Gross - Spine and Back Flashcards
What is the internervous plane on the back?
midline of back
no innervation down midline of back - good for surgical intervention
What portion of the back is good for surgical intervention because there is no innervation?
internervous plane
What are the two primary curvatures of the spine?
Are they convex/concave?
Are they lordosis/kyphosis?
thoracic and sacroccygeal
kyphosis
convex
What are the two secondary curvatures of the spine?
Are they convex/concave?
Are they lordosis/kyphosis?
cervical/lumbar
lordosis
cocave
What are the main two ligaments of the atlantoaxial joint?
posterior longitudinal ligament
anterior longitudinal ligament
(they are posterior/anterior to the vertebral BODY)
What do the posterior/anterior longitudinal ligaments on the antlantoaxial joint do?
help maintain a large deal of stability from the vertebral column
What is the vertebral canal called in the superior/inferior aspect of the sacrum?
superior sacrum - sacral canal
inferior sacrum - sacral hiatus
What is special about the foramina of the sacrum?
anterior/posterior foramina
anterior foramina - for ventral ramus passage
posterior foramina - for dorsal ramus passage
Is spinal cord present in the sacral canal?
No.
It is cauda equina (horsetail) - spinal nerves enclosed by dura mater continuation from spinal cord
What is cauda equina and where is it located?
horsetail.
spinal nerves enclosed by dura mater continuation from spinal cord
found in the sacral canal
What are the symptoms of occulta spina bifida?
most common type (10% population)
In L5-S1, identified with patches of hair.
Mostly asymptomatic
What are the two forms of spina bifida where there is failure for the posterior arch to fuse?
What is specific of each of these types?
Meningocele - contains CSF
myelominengocele - contains spinal cord itsel
What are meningocele and myelominengocele?
What is the difference
These are each forms of spina bifida in which the posterior arch of vertebrae failed to fuse correctly
meningocele- contains CSF
myelomeningeocele - contains spinal cord
Describe the naming of spinal cords relative to their vertebral levels
Spinal nerves C2-C7 emerge above pedicles of corresponding vertebrae
Spinal nerves C8-Rest of spinal cord emerge below pedicles of corresponding vertebrae
What is a laminectamy? What is seen what this is done?
remove the vertebral laminae
To see the dorsal surface of the cords/roots
Describe the general cervical vertebrael vasculature
vertebrael/ascending cervical arteries
Describe the general cervical innervation
Recurrent meningeal branches of spinal nerveds
recurrent - follows back on it’s own path
What are the 3 basic groups of back muscles and their basic functions?
- superficial (anchor UL to axial skeleton)
- intermediate (assist in respiration)
- deep muscles (maintain posture, act on vertebral column to raise/lower spine)
What are the 5 muscles of the superficial back?
- trapezius m
- lattisimus dorsi m
- levator scapulae m
- rhomboid minor m
- rhomboid major m
What is the action of trapezius muscle?
trapezius is superficial back muscle
it elevates, depresses, and retracts the scapula
Describe the different fibers of the trapezius muscle and how they affect the action
upper fibers: elevate
middle fibers (transverse): adduct/retract
lower fibers (oblique): assist rotating the scapula during abduction of the humerus
Describe the neurovasculature of the trapezius muscle
Motor: accessory nerve (cn XI)
Proprioception: C3/4
Transverse cervical vessels
Describe how the accessory nerve (cn xi), motor, runs along the trapezius muscle?
accessory nerve runs deep along the trapezius muscle of superficial back
posterioinferiorly from jugular foramen
Describe how C3/C4, proprioception, runs along the trapezius muscle?
C3/C4 run deep to trapezius muscle of superficial back
posteriorly from intervertebral foramina
Describe how transverse cervical vessels run along the trapezius muscle?
runs deep to trapezius muscle of superficial back
posterolaterally from thyrocervical trunk
What is the subtrapezius plexus made up of? Where is it?
