Superficial back and spine objectives Flashcards
Describe the organization of the vertebral column: How many cervical columns are there? Thoracic? Lumbar?
Define scoliosis, kyphosis, lordosis, spina bifida, and osteoarthritis
7, 12, 5
- scoliosis is lateral curvature with rotation of the vertebrae
- kyphosis is hunchback in THORACIC region
- lordosis is swayback or increase in lumbar curvature, can be seen in pregnant women
- spina bifida is neural tube defect characterized by failure of closure of the vertebral arch
Describe the curvatures of the vertebral column:
What are the primary curvatures in the spine?
What is the type of the primary curvature and why is it primary?
Secondary? Which is concave/convex?
Thoracic and sacral are primary. Cervical and lumbar are secondary. Primary is concave (thoracic and sacral) and secondary is convex (cervical and lumbar). (Think about spine). Remember: cavemen came first; hunchback of notre dame
kyphotic curvature in the fetal spine, called primary bc first and eventually develops into multiple curvatures later
What makes up the functional unit of the vertebral column. Give the functions/purpose.
2 adjacent posterior and anterior vertebrae including the intervertebral disk make up the functional unit of the vertebral column. The anterior includes the vertebral bodies. (4 things)
The anterior is weight bearing and the posterior is for movement
Describe a typical vertebrae. Which cervical vertebrae is not like the others and why?
C1 doesn’t have a spinous process nor a body. Typical vertebrae has (1) body, (2) vertebral arch, (3) vertebral foramen, (4) superior articular facet, (5) superior articular process, (6) transverse process, (7) inferior vertebral notch, (8) spinous process
What are the 2 components of the vertebral arch?
lamina and pedicle
What are the 5 regions of the vertebral column and how many movable vertebrae in each? How many movable vertebrae in all?
Cervical has 7; thoracic has 12; lumbar has 5; 24 movable in all. sacral has 5 fused; coccygeal has 3-5 fused (mean=4)
No disks between where? WHy not? Be specific
C1 and C2 ; this is the atlantodental joint which prevents rotation and allows us to say no with our head.
which joint lets us say no with our head. where is it located
atlantodental joint; located on C1
Where is most of the weight bearing part of the vertebrae?
Where are more of the neural influences in the vertebrae?
in the lumbar, increases as go down the spine
in Superior aspect, so as you go up the vertebrae with cervical having the most
What 2 things cause dehydration of the disc?
What percent of the height is the disk?
Daily, so as the day gets longer, we get shorter; age- so as we get older, we get shorter too.
25%
General height of the column? What about male and female?
a. 60-70 cm
b. women : 60cm ; men: 70cm
Where does the head articulate with the vertebrae inferiorly and superiorly?? How is this
joint different than the atlantodental joint?
At the atlantooccipital joint- superiorly at this joint, you can say yes.
Also articulates inferiorly with the coxae at the sacroiliac joint.
where does the head say yes
articulation at the atlantooccipital btwn dens of C2 and facet of dens of C1
How do you distinguish a cervical vertebrae?
Count 3 foramens because may have transverse foramen (This hole transmits the vertebral artery and vein along with a plexus of sympathetic nerves.)
b. SOme have bifid spinous process…except C3-6
How do you distinguish a thoracic vertebrae?
(1) Costal demifacets- on T1, T10-12→ areas of attachment where joints are formed btwn vertebrae and ribs
(2) long anteroinferior spinous process
(3) transverse facet
the spinal nerves exit the vertebral canal via the…
intervertebral foramina
How do you distinguish lumbar vertebrae
a. thicker body
b. mamillary processes ( rough posterior portion of the superior articular process)
c. also has smaller vertebral foramen
what is the C1 and C2 vertebrae called?
