-T4 |
similar to C spine |
|
T9-T12 |
similar to lumbar spine |
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vertebral foramen of thoracic spine |
smaller than C spine |
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transverse process of thoracic spine |
wider, longer; start pointing posterior and lateral |
|
facet joints of thoracic vertebrae |
vertical (btw superior and inferior articular facets) |
|
lumbar spine characteristics |
bodies significantly larger, vertebral foramen bigger than in thoracic, not as big as cervical, facets in coronal plane (J shaped) |
|
transverse process of lumbar spine |
accessory process: base of transverse process mammillary process: articulating on process |
|
anterior longitudinal ligament |
covers and connects anterolateral aspects of vertebral bodies and intervertebral disks from head to pelvic surface of sacrum; only ligament that limits hyperext of vertebral column |
|
posterior longitudinal ligament |
posterior side of vertebral bodies and mainly attaches to intervertebral disks C2 to sacrum; more narrow and weaker than ALL; anterior to spinal cord, good for protecting spinal cord from herniated disks; stronger and more central- redirects laterally to protect spinal cord; limits hyperflex |
|
ligamentum flavum |
join adjacent lamina vertebra to vertebra, yellow, stretchy, strong elastic ligament, prevents hyper flexion and separation of lamina; elasticity helps return spine to neutral when already flexed; runs lamina to lamina, important for when doing epidural |
|
interspinous ligament |
connects spinous process to spinous process; after C2 down |
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supraspinous ligament |
C7 to sacrum, covers most superficial part; mohawk of spine |
|
nuchal ligament |
supraspinous blends w/ nuchal C7 and above, really strong and really broad; extension of spinous processes to allow muscles to attach |
|
mamillary processes |
lumbar; btw transverse process and superior articulating process |
|
costal process on lumbar |
end of transverse process; bump on lamina
|
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accessory process |
inferior to mammillary process; bump on lamina |
|
why is it important that lumbar vertebrae made of trabecullar bone? |
standing = forces redistributed to body, disks in btw bodies of vertebrae; forces go posterior, but redistributed to body |
|
pars articularis |
part on lamina in btw superior and inferior articular process |
|
what attaches at accessory process? (lumbar vertebrae) |
intertransvarii laterales lumborum |
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superior facets of lumbar vertebra face |
posteriomedial |
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inferior facets of lumbar vertebra face |
anteriolateral |
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flex and extension good in ____ spine, but ____ is bad here |
lumbar rotation |
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function of intervertebral disks |
major = shock absorption; allows for movement in spine and protection of nerves |
|
annulus fibrosus made of |
fibrocartilage |
|
nucleus pulposus |
water |
|
t/f: only outer 1/3 of annulus fibrosus is innervated |
true |
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how does the lumbar disk get nutrition? |
weight bearing (like meniscus), inside not well vascularized |
|
deep to superficial posterior spinal ligaments |
ligamentum flavum > interspinous ligament > supraspinous ligament |
|
hole in single vertebra |
vertebral foramen |
|
spinal cord |
lives in vertebral canal; terminates at L1 = conis medlars; spinal canal travels all the way down to coccyx |
|
cauda equina |
nerve roots keep coming down and exit further down in lumbar vertebra |
|
gray matter |
cell bodies here; looks like butterfly; anterior and posterior horn |
|
white matter |
nerve tracts |
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ventral rootlets come from |
anterior horn |
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dorsal rootlets come from |
posterior horn |
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dorsal root ganglia |
cell bodies live here, sensory nerves |
|
where do cell bodies of motor nerves live? |
gray matter |
|
spinal nerves are what type of nerve? |
mixed nerves |
|
how do spinal nerves branch? |
dorsal = dorsal ramus/arm to supply back muscles ventral = ventral ramus (larger) to become part of plexus to become bigger nerves in extremity |
|
other 2 names for meningeal ramus |
sinuvertebral n or nerve of von Lushka |
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3 primary splits of spinal nerve |
dorsal primary ramus ventral primary ramus meningeal nerve (supplies intervertebral disks) |
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Nerve roots up to ____ exit above that vertebrae. At ____ this switches and nerve root named for vertebrae ____ it