Mostly the accessory nerve and superficial branch of the transverse cervical vessels
on the underside of the trapezius muscle
What are the actions of the lattisimus dorsi muscle?
adducts
extends and medially rotates the humerus
What is the neurovasculature of the lattisimus dorsi muscle?
thoracodorsal nerve
thoracordorsal vessels
interocstal vessels
Why does the lattisimus dorsi muscle have two separate vessels supplying it? What are they?
thoracodorsal vessels and intercostal vessels
this is because lattismus dorsi is a humongous muscle
Describe the levator scapulae muscle
muscle of the superficial back
long, thin badn that comes from the superior angle on the medial surface of the scapula
What is the action of the levator scapulae muscle?
elevate the scapula
What is the neurovasculature of the levator scapulae muscle?
C3/C4 innervation
dorsal scapular nerve
dorsal scapular vessels
Describe the rhomboid major and minor muscles
muscles of the superficial back
deep to the trapezius muscle
- when trapezius is in place, can only see the most inferior portion of rhomboid major
remember - minor over major
What are the actions of rhomboid major and minor?
retract, adduct, elevate the scapula
What is the neurovasculature of the rhomboid major and minor?
dorsal scapular nerve
dorsal scapular vessels
What is the general function for intermediate back muscles?
assist in respiration and proprioception
What are the two intermediate back muscles?
serratus posterior superior
serratus posterior inferior
Describe the intermediate back muscles physical characteristics
very thin and flat muscle fibers
serratus posterior superior - upside down V shape most superior
serratus posterior inferior - broader bands but still thin/flat and right side up v shape
Are the deep muscles of the back short or long?
LONG. span the entire length of the back
Why is naming the deep back muscles different than naming the superficial and intermediate back muscles?
because deep back muscles all span the entire length of the back, they each have a second part of the name to denote where on the back we’re talking about.
We talk about the most predominant one
What is the neurovasculature for ALL of the deep muscles of the back?
posterior rami!
Splenius capitus: where is it physically?
spanning from skull and overlying semispinalis
Describe the action of splenius capitus (bilaterally and unilaterally)
bilaterally: draws head backwards and extends the neck
unilaterally: rotates the head and face ipsilaterally
Describe the action of splenius cervicis (bilaterally and unilaterally)
Bilaterally: extends the neck (does NOT draw head backward)
unilaterally: rotates head and face ipsilaterally
Why does splenius capitis draw the head back when working bilaterally but splenius cervicis does not?
because splenius cervicis is in the cervical region - it only works on the head (extends)
Splenius mm aka ____
spinotranversales
Describe where semispinalias capitis is phyiscally?
semispinalis lies deep to splenius capitis, more horizontal
Semispinalias mm aka ____
transversospinalis
What is semispinalis action (bilaterally and unilaterally)
bilaterally: extends vertebral column
unilaterally: rotates trunk contralaterally (except seminispinalis capitis which rotates head ipsilaterally)
How is the action different for semispinalis capitis vs the rest of semispinalias mm unilaterally?
rest of semispinalis = rotates trunk contralaterally
semispinalis capitis = rotates head ipsilaterally
Where is the greater occipital nerve (C2) found in the occipital region?
in sub-cutaneous tissue, just inferior/lateral to external occipital protuberance
pierces semispinalis capitis muscle
Greater occipital nerve (C2) pierces ____ mm
semispinalis capitis
Where are the occipital vessels in relation to the greater occipital nerve?
occipital vessels are just lateral to greater occipital nerve
Where is the third occipital nerve (C3) in relation to the occipital region?
lower and just lateral to midline
What are the 4 muscles of the suboccipital region?
- rectis capitis posterior minor
- rectis capitis posterior major
- obliquos capitis superior
- obliquis capitis inferior
Describe rectis capitis posterior minor’s physical location compared to rectis capitis posterior major
rectis capitis posterior minor is closest to the midline
rectis capitis posterior major is just inferior to rectis capitis posterior minor
What is the suboccipital triangle made up of?
rectis capitis posterior major
obliqous capitis superior
obliquis capitis inferior
What two structures are found within the suboccipital triangle?
Dorsal root of C1 (supplies all 4 muscles of suboccipital region)
Vertebral artery (goes along the floor of triangle, goes through the transverse foramina in cervical vertebrae)
What is the neurovasculature for the entire suboccipital region?
