Back + Spine/ LE
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Questions and Answers

Which of the following anatomical structures provides stability to the vertebral column?

  • Spinal ligaments (correct)
  • Vertebral body
  • Zygoapophyseal joints
  • Transverse foramina

    • A 12-year-old boy sustains a forward flexion injury resulting in a fracture of T12 vertebral body. He was using a lap seat belt. Which of the following spinal fractures is most likely?

  • Tear drop
  • Clay-Shoveler's
  • Burst fracture
  • Chance fracture (correct)

    • A 31-year-old man comes to the clinic for pain in the right heel and lower back after a fall. Radiographs show a fracture of the calcaneus and the spine. Which of the spinal vertebral bodies is most likely fractured?

  • T11
  • L2
  • T12 (correct)
  • L1

    • A 62-year-old woman is diagnosed with severe degenerative disease in the facet joints. Which of the following nerves is the likely cause of her pain?

    <p>Medial branch posterior rami</p> Signup and view all the answers

    Which of the following anatomical structures is a continuation of the pia mater inferiorly and descends to the coccyx, anchoring the spinal cord?

    <p>Filum terminale</p> Signup and view all the answers

    Which part of the spine is formed by the fusion of sacral vertebrae?

    <p>Sacrum</p> Signup and view all the answers

    What is the primary function of the vertebral column?

    <p>Protecting the spinal cord and nerves</p> Signup and view all the answers

    What contributes approximately 75% to the height of the vertebral column?

    <p>Vertebrae</p> Signup and view all the answers

    What is the most common abnormal curvature of the spine?

    <p>Scoliosis</p> Signup and view all the answers

    What is used to measure the Cobb angle in scoliosis?

    <p>The angle between intersecting lines drawn perpendicular to the top and bottom vertebrae</p> Signup and view all the answers

    Which part of the spine forms an angle at the junction of L5 and the sacrum?

    <p>Lumbar spine</p> Signup and view all the answers

    What structure separates the vertebrae and contributes approximately 25% to the height of the vertebral column?

    <p>Intervertebral discs</p> Signup and view all the answers

    What is the primary role of the deep fascia in the back?

    <p>Encasing the muscles and nerves</p> Signup and view all the answers

    Which type of fracture is caused by violent forward flexion, resulting in a pure bony injury extending from posterior to anterior through the spinous processes, pedicles, and vertebral body?

    <p>Chance Fracture</p> Signup and view all the answers

    Which type of fracture is a stable fracture through the spinous process of a lower cervical or upper thoracic vertebra?

    <p>Clay-Shoveler’s fracture</p> Signup and view all the answers

    Which vertebrae have limited range of motion, with T12 being the most commonly fractured vertebra?

    <p>Thoracic vertebrae</p> Signup and view all the answers

    Which vertebrae have large bodies for support, and L5-S1 is a common site for disc degeneration and other spinal issues?

    <p>Lumbar vertebrae</p> Signup and view all the answers

    What can metastasize to the lumbar vertebrae via Batson's venous plexus?

    <p>Prostate cancer</p> Signup and view all the answers

    What causes loss of fluid contents, disruption of collagen and protein, resulting in abnormal motion and bony changes?

    <p>Degenerative disc disease</p> Signup and view all the answers

    What is the inflammation of the vertebral disk space, often related to infection and diagnosed through MRI with contrast?

    <p>Discitis</p> Signup and view all the answers

    What is a surgical procedure to relieve pressure on the spinal cord or nerve roots, often due to herniated discs, bony hypertrophy, or tumors?

    <p>Laminectomy</p> Signup and view all the answers

    What in the lumbar region can cause pain with standing and walking and may require surgical decompression?

    <p>Spinal stenosis</p> Signup and view all the answers

    What separates adjacent vertebrae and acts as shock absorbers, with the nucleus pulposus providing elasticity and compressibility?

    <p>Intervertebral disc</p> Signup and view all the answers

    What is an unstable fracture/dislocation at the thoracolumbar junction, caused by a flexion/rotation injury?

    <p>Holdsworth Fracture</p> Signup and view all the answers

    What is a common disc problem affecting the spine characterized by abnormal growth of bone in and around the discs?

    <p>Spondylosis</p> Signup and view all the answers

    Which region of the vertebral column lacks transverse foramina and costal facets?