|
C7 C8 below |
|
why is it significant that annulus fibrosis is thinner posteriorly? |
most common herniation = posteriolateral enters intervertebral foramen takes away space from dorsal and ventral root ganglion |
|
how does posteriolateral herniation affect ventral and dorsal root ganglions? |
ventral- motor loss/changes in myotomal pattern dorsal- sensory loss in dermatomal pattern |
|
bulging disk at L3 presents as |
issues w/ knee extension |
|
spinal nerve begins as exits |
intervertebral foramen |
|
central herniation |
effects spinal cord more than peripheral myotomes/dermatomes |
|
sinuvertebral nerve innervates |
outer 1/3 of annulus and PLL |
|
anterior ramus |
medial and lateral branches; innervates facet joints |
|
medial branch block |
numb input coming from medial branch; injects facet w/ lidocaine; medial branch = sensory nerve (from facet to gray matter) |
|
lumbar spine what kind of joints? |
planar |
|
3 ways vertebral bodies adapt |
intervertebral disks (nucleus pulposus can change shape), facet joints (glide on each other), space btw spinous processes |
|
what happens during lumbar flexion? |
bones start separating- pulposus stretched posteriorly, compression anterior disk, tension on posterior ligs and muscles; spinous processes get further apart, limited by soft tissue |
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what happens to facet joints in lumbar flexion? |
superior and anterior glide superior vertebrae |
|
what happens to inter body during lumbar flexion |
anterior disk compressed, posterior disk stressed, nucleus posteriorly displaced |
|
what happens during lumbar extension? |
spinous processes closer together = approximation; disks = posterior compression, anterior tension, anterior translation of nucleus pulpous, restricted by bone structure |
|
what happens to facet joints during lumbar extension? |
inferior facet of superior vertebrae glides inferior and posterior on superior facet of inferior vertebrae |
|
what motions is disk most susceptible to injury? |
flexion w/ rotation |
|
main limitation of lateral flexion/side bend |
quadratus lumborum, multifidus, intertransversarii |
|
lateral flexion: compression on ipsilateral lateral side of disk results in tension on ____ side of disk, nucleus translated _____ |
contralateral lateral; _______ |
|
ask about mechanics of rotation |
ask |
|
thoracolumbar fascia |
anterior: thin and derived from fascia of QL, blends w/ intertransverse ligament middle: lies behind QL, gives rise to aponeurosis of TA posterior: arises from lumbar spine wraps around back muscles- blends w/ anterior and middle layers at lateral border of iliocostalis lumborum- lateral raphe (where all 3 layers come together) |
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transverse processes are sandwiched btw ___ and ___ in lumbar spine |
QL and iliosoas |
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transverse abdominis, rectus abdominis, and arcuate line relationships |
above arcuate line = transverse abdominis posterior to rectus abdominis below arcuate line = transverse abdominis superficial to rectus abdominis |
|
rectus abdominis |
causes a lot of trunk flex, attaches to little pieces of fascia, global muscle, causes a lot of mvmt; we see 8 pack b/c bottom pair deep to transverses abdominis (10 total portions) |
|
how do you "tone" transverse abdominis |
trunk rotations |
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thoracolumbar fascia |
covers low back and abdominals; glutes and lats attach to it |
|
diaphragm |
involved in respiration, postural muscle |
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main fxn of pelvic girdle |
connecting vertebral column to 2 lower extremities used to bear weight of upper body in sitting and standing; transfers load of axial skeleton to appendicular skeleton when standing and walking; provides attachment site for muscles |
|
pelvic girdle protects |
urinary and reproductive organs |
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inominate |
1/2 of pelvis (2 inominate bones + sacrum = pelvis) |
|
ala |
wing of ilium |
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sacrum |
fusion of 5 sacral vertebra |
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auricular surface of ilium |
where ilium articulates w/ sacrum |
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acetabulum |
where majority of load transfers occur |
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posteriorly inominates fused by ____ to form ___ joints by bony congruency |
sacrum; SI |
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pelvic outlet/lesser pelvis/true pelvis |
lower part of pelvis, contains all of your pelvic organs (pelvic cavity) |
|
pelvic inlet |
houses abdominal cavity (abdominal organs) |
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pubic arch (males vs. females) |
