Back Flashcards
Referred pain of upper GI structures
Mid-back
Liver, gallbladder also to shoulder
Referred pain of lower GI structures
Low back
Referred pain of GU structures
Low back, flank to groin, sacral region
Upper quadrant landmarks
C7 Medial scapula border Spine of scapula Inferior angle of scapula Upper trap
Lower quadrant landmarks
CVA T12 Lower trap Lumbar paraspinal muscles Iliac crest L4 PSIS (dimples) Sacrum
Function of spine curves
Absorb shock
Kyphotic curves
Primary
Thoracic and sacral
From birth
Lordotic curves
Secondary
Cervical and lumbar
Develop with weight bearing
Movements of the spine
Flexion
Extension
Lateral flexion
Rotation
Which vertebrae are “typical”
C3 - L5
Everything but C1, C2
Vertebral body
Main part of vertebra
T4 and below gradually increase in size to support increasing body weight
Vertebral (neural) arch
Pedicles and lamina
Spinous process
Project posteriorly from junction of lamina
Attachment and lever for spinal muscles
Transverse process
Project laterally from junction of pedicles and lamina
Attachment and lever for spinal muscles
Articular process
Superior and inferior processes
Project from junction of pedicle and lamina
Adjacent articular processes form facet joints b/w vertebrae
Vertebral notches
Superior and inferior
Forms IVF between 2 vertebrae
Intervertebral foramen
Formed “between vertebrae” via vertebral notches of 2 adjacent segments
Vertebral foramen
Formed by body and vertebral arch
Vertebral canal
Vertebral foramina collectively form the canal
C1 landmarks
Anterior, posterior arches
Lateral mass (superior and inferior facets)
TP
Lateral mass
Superior facets of C1 articulate with occiput for extension/flexion movement
Inferior facets of C1 articulate with C2 for rotation movement
Dens (odontoid process)
C2
Forms “pivot” or axis for rotation between C1-C2
Forms a small synovial joint with anterior arch of C1
Typical C3-C7 features
- Small rectangular body
- Large triangular VF
- Transverse foramen (vertebral artery)
- Spinous process (bifid C3-5, C7 most prominent)
Thoracic vertebrae features
- Heart shaped body
- Small circular VF
- Long TPs
- Long SPs
Lumbar vertebrae features
- Kidney shaped body
- Triangular VF (smaller than C, larger than T)
- SP (sturdy, hatchet shape)
- Accessory process (base of TP)
- Mammillary process (on superior articular pillar)
Apex of sacrum
Inferior end (same as heart, opposite of lungs)
Base of sacrum
Superior portion
Promontory
Prominent anterior edge of S1
Ala
“Wings” of sacrum
Median sacral crest
Midline, formed by fused SPs
Sacral hiatus
Formed by failure of lamina of S5 to fuse
Sacral cornu
Horns
Formed by pedicles of S5
Sacral canal
Contain nerve roots of cauda equina
Coccyx
Wedge shaped bone of 4 fused coccygeal vertebrae
Provide attachment for pelvic muscles
Lordosis description and causes
Excessive anterior curve in lumbar region
Caused by: orthopedic anomalies, postural habits, pregnancy, etc.
Kyphosis description and causes
Excessive posterior curve in thoracic spine
“Hump back”
Caused by: compression fracture, postural habits, pathology, etc.
Scoliosis description
Lateral deviation with rotary component (convexity)
Facet joint
- Synovial joint
- B/w superior and inferior facets of articular process
- Some weight bearing function in C and L regions
- Prone to degenerative changes (limited movement & pain)
- Excessive bone spurs can cause stenosis of IVF
Intervertebral disc function, composition
Acts as a shock absorber, influences motion
Composition = water, collagen fibers, proteoglycans
Two parts: annulus fibrosis, nucleus pulposus
NOTE: no disc between occiput & C1 OR C1-C2
Annulus fibrosis composition, function
Concentric layers of collagen fibers
“Crosswoven” effect - direction of fibers alternates each layer
Anchor disc to bone or cartilaginous end plate
Outside layers will blend with ALL, PLL and do have innervation (pain possible)
Nucleus pulposus composition, function
Inner layer of disc
Proteoglycans attract water
Finer collagen fibers, loose, random network
Aging causes decrease in proteoglycan content (so less H2O) = decreased disc height
Clinical problems a/w intervertebral discs
- Fissures (discogenic pain)
- Herniation (potential to compress nerve roots)
- Degenerative changes (loss of disc height)
Joints of Luschka
- Uncovertebral
- Formed by uncinate processes of C3-C7
- “Pseudo” joint looks similar to synovial
Clinical problems a/w joints of Luschka
Prone to degenerative changes (bone spur formation)
Atlanto-axial joint
Comprised of: facet joints C1-C2, dens and anterior arch
Provides rotation of head/neck
Atlanto-occipital joint
Synovial joints between C1 facet and occipital condyles
Provides flexion/extension of head and neck
Anterior longitudinal ligament
Anterior portion of vertebral column
C2-sacrum
Posterior longitudinal ligament
Posterior vertebral column within vertebral canal
C2-sacrum
Ligamentum flavum
Connects lamina between each vertebra
Forms part of posterior wall of vertebral canal