atlas is C1 and axis is C2
describe the anatomical position
body erect, feet together arms at the sides and palms facing FORWARD
Objective 1) Describe the body wall in terms of tissue layers
- epidermis- stratified squamos epithelial
- dermis- dense, irrigular connective tissue
- hypodermis / superficial fascia- loose connective tissue with cutaneous vessels and nerves
- deep fascia- dense irregular connective tissue with muscles and deep structures
- muscle, bone, connective tissue
- deep fascia
- loose connective tissue- endothoracic fasci in thorax; extraperitoneal tissue in abdomen
- parietal serous membrane- pleura in thoracic and peritoneum in abdominopelvic cavity
- body cavity
- visceral serous membrane - adherent to surface of viscera
Describe the unique characteristics of c1. what does the dens articulate with?
no spinous process or vertebral body; anterior tubercle, FACET for dens, posterior and anterior tubercle, transverse foramen, superior articular facet. *dens is anterior and articulates with occipital condyle and the dens of the C2 or axis
describe unique characteristics of c2, what is it called?
c2 is the axis and the dens is posterior here. dens articulates with C1 at the facet for dens on C1
what is a jefferson fracture? what is it caused by?
burst fracture of the atlas (C1) ; often caused by blow to the top of the head. arch broken in one or more places
what is a type 1 fracture of the c2?
type I is an oblique fracture through the upper part of the odontoid process. avulsion fraction (fragment of bone tears away from major bone) this is mechanically stable but associated with life threatening atlantooccipital dislocation. incidence is very low at <5%. treat: hard collar immobilization for 6-8 weeks. caused by motor vehicle accidents and falls
what is the cause of odontoid fractures?what is a type II odontoid fracture?
usually falls and motor vehicle accidents (C2) type 2- 60% incidence; occurs at base of the densrequire halo immobilization of 12-16 weeks; internal fixation (screw dens parts back together); posterior atantodental arthrodesis may be required.
what is a type 3 c2 fracture?
type 3- 30% (more frequeent that type 1 but also rare) ; halo immobilization, internal fixation; c1/c2 arthrodesis= where you have clamps, screws or wire bolting the parts together and leaves 50% rotation/mobility
Which C spine injuries are the worst?
the higher or more superior, the higher the morbidity and mortality; craniocervicaljunction injiries are the deadliest
What are symptoms, mechanism of injury and clincial findings of c-spine injuries?
a. b.mechanism of injury: combination of flexion, extension, and rotationsymptoms: pain and inability to actively move neck, sensation of instability so patients may present holding thier headclinical findings range: quadriplegia w/ respiratory center problems or minimal sensory/motor deficitsc.
Describe cause hangmans fracture; where is the fulcrum? What type of extension?
both pedicles are brokenbeing hanged, falls, or motor vehicle accidents: momentum carries body forward into windshield and rebound movement or whiplash, causes forceful hyperextension that breaks the pediclesforced hyperextension with cervical spine as fulcrum
Know xray for hangman’s fraction/ presentations
broken bilateral pedicles forward displacement of C1speration of upper cervical spine from lower cervical spin
how does fusion happen
Lateral mass screws and pedicle screws go at an angle and then stablize with fusion rods to connect between. This is called a fusion. Laminectomy is sometimes coupled with this (spinous process being removed therefore need stabilization)
How do you repair a hangman’s fracture?
intervention: c2 pedicle arthrodesis: lateral mass screws in c1 and pedicle screws inc2 and 2 plates for stabilization
describe vertebral subluxation
displacement of vertebrae that can stress spinal cord and nervous system causes: poor posture and sleeping posture, mva, slips/ falls, strenous excercise,can cause impinged nerve
what kind of joint is the anterior intervertebral joint?
synarthrosis joint: specifically a secondary cartilagenous, also known as a syphysis type joint where the bodies of adjacent vertebrae would articulate with the intervertebral disc located betwen them
Describe the zygapophyseal joint. what type is it?