convergence of 2 inferior pubic rami; males 50-82 degrees (wide and narrow pelvis); females at least 90 degrees (wide and short pelvis) |
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iliac crest may line up w/ ____, but can be as low as ___/____ in females |
L1; L3/L4 |
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dual joints of SI |
1 anterior = synovial 1 posterior = syndesmosis |
|
anterior SI ligaments |
makes up synovial capsule of anterior SI joint |
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iliolumbar ligament |
strongest ligament and primary stabilizer between vertebral column and ilium |
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interosseous sacroiliac ligament |
primarily load transfer structure |
|
posterior SI ligaments |
lock irregular joint surfaces |
|
what are the different ways of approximating/giving stability to SI joint? |
form closure: bony congruency and ligaments force closure: tension of muscles around area |
|
sacrotuberous ligament |
continuation of proximal HS insertion; closes off sciatic notch to form sciatic foramen |
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pubic symphysis |
secondary cartilagenous joint; made up of fibrocartilage; covered by ligaments; strengthened by abdominal muscles that attach there |
|
what structures form closure of SI joint? |
vertebral column, iliolumbar ligament, sacrum btw 2 ilium, posterior interosseous ligament, interosseous ligaments |
|
coccyx |
secondary cartilagenous joint: "tailbone" |
|
4 functions of muscles of pelvis (4 S's) |
supportive, sphincteric, sexual, stability |
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sphincteric function of pelvic muscles |
regulates openings of urethra and rectum to allow urination and defecation; voluntary and involuntary; urogenital diaphragm |
|
layers of urogenital diaphragm |
peripheral membrane, sphincter urethrae, deep transverse perineal muscle
|
|
urogenital diaphragm innervated by what nerve? how can it become damaged? |
pudendal nerve; cycling which leads to incontinence |
|
sphincteric muscles |
UGT diaphragm (layer 2), external anal sphincter (layer 1) |
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sexual muscles |
bulbospongiosus and cavernosus |
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function of external urethral sphincter |
voluntary and involuntary control; layer 2 of UGTD |
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internal urethral spincter function |
involuntary control; layer 2 of UGTD |
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___ artery provides blood flow to penis and clitoris |
internal pudendal |
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males have bulbo___ and females have bulbo____ |
bulbospongiosus; bulbocavernosus |
|
layers of sexual muscles |
1) bulbospongiosus, ischiocavernosus, |
|
pelvic diaphragm |
functional group made up of third layer muscles that support pelvic viscera; levator ani, coccygeus, obturator internus, piriformis |
|
pelvic stability muscles |
abdominal canister, pelvic floor is inferior stabilizer of core, local stabilizer, maintenance of intra-abdominal pressure |
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action of bulbospongiosus/bulbocavernosus |
assists in erection, ejaculation/compresses urethra |
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ischiocavernosus |
assist/maintain erection |
|
pubococcygeus/puborectalis |
supports pelvic viscera (PC); voluntary sphincter of anal canal (PR) |
|
coccygeus |
flexes coccyx, supports pelvic viscera, stabilizes SI |
|
3 main nerves of pelvis (come from lumbar pelvis) |
iliohypogastric, ilioinguinal, genitofemoral |
|
iliohypogastric n |
motor: supplies part of transverse abdominis and internal oblique sensory: posterolateral gluteal and suprapubic regions |
|
ilioinguinal n |
motor: transverse abdominis and internal oblique sensory: medial skin of thigh and genital region |
|
genitofemoral n |
sensory: genital region and anteromedial skin of thigh passes under ligament of ovary- can become entrapped in ligament = right knee pain during 1st menstrual period due to inflammation |
|
anterior pelvic tilt |
ASIS forward and down; nutation of sacrum |
|
posterior pelvic tilt |
ASIS posterior; counternutation of sacrum |
|
what type of motion does sacrum have? |
rocking motion |
|
nutation |
top of sacrum moves anteriorly |
|
counternutation |
top part of sacrum moves posteriorly |
|
lumbopelvic rhythm |
how pelvis moves in relation of lumbar spine |
|
ipsidirectional lumbopelvic rhythm |
lumbar spine flexion, sacrum nutation (same direction), anterior pelvic tilt |
|
contradirectional lumbopelvic rhythm |
sacrum nutation, extension of lumbar spine, |
|
pelvic torsion |
nominates go in pop direction; happens when we walk, leading leg PPT, leg trailing APT |
|
5 divisions of mediastinum |
