Module 5- back and axilla Flashcards
sacrum anad coccyx
weight-bearing, and integral functions such as walking
what is the sacrum
- large bone located at the terminal part of the vertebral column where it forms the posterior aspects of the bony pelvis
- thick (support weight)
what is the sacrum composed of
five fused sacral vertebrae, articulates with the ilium bilaterally, and with the fifth lumbar vertebra (L5)
sacral canal
- a continuation of the vertebral canal terminating at the sacral hiatus
cauda equina and filum terminal
are protected by the sacral canal
sacral foramina where are they located
lateral to the fused sacral bodies on both the anterior and posterior surface
sacral foramina
decrease in size with the most superior foramina being the largest
what exits through the sacral foramina
anterior and posterior rami
sacral cornua
are 2 bony processes and are palpated by clinicians as an anatomical landmark when administering injections into the sacral hiatus
promontory
- the upper border or base of the sacrum articulates with the L5 vertebody
- projects forward, decreasing the anteroposterior diameter diameter of the pelvic brim
promontory in females
considerable obstetric important and is used when measuring the size of the pelvis
what is the coccyx composed of
four fused rudimentary coccygeal vertebrae, which articulates with the sacrum superiorly at the sacrococcygeal joint
about the coccyx
- smaller in size compared to sacrum
- serves as an attachment site for ligaments and muscles (pelvic floor)
coccyx when sitting
- small and variable amount of flexion and extension occurs at the sacrococcygeal joint
vertebral when you go down the column
- body size increase, vertebral foramen size decreases
with smaller foramen
it is more likley a blockage to the foramen could irriate nerves in the lumbar region resulting in lumbar back pain
accessory ligaments of the vertebral column
- ligamentum flavum
- anterior longitudinal ligament
- posterior longitudinal ligament
what are accessory ligaments
- strong fibrous bands of tissue that stabilize the vertebral column and protect the intervertebral discs
lumbar spinal stenosis
- narrowing of the vertebral canal in the lumbar region
- can be caused by extra bone and/or tissue growth in the vertebral canal from the calcification of the ligamentum flavum, or the outgrowth of bone
lumbar spinal stenosis : compression of spinal cord
- overcrowding can irrate the spinal cord and nerves
- numbness and weakness in lower limb
- pain in lower back
- worse during weight bearing activities (walking and standing) released when bending forward (releasing the weight)
what are extrinsic muscles of the back
is for movement of the upper extremitis
what are the extrinsic muscles of the back?
- latissimus dorsi
- trapezius
- rhomboid minor
- levator scapulea
- rhomboid major
about the latissimus dorsi
- broad, triangular-shaped extrinsic muscle
- covers the lumbar region and inferior portion of the thoracic cage
one of the largest points of origin for the latissimus dorsi
- broad fascial sheath
features of the latissimus dorsi
- thoracolumbar fascia
- intersection point
Thoracolumbar fascia
Made from of multiple crosshatched layers of collagen, the thick thoracolumbar fascia plays an
important role in stabilization and load transfer.
intersection point
all muscle fibers of the latissumus dorsi insert in the intertubercular sulcus (bicipital groove) of the humerus
what are the fibers of the latissiumus dorsi
- horizontal
- oblique
- vertical
latissimus dorsi strain
- caused by overuse of the muscle
- individuals with poor posture are at higher risk of straining this muscles
actions of latissiumus dorsi strain
- extends
- adducts
- medially rotates the arm
symptoms of a latissimus dorsi strain
- lower back pain going into her scapula
- pain/discomfort with lateral flexion of back or with extension, adduction, rotation of the arm
erector spinae muscles
- compromised of 3 deep muscles in the back organized in paraellel columns on either side of the vertrebral column
from medial to lateral of erector spinae muscles
- ilicostalis
- longissimus
- spinalis
what are the erector spinae muscles responsible for
extending (straightening) the vertebral column
what spinae muscle is the longest and widest
- ilicostalis l
what can the iliocstalis muscles be divdied into
- cervicus
- thoracis
- lumborum
what is iliocostalis muscles strain
can be caused from overuse or poor posture
symptoms of iliocostalis muscle
- back pain espically after heavy lifting
- decreeased range of motion of the spine
- pain that worsens when sitting for long periods
- standing
- climbing staris
iliocostalis thoracis
- pain from a strain here would be felt along the medial border of the scapula and posterior thorax
- pain also referred to the anterior thorax if the stained muscles irritates underlying intercostal nerves
iliocostalis lumborum
- pain here can be felt in the sacroiliac region (lumbar spine to top of buttocks)
latissimus dorsi muscles strain often presents
more superolaterally especially during movements of the arm at the shoulder joint
pain associated with iliocostalis thoracis strain
located in the anterior and posterior thorax
pain associated with the iliocostalis lumborum strain
can radiate into the sacroiliac region
what is the axilla
- armpit
- pyramidal shaped space between the upper thorax and arm
- passage for major nerves and blood vessels to enter and leave the upper limb
borders of the axilla
- anterior wall
- posterior wall
- medial wall
- lateral wall
- apex
- base
anterior wall : border of the axilla
pectoralis major muscles
posterior wall of axilla
subscapularis, latissimus dorsi, teres major muscle
medial wall of axilla
serratus anterior muscles
lateral wall of axilla
intertubercular sulcus of the humerus
apex of the axilla
base of neck
base of the axilla
skin (of armpit)
what lymph nodes are in the axilla
axillary lymph nodes that drain the breast there is 3 of them (axillary, parasternal, subraclaviuclar )
what is the bracial plexus
- network of nerves that supplies motor and sensory innervation to the upper limb
- begins in the neck passes through the axilla and its terminal branches run through the entire upper arm
what is the brachial plexus divided into
- roots
- trunks
- divivision
- cords
- branches
Roots
Formed from the ventral rami of spinal nerves C 5 -T 1 , the five spinal nerve roots leave the spinal cord
through the intervertebral foramen of the vertebral column.
