Back Flashcards
Attachments of the erector spinae muscles
- medial crest of sacrum
- supraspinous ligament
- to back of iliac crest and lateral crest of sacrum to ribs & vertebrae
action of the erector spinae muscle
Extension of Vertebral column
Lateral flexion
Head extension
innervation of erector spinae
posterior ramus of spinal nerves
what muscles are involved in flexion
External/internal oblique (working together), rectus abdominis, psoas major/minor, sternocleidomastoid (working together).
what back muscles are involved in extension
Erector spinae, trapezius, quadratus lumborum.
muscles involved in lateral flexion
Trapezius, erector spinae, quadratus lumborum, external oblique, internal oblique.
define kyphosis
Kyphosis- over-curvature of the thoracic vertebrae.
define lordosis
Lordosis- excessive anterior convexity of the cervical and/or lumbar spine.
define scoliosis
Scoliosis- lateral curvature of the spine.
which sections of the spine have natural lordotic curvature
cervical and lumbar
which sections of the spone have a natural kyphotic curvature
Thoracic and sacral
why is the spine curved?
To help maintain balance in standing and sitting and help with movement and weight distribution
attachments of the nuchal ligament to the skull and the cervical vertebrae
Extends from the external occipital protuberance and median nuchal line to the spinous process of C7.
what are the functions of the nuchal ligament
Sustain the weight of the head.
Why might an obstetrician be interested in the nuchal ligament of a foetus?
The obstetrician checks nuchal ligament via ultrasound to identify any abnormal developments e.g. translucency shown with downs syndrome
what movement stretches the anterior longitudinal ligament
extension
why is the posterior longitudinal ligament thicker in the thoracic region
Attenuate posterior forces due to kyphosis.
why is the ligamentum flavum yellow?
elastin
what does the ligamentum flavum connect
lamina of adjacent vertebrae
function of the cruciform ligament
Restrains posterior movement of odontoid process.
function of alar ligaments of the axis
Limit side-to-side movements of the head when it is turned.
In herniation of the intervertebral disc (slipped disc), in which direction does the nucleus pulposus extrude?
Posterolateral owing to the presence of the posterior longitudinal ligament in the spinal canal and anterior collapse of vertebrae (wedging due to osteoporosis).
Which disc is most commonly affected by disc herniation? Why is this?
Lumbar: between L4-L5 or between L5-Sacrum. Weight of the body and propensity for anterior wedge fractures.
Why are we taller in the morning than when we went to bed?
During the day our cartilage slowly compresses taking a lot of force, when we rest it returns to its normal state.
Why are fractures typically common between T12-L1?
Compression fractures due to osteoporosis
L4/L5 disc herniation can produce what neurological problem?
Sciatica
At what vertebral level does the spinal cord terminate?
L1, L2 as the Conus
Medullaris.
At what level does it terminate in the neonate?
Upper border of L3
define strain
stretching or tearing of ligaments
define disc prolapse
when the outer fibres of the intervertebral disc are injured, and the soft material known as the nucleus pulposus, ruptures out of its enclosed space.
define spondylosis
degenerative process affecting the vertebral disc and facet joints that gradually develops with age. Degeneration of vertebral column
define radiculopathy
describes a range of symptoms produced by the pinching of a nerve root in the spinal column. Damage to the spinal nerves as they exit the roots.
define spondylolysis
is a crack or stress fracture in one of the vertebrae
define spondylolisthesis
the fractured pars interarticularis separates, allowing the injured vertebra to shift or slip forward on the vertebra directly below it. Basic- displaced vertebra
define spondylitis
Inflammation of one or more of the vertebrae of the spine.
what is spinal stenosis
A narrowing of spinal canal e.g. due to osteoarthritis – symptoms – leg heaviness and aching on walking (spinal claudication)
symptoms of spinal stenosis
cramp in thigh or leg on walking, worse walking downhill or standing associated with back pain
signs of spinal stenosis
pain on straight leg raise and back extension – often no neuro symptoms
red flags for back pain
Bladder/Bowel changes Fever Weight loss Previous cancer Perianal anaethesia Pulsatile abdominal mass Progressive neurological deficit
causes of vertebral collapse
Trauma, osteoporosis, tumour
signs and symptoms of vertebral collapse
Sudden onset back pain, mild trauma. Central Signs & symptoms: vertebral tenderness, reduced mobility
causes of cauda equina
Central disc prolapse, tumour, abscess/TB haematoma, trauma
signs and symptoms of cauda equina
Urinary incontinence or retention, faecal incontinence, bilateral weakness and pain – important to remember to catheterise
Reduced perianal sensation (saddle), reduced anal tone, bilateral absent ankle reflexes
Read around further for management and investigations
causes of cord compression
Tumour, abscess/TB trauma central disc prolapse
signs of cord compression
- Continuous shooting pains, faecal incontinence, urinary retention
define osteopenia
is decreased bone mass. Two metabolic bone diseases decrease bone mass: osteoporosis and osteomalacia.
causes of osteomalacia
. Osteomalacia is due to impaired mineralization, usually because of severe vitamin D deficiency or abnormal vitamin D metabolism (see Vitamin D). Osteomalacia can be caused by disorders that interfere with vitamin D absorption (eg, celiac disease) and by certain drugs (eg, phenytoin, phenobarbital).
define osteoporosis
decreased bone mass, but ratio of bone mineral to bone matrix is normal
