Learning Objectives for Superficial/Deep Back Flashcards
Identify the specialized vertebrae
Atlas (C1)
Axis (C2)
Vertebra Priminens (C7)
Axis (C2)
dens (odontoid process) projects superiorly from body and articulates with atlas
first moveable rotation of spinal column “axis” of rotation at atlanto-axial joint (inferior articulating process of C1)
Vetebra Prominens (C7)
“spina prominens”
long, non-bifid, and palpable through skin of neck
Distribution of vertebrae in spine
7 cervical 12 thoracic 5 lumbar 5 sacral 4 coccygeal (think times of day that you eat 7, 12, 5)
Movements of spinal column
Flexion (toe touch)
Extension (bend backwards)
Lateral Bending
Rotation (head and/or neck, or torso)
Four Curvatures of the Spine
Cervical: secondary, concave posteriorly
Thoracic: primary, concave anteriorly
Lumbar: secondary, concave posteriorly
Sacral: primary, concave anteriorly
Laminectomy
Surgery to remove the lamina or bone spurs used to treat spinal stenosis
Atlas (C1)
no vertebral body
anterior and posterior arches
articulates with odontoid process of C2 (atlanto-axial joints)
articulate with occipital condyles (atlanto-occipital joints)
Hangman’s fracture
aka traumatic spondylolisthesis of axis
result of hyperextension and distraction (high velocity injury)
involves the pars interarticularis of C2 on both sides
Lumbar spinal stenosis and what are its implications
Intervertebral disks lose water content and shrink forming spurs, ligaments thicken
- -> narrowing spinal canal
- ->pain, numbness, tingling, or weakness of legs improving with sitting
What levels does intervertebral disc herniation typically occur?
most commonly in lumbar region
results in the compression of spinal nerves (clinical presentation)
Describe the anatomy of an intervertebral disc herniation in relation to the ligaments of the vertebral column.
Herniation occurs when the annulus fibrosus becomes damaged allowing the gelatinous nucleus pulpous to leak out into the vertebral foramen due to the smaller size of the posterior longitudinal ligament
Lumbar Spinal Puncture (what/why)
insertion of a hollow needle into the subarachnoid space in the lumbar area to collect the CSF that runs between the brain and spinal cord
detect: meningitis, encephalitis, certain cancers, subarachnoid bleeding, Reye syndrome etc
What layers are penetrated to accomplish lumbar puncture?
Skin/superficial fascia ligaments (supraspinous, interspinous, ligamentum flavum) epidural space dura mater subdural space arachnoid space subarachnoid space (contains CSF) PIA not pierced
Whiplash Injury
Stretching/tearing of anterior longitudinal ligament
What is spondylolysis and the “scotty dog” phenomenon?
A defect through the pars interarticularis, L5 vertebral segment. fibrous tissue fills the defect, which contains free nerve endings, and causes pain
Scotty Dog– oblique view of the spine shows the scotty dog view– the fracture of the pars shows up as a black collar on the dog’s neck
Superficial extrinsic mm of the back? F(x)
Trapezius Latissimis Dorsi Rhomboid Major Rhomboid Minor Levator Scapulae Move the upper limbs (humerus and scapula)
Intermediate Extrinsic mm of back? General f(x)
Serratus Posterior Superior
Serratus Posterior Inferior
extend/depress ribs
Explain the difference between superficial and deep (true) back muscles
Extrinsic originate in back, but attach to another location/move another part of the body (in this case, upper limbs or ribs). Back is a major support structure and movement (rotation/extension/flexion) of spinal column
Describe the pattern of cutaneous nerves on the back.
Sensory nerves: dorsal primary ramus of associated spinal nerve (above mid thorax pierce trapezius near mid-line, travel laterally to innervate skin) (below mid-thorax, cutaneous pierce muscles increasingly lateral positions as you move inferiorly)
Innervate skin from back of the head to upper buttocks, as far laterally as rib angles
Rest of skin of limbs suppled by ventral primary rami
Triangle of Auscultation
formed by: superior horizontal border of latissimus dorsi medial border of scapula inferolateral border of trapezius **posterior segments of lungs
Lumbar Triangle
aka Triangle of Petit medially by latissimus dorsi laterally by external abdominal oblique interiorly by iliac crest ** abdominal hernia
F(x) of intrinsic muscles
Act to maintain posture, control movement (flexion, extension, rotation, lateral flexion)
How are intrinsic back muscles grouped?
Spinotransverse
Erector Spinae
Transverso-spinal
Spinotransverse Muscles
Splenius Capitus
Splenius Cervicis
Erector Spinae
Iliocostalis
Longissimus
Spinalis
Transverso-spinal
Semispinalis
Multifidus
Rotators
How are the intrinsic muscles innervated?
Dorsal posterior rami of spinal nerves
Which of the intrinsic muscle groups is most superficial?
Spinotransverse
Which of the intrinsic back muscle group is deepest?
Transversospinal
Which of the suboccipital muscles forms the suboccipital triangle?
rectus capitus posterior major
obliquus capitus superior
obliquus capitus inferior
What are the contents of the suboccipital triangle?
vertebral artery suboccipital nerve (C1)
What forms the floor of the suboccipital triangle?
posterior arch of C1
posterior atlanto-occipital membrane
What innervates the muscles that form suboccipital triangle?
obliquus capitis inferior -suboccipital nerve
obliquees capitis superios - suboccipital nerve
rectus capitis posterior major - suboccipital nerve
Which of the suboccipital muscles attach to the spinous process of C2
rectus capitis posterior major
obliquus capitis inferior