superior inferior (anterior, middle, posterior) |
|
superior mediastinum |
superior border: superior thoracic inlet inferior border: sternal angle (ant) to T4-T5 (post) |
|
inferior mediastinum |
superior border: from sternal angle (ant) to T4-T5 (post) inferior border: diaphragm |
|
anterior mediastinum |
everything anterior to pericardium but posterior to sternum |
|
middle mediastinum |
pericardium + everything inside it (heart, vessels, pericardial fluid) |
|
posterior mediastinum |
everything anterior to spine but posterior to pericardium |
|
2 layers of pericardium |
fibrous (superficial) and serous (deep) |
|
fibrous layer pericardium |
superficial; used to anchor heart into place, prevents over stretching |
|
serous layer pericardium |
deep; has 2 layers = parietal, visceral (pericardial space btw 2 layers which contains pericardial fluid to decrease friction w/ each beat of heart) |
|
phrenic nerve |
nerve roots C3, C4, C5 (3, 4, and 5 keep diaphragm alive) |
|
from left to right branches of arch of aorta |
brachiocephalic trunk, left common carotid, left subclavian a |
|
label pics from cardiac ppt |
ppt |
|
normal circulation |
deoxygenated blood, SVC/IVC, RA, tricuspid valve, RV, pulmonic valve, pulmonary a, lungs, oxygenated blood, pulmonary veins, LA, mitral valve, LV, aortic valve, aorta, rest of body |
|
SVC |
bringsdeoxygenated blood from the upper extremities andhead to the right atrium |
|
IVC |
brings deoxygenated blood from the lowerextremities and abdomen to the right atrium; **largest veins in the body** |
|
coronary sinus |
- brings deoxygenated blood fromthe coronary veins back to the right atrium |
|
fossa ovalis |
- end of the embryonic structure(foramen ovale)connecting the two atria |
|
pectinate muscle |
“rough” muscle on the anterior wallof the atrium; These rough looking muscles increase the amount of force inpumping compared to the actual mass of the muscle that is present (think wovenrope vs. many strings put together next to each other) |
|
crista terminalis |
thickened muscle that forms a lineseparating the pectinate muscle (anterior wall) from the smoothposterior muscle wall |
|
tricuspid |
- valve between the right atriumand right ventricle |
|
chordae tendinae |
.fibrous tendons that prevent thetricuspid valve from inverting from the high pressure created in the ventricleduring systole |
|
papillary muscles |
muscles which anchor into the rightventricular wall. The chordae tendinae are anchored into these muscles. Thesetwo structures prevent the Tricuspid valve from inverting. These DO NOT pull the valve open!! The valve opens and closes due tochanges in the pressure gradient. |
|
trabeculae carneae |
similarto the pectinate (rough muscle) muscles seen in theright atrium; These muscles are thicker andstronger than the pectinate muscles of the right atrium |
|
Septomarginal trabeculae (moderator band) |
runs between the anterior papillarymuscle and the interventricular septum. It makes up part of theRight Bundle Branch which is used in conduction and helps with coordinatedcontraction of the myocytes of the heart; Names moderator band as it wasthought to prevent overdistention of the RV based on its attachment sites. |
|
pulmonic valve |
semilunar valve |
|
pulmonary a |
connects the heart to the lungsin order to allow for oxygenation of the blood; carries deoxygenated blood***The only artery that does this!!•Arteriesalways go Awayfrom the heart, but they do NOT always carry oxygenated blood. |
|
left auricle |
.also known as the left atrial appendage;commonly the origin of arrhythmias– major one is afib1.Often pt have this cauterized to preventirregular electrical activity. |
|
has 3 branches (BCS) |
aortic arch |
|
pulmonary arteries |
contains deoxygenated blood |
|
pulmonary veins |
contains oxygenated blood |
|
coronary sinus |
remember that the coronary sinus emptiesinto the RIGHT atrium but the coronary sinus is located at the posterior sideof the heart at the base of each atrium |
|
A-fib |
most common arrhythmia; disorganized electrical activity of atria; does not allow for full contraction of atria; most common origin is left atrial appendage (left auricle) considerations for PT: 15-20% decrease in CO, may require anticoagulation therapy to prevent stroke |
|
what happens if fossa ovalis does not close after birth? |
? |
|
patent foramen ovale |
failure of foramen ovale to close; allows for oxygenated and deoxygenated blood to mix |
|
atrial septal defect (ASD) |
failure for walls of atria to form |
|
ventricular septal defect (VSD) |
most common congenital heart defect |
|
diastole |
AV valves open, semilunar valves closed, atria contract, ventricles relaxed, blood flows into ventricles |
|
systole |
AV valves closed, semilunar valves open, atria are relaxed, ventricles contract, blood flows from ventricles to rest of body |
|
right coronary artery |
