Conference: The Back Part 1 (8/14/13)

Question 1

Which branch of the spinal nerves provide sensory innervation to the skin on the ENTIRE back?

Answer 1

BOTH the dorsal and ventral rami

Question 2

What part of the skin on the back is supplied by the dorsal rami?

Answer 2

skin on the medial 2/3 of the back

Question 3

What else do the dorsal rami innervate?

Answer 3

1) zygapophyseal (Facet) joints
2) posterior ligaments of spine
3) deep muscles of the back (erector spinae)

Question 4

What is the functional difference between a dorsal ramus and a dorsal root?

Answer 4

dorsal ramus contains both sensory and motor fibers while dorsal root contains only sensory fibers

Question 5

Type of contraction in deep back that describes flexed spine movement to extended spine

Answer 5

Shortening (concentric) contraction

Question 6

After spine flexion is initiated from upright, what type of contraction occurs in the deep back during continued flexion?

Answer 6

Lengthening (eccentric) contraction

Question 7

Type of contraction in deep back when spine is held in a partially flex position?

Answer 7

Isometric contraction

Question 8

Contractions of deep back during lateral bending of spine

Answer 8

ipsilateral shortening contraction (initiates)

contralateral lengthening contraction (controls)

Question 9

Define “lesion”

Answer 9

a structural or functional abnormality

Question 10

Types of Nerve Lesions

Answer 10

Irritative: an acute or chronic trauma causing impulse or stimulation to sensory or motor areas. (ie. muscle spasms, pain or paresthesias)
Destructive: chronic trauma causing sensory/motor loss surrounded by an are of partial deficit. (ie. Muscle weakness or paralysis, diminished or absent sensation)

Question 11

Location of spinal nerve in lumbar region

Answer 11

superior within intervertabral foramen

Question 12

Location of spinal nerve in cervicle region

Answer 12

central location (intervertabral disc located in middle of anterior boundary)

Question 13

Case 1:

• 55, female, overweight
• intermittent, vague back pains for year but has worsened in past 2 months
• pain localized to right posterior thoracolumbar region with radiation into right groin and proximal lower limb.
• Tightness (spasm) in deep back muscles and decreased mobility in the thoracolumbar region.

Answer 13

Process:
-Dermatome and landmarks to find affected area.
>T11-L2
-Symptoms traced back to motor or sensory?
>both
-Where could lesion have occurred?
> must be at every vertebral level
> both sensory and motor = spinal nerve
DX:
- dx imaging (CT and X-ray) revel osteoarthritis. Bone spur in foramen, rough facet joints, overgrown bone => irritation of spinal nerve.