Anatomy II Test 1 Review

Review of Cervical Muscles-

ACTION ORIGIN INSERTION NERVE ROOT
MS LEVEL

Upper Draws scapula Occipital Clavicle Accessory C3-C4

Trapezius obliquely bone; (lateral ⅓) n. (CN XI) of
upward; rotates spinous cervical
glenoid cavity process of plexus
superiorly; tilts C1-C7
head to same
side and rotates
it to opposite

Splenius Bilateral: Nuchal lig; Lateral Spinal nn. C1-C6

Capitis Extends cervical C7-T3/T4 third of (posterior
spine and head (spinous nuchal line rami, lateral
Unilateral: processes) (occipital branches)
Flexes and bone);
rotates head to mastoid
same side process
(temporal
bone)

Longissimus Bilateral: T1-T3 Temporal Spinal nn. C1-L5

Capitis Extends head (transverse bone (posterior
Unilateral: processes); (mastoid rami, lateral
Flexes and C4-C7 process) branches)
rotates head to (transverse
same side and
articular
processes)
 Semispinalis Bilateral: C4-T7 Occipital Spinal nn.
Capitis Extends (transverse bone (posterior
thoracic and and (between rami)
cervical spines articular superior
and head processes) and inf
(stabilizes nuchal
craniovertebral lines)
joints)
Unilateral:
Bends head,
cervical, and
thoracic spines
to same side,
rotates
opposite

Rectus Bilateral: C2 (spinous Occipital C1 C1

Capitis Extends Head process) bone (inf (Posterior
Posterior Unilateral: nuchal line, Ramus =
Major Rotates head to mid third) suboccipital
same side n.)
Rectus C1 Occipital
Capitis (posterior bone (inf
Posterior tubercle) nuchal line,
Minor inner third)

Obliquus Bilateral: C1 Occipital

Capitis Extends Head (transverse bone (inf
Superior Unilateral: Tilts process) nuchal line,
head to same mid third;
side; rotates to above RCP
opposite side maj)

Obliquus Bilateral: C2 (spinous C1

Capitis Extends head process) (transverse
Inferior Unilateral: process)
Rotates head to
same side

Can refer to Lecture 2 slide 2 for more info on Suboccipital muscles.

The OCI runs directly medial to the mastoid process.
Which muscles affect C1?
Which muscles affect C2?
Most suboccipital muscles are tender to palpation when palpating on the TP of C1
Osteology Review:

Describe the orientation of the Z joints

(facet) in the cervical region.
- From superioanterior to
inferioposterior (blue arrow)
Which process is present in the cervical spine, but not
thoracic or lumbar?
- Unicinate processes
If arthritis was present, what motion would be limited?
- Side-bending

Atlas – C1
 Axis – C2

C4 Vertebrae – Anterior View/Superior View

Which motion is limited if the uncinate process had osteophytes?
 Side-bending
What structure lies within the foramen?
 Transverse foramen: Vertebral arteries
 Vertebral foramen: Spinal cord
Note slope of facet joint- facilitate which movement?
- The facet joints are in a 45-degree angle for Side bending
- With lateral flexion, the ipsilateral uncinate processes aided the ipsilateral facet joints in
maintaining the integrity of the ipsilateral intervertebral foramen.

Name as many landmarks as you can…

Name 3-4 ms in the posterior upper

cervical region
Primary Cervical Vertebrae Characteristic:
• Small vertebral body, squared-off
• Vertebral body has concave superior surface and convex inferior surface
• Transverse processes have trough, contain foramina transversarii
• Spinous process short and bifid (not C7)
• Vertebral foramen is triangular
• C7 is a transitional vertebra
• Z joints(facet) slope from anterior to posterior (facilitates flexion and extension)
• Bear weight of head- 8-12 #
• Allow neck to move all directions
• C7= vertebra prominens – long palpable spinous process

Keep in mind in the spine, Cervical spinal nerves exit above the cervical spine, but at C7
because C8 spinal nerve will exit below.
 Z joints (synovial slope Facilitates Limits
joints)
zygapophyseal
Cervical 45/ inferiolateral Flex-Ext and allows LECTURE 3
>superiomedial more freedom in reference
other planes SB
Thoracic Vertical - Rotation Flex-Ext
Lumbar (TD) Vertical Flex-Ext Rotation

Thoracic Vertebrae – up/down facets (mediolateral)

Describe all articulations to this vertebra

 10: 2 superior costal facets, 2 inferior facets, 2 superior articular facets, 2 inferior
articular facets.