•Normally (70%) Gives off the PosteriorDescending Artery (Posterior Interventricular Artery) which is the vessel thatdecides coronary dominance•Thismeans that a patient is “right heart dominant”meaning that the RIGHT coronary artery supplies both the SA and AV nodalpacemakers•This is advantageous because BOTHpacemakers are supplied by the RCA and all of the left coronary arteries aremore commonly blocked- this leads to protection of your conduction system |
|
left main coronary a |
•splits into two major branches.- LAD (left anterior descending) and Lcx (left circumflex) |
|
left anterior descending a |
•supplies the septum and apex of the heart;anterior and interventricular of the heart; supplies 70% of the leftventricle; widow maker (supplies majority of LV) |
|
left circumflex a |
left lateral and posterior aspects of heart |
|
MI |
•Blockage of the coronary arteries• •Decreased blood supply to the myocardium (heart muscle)• •Results in death of the muscle tissue if intervention does not occur |
|
where does coronary sinus empty? |
right atrium |
|
cardiac veins |
great cardiac vein, middle cardiac, small cardiac, coronary sinus |
|
congestive heart failure |
not supplying blood to tissues adequately, diastolic: HTN, less blood fills ventricles b/c hypertrophied; systolic = too much space |
|
people most commonly have left or right CA dominance? |
right coronary dominance |
|
inferior thoracic aperture |
location of diaphragm |
|
manubrium level |
T3/T4 level |
|
body of sternum level |
T5-T9 |
|
xiphoid process level |
T10 |
|
sternal angle is bony landmark for what 5 things? |
2 BAAD 2- 2nd rib B- bifurcation of trachea A- arch of aorta A- arch of azygous vein D- division btw superior and inferior mediastinum |
|
inspiration |
expanding thoracic cavity; larger space = lower pressure inside body, air rushes IN |
|
quiet inspiration |
diaphragm only contracts |
|
force inspiration |
diaphragm, accessory and intercostals contract |
|
primary inspiratory muscles |
diphragm, external intercostals |
|
external intercostals |
inspiratory intercostals, elevate ribs during forced inspiration; think of putting your hands in outer coat pocket to think of what direction fibers of muscles go |
|
expiration |
shrinking thoracic cavity; smaller space = higher pressure inside body, air exits |
|
quiet expiration |
elastic recoil of lungs, gravity lowers ribs, abdominal pressure raises relaxed diaphragm |
|
forced expiration |
contraction of abd muscle forces diaphragm up |
|
primary expiratory muscles |
diaphragm, intercostals = internal intercostals, subcostalis, innermost intercostals, transversus thoracis |
|
expiratory intercostals |
internal intercostals most active during expiration, pulls ribs down, think of putting your hand inside inner coat pocket to think of direction of muscle fibers |
|
subcostalis |
active during expiration; only located on posterior thoracic wall |
|
innermost intercostals |
active during expiration; origin inferior border of ribs; insertion superior border of ribs |
|
transversus thoracis |
weak depression of ribs during expiration |
|
layers of pleura |
parietal (superficial), visceral (deep), pleural space/pleural fluid (decreases friction) |
|
pleural effusion |
pleural fluid accumulates in pleural space due to any number of reasons (bacterial infection, cx, surgery), symptoms include: pleuritic chest pain= pain associated w/ breathing, SOB; tx: may resolve on own, may require chest tube or thoracentesis |
|
hilum |
location on lung where structures of root of lungs enter and exit lung |
|
root of lung |
structures that enter and/or exit lung; attach lung to body = pulmonary a, pulmonary v, bronchi, nerves, lymphatics |
|
lung divisions |
right lung: 3 lobes = superior, middle, inferior (horizontal and oblique fissures) left lung: 2 lobes: superior and inferior (oblique fissure) fissures: horizontal and oblique x2 |
|
most superior structures in lungs |
pulmonary a's |
|
most anterior and inferior structures in lungs |
pulmonary veins |
|
most central and posterior structures in lungs |
bronchi |
|
SVC ___ and ___ to trachea |
anterior and lateral |
|
____ loops over left main bronchus |
aorta |
|
carina |
bifurcation of trachea into left and right main bronchi
|
|
types of bronchi |
primary, secondary, tertiary, bronchioles |
|
types of bronchioles |
conducting, terminal, respiratory, alveoli |
|
located on posterior abdominal wall; anteriorly to vertebral column and to right of abdominal aorta |
IVC |
|
runs up vertebral column and connects IVC and SVC and can drain either if one is blocked |
azygous vein |
|
femoral a |
continuation of external iliac a (terminal branch of abdominal aorta); external iliac becomes femoral artery when crosses under inguinal ligament and enters femoral triangle |
|
medial femoral circumflex a |
wraps around posterior side of femur, supplying neck and head of femur. in fx of femoral neck, this artery can easily be damaged, and avascular necrosis of femur head can occur |
