The Back- Bones, Joints and Muscles Flashcards
What separates the vertebrae?
Fibrocartilaginous intervertebral discs.
What does the vertebral column enable?
Upright posture.
What does the vertebral column support?
Body weight and the skull and allows for its movements.
What does the vertebral column protect?
Protect and transmits spinal cord and spinal nerves.
How is the vertebral column involved in locomotion?
Provides attachment for trunk muscles.
What are the curvatures of the vertebral column?
Has primary (Kyphosis) and secondary (lordosis) curvatures.
When are only primary curvatures present?
In-utero.
What is the structure of the primary curvatures?
Concave anteriorly(kyphosis) and remains in the thoracic and sacral regions.
Are secondary curvatures present in-utero?
No, they do not develop until the infant lifts their head and stands to walk.
What are the structures of the secondary curvatures?
Concave posteriorly (lordosis) and are in cervical and lumbar regions.
What is present in the typical vertebra?
Vertebral body, intervertebral surface, vertebral arch and vertebral foramen.
What is included in the vertebral arch?
Pedicle and lamina
What are susceptible to arthritis and back pain?
Articular facets and joint.
What is the structure of regional vertebra?
Small body, uncinate processes, transverse foramen, bifid spinous process and superior articular facets.
Where is the uncinate process?
At lateral edges, synovial articulation with vertebra above.
What is the structure of superior articular facets?
Flat and facing superiorly and posteriorly.
What movement do the regional vertebra permit?
Flexion, with some lateral flexion.
How many C regional vertebra are there?
2- C1 and C2
What is the name of the C1 regional vertebra?
Atlas
What is the name of the C2 regional vertebra?
Axis
What are the facets called in the atlas regional vertebra?