How do zygapophyseal joints prevent movement? Difference btwn disc and joint? Describe regional differences
has superior and infereior facets- the superior articulates with the inferior one above it, forming a diarthrosis joint (plane) therefore movements are gliding or sliding. Intervertebral formaina is between adj vertebrae and allows for spinal nerves
disc controls AMOUNT of movement whereas joint controls DIRECTION of movementin cervical region- 45 degrees; transverse to frontal plane allows rotation, flexion, and extension in throacic region- 60 degrees; front plate has sets that permit rotation in lumbar is 90 degrees (sagittal place); sagittal plane only permits extension and flexion
in facet joint degeneration, what do we see at L4/5? from what view?
coronal view we see severe bilateral facet joint degeneration at L4/5 with air in the joints (show as gaps on X-ray)
what are the ligmental supports?
posterior longitudinal= NARROW band from sacrum to C2 on posterior vertebral bodies and discsligamentum favum= runs from lamina to lamina from axis to sacrumanterior longitudinal= WIDE band from sacrum to occiput on anterior vertebral bodies and discs facet joint capsuleinterspinous and intertransverse= goes from spinous processes to spinous process and the intertransverese goes from transverse to transverse supraspinous= continuous attachment to tips of spinous process from sacrum to C7nuchal= thickened continuation of supraspinous ligament from C7 to occiput
what are the 3 region specific joints in the cervical region?describe actions and what type of joints they are
uncovertebral-it prevents lateral translation and is at the uncinate procces (edge of the body) and the one aboveatlantodental-synovial/diarthrotic joint of the pivot type (move in one plane about vertical axis). artculation btwn dens and posterior facet of anterior tuberclerotation: just say no! (antlantoaxial), atlantoccipital-synovial/diathrotic, of the condyloid type, superior articular facets of c1 articulate with the occiptal condyles on the occiptal bone of the skull
at the atlantodental joint, the dens is held in place by
transverse ligament
which don’t have transverse costal facets?
T11 and T12
Costovertebral joint? what region is this in?
plane joint therefore just permits linear movement of articulating surfaces past one anotherribe is wedge shaped so that each side can articulate with each demifacetarticulation btwn tubercle of rib with transverse costal facet; lateral and supiror cosotransverse ligaments support this joint. thoracic region
what is the region specific joint of the sacral region? what type of joint is it/
sacroiliac joint is a synarthrosis type joint; auricular suface on coxa with auricular surface (resembles ear) on sacrum. with bilateral erosion of bony surfaces
what are the 2 muscle layers of the back? what is their function
1) superficial muscles/ extrinsic : they act on upper limb2) deep/intrinsic muscles act on vertebral column
trapezius
origin: superior nuchal line, external occipital protuberance, ligamentum nuchae, spinous processes of vertebrae C7-T12
insertion: clavicle, medial side of acromion, upper crest of the scapular spine, tubercle of the scapular spine
innervation:
- motor:spinal accessory nerve 11
- proprioception: C3-C4
blood supply: ascending transverse cervical artery
fx:
- elevates and depresses the scapula
- rotates the scapula superiorly
- retracts scapula
what is the function of the throracolumbar fascia
supports secondary curvature
what is the neuromuscular bundle
vein, artery, nerve
what are the cutaneous nerves of the back?
sensory to skin, motor to sweat glands and erector pili muscles anterior aspect of trapezius muscle: dorsal rami (come every 2 inches apart and send cutaneous innervation to the skin) , sensory to skin, motor to sweat glands & motor to erecto pili muscles that generate tension when you get scared and hair stands on end
Describe nerve distribution to the body wall
spinal cord supplies the cord. can see dorsal root ganglion and spinal nerve which distributes its dorsal ramus through the back muscle to the skin which it supplies and ventral ramus supplies most of the rest of the body wall
dermatome vs cutaneous
dormatome is a strip of skin that is innervated bya pair of spinal nerves. cutaneous: areas of skin innervated by cutaneous nerve
what are the superficial layer muscles of the extrinsic back (hypaxial) muscles? where do they all act?
trapezius, levator scapulae, rhomboideus, and latissimus dorsiall act on the scapula or humerus and associated with movements of the upper limb and respiration http://www.anatomyguy.com/essential-anatomy-series-back-muscle-basics-2/
location of supra scapular nerve and artery?
on posterior view:navy over army under
nerves of quadrangular spacetriangular spacetriangular interval
axillary nerveposterior humeral circumflex artery-br of scapular circumflex artery(rearrange space) -radial nerveprofunda brachii arteyr
quadrangular space syndrome
hypertrophy of quadrangular space muscles or fibrosis of muscle edges may impinge on axillary nervecould produce weakness even atrophy in muscles it supplies-deltoid muscle-teres minor muscle===> more common could affect control that rotator cuff muscles exert on glenohumeral joint
intermediate layer of posterior back has:why can the intermediate layer still be included?