Facet joint facilitates which motion

  Side bending
Which structure exits the intervertebral foramen?
 Spinal nerves
Thoracic Vertebrae Characterizes –
• Vertebral body is heart-shaped
• Vertebral foramen is round
• Transverse processes angle posteriorly with a costal facet for rib
• Spinous processes angle downward
• Costal processes on sides of body for articulation with heads of ribs (superior and
inferior facets on most)
• T12 – transitional vertebra
• Facilitates rotation; limits flexion / extension
• Head of most ribs articulates with vertebrae of its own number and vertebra superior.
Ribs 1, 11, and 12 only articulate with their own vertebrae.

Ribs 1 and 2 – shorter,

more concave
Ribs 11 and 12 – shorter,
less curved

Lumbar Vertebra – up/down facets (antio-posterior)

Lumbar Spine Vertebra – common characteristics
• Large, bean-shaped body
• Long, thin transversely-oriented transverse processes
• Spinous processes are large and flat
• Vertebral foramen triangular
• Facets vertical; superior is concave and faces posteromedial. Limits some ROM,
although flex- ext occur
• Inferior facet is convex and faces anterolaterally
Sacrum Characteristics:
• 5 fused vertebrae
• Triangular in shape
• Concave anteriorly, convex posteriorly
• Articulates laterally with ilium
• Center of gravity: S2

Ligament attachments/purpose of ligaments, including C1-2:

 Taut with

Alar Rotation , extreme of all Full cervical rotation would stretch the
other motions vertebral artery
Apical Flex/ext Sits around the dens of the axis

Transverse Keeps axis from slipping Strong 2 cm long ligament

forward

Tectorial membrane- continuation of the PLL – attaches to the basilar part of the occipital bone anterior to
foramen magnum. Provides multidirectional stability of cranium and cervical region.

What is the continuation of the PLL? Tectorial membrane

The nuchal ligament is a continuation of what ligament? Supraspinous ligament
Ligamentum Flava- Helps with upright posture, is yellow, and is thinner in the neck. Can cause spinal
compression. This would be removed in a laminectomy.
Laminectomy would be preformed for a spinal stenosis.

Possible Transverse Section:

Skull sutures:
 Maxillary Nerve of Trigeminal (V2)
If one frx
inferior orbit
of eye, would
they have any
sensory
losses?

Gilroy Fig 39.9B, p. 531

Trigeminal foramen of the face-

Trigeminal Nerve
Ophthalmic Nerve (of Trigeminal) (V1)

Gray’s Fig 8.58, p. 866

Gilroy Fig 39.9A, p. 531

Mandibular n. of Trigeminal (V3)

Gilroy Fig 39.9C, p. 531

Foramen Ovale
Exit of mandibular
branch of trigeminal
n. (CN V3) from skull
Foramen ovale
What foramen does the
trigeminal n. exit? Styloid
Facial n.? Find them on process
the skull

Stylomastoid
Foramen
Exit of facial n. (CN VII)
from skull Gilroy Fig 37.6, p. 510

~ Review Spinal Cord Lecture 4 ~

• Differentiate all the coverings of the spinal cord
– Dura, Arachnoid, Pia ; also denticulate ligament_ not true covering
• What is the purpose of the denticulate ligament?
– Stabilizes SC within vertebral canal
• What is the difference of viewing the spinal cord cranially @
cervical region compared to L5 region?
• C5 nerve root travels
– a. above C5 vertebra
– b. below C 5 vertebrae c. neither
• Where does the conus medullaris end? L1-2 ( in adults)
• Where is the end of the dural sac? S2 ( in adults)
• Describe the arterial supply to the spinal cord at the cervical vertebrae. Also describe at the thoracic
region and lumbar region. Segmental spinal a---segmental medullary a—Goes to ant /post spinal a
• Which nerve would supply the posterior disc in someone with a lateral HNP at L4( disc between L4 and
L5)?
– Sinuvertebral n. goes to tissues within vertebral canal
– Posterior Lumbar spinal plexus/ n.- L4 goes above disc; L 5 would be irritated.
Spina bifida : serious birth abnormality in which the spinal cord is malformed and lacks its
usual protective skeletal and soft tissue coverings
May result in paralysis and bladder dysfunction
 2. Meningocele: The meninges, or protective
covering around spinal cord, pushed out through the
opening in vertebrae in a sac called the
"meningocele." Spinal cord remains intact. This form
can be repaired with little or no damage to nerve
pathways.

