Clinical Anatomy
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178 terms
Terms | Definitions |
|---|---|
 Lumbar spine | has increased stresses; lower back problems are more common |
| Pathologies that reduce the size of intervertebral foramen | bone loss, herniation, and dislocation of zygapophysial joints - can affect the function of the associated spinal nerve |
| Spina bifida | sides of vertebral arches fail to fuse during development leave open vertebral canal |
| Occulta | tuft of hair, asymptomatic |
| Meningocele | contains CSF |
| Myelomeningocele | contains portion of spinal cord |
| Rachischisis | open wound |
| Vertebroplasty | vertebra filled with bone cement - vertebral body collapse, wedge fractures |
| Scoliosis | abnormal lateral curvature of vertebral column |
| Kyphosis | abnormal curvature in thoracic region - gibbus deformity - tuberculosis is common cause |
| Lordosis | swayback - abnormal curvature of lumbar region - pregnancy |
| Klippel-Feil syndrome | Variation in vertebral numbers - fusion of cervical vertebrae (CI-CII or CV and CVI) - |
| Sacralization of lumbar vertebra | LV with SI |
| Lumbarization of first sacral vertebra | S1 is not fused with other sacral vertebrae |
| Hemivertebra | vertebra develops only on one side |
| Osteoporosis | Bone quality is normal but quantity is deficient - genetic, level of activity, nutrition, estrogen in women |
| In what direction do herniations happen in the intervertebral disc | Posterolateral herniation is common of the nucleus pulposus through the degenerative anulus fibrosis - can impinge on roots of spinal nerve in intervertebral foramen |
| Rheumatoid arthritis | primarily affects synovial joints and bursae - symphyses are usually preserved |
| Hypertrophy of Ligamentum Flavum | hypertrophy and arthritic changes can cause spinal stenosis |
| What happens when zygapophysial joints (pars articularis) are fractured | vertebra can slip anteriorly and press on canal (spondylolysis with spondylolisthesis) |
| Spondylolisthesis | slipping anteriorly on its inferior counterpart without pars fracture |
| Laminectomy | midline approach to the right or left of the spinous process - windowing within the ligamentum flavum - meningeal sac and contents are retracted exposing nerve root and offending disc |
| Spinal Fusion | surgical stabilization for various reasons |
| Accessory nerve XI | Trapezius - drooping of the shoulder, inability to raise the arm above the head, weakness shrugging the shoulder |
| Thoracodorsal nerve | Latissimus dorsi - weakness in pulling body up (climbing) |
| Dorsal scapular nerve | Rhomboids - lateral shift of the scapula, weakness retracting it |
| Where does the spinal cord end (conus medullaris) | Spinal cord ends at LI-LII |
| Where does the Subarachnoid space end | at lower border of SII - contains CSF |
| Where is anesthesia placed in terms of the meninges and ligaments | epidural space |
| Where is Batson's venous plexus | epidural |
| Herpes zoster | chicken pox virus, remains dormant in dorsal root ganglia, virus becomes active and affects dermatome of DRG |
| Lumbago | generic term for low back pain |
| Sciatica | Sciatic nerve - L4-S3, commonly felt in buttock and over posterolateral aspects of leg |
| What innervates the diaphragm | Phrenic nerve - C3-C5 - innervates diaphragm - important for breathing |
| If there is a lesion of the spinal cord, is there movement below the lesion? | Lesion of spinal nerve allows reflexes to work below site of lesion, but no communication to the brain. |
| Psoas abscess | lung infection - TB - spreads to blood to vertebra LI and bone destruction in cancellous bone of body - intervertebral disc became infected and destroyed - usually passes into psoas muscle sheath - hard mass in groin |
| How do you test lower cervical and T1 nerves | Examining dermatomes, myotomes and tendon reflexes (unconscious patients) in the upper limb |
| C5 dermatome | upper lateral region of the arm |
| C6 dermatome | palmar pad of the thumb |
| C7 dermatome | pad of index finger |
| C8 dermatome | pad of little finger |
| T1 dermatome | skin on medial aspect of elbow |
| C5 myotome | abduction of the arm at GH joint |
| C6 myotome | Flexion of the forearm at the elbow |
| C7 myotome | extension of the forearm at the elbow |
| C8 myotome | flexion of the fingers |
| T1 myotome | abduction and adduction of the index, middle and ring finger |
| Musculocutaneous nerve supplies: | Anterior compartment of arm and the skin on anterolateral side of forearm |
| Median nerve supplies | muscles in anterior compartment of forearm except flexor carpi ulnaris and half of digitorum profundus, and Palmar surface of lateral 3.5 digits |