- accessory muscles for respiration2. serratus posterior inferior (deep to latissimus dorsi) and superior (level with clavicle, deep to rhomboid) intermediate layer of muscle but can also be included in superficial back because supplied by ventral rami or 11th cranial nerve (like in the case of the trapezius
on the back, the skin is innervated by ___ but the muscles are innervated by ___ except ___
skin innervated by dorsal ramimuscles innervated by ventral rami, excel the trap which is innervated by cranial nerve 11
The primary action at the atlanto-axial joint is:
The atlanto-axial joint is a complex joint with multiple articulations between the atlas (C1 vertebra) and the axis (C2 vertebra). The primary action at this joint is rotation of the head on the neck.
describe unique characteristics of c2, what is it called?
c2 is the axis and the dens is posterior here. dens articulates with C1 at the facet for dens on C1
deltoid
innervation: axillary nerve (C5, C6)
blood supply: posterior circumflex humeral artery
origin: lateral 1/3 of clavicle, acromion, lower lip of the crest of the spine of the scapula
insertion: deltoid tubersoity of the humerus
fx:
-adduct arm
flex and medially rotate arm
laterally rotate arm
levator scapula
innervation: dorsal scapular nerve (C5)
blood: dorsal scapular artery
origin: transverse processes of C1-C4
insertion: medial border of the scapula to the from superior angle to the spine
fx: elevates scapula
latissimus dorsi
innervation: thoracodorsal nerve (C7,8)
blood: thoracodorsal artery
origin: vertebral spines form T7 to the sacrum, lower 3 or 4 ribs
insertion: floor of the inter tubercular groove
fx: extends the arm and rotates the arm medially (think rock climbing)
rhomboideus major
inn: dorsal scapula nerve (C5)
blood: dorsal scapular artery
origin: spines of vertebrae T2-T5
insertion: medial border of the scapula inferior to the spine of the scapula
fx:
retracts, elevates, and rotates the scapula inferiorly
rhomboideus minor
inn: dorsal scapular nerve
blood: dorsal scapular a
origin: inferior end of the ligamentum nuchae, spines of C7 and T1
insert: medial border of the scapula at the root of the spine
fx: retracts, elevates, and rotates the scapula inferiorly
teres major
inn: lower sub scapular nerve from the posterior cord of the brachial plexus
blood: circumflex scapular a
origin: dorsal surface of the inferior angle of the scapula
insert: crest of the lesser tubercle of the humerus
fx: adducts the arm, medially rotates the arm, assists in arm extension
infraspinatus
inn: suprascapular n
blood: suprascapular a
origin: infraspinatous fossa
insertion: greater tubercle of the humerus (middle facet)
fx: laterally rotates the arm
subscapularis
inn: upper and lower sub scapular nerves
blood: subscapular a
origin: medila 2/3 of the scapula
insert: lesser tubercle of the humerus
fx: medially rotates the arm; assists in extension
supraspinatous
inn: suprascapular nerve
blood: suprascapular a
origin: supraspinatous fossa
insert: greater tubercle of the humerus (highest facet)
fx: initiates abduction
teres minor
inn: axillary nerve
blood: circumflex scapular a
origin: upper 2/3 of the lateral border of the scapula
insert: greater tubercle of the humerus (lowest facet)
fx: laterally rotates the arm
triangle of auscultation
triangular gap for examining posterior segments of the lungs with a stethoscope
borders: trapezius, rhomboid major and latissimus dorsi