3. Myelomeningocele: Most severe form of spina

bifida, in which a portion of spinal cord itself
protrudes through the back. In some cases, sacs are
covered with skin; in others, tissue and nerves are
exposed. Generally, people use the terms "spina
bifida" and "myelomeningocele" interchangeably.
Facial muscles and action,
how to grade them, and how
to exercise them.
1) Look over Bell’s Palsy
assessment from
modules
Muscle Action Attachment/Extra Info
Corrugator Causes vertical wrinkles above XXXXXXXXXXXXXXXXXXXXX
Supercilii the nose X
Orbicularis Closes eye forecefully with some XXXXXXXXXXXXXXXXXXXXX
Oculi - Orbital wrinkling of the forehead X
Orbicularis Closes eye gently XXXXXXXXXXXXXXXXXXXXX
Oculi – X
Palpebral
Procerus Draws medial border of XXXXXXXXXXXXXXXXXXXXX
eyebrows downward to produce XX
transverse wrinkles over bridge
of nose (horizontal wrinkle)
Occipitofrontali Full muscle: raises eyebrows; XXXXXXXXXXXXXXXXXXXXX
s Occipital belly: retracts scalp X
Frontal Belly: elevates eye
brows and scalp
Nasalis Compresses Nares XXXXXXXXXXXXXXXXXXXXX
-Transverse X
Nasalis – Alar Draws alar cartilages downward XXXXXXXXXXXXXXXXXXXXX
and laterally, opens nares X
Depressor Flares nares Found below nose under
Septi Nasi septum
Orbicularis Oris Narrows mouth, closes lips, Exercise this muscle by
helps with pursing lips as in singing
whistling supercalifragalisticexpialidoc
ious
Buccinator Helps blow air out of cheeks Zygomatic arch to mandible
(fish face). Helps keep food from
sticking to teeth and cheek. If “Trumpeter Muscle”
activated on one side, look of
contempt. Whistling
Risorus “Grin muscle”
Zygomaticus “Smile Muscle”
Major/Minor
Levattor Anguli Bilateral: Assist with smiling, “smirk muscle”
Oris Unilateral: Elevates corner of mouth.
Levator Labii Unilateral: snarl “elvis or snarl muscle.”
Bilateral: elevate and protrude upper
lip, like when searching for stuck food.
Mentalis Sticks out lower lip “Pouting ms”
Depressor Pulls corner of mouth inferiorly “Pouting ms”
Anguli Oris and laterally
Depressor Labii Depresses lower lip XXXXXXXXXXXXXXXXXXXXX
Inferioris XXXXX
Platysma Draws lower lip and mouth “frog muscle”
angles down, helps depress
mandible
Auricular Elevate, retract or pull the ear Wiggles ears
(superior, forward
anterior, and
posterior)
 Muscles of Mastication(p. 522-23)
• Masseter Innervation?
Medial Pterygoid
• Temporalis Trigiminal
Lateral Pterygoid

Muscles of Mastication Insertions Actions/Extraneous Info

Masseter Zygomatic arch to Elevates and protrudes
mandibular angle mandible
Temporalis Temporal fossa to coronoid Elevate, retract, and lateral
process of mandible movements used in chewing
Medial Pterygoid Maxilla and Lateral pterygoid Elevation, Protrusion, and
Action Muscle Involvement
plate as well as pterygoid lateral excursion
fossa to the medial surface of
the mandibular angle
Elevation of Mandible (closing mouth) Masseter
Lateral Pterygoid Greater wing Temporalis
of sphenoid Stability of elevation and
Medial Pterygoid
and lateral pterygoid plate to depression, does protrusion
(Superior head of lateral pterygoid(stabilizes disc)
TMJ and condylar process and lateral excursion.
Depression of Mandible(opening Gravity
All innervated by the CN V3 - mandibular
mouth) (Lateral Pterygoid-pulls on disc)
Digastric, Geniohyoid, Mylohyoids
Protrusion Masseter
Medial Pterygoid
Lateral Pterygoid
Retraction Temporalis
Suprahyoids
Geniohyoid
Digastric
Lateral Excursion Temporalis(ipsilateral)
Medial Pterygoid (grinding)
Inferior head of contralateral lat pterygoid
Cranial Nerves on skull and brain
Mnemonic Cranial Nerve #/Name Fossa
Oh CN I Olfactory Foramina of Cribiform Plate
Oh CN II Optic Optic Canal
Oh CN III Oculomotor Superior Orbital Fissure
To CN IV Trochlear Superior Orbital Fissure
Touch CN V Trigeminal Maxillary- Foramen
Rotundum
Mandibular- Foramen Ovale
Opthalmic – Superior Orbital
Fissure
And CN VI Abducens Superior Orbital Fissure
Feel CN VII Facial Internal Acoustic Meatus
Very CN VIII Vestibulocochlear Internal Acoustic Meatus
Good CN IX Glosopharyngeal Jugular Foramen
Velvet CN X Vagus Jugular Foramen
Ah, CN XI Accessory Foramen Magnum
Heaven CN XII Hypoglossal Hypoglossal Canal
CRANIOSYNTOSIS
• Closing of the cranial bones early
• Normal closure by age 2