| Ulnar nerve supplies | intrinsic muscles of the hand except for thenar and first two lumbricals (median), and the palmar surface of medial 1.5 digits |
| Radial nerve supplies | posterior compartments of arm and forearm (plus brachioradialis) and skin on posterior surface of forearm and dorsolateral surface of hand |
| What structures are at risk in a fracture of the surgical neck of humerous | PHC and axilla pass posteriorly to surgical neck can be damaged if the surgical neck is fractured |
| What structures are at risk in a fracture of the midshaft of the humerous | radial nerve and deep brachial artery |
| What structures are at risk in a supracondylar fracture | median nerve and brachial artery |
| What structure is at risk in a medial epicondylar fracture | ulnar nerve |
| What part of the clavicle is most often fractured | Middle third of clavicle is most often fractured, other thirds rarely fractured |
| Which end of the clavicle tends to dislocate | Acromial end tends to dislocate at the acromioclavicular joint with trauma |
| Minor injury to the clavicle can tear what ligament? | can tear acromioclavicular ligament - separation |
| More severe trauma to the clavicle can tear what ligament | the coracoclavicular ligament |
| Posterior dislocation of the sternoclavicular ligament can impinge on what structures | great vessels of superior mediastinum |
| Dislocation of the glenohumeral joint most often happens where and what structures can at risk? | Often happens at the anterior-inferior location. Can injure the axillary nerve, lengthen radial nerve - produce radial paralysis |
| Posterior dislocation of the glenohumeral joint is very rare but commonly seen with what type of trauma? | Seizures from electrocution |
| What are the main two rotator cuff disorders? | Main two are impingement and tendinopathy - usually supraspinatus, Swells between acromion and AC ligament - impingement when arm is abducted; Low blood supply makes the supraspinatus tendon susceptible to tears |
| What happens during inflammation in the subdeltoid bursa and what is the treatment? | Supraspinatus tendinopathy leaves bursa inflamed, making movements painful, Treated by injection of corticosteroid and local anesthetic agent |
| How do you test the trapezius and what nerve supplies it? | Trapezius tested by shoulder shrug (accessory nerve) |
| What is the quadrangular space? | Inferior margin of teres minor, surgical neck of humerous, superior margin of teres major and lateral margin of long head of triceps brachii - axillary nerve and PHC |
| What is the quadrangular space syndrome? | Hypertrophy of q-space muscles or fibrosis of muscle edges can impinge on axillary nerve. Produces weakness of deltoid and atrophy of teres minor - affects control of rotator cuff on shoulder movement |
| What deformity is shown due to damage of the long thoracic nerve and what spinal nerves supply it | winged scapula (C5, C6, C7, wings go up to heaven) |
| Where is the venous access in the arm | cephalic vein next to snuffbox, antecubital veins in the superficial tissues of the cubital fossa |
| What is the purpose of anastamosis around scapula and proximal end of humerous and what arteries are involved | prevents ischemia in arm in case subclavian is blocked, axillary artery can still get blood. PHC and AHC, circumflex scapular and dorsal scapular |
| What is subclavian pinch off syndrome | enter first part of axillary vein for long or short term venous access and insertion site for pacemaker wires, Needs to be away from subclavius muscle as contraction will give a kink in the catheter or wire. |
| In Breast cancer where does lymphatic drainage from lateral part of breast drain to | passes through nodes in axilla, surgically removing nodes can cause lymphedema in the arm |
| Biceps brachii tendon tap tests which spinal nerve? | C6 |
| Rupture of biceps tendon | most commonly ruptured, bulge of the muscle belly on flexing of the elbow - Popeye's sign |
| Triceps brachii tendon tap tests which spinal nerve | C7 |
| Radial nerve injury in arm | bound between medial and lateral triceps in radial groove, if humerus is fractured, radial nerve may be stretched or transected - permanent damage and loss of function. Symptoms usually include wrist drop and sensory changes over dorsum of hand. |
| Median nerve injury in arm | deep in the arm, not usually injured by trauma, compression in carpal tunnel is common. Calcification of ligament of Struthers can compress median nerve resulting in weakness of flexor muscles of forearm and the thenar muscles. |
| Supracondylar fracture of the humerous | transverse fracture of distal end of humerus in children (Volkmann's ischemic contracture) |