    <p>Lumbar vertebrae</p> Signup and view all the answers

    What type of joints permit gliding movements and can cause dermatomal pain with degenerative changes?

    <p>Facet joints</p> Signup and view all the answers

    Which ligament plays a role in preserving normal spinal curvature and preventing abrupt flexion?

    <p>Ligamenta flava</p> Signup and view all the answers

    Which movements are permitted by the vertebral column?

    <p>Flexion, extension, lateral bending, and rotation</p> Signup and view all the answers

    What is the approximate length of the spinal cord in adults?

    <p>42-45cm</p> Signup and view all the answers

    Which veins form within the vertebral bodies for venous drainage?

    <p>Basivertebral veins</p> Signup and view all the answers

    What do the spinal nerve roots and spinal meninges contain?

    <p>Spinal cord, spinal nerve roots, and CSF</p> Signup and view all the answers

    What do the meninges surround and protect?

    <p>Spinal cord and nerve roots</p> Signup and view all the answers

    Where do spinal nerves exit the vertebral column?

    <p>Through intervertebral foramina</p> Signup and view all the answers

    What is the arterial blood supply of the vertebrae primarily involve?

    <p>Segmental arteries supplying vertebral bodies</p> Signup and view all the answers

    What type of branches supply bones, periosteum, ligaments, and meninges?

    <p>Spinal branches</p> Signup and view all the answers

    Which region of the spinal cord is enlarged for limb innervation?

    <p>Cervical region</p> Signup and view all the answers

    Which imaging position is recommended for assessing the degree of curvature in scoliosis films?

    <p>Standing position</p> Signup and view all the answers

    What is the primary role of the transverse ligament of the atlas in the cervical spine?

    <p>Prevents spinal cord compromise</p> Signup and view all the answers

    What is the distinctive feature of cervical vertebrae related to foramina in transverse processes?

    <p>For vertebral arteries</p> Signup and view all the answers

    Which condition can cause severe arthritis in the upper cervical spine, leading to restricted neck rotation?

    <p>Rheumatoid arthritis</p> Signup and view all the answers

    What is the pivotal joint visible in the 'open mouth' or 'water's view' X-ray?

    <p>C1-C2 articulation</p> Signup and view all the answers

    What is the primary purpose of the Risser classification in scoliosis assessment?

    <p>Grading skeletal maturity</p> Signup and view all the answers

    What is the function of the vertebral foramen in typical vertebrae?

    <p>Protection of spinal cord</p> Signup and view all the answers

    What is the primary cause for obtaining MRI in specific scoliosis cases?

    <p>Rapid curve progression</p> Signup and view all the answers

    What is the primary purpose of the scoliometer in scoliosis assessment?

    <p>Measuring truncal rotation</p> Signup and view all the answers

    What condition can cause lateral tilt, listhesis of vertebral body, and sciatica in the context of spinal anatomy?

    <p>Scoliosis</p> Signup and view all the answers

    What are the landmarks on physical exam for assessing spinal anatomy?

    <p>Vertebral prominence, spinous process</p> Signup and view all the answers

    What is the primary characteristic of cervical vertebrae related to dislocation and fractures?

    <p>More easily dislocated</p> Signup and view all the answers

    Which of the following regions is heavily reliant on ligaments for stability?

    <p>Foot region</p> Signup and view all the answers

    What is the primary cause of overuse inflammation often implicated in the greater trochanter?

    <p>Inflammation of the hip joint</p> Signup and view all the answers

    Which soft space is usually indicative of meniscal pathology?

    <p>Popliteal fossa</p> Signup and view all the answers

    During puberty, the 3 main sections of the hip bone solidify via the triradiate cartilage and become the hip. Which sections are these?

    <p>Ilium, ischium, and pubis</p> Signup and view all the answers

    Which bone in the lower limb is mainly for muscle attachment and not weight-bearing?

    <p>Fibula</p> Signup and view all the answers

    Which bone in the lower limb is encapsulated in tendon and articulates at the intercondylar groove of the femur?

    <p>Patella</p> Signup and view all the answers

    Which bone in the lower limb widens and flattens out proximally to form the tibial plateau?

    <p>Tibia</p> Signup and view all the answers

    Which bone in the lower limb consists of the head, neck, and greater and lesser trochanters?

    <p>Femur</p> Signup and view all the answers

    Which bone in the lower limb is a common site for fractures and has specific angles of inclination and torsion?

