Back Flashcards
How many cervical vertebra are there?
7
How many thoracic vertebrae are there?
12
How many lumbar vertebrae are there?
5
How many segments of the sacrum are there?
5
How many segments of the coccyx are there?
4
How are cervical and lumbar lordosis related?
Both developed during childhood
Both angled backward (2nd degree curvature)
How are thoracic and sacral kyphosis related?
Both leaning forward, 1 degree curvature, present during fetal development
Back clinical correlates
scoliosis, lateral
lordosis, increase in lumbar curves
kyphosis hump back (osteoporosis)
Why is the vertebral foramen important?
Forms the canal where the spinal cord, meninges, fat, spinal nerve roots, and vessels are
Why is L4/L5 important?
Where most back pain is
Where is the atlanto-occipital joint?
In between the foramen magnum and C1
What is a hangman’s fracture?
hyperextension trauma injury, with prevertebral soft tissue swelling, rupture of the anterior longitudinal ligament, anterior dislocation of the C2 body, and interarticularis fractures
What is the anterior longitudinal ligament?
Anterior ligament extending from C1 to the sacrum. Wide, located on vertebral bodies
Limits extension
What is the posterior longitudinal ligament?
Narrow, weaker, on the posterior side of the spine, within vertebral canal. This limits flexion.
What is the nuchal/nuchae ligament?
Median ligament of the neck –> substitutes as bone for muscle attachment for C3-C5 spinous processes
looks like a fin
What is the ligament flavum?
between the lamina, thick tarp-like ligament that stops abrupt flexion, preventing injury to the intervertebral discs.
What are the accessory ligaments?
Intraspinous between spinous processes, supraspinous, and intertransverse
How long is the spinal cord?
about 45 cm
Where does the conus medullaris end?
L1-L2 in adults
Where does the conus medullaris end in neonates?
L3
What is the cauda equina?
The end of the spinal cord, which sends and receives messages between lower limbs and pelvic organs which consist of the bladder, rectum, and internal genital organs
When should you immediately be concerned regarding a patient with back pain?
If they complain of any issues with bladder, rectum, or genital organs which could mean a more serious nerve issue.
What is dura mater?
outermost layer of the meninges, which has a tough dural sac which ends at the 2nd sacral vertebrae. Spinal blocks are given between L3 & L4 or L4 & L5
What is arachnoid mater?
The middle layer, separated by dura-arachnoid
What is the pia mater?
vascular membrane that covers the spinal cord, separated from the arachnoid mater by the subarachnoid space, with CSF. Covers nerve roots and spinal cord vessels
How is the spinal cord held in place?
Filum terminale ( long piece of cauda equina)
How many spinal nerves are there?
31
How are spinal nerves diveded?
poster/dorsal or anterior/ventral
where do the spinal nerve roots exit the spine?
through intervertebral foramina
How are the cervical different from the thoracic and lumbar when considering innervation?
Cervical exits above their corresbonding vertebral body, thoracic/lumbar exits below
What is annulus fibrosus?
a ring of ligament fibers that connects the spinal vertebrae above and below disc
What is nucleus pulposus?
Jelly like material (mostly water), vertebral disc to withstand forces of compression/torsion
What is a herniated disc?
Mostly L4/L5 or L5/S1, or cervical . caused by heavy lifting or violent rotation where the nucleus pulposus squeezes out and is infringing upon the nerves
What is the trapezius’ origin?
External occipital protuberance, spinous process of vertebrae C7-T12, “nuchal ligament”
What is the trapezius’ insertion?
clavicle, acromion process, spine of scapula
What is the trapezius’ arterial supply and innervation?
transverse cervical artery, spinal accessory nerve
What is the trapezius action?
rotation, retraction, elevation, depression
Where is the origin of the latissimus dorsi?
T7-L5 spinous processes, inferior angle, thoracolumbar fascia
Where is the insertion of the latissimus dorsi?
intertubercular groove of the humerus
What is the arterial supply and innervation of lats dorsi?
thoracodorsal branch off the subscapular artery and thoracodorsal nerve
What is the latissmus dorsi actions?
adducts, extends, and internally rotates the arm
Where is the thoracolumbar fascia?
Site of attachment sort of by your tailbone in a triangle shape
What is the rhomboids’ origin?
C7-T1, T2-T5
What is the rhomboids’ insertion?
Medial border of scapula
What is the rhomboids action?
retract scapula, rotate, depress glenoid cavity, fix scapula to wall
What is the rhomboids’ innervation and blood supply?
dorsal scapular nerve & dorsal scapular artery
What is the levator scapulae?
Muscle extending from medial top scapula border to C1. Elevates scapula, rotates scapula
What is the levator scapulae’s innervation and blood supply?
dorsal scapular nerve, brachial plexus and deep branch of dorsal scapular artery
What is the serratus posterior muscle?
forced inspiration (superior), forced expiration (inferior),
T1 downwards to intercostal (superior)
T11 up to intercostal (inferior)
HOTEL SPA (supply for scapula)
Highest thoracic artery
O
Thoracoacromial trunk
E
Lateral thoracic artery
Subscapular artery
Posterior Humeral Circumflex artery
Anterior Circumflex artery
How to remember supply for the scapula?
HOTEL SPA (6)
How many scapula vasculatures do you need to know?
6
What is on the superficial layer of the back?
Splenius cervicis (T6 to C1 transverse process) and splenius capititis (T4 to mastoid process)
What are the erector spinae muscles?
iliocostalis, longissimus, spinalis
What does the iliocostalis do?
Extends and lateral flexes spine (outermost)
What does longissimus do?
extends spine (middle)
What does spinalis do?
Lateral flexion of spine (closest to spine)
What is the H for in HOTELSPA?
highest thoracic artery
What is the T for HOTELSPA?
thoracoacromial trunk
What is the L for HOTELSPA?
Lateral thoracic artery
What is the S for HOTELSPA?
Subscapular artery
What is the P for HOTELSPA?
posterior humeral circumflex artery
What is the A for HOTELSPA?
anterior circumflex artery
What can sciatica be caused by?
herniation of L5-S1
What is the most common herniation?
L4-L5
Where is the most common winging of the scapula?
Medial winging, caused by injury to the long thoracic nerve
How do you examine winging with an injury to the long thoracic nerve?
Occurs medially. Have patient stand, put both hands on wall, hands pressed against the wall
How do you examine winging with an injury to the dorsal scapular nerve?
Occurs laterally. Patient needs to place their hand behind their back or against the wall
What nerves are affected if winging occurs medially (1) and laterally (2)?
1-long thoracic nerve
2-dorsal scapular nerve