Dorsal root of C1 and it’s branches supply all 4 muscles of the suboccipital region
What is the bony prominence that acts as an anchor between oliqous capitis inferior and onbliquis capitis superior?
transverse process of atlas (C1)
within suboccipital region
the transverse process of the atlast (c1) acts as an anchor for ____ and ____
obliquis capitis inferior and obliquis capitis superior
muscles of suboccipital region
What is the bony prominence that acts as an anchor between obliquis capitis inferior and rectus capitis posterior major?
spinous process of axis (C2)
The spinous process of axis (C2) acts as an anchor for ___ and ____
obliqous capitis inferior and rectus capitis posterior major
What are the erector spinae mm?
lateral to medial:
iliocostalis m
longissimus m
spinalis m
“i love spaghetti”
Where are the erector spinae mm most prominent?
in lumbar and sacral regions
What is the action of the erector spinae mm?
Erect the spins (postural muscles)
primary extensors of the head and spine
What are the primary extensors of the head and spine?
erector spinae mm
iliocostalis, longissimus, spinalis m
Describe the multifidus m physically
(deep back)
spans 2-4 vertebrae in the lumbar region (deep to longissimus)
What is the neurovasculature of erector spinae mm?
dorsal rami of spinal n
lumbar and intercostal vessels
What is the neurovasculature of multifidus m?
dorsal rami of spinal nn
lumbar vv
Multifidus is found deep to ____. However, they are both found in the ___ layer of back musculature.
Multifidus is found deep to longissimus
But they are both found in the deep layer of the back musculature
Describe the rotatores muscle physically
Span 1-2 vertebrae, not well identified for practical
What is the action of the rotatores muscle?
rotates spine
bilaterally: extends vertebral column (minor extension because so small)
unilaterally: rotates contralaterally
What is the neurovasculature of the rotatores muscle?
dorsal rami of spinal n
intercostal vessels
What are the 3 minor muscles of the deep back?
interspinalis muscle
intertransversarius muscle
levatores costarum
What is the action of interspinalis muscle?
(minor muscle of deep back)
minor extensor of spine
Where is interspinalis muscle?
(minor muscle of deep back)
between spinous processes of adjacent vertebrae
What is the action of intertransversarius muscle?
(minor muscle of deep back)
minor lateral flexors of the spine
Where is intertransversarius muscle?
(minor muscle of deep back)
Between transverse processes of adjacent vertebrae
What is the action of levatores costarum?
(minor muscle of deep back)
minor elevators of ribs (for inspiration)
Where is levatores costarum?
(minor muscle of deep back)
Between the transverse processes of vertebrae to ribs
Superficial back muscles are innervated by _____
ventral rami
Intermediate back muscles are innervated by _____
ventral rami
Deep back muscles are innervated by ____
dorsal rami
Is serratus anterior m a muscle of the back?
no.
muscle of the upper extremity.
but plays a large role/seen in back dissection
Serratus anterior m is deep to ____
lattisimus dorsi m
What is the action of serratus anterior m?
protracts scapula and holds it to the body wall
What is the neurovasculature of serratus anterior m?
long thoracic nerve
lateral thoracic vessels
What causes winging of the scapula?
malfunctioning of the serratus anterior muscle
aka long thoracic nerve damage
What are the 2 triangles of the superficial back?
Triangle of auscultation
Lumbar Triangle
What are the boundaries of the triangle of auscultation?
superior: trapezius m
inferior: latissimus dorsi m
lateral: rhomboid major m
floor: 6th intercostal space
The triangle of auscultation is found between which ribs? in which intercostal space?
between ribs 6 and 7
in the 6th intercostal space
Triangle of auscultation is accentuated when ____
the scapula is protracted
The triangle of auscultation is used to listen to ____
the organs of the thorax with a stethoscope.
Diagnostic importance.
Located in the 6th intercostal space because this is where it is “least obstructed” by mm
What are the boundaries of the lumbar triangle?
medial: lattisimus dorsi m
lateral: external oblique m
inferior: iliac crest
floor: internal oblique m
Lumbar triangle can become a site of a ____
lumbar hernia