| Transection of radial or ulnar arteries | One common cause is a hand forced through a plate glass window. Surgeons are able to tie off either the ulnar or radial artery without significant consequence due to collateral circulation and anastamosis |
| Nurse-maid's elbow | radius is pulled out of the anular ligament - easily relocated |
| Fracture of the head of the radius | FOOSH - loss of full extension, fluid fills synovial cavity and elevates small pad of fat within coronoid and olecranon fossae - fat pad sign on radiograph |
| Lateral epicondylitis | tennis elbow - From overuse strain of origins of flexor extensor muscles of forearm |
| Medial epicondylitis | golfers elbow - From overuse strain of origins of flexor muscles of forearm |
| Ulnar nerve injury | posterior to medial epicondoyle in cubital tunnel - degenerative changes in tunnel can compress ulnar nerve when flexed. Repeated flexion and extension of the elbow can cause nerve damage |
| Blood pressure auscultation is done where? | Over brachial artery in cubital fossa |
| Colle's fracture | distal fracture of radius with posterior displacement |
| What is special about palmaris longus? | is absent in about 15% of the population |
| Where is the radial pulse found | Radial pulse is found lateral to flexor carpi radialis |
| Why can the hand be adducted more than abducted | Radial styloid process extends further than ulnar styloid |
| What carpal bone is most fractured and how do you test for it? | Scaphoid is most fractured - palpate anatomical snuffbox to see if patient has fracture |
| Carpal tunnel | pressure on median nerve - swelling of tendons from overuse - pins and needles in the distribution of the median nerves - thenar atrophy |
| How do you test for carpal tunnel | Tinel's sign- Tap on flexor retinaculum to reproduce symptoms. Or Phalen's test - wrists in flexion with arms up |
| How do you treat carpal tunnel | Treatment would reduce inflammation or surgically decompress flexor retinaculum |
| Allen's test | testing for anastamosis in hand |
| Venipuncture in the hand | cephalic vein next to snuffbox - cubital fossa is better |
| Ulnar nerve injury in hand | clawing of the hand - MCP are hyperextended and IPs are flexed (lumbricals), most pronounced in medial fingers, adductor pollicis function is lost |
| Radial nerve injury in the arm | wrist drop and dorsal skin of hand |
| What is the purpose of a brachial plexus nerve block | inject anesthetic into axilla and the whole arm can be numbed, easier than injecting each nerve in arm or forearm |
| What vertebral curvatures are primary and which are secondary | primary - sacral and thoracic, secondary - cervical and lumbar |
| What happens in a lesion to the spinal accessory nerve | loss of muscle bulk (trapezius), loss of symmetry to neck line, inability to shrug the shoulder (drooping shoulder), inability to turn head to the opposite side (sternocleidomastoids) |
| Damage to what nerve causes winged scapula? | Long thoracic nerve - serratus anterior C5-7 |
| Herniation in cervical and lumbar regions affect which nerve | nerve number of vertebra below injury. |
| Herniation in thoracic region affect which spinal nerve | nerve number of vertebra above injury |
| Spina bifida Occulta | tuft of hair, incomplete fusion of vertebral arch |
| Spina bifida cystica with meningocele | meninges with a large cyst where incomplete fusion takes place |
| Spina bifida cystica with meningomyelocele | meninges and spinal cord displaced posteriorly |
| Spina bifida with myeloschisis | neural folds fail to fuse leaving flattened mass of tissue |
| Artery of Adamkiewicz | Important for blood supply to anterior and posterior spinal arteries - Can lead to loss of sensation and voluntary movement inferior and at the level of the injury. |
| Why is cancer easily spread through Batson's venous plexus | Valveless |
| Increased thoracic curvature | Kyphosis |
| Abnormal lateral vertebral curvature | Scoliosis |
| Abnormal lumbar vertebral curvature | Lordosis |
| Jefferson/ Burst fracture | fracture of the anterior or posterior arches of atlas |
| Hangman's fracture | broken pedicles of axis |
| Fracture of the dens (Odontoid process) | usually death or quadriplegia - transverse cervical ligament of atlas holds it in place - usually torn. |
| Spondylolisthesis | anterior dislocation without articular notch fractures - from frequent forced hyperextension - ex. pitcher/bowler |
| Spondylolysis | fractured pars interarticularis - fractures of pedicles - zygapophysial joint, compresses spinal nerve - sciatica |
| Wedge fractures | compression from a fall, vertebra is compressed |