|
Thefemoral artery moves throughadductor hiatusand enters the posterior compartment of the thigh, proximal to the knee, now known as |
popliteal a |
|
arteries of leg (from aorta down in order) |
Aorta> Common Iliac a. > Internal Iliac a. +External a. ExternalIliac a. > Femoral a. > Deep Femoral a.+ Popliteal a. Popliteal a. >anterior + posterior tibial a. |
|
4 pulse sites of PT eval |
femoral, popliteal, posterior tib, dorsalis pedis |
|
avascular necrosis of femoral neck/head |
femoral neck fx could cause damage to medial femoral circumflex a; primary blood supply to femoral neck and head |
|
.isformed by the dorsal venous arch of the foot, and the dorsal vein of the littletoe. It moves up the posterior side of the leg, passing posteriorly to the lateralmalleolus,along the lateral border of the calcaneal tendon. It moves between the twoheads of the gastrocnemius muscle and empties into the poplitealvein inthe poplitealfossa. |
small saphenous v |
|
great saphenous v |
.thevein moves up the leg, it receives tributaries from other small superficialveins. The great saphenous vein terminates by draining into thefemoral vein immediately inferiorto theinguinal ligament. |
|
deep vein thrombosis |
blood clot in deep veins, blocking blood return; sx's: pain, redness, swelling, impaired mobility who's at risk: post op, smoking, diabetes, OW, sedentary virchow's triad: endothelial damage, period of stasis, hyper coagulable state |
|
CABG surgery |
great saphenous vein harvested; pt may have pain, swelling, and mobility difficulty following CABG if site is used |
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spleen |
fans mainly as blood filter, removing old RBCs; plays role in immune response |
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thymus |
responsible for dev't and maturation of T lymphocyte cells |
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red bone marrow |
responsible for maturation of immature lymphocytes, like thymus |
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lymph fluid |
transparent and yellow; formed when fluid leaves capillary bed in tissues due to hydrostatic pressure; comp = 95% water, 5% proteins lipids carbs, ions, lymphocytes |
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lymph nodes |
adults have 400-500 majority located in abdomen house T lymphocytes, B lymphocytes, other immune cells |
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lymph node groups |
cervical, mediastinal, axillary, inguinal |
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right lymphatic duct |
drains right side of head, right arm, and right thorax; dumps into R internal jugular vein |
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thoracic duct |
drains rest of body; drains into left internal jugular vein |
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ultrafiltration (lymph drainage) |
fluid leaving arterial capillaries |
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re-absorption (lymph drainage) |
fluid re-entering venous capillaries or returning to venous system just before heart |
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lymphoma |
tumor from lymphocytes (non-hodgkin 90%, hodgkin 10%), RFs = epstein-barr virus, AI diseases, HIV/AIDS, large amts meats and fats |
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lyphadema |
abnormal swelling due to: removal of lymph nodes, blockage of lymph system; tx w/ compression therapy |
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thoracic spine role |
protection of viscera; provides attachment for upper extremities, muscles of abdomen, back, respiration, and upper limb, resists internal pressure of lungs; most stable part of spine b/c of all the joints |
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transitional zones of thoracic spine |
upper thoracic T1-T4 = like cervical mid thoracic T4-T8 = typical thoracic lower thoracic T9-T12 = like lumbar |
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demifacets |
bumps posterolateral side of body; heads of ribs articulate here |
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why do heads of ribs cover intervertebral disks? |
extra protection; hard to herniate disk in thoracic spine; costal facets aka costovertebral joints |
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costotubercular facet |
on transverse process; where tubercle of rib articulates w/ transverse process = costotransverse process |
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superior articular facets |
zygoapophyseal joint and inferior articular facets; 60-90 degrees in frontal plane; good at lateral flex |
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head of rib articulates w/ |
demifacets |
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t/f: each rib has own segmental innervation and blood supply |