    <p>Femur</p> Signup and view all the answers

    Which part of the lower limb consists of the talus, calcaneus, cuboid, navicular, and 3 cuneiforms?

    <p>Tarsus</p> Signup and view all the answers

    Which part of the lower limb consists of 5 metatarsals, with the 3rd metatarsal often implicated in stress fractures?

    <p>Metatarsus</p> Signup and view all the answers

    How many phalanges are there per foot, with the 1st toe having 2 and toes 2-5 having 3 each?

    <p>14</p> Signup and view all the answers

    Which artery supplies various muscles and tissues in the thigh and gluteal area?

    <p>Femoral artery</p> Signup and view all the answers

    Which artery bifurcates into anterior and posterior tibial arteries, with specific clinical considerations for protection during total knee arthroplasty?

    <p>Popliteal artery</p> Signup and view all the answers

    Where does lymph drainage of the lower limb run parallel to venous drainage, with superficial and deep divisions and clinical implications for lymphadenopathy?

    <p>Skin</p> Signup and view all the answers

    Which bone in the lower limb terminates as the medial and lateral femoral condyles, which articulate with the tibia to form the knee?

    <p>Femur</p> Signup and view all the answers

    What is the largest nerve in the body that can be affected by posterior hip dislocation, causing symptoms like positive straight leg raise and tenderness in the sciatic notch?

    <p>Sciatic nerve</p> Signup and view all the answers

    Which ligament complex in the ankle joint prevents inversion?

    <p>Deltoid ligament complex</p> Signup and view all the answers

    Which nerve is important clinically and its dysfunction can cause foot drop or indicate brain injury or cerebral disease?

    <p>Common fibular (peroneal) nerve</p> Signup and view all the answers

    Which compartment syndrome in the leg is characterized by pain, pallor, paresthesia, paralysis, and pulselessness?

    <p>Posterior compartment syndrome</p> Signup and view all the answers

    Which nerve supplies the dermatomes of the lower limb, with specific patterns illustrated in Figure 5.9?

    <p>Femoral nerve</p> Signup and view all the answers

    Which muscle is part of the posterior compartment of the leg?

    <p>Gastrocnemius</p> Signup and view all the answers

    Which joint is primarily a hinge joint supported by ligaments and menisci?

    <p>Knee joint</p> Signup and view all the answers

    Which band extends from the tensor fascia lata and gluteus maximus, providing lateral support for the anterolateral thigh muscles?

    <p>Iliotibial band</p> Signup and view all the answers

    Which anesthesia is used for intraoperative anesthesia and post-operative pain control in lower limb procedures?

    <p>Epidural anesthesia</p> Signup and view all the answers

    Which triangle in the thigh contains the femoral nerve, femoral artery, femoral vein, and deep inguinal lymph nodes?

    <p>Femoral triangle</p> Signup and view all the answers

    Which joint is a large, multiaxial ball-and-socket joint stabilized by ligaments and muscles?

    <p>Hip joint</p> Signup and view all the answers

    Which nerve, sural nerve, and plantar reflex are important clinically, with potential dysfunction causing foot drop or indicating brain injury or cerebral disease?

    <p>Sural nerve</p> Signup and view all the answers

    Which muscle is often harvested for transplantation due to its weakness as an adductor muscle?

    <p>Gracilis</p> Signup and view all the answers

    Which muscle group consists of semitendinosus, semimembranosus, and biceps femoris?

    <p>Hamstrings</p> Signup and view all the answers

    Which muscle is a superficial muscle of the posterior leg compartment?

    <p>Gastrocnemius</p> Signup and view all the answers

    Which nerve innervates the medial thigh muscles, such as adductor longus, brevis, and magnus?

    <p>Obturator nerve</p> Signup and view all the answers

    Which muscle is part of the anterior leg compartment?

    <p>Tibialis anterior</p> Signup and view all the answers

    Which muscle is a hip flexor with specific origins, insertions, and actions?

    <p>Iliopsoas</p> Signup and view all the answers

    Which muscle is commonly referred to as the "hip pointer" when contused?

    <p>Rectus femoris</p> Signup and view all the answers

    Which muscle group consists of four parts with distinct origins, insertions, and functions?

    <p>Quadriceps femoris</p> Signup and view all the answers

    Which muscle is not part of the "hamstrings" group?