| Burst fracture of cortex | fracture of vertebral body rim |
| Prolapsed intervertebral disc | herniation - rupture of nucleus pulposus (from notochord) through the annulus fibrosis (thinner posteriorly) - can compress spinal nerves |
| Anastamosis to cavae and azygous systems | cancer spread - veins are valve less in Batson's plexus |
| Where is the proper place to do a lumbar puncture | L4-L5 through arachnoid mater to subarachnoid space for CSF, epidural for anesthetic - cord ends at L1-L2 |
| What vessels are used for anastamosis around the scapula | suprascapular, circumflex scapular, branch of transverse cervical |
| Describe an upper brachial plexus injury | C5/C5 and sometimes C7 - Erb's Palsy - stretching of the neck and shoulder - motorcycle accident, obstetrical trauma - waiters tip - arm adducted, medially rotated forearm pronated and extended at elbow, and sometimes wrist is flexed |
| Describe a lower brachial plexus injury | C8/T1 - Klumke's Palsy - from grabbing onto something while falling or obstetrical (pulling arm first) - cervical rib could cause this as well - loss of intrinsic muscles of hand (ulnar and median) Ape hand - clawing of fingers, flattening of thenar eminence |
| Acromioclavicular separation | falling on point of shoulder - pushes acromion down, acromioclavicular ligament tears - sometimes with major trauma coracoclavicular ligament tears |
| Subluxation of the radial head | nursemaid's elbow - radial head slips out of anular ligament - easily replaced |
| Synovial sheaths in digits | 1st (FPL) and 5th digits (FDP and FDS) tendon sheaths are continuous with midpalmar space and wrist - won't stop infection. FDP and FDS tendon sheaths of 2, 3 and 4 enclosed before midpalmar space - localize infection in single digit |
| Where can you assess a scaphoid fracture? | In the anatomical snuffbox - there will be tenderness in the floor |
| Sirenomelia (caudal dysgenesis) | fusion of lower limbs into one - caudal portion of mesoderm doesn't form |
| Sacrococcygeal teratoma | remnants of the primitive streak - affects females primarily, contains hair bone, cartilage and nerve tissue |
| Gastroschisis | failure of lateral folds to fuse - loops of intestines herniated into amniotic cavity |
| Ectopia cordis | failure of lateral folds to fused - heart is partly or completely exposed |
| Median nerve injury at supracondylar fracture of the humerus | weakened wrist flexion, ulnar deviation (FCU unopposed); flexion of index and middle fingers at DIP and PIP lost (FDP and FDS), pronation lost; opposition, abduction and flexion of thumb lost. Sensory loss on palmar and dorsal aspects of index, middle, and half of ring finger and palmar aspect of thumb. Thenar eminence is flattened due to OAF muscles - benediction hand when flexing |
| Median nerve injury at the wrist | flexor muscles are working (no benediction hand) LLOAF muscles are paralyzed, thenar eminence flattened, loss of opposition of thumb. Sensory loss distal to injury |
| Ulnar nerve injury at elbow | paralysis of FCU - radial deviation at wrist, paralysis of ulnar FDP - lose flexion of ring and little fingers at DIP, paralysis of 3, 4 lumbricals and all of interosseous - claw hand - Froment's test - lose adduction of thumb - can't hold on to paper, use flexor |
| What 3 muscles are lost in an upper brachial plexus injury | SAM - suprascapular, axillary, musculocutaneous and sometimes extensors of wrist (C7) |
| Explain what happens in a typical glenohumeral dislocation | typically anterolateral - axillary nerve can be damaged - deltoid and teres minor (abduction 15-90 and lateral rotation) - axillary nerve cutaneous can be damaged (regimental badge patch sensory loss) |
| Colle's Fracture | FOOSH - dinner fork deformity, distal radius fractured towards dorsal side of hand |
| Mallet finger | baseball finger - trauma to DIP, breaks tendon and can't extend - use baseball splint |
| Boutonniere finger | button hole deformity - usually from soft tissue disease, hyperflexion at DIP and flexion at PIP - splint |
| Swan neck deformity | hyperflexion at PIP, flexion at DIP |
| Dupuytren's Contractures | flexion of fingers |
| Trigger finger | extension at MCP, nodule gets stuck behind MCP and flexes DIP and PIP |
| Congenital diaphragmatic hernia (Bochdalek's) | posterolateral - pleuriperitoneal membrane doesn't form - diaphragm can't contract - small lung develops due to intestines in the lung compressing it - hypoplastic lung |
| Eventration of diaphragm | defective musculature in one half of the diaphragm - that half goes up with contraction of diaphragm during respiration - paradoxical respiration |