T |
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end of rib articulates w/ |
hyaline cartilage (costal cartilages) and articulates w/ sternum |
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radiate ligament |
anterior support of costovertebral joint |
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costotransverse ligament |
btw neck of rib, transverse process and costotransverse joint |
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rules of 3's for spinous processes in thoracic spine |
take 1st 3 thoracic vertebrae spinous processes line up w/ transverse processes (t1-T3); T4-T6 spinous process of vertebrae 1/2 way btw own transverse process and one below it; T7-T9 lines up w/ transverse process full level below it; T10-T12= T10 just like T1 so in line w/ transverse, T11 1/2 way btw own transverse and one below, T12 1 whole vertebrae below |
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sternal angle |
T4-T5 level |
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manubriosternal joint |
symphysis joint in most but could be synovial |
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body of sternum |
T5-T9 |
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1st rib attaches at |
manubrium |
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what ribs attach directly to sternum? |
1-7 (sternalcostal joint) aka true ribs |
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___,____, and _____ cover each whole rib on inside of "ring" |
nerve, a, v |
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false ribs |
T8-T10, attach to costal cartilages, more elasticity for breathing |
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floating ribs |
T11-T12, no attachment |
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cervical rib |
articulates w/ C7 (only some people have) |
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1st rib |
acute arc, broad and flat |
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be able to identify rib level |
practice identifying ribs |
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ribs 2-7 |
wider and more circular |
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8-11 ribs |
more circular |
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12th rib |
short and flat |
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intercostal spaces |
space btw ribs; named by superior rib (btw 4 and 5 ribs = 4th intercostal space) |
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ext of thoracic spine |
inferior glide of facets; disk is post compressed, zygoapophyseal slides inferior; costovertebral post roll; costotransverse inferior glide; superior vertebra slide inferior |
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flex of thoracic spine |
superior glide of facets; disk is stretched posterior and compressed anterior; costovertebral joint rolls anterior, costotubercular joint rolls superior |
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side bending to left thoracic spine |
ispilateral articulating process glides inferior, contralateral articulating process glides superiorly |
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thoracic spine rotation to left |
ipsilateral side gapping, contralateral side approximation |
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which spine has largest vertebral foramen |
cervical |
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vertebral arteries go through ____ in c spine |
transverse foramen |
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typical cervical vertebrae |
C3-C7 |
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facet orientation in cervical spine |
45 degrees above horizontal (z-joints) |
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intervertebral foramen |
where nerves come out |
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flexion of c spine |
anterior and superior; superior vertebrae inferior, articular facet anterior and superior |
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extension of c spine |
posterior and inferior; superior vertebrae inferior, articular facet posterior and inferior; post element stretched, anterior compressed, disk shifted posterior |
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rotation of c spine |
ipsilateral side = post and inferior glide, contralateral = anterior and superior glide; same mechanics as side bending, named by direction of body |
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trap |
upper, middle, lower; scapulae medially and downward |
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lat dorsi |
adducts, ext, IR shoulder |
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thoracodorsal fascia |
blends w/ lat dorsi |
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lat dorsi + thoracolumbar fascia |