    <p>Sartorius</p> Signup and view all the answers

    Which muscle is not a part of the lateral leg compartment?

    <p>Tibialis posterior</p> Signup and view all the answers

    Which muscle is often used for transplantation due to its minimal impact on lower limb function?

    <p>Gracilis</p> Signup and view all the answers

    Which muscle is responsible for dorsiflexion and inversion of the foot?

    <p>Tibialis anterior</p> Signup and view all the answers

    Which artery becomes the dorsalis pedis artery and feeds the dorsum of the foot?

    <p>Anterior tibial artery</p> Signup and view all the answers

    Which veins are formed by convergence of dorsal metatarsal, dorsal venous, and plantar venous networks in the leg?

    <p>Great and small saphenous veins</p> Signup and view all the answers

    Which veins mimic the arterial system and run alongside major arteries in the lower extremity?

    <p>Deep veins</p> Signup and view all the answers

    Which veins empty into the femoral and popliteal veins respectively?

    <p>Great and small saphenous veins</p> Signup and view all the answers

    What is the primary cause of varicose veins according to the text?

    <p>Valve incompetence between deep and superficial circulation</p> Signup and view all the answers

    Where do the deep veins of the leg, including the anterior tibial, posterior tibial, and fibular veins, empty?

    <p>Popliteal vein</p> Signup and view all the answers

    What is the primary function of the great and small saphenous veins?

    <p>Emptying into the femoral and popliteal veins</p> Signup and view all the answers

    Which veins have a mirror venous complex that empties into the popliteal vein?

    <p>Great and small saphenous veins</p> Signup and view all the answers

    Which artery bifurcates into medial and lateral plantar arteries?

    <p>Posterior tibial artery</p> Signup and view all the answers

    Which artery feeds the deep posterior compartment and lateral aspect of the leg?

    <p>Fibula artery</p> Signup and view all the answers

    What do the deep and superficial networks in the foot work together to drain?

    <p>Soft tissue and structure of the foot</p> Signup and view all the answers

    Which veins run alongside major arteries in the lower extremity?

    <p>Deep veins</p> Signup and view all the answers

    Study Notes

    Chief Characteristics and Anatomy of the Vertebral Column

    • The vertebral column has distinct regional characteristics, including the presence of transverse foramina in cervical vertebrae and costal facets in thoracic vertebrae.
    • Lumbar vertebrae lack transverse foramina and costal facets, and adjacent sacral vertebrae can fuse.
    • The vertebral column has various joints, including symphyses between vertebral bodies, uncovertebral joints in the C3-C7 region, and facet joints that permit gliding movements and can cause dermatomal pain with degenerative changes.
    • Ligaments like the ligamenta flava and anterior/posterior longitudinal ligaments play roles in preserving normal spinal curvature and preventing abrupt flexion.
    • The vertebral column allows movements such as flexion, extension, lateral bending, and rotation, with specific muscles responsible for each movement.
    • The arterial blood supply of the vertebrae involves segmental arteries supplying vertebral bodies, while spinal branches enter through IV foramina to supply bones, periosteum, ligaments, and meninges.
    • Venous drainage parallels arterial supply and involves external and internal vertebral venous plexuses, with basivertebral veins forming within the vertebral bodies.
    • Nerves of the vertebral column include medial branches, meningeal branches, and branches supplying periosteum, ligaments, and the spinal cord, contributing to the origin of back pain.
    • The vertebral canal contains the spinal cord, spinal nerve roots, and spinal meninges with cerebrospinal fluid (CSF), including the dura, arachnoid, and pia mater.
    • The spinal cord is approximately 42-45cm long in adults, extending from the foramen magnum to L1-L2 and enlarged in the cervical and lumbar regions for limb innervation.
    • Spinal nerve roots emerge between specific vertebrae, and the spinal nerves exit the vertebral column through intervertebral foramina, forming mixed spinal nerves carrying motor and sensory fibers.
    • The meninges, including the dura, arachnoid, and pia mater, surround and protect the spinal cord and nerve roots, containing CSF in the subarachnoid space and supporting the cauda equina.