High elastin content
Restore neutral position after flexion of spine
Interspinous ligaments
- Connect adjacent SPs
- Attach along inferior and superior portion of SP
Supraspinous ligaments
Connect adjacent SPs (C7-sacrum)
Anterior atlanto-occipital membrane
- Continuation of ALL
- Connect arches of C1-occiput (edges of foramen magnum)
Tectorial membrane
- Continuation of PLL
- C2-foramen magnum
Posterior atlanto-occipital membrane
- Continuation of ligamentum flavum
- Connect arches of C1 to occiput (edges of foramen magnum)
Nuchal ligament
- Continuation of supraspinous ligament
- EOP to C7
- Acts as septum separating muscles of R/L posterior neck
Cruciate ligament
Stabilizes dens against anterior arch of C1
3 sections - transverse, superior (occiput to dens), inferior (C2 body to dens)
Alar ligament
Sides of dens to lateral margin of foramen magnum
LIMITS excessive rotation
Apical ligament
Apex of dens to foramen magnum
Superficial layer of back muscles
Trap
Lat dorsi
Rhomboid
Levator scapula
Trapezius attachments, innervation, actions
Attachments: EOP/SP C7-T12, clavicle/scapula
Innervation: CN 11
Actions: elevation + upward rotation of scapula (upper), scap retraction (middle), depression + upward rotation (lower)
Lat dorsi attachments, innervation, actions
Attachments: SP of T7-L5/inferior angle of scapula, humerus
Innervation: Thoracodorsal
Actions: “Handcuffs” - extends arm back, internal rotation, adduction
Rhomboid attachments, innervation, actions
Attachments: nuchal ligament/SP of C7-T5, medial border of scapula
Innervation: Dorsal scapular
Actions: retraction (squeezing shoulders together), some shrug action
Levator scapula attachments, innervation, actions
Attachments: TP C1-C4, medial border of scapula
Innervation: Dorsal scapular
Actions: Elevates scapula, ipsilateral lateral movement of neck
Intermediate layer of back muscles
Serratus posterior superior and inferior
Serratus posterior superior actions
Elevates the ribs which aids in inspiration
Serratus posterior inferior actions
Depresses the lower ribs, aiding in expiration
Deep layer of back muscles
Superficial, intermediate, deep layers
Deep layer (superficial) of back muscles
Splenius capitis/cervicis
Splenius capitis attachments and actions
Attachments: SP C7-T3, mastoid process
Actions: Unilateral contraction - ipsilateral bending and rotation
Splenius cervicis attachments and actions
Attachments: SP T3-T6, TP C1-C3
Actions: Unilateral and bilateral contraction (extend, flex, rotate head and neck to same side)
Deep layer (intermediate) back muscles and actions
Erector spinae (paraspinal muscles) - iliocostalis (most lateral), longissimus, spinalis (most medial)
Actions: bilateral - extension also assists with flexion (eccentric contraction)
Deep layer (deep) back muscles and actions
Semispinalis (attachments go up 4-6 levels)
Multifidi
Rotators (attachments up 2-3 levels)
Actions: Unilateral - contralateral rotation of spine (opposite of splenius capitis)
Sub-occipital triangle borders
Rectus capitis posterior major
Obliquus capitis inferior
Obliquus capitis superior
NOTE: Rectus capitis posterior minor is NOT included
Sub-occipital triangle contents
Vertebral artery and CN1 (sub-occipital nerve)
Cervical enlargement of spinal cord
C4-T1 segments
Most anterior rami arising from here form brachial plexus
Lumbosacral enlargement of spinal cord
T11-S1 segments
Anterior rami from here make up lumbar and sacral plexuses
Conus medullaris
Tapered, lower end of spinal cord
May terminate as high as T12 or as low as L3
Cauda equina
Bundle of spinal nerves beginning from conus medullaris (end of spinal cord) through sacrum
“Horse tail”
Denticulate ligaments
Ligaments on each side of spinal cord connecting pia mater to arachnoid and dura mater
Filum terminale
Suspends the spinal cord in the dural sac (“mechanical anchor”)
Lumbar cistern
Enlargement of subarachnoid space between conus medullaris of spinal cord
Occupied by cauda equina, filum terminale, CSF
Site for lumbar puncture and spinal anesthesia
Pia filament
Portion of filum terminale within the dural sac
Goes all the way to coccyx
Spina bifida occulta
Failure of vertebral arch to fuse, bony defect
Meningocele
Type of spina bifida (uncommon)
Meninges protrude through bony defect of vertebral arch
Myelomeningocele
Type of spina bifida (most severe)
Meninges AND spinal cord protrude through defect of vertebral arch
These three longitudinal arteries supply the spinal cord
1 anterior spinal artery
2 posterior spinal arteries
Anterior and posterior segmental medullary arteries
Support the A & P spinal arteries
Occur mainly in association with cervical and lumbosacral enlargements (where good blood supply is needed)
Anterior and posterior radicular arteries
Run along nerve roots
Most are small and supply only nerve roots
Spondylolisthesis
Pars defect
Forward displacement of a vertebra - esp L5
MC occurring after break/fracture
X-ray finding = scotty dog
Scotty dog sign on x-ray
Spondylolisthesis