ext and supports lumbar spine |
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serratus posterior inferior, serratus posterior superior |
respiration |
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superficial muscles of back |
trap, lat dorsi, serratus muscles |
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deep muscles of back |
erector spinae (iliocostalis, longissimus, spinalis) |
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deep intrinsic muscles of back |
rotatores, multifidus, semispinalis, intertransversarii |
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rotatores |
good at rotation; short and stocky; transverse process to spinous process (1level) |
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multifidus |
oblique, transverse process 2-4 levels above and attach to spinous process (side bend by themselves and ext) |
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semispinalis |
6-8 levels transverse process to spinous process |
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intertransversarii |
in btw transverse processes |
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levator scapulae |
raises scapula, rotation of neck, side bend and rotation of neck; primary job = resists anterior shear of vertebrae |
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trace anterior thigh vasculature aorta down |
aorta > internal and external iliac a > external iliac becomes femoral a > profound femoris (goes through adductor canal in add magnus), lateral circumflex a, medial circumflex a |
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posterior thigh vasculature down |
aorta > common iliac a > internal iliac a > superior gluteal, inferior gluteal, perforating branches profunda femoris > popliteal a (at adductor hiatus) > anterior tibial a which becomes dorsalis pedis/posterior tibial a which becomes fibular a |
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ligamentum teres |
runs through fovea capitis and supplies blood to head of femur; avascular necrosis (no mechanism of injury); comes from iliac a |
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medial circumflex a |
supplies lateral part on outside of femoral head; fine unless fx neck of femur then cuts off flow to external femoral head |
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pulse points |
femoral a, popliteal a, posterior tib a, dorsalis pedis a |
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decrease pulse at post tib a, but pulse at femoral is fine |
not strong enough to pump down, poor circulation, check popliteal if normal, compartment syndrome (check dorsalis pedis = compartment syndrome if normal) |
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saphenous nerve |
anterior and medial knee from femoral n; cutaneous n |
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diaphragm O, I, In, A |
O: lower ribs, vertebral bodies L1-L3 and their disks, ALL, xiphoid process; I = central tendon; In = phrenic n C3-5; A = respiration |
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perforating branches |
3 or 4 branches that perforate add magnus; supplies muscles in medial and posterior thigh |
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lateral femoral circumflex |
wraps around anterior and lateral side of femur; supplies some muscles on lateral side of thigh |
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medial femoral circumflex |
wraps around posterior side of femur; supplies head and neck of femur; can be damaged w/ femoral neck fx |
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superior gluteal a |
exits above PF and supplies gluteal muscles |
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inferior gluteal a |
exits below PF and supplies gluteal and muscles of post thigh |
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obturator a |
descends through obturator canal to medial thigh |
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popliteal a |
continuation of femoral a; gives off genicular branches that supply knee joint; divides into anterior and post tibial a |
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posterior tibial a |
splits into medial and lateral plantar a which supplies plantar aspect of foot and toes; branches to fibular a in lower leg |
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cervical forward bending |
inferior facet glides anterior and superior; increases lateral foramen diameter and vertebral canal widens |
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cervical back bending |
inferior facet glides inferior and posterior on superior facet |
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rotation of cervical spine |
ipsilateral: inferior/posterior glide; contralateral: superior/anterior glide (decreases intervertebral foramen diameter on ipsilateral side) |