Trunks
Each trunk branches into an anterior and posterior division whereby the nerve fibres for the anterior
muscles are sorted from those for the posterior muscles of the arm, forearm and hand.
Divisions
Each trunk branches into six divisions: three anterior and three posterior division
Cords
Once the anterior and posterior divisions have entered the axilla, they combine together to form three
cords, named by their position (medial, lateral, posterior) relative to the axillary artery.
Branches
In the axilla and the proximal aspect of the upper limb, the three cords give rise to five major terminal
nerve branches. In this section, we will explore these five nerve branches
what parts of the brachial plexus form before the axilla
- roots, trunks and divisions
how many branches are there of the brachial plexus
5 terminal branches and continue into the arm, forearm, and hand to provide motor and sensory innervation
what are the 5 terminal branches
- musculotaneous nerve
- axillary nerve
- median nerve
- radial nerve
- ulnar nerve
Musculocutaneous Nerve
Motor innervation of the anterior compartment (flexion) of the arm.
Axillary Nerve
Motor innervation to the deltoid (abduction of arm), and teres minor (lateral rotation of arm).
Median Nerve
Motor innervation to most of the muscles of the anterior compartment of the forearm, as well as five
of the intrinsic muscles of the hand
Radial Nerve
Motor innervation of the posterior compartment (extension) of the arm and forearm.
Ulnar Nerve
Motor innervation of two muscles of the anterior compartment of the forearm as well as most of the
intrinsic muscles of the hand.
what are the 2 compartment of the arm
posterior and anterior compartments
posterior compartment of arm
involved in the extension of the forearm at the elbow joint
anterior compartment
flexion of the forearm at the elbow joint and supination* of forearm. Certain muscles of this compartment may also play a minor role in adduction and flexion of the arm at the shoulder
joint.
what muscles are involved in extension of arm
posterior compartment of arm
what muscles are involved in inability to extend wrist
posterior compartment of the forearm
waht nerve only supplies innervation to the posterior compartment of the arm and forearm
radial
Bindis nerve damage
- inability to perform certain movements likley due to impairment of the raidal nerve
- mostly likley because her posterior cord is damaged and this affects her radial and axillary nerve
symptoms of posterior cord damage
- paralysis of deltoid (abduction)
- muscles of the posterior compartment (extension) of arm and forearm and be paralyzed
- some cutaneous effects as well
arterial supply from the subclavian artery as it supplies the upper limb
- subclavian artery
- axillary artery
- brachial artery
- radial and unlar artery
what arerty damage would occur due to posterior cord injury
damage to axillary artery and brachial, radial and ulnar arteries
axillary artery damage symptoms
- bruising caused by the pooling of blood under skin
- swelling/redness caused by occlusion (possible from a blood clot)
- elevated temperature/warmness caused by the disruption of circulation or pooling of blood
- weak pulse; a reduction in blood flow would result in a low radial pulse
veins as you travel up the hand
- radial vein
- ulnar vein
- cephalic vein
- basilic vein
- medial cubital vein
- brachial vein
- axillary vein
then goes to the subclavian –> brachiocephalic vein–> superior vena cava –> heart
Radial vein
Drains blood from deep structures of the palm and lateral aspect of the forearm.
Ulnar Vein
Ulnar Vein
Drains blood from deep structures of the palm and medial aspect of the forearm.
Cephalic Vein
The long cephalic vein begins on the dorsum of the hand and ascends on the lateral side of
the anterior surface of the forearm and arm to drain into the axillary vein.
Basilic Vein
The long basilic vein begins on the dorsum of the hand and ascends on the medial side of the
anterior forearm and arm to become the axillary vein.
Median Cubital Vein
in the roof of the cubital fossa, the median cubital vein connects the basilic and cephalic veins.
It is often the site of venipuncture for drawing blood.
Brachial Vein
Receives blood from the radial and ulnar veins and drains into the axillary vein.
Axillary Vein
A continuation of the basilic vein and becomes the subclavian vein as it crosses the lateral
border of the first rib.