| Congenital hiatal hernia | part of the stomach is pushed through the esophageal hiatus - Metaplasia - precancerous |
| Thoracic outlet syndrome | typically from cervical rib - pain in 4th and 5th finger - pressure on lower brachial plexus - C8-T1 - muscle pain in upper limb when limb is elevated - Holsen Maneuver |
| Spontaneous pneumothorax | bulla of the lung bursts and tears visceral pleura |
| Tension pneumothorax | trauma ruptures visceral pleura - when you breathe in air escapes to pleural space - pushes lung the other way. |
| Where do you do a thoracocentesis | superior to border of rib to avoid VAN |
| Tracheal esophageal fistula | abnormal communication between trachea and esophagus - typically esophageal atresia (ends blindly) |
| Oligohydramnios | insufficient amount of amniotic fluid - can lead to retarded development of the lungs - hypoplasia |
| Respiratory Distress syndrome | infants develop labored breathing shortly after birth * surfactant deficiency is the major cause of RDS - glucocorticoids stimulate fetal lung movements and surfactant production. |
| Congenital lung cyst | formed by dilation of terminal bronchioles - cysts drain poorly so frequently cause infection |
| Agenesis | failure of lungs to develop - unilateral agenesis is compatible with life - one lung |
| Pericardial effusion | fluid in cavity - pericarditis - inflammation post MI, congestive heart failure - inability to maintain circulation |
| Cardiac tamponade | blood in pericardial cavity - constriction of the heart leads to poor contractility - less blood coming out - Stab wound or myocardial infarct - Beck's triad - low blood pressure, muffled heart sounds, distended neck veins - backup in vena cava - pericardiocentesis under costal margin towards left shoulder. |
| Dextrocardia | bending of the heart tube to the left rather than the right, heart goes to the right |
| What do atrial septal defects (ASDs) cause? | left to right shunt, lung congestion, right ventricular hypertrophy |
| What is the most common type of ASD? | Patent foramen ovale - failure of fusion between septum primum and secondum |
| What is a septum secondum type of ASD? | Abnormally large foramen ovale, normal septum primum, short septum secundum |
| What is a primum type ASD? | Patent ostium primum due to AV valve deformity - associated with Down syndrome |
| What is a sinus venosus type ASD? | Due to defective absorption of the sinus venosus into right atrium - high atrial septal defect - normal fossa ovalis |
| Common atrium (cor triloculare biventriculare) | 3 chambered heart due to complete failure of septum primum and secundum to develop - total absence of interatrial septum |
| Ventricular septal defects | most common congenital heart diseases, most common at membranous part of IV septum, may close spontaneously - left to right shunts, pulmonary hypertension with dyspnea, cardiac failure |
| What is membranous VSD | most common CHD - failure of membranous portion of IV septum to develop |
| What is muscular VSD | multiple defects anywhere along muscular part from excessive myocardial cavitation |
| What is cor triloculare? | Single common ventricle - aorta and pulmonary trunk arise from one ventricle - failure of IV septum formation leading to 3 heart chambers |
| Where do you auscultate the pulmonic valve? | 2nd intercostal space to the left |
| Where do you auscultate the aortic valve? | 2nd intercostal space directly to the right of the sternum |
| Where do you auscultate the tricuspid valve? | 5th intercostal space to the left of the sternum |
| Where do you auscultate the mitral valve? | 5th intercostal space on the midclavicular line to the left of the sternum |
| Tetralogy of Fallot | Pulmonary stenosis, VSD, right ventricular hypertrophy, over-riding of aorta - primary defect is the abnormal alignment of bulbus cordis - cyanosis due to right to left shunt |
| Coronary heart disease | plaque buildup in arterial wall, PCTA (percutaneous transluminal coronary angioplasty) (stint) |
| What defects are caused by faulty migration of the neural crest cells or abnormal alignment of the bulbus cordis? | Persistent truncus, aorticopulmonary septal defects, transposition of great vessels, and Tetralogy of Fallot |
| Persistent truncus | associated with VSD, failure of neural crest cell migration cause absence of spiral septa, and the truncus arteriosis is not divided into the aorta and pulmonary artery |
| Transposition of the great vessels | faulty migration of neural crest cells leads to absence of the twist in the spiral septum, aorta on the right, pulmonary artery on the left, may be associated with a PDA |
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