    Scoliosis and Spinal Anatomy Summary

    • Scoliosis films should be done in a standing position to assess the degree of curvature, with attention to the heights of scapula and hemipelvis and measurement of truncal rotation with a scoliometer.
    • The Risser classification grades skeletal maturity based on the level of ossification and fusion of the iliac crest apophyses, and MRI should be obtained in specific scoliosis cases, including rapid curve progression, unusual curve pattern, and neurologic deficit.
    • Scoliosis can be degenerative, causing lateral tilt, listhesis of vertebral body, spinal stenosis, and sciatica.
    • Landmarks on physical exam include the vertebra prominence, spinous process, L4-L5 disc space, and "dimples" of the posterior superior iliac spines.
    • Typical vertebrae have various structures including spinous process, transverse process, lamina, superior articular facet, vertebral foramen, pedicle, and vertebral body.
    • Cervical vertebrae are less tightly interlocked and more easily dislocated than fractured due to their horizontal facets.
    • The C1-C2 articulation is a pivotal joint and visible in the "open mouth" or "water's view" X-ray.
    • Cervical vertebrae have unique characteristics including foramina in transverse processes for the vertebral artery, with C1 as the atlas and C2 as the axis.
    • Rheumatoid arthritis and psoriatic arthritis patients are prone to severe arthritis in the upper cervical spine, leading to restricted neck rotation.
    • The transverse ligament of the atlas prevents spinal cord compromise by holding the dens of C2 in position and preventing displacement.
    • Cervical spine distinctive features include the transverse foramen for vertebral arteries, veins, and large vertebral foramen accommodating cervical spinal nerves.
    • Fractures like the burst fracture of C1, Jefferson or burst fracture, and cervical subluxation dislocations can lead to spinal cord compression and paralysis, with specific causes and mechanisms.

    Muscles of the Hip and Leg Anatomy

    • "Hip pointer" refers to a contusion at the origin, typically from contact sports
    • Iliopsoas and iliacus are hip flexor muscles with specific origins, insertions, and actions
    • Quadriceps femoris consists of four parts with distinct origins, insertions, and functions
    • Medial thigh muscles, such as adductor longus, brevis, and magnus, are all innervated by the obturator nerve
    • Gracilis is a weak adductor muscle and is often harvested for transplantation
    • The "hamstrings" include semitendinosus, semimembranosus, and biceps femoris, which have dual actions
    • Tibialis anterior, extensor hallucis longus, and extensor digitorum longus are muscles of the anterior leg compartment
    • Fibularis tertius, longus, and brevis are muscles of the lateral leg compartment, each with specific actions and innervations
    • Gastrocnemius is a superficial muscle of the posterior leg compartment with a specific origin and action

    Anatomy of Lower Extremity Blood Vessels and Muscles

    • The anterior tibial artery becomes the dorsalis pedis artery, feeding the dorsum of the foot and contributing to the plantar arch.
    • The posterior tibial artery bifurcates into medial and lateral plantar arteries, feeding the posterior and lateral aspects of the leg and contributing to the knee.
    • The fibula artery, a branch of the posterior tibial artery, also feeds the deep posterior compartment and lateral aspect of the leg.
    • The venous return system mimics the arterial system, with deep and superficial systems running alongside major arteries.
    • The deep and superficial networks in the foot work together to drain the soft tissue and structure.
    • The great and small saphenous veins are formed by convergence of dorsal metatarsal, dorsal venous, and plantar venous networks in the leg.
    • The great saphenous vein ascends anterior to the medial malleolus and empties into the femoral vein, while the small saphenous vein ascends posterior to the lateral malleolus and empties into the popliteal vein.
    • Varicose veins are usually caused by valve incompetence between the deep venous and superficial circulation.
    • The genicular arterial complex has a mirror venous complex that empties into the popliteal vein.
    • The deep veins of the leg, including the anterior tibial, posterior tibial, and fibular veins, all empty into the popliteal vein in the popliteal fossa.
    • The popliteal vein ascends and turns into the femoral vein proximal to the adductor hiatus, leading into the external iliac vein in the pelvis.
    • Muscles of the gluteal region, including the gluteus maximus, gluteus medius, gluteus minimus, piriformis, and tensor of fascia lata, have specific origins, insertions, innervations, and actions.

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    Description

    Explore the chief characteristics, anatomy, and functions of the vertebral column, understanding scoliosis and spinal structures, muscles of the hip and leg, and lower extremity blood vessels. Learn about spinal nerves, musculoskeletal landmarks, and lower limb vascular anatomy.

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