1st 3 layers of scalp held tightly together as one unit. Scalping injuries usually occur with these 3 layers being
torn away.
• Dense CT, if scalp is cut- profuse bleeding due to 1)vessels tend to hold vessels open 2)also due to fact
that it is mostly arterial due to venous pressure low).& 3)Walls of arteries closely connected to dense CT
so cannot constrict, thus excessive bleeding in scalp.
• Loose CT- facilitates movement of scalp over calvaria. Infections can localize and spread through loose
connective tissue .
• Periosteum: on outer surface of
calvaria. Removable except in
areas where sutures exist.
1. Know facial ms and actions, and locations. Not important for attachments
o Occipitofrontalis
 Raises eyebrows, occipital belly retracts scalp, frontal belly elevates eyebrows and scalp
o Orbicularis oculi
 Squint or tightly closes eyes
o Palpebral
 Involuntary close eyelid with blinking and sleeping (gentle)
o Corrugator supercilia
 Vertical wrinkles above nose
o Procerus “mouse muscle”
 Wrinkles skin of nose (sneezing), draws down skin between eyebrows
 Draws medial border of eyebrows downward to produce transverse wrinkles over bridge
of nose
o Depressor septi nasi
 Flares nares
o Nasalis
 Constrict nostril and raw down the tip of nose, flares nostril during forced respiration
o Orbicularis oris
 Narrows mouth, closes lips, helps with pursing lips
o Buccinator
 Blow air out of cheeks, helps keep food from sticking to teeth and cheek (bolus)
 “trumpeter muscle”
o Risorus
 “grin muscle”
o Zygomatic major
 “smile muscle”
o Zygomatic minor
 “smile muscle”
o Levator anguli oris
 Bilateral: assist with smiling
 Unilateral: elevates corner of mouth
 “smirk muscle”
o Levator labii superioris
 “elvis or snarl muscle”
 Unilateral: 
 Bilateral: elevate and protrude upper lip
o Mentalis “pouting muscle”
 Sticks out lower lip
 Elevates skin of chin and protrudes lower lip
o Depressor anguli oris
 Pulls corner of mouth inferiorly and laterally
 “clown smile muscle”
o Platysma
 “frog muscle”
 Draws lower lip and mouth angles down
 Tenses skin of neck
 Depresses mandible
o Depressor labii inferioris
 Depresses corner of mouth while protruding and drawling lower lip lateally
 “grimace muscle”
 o Auricular muscles
 Elevate, retract and anterior movements of the ear

• Differentiate all the coverings of the spinal cord

– Dura, Arachnoid, Pia ; also denticulate ligament_ not true covering
• What is the purpose of the denticulate ligament?
– Stabilizes SC within vertebral canal
• What is the difference of viewing the spinal cord cranially @
cervical region compared to L5 region?
• C5 nerve root travels
– a. above C5 vertebra
– b. below C 5 vertebrae c. neither
• Where does the conus medullaris end? L1-2 ( in adults)
• Where is the end of the dural sac? S2 ( in adults)
• Describe the arterial supply to the spinal cord at the cervical vertebrae. Also describe at the thoracic
region and lumbar region. Segmental spinal a---segmental medullary a—Goes to ant /post spinal a
• Which nerve would supply the posterior disc in someone with a lateral HNP at L4( disc between L4 and
L5)?
– Sinuvertebral n. goes to tissues within vertebral canal
– Posterior Lumbar spinal plexus/ n.- L4 goes above disc; L 5 would be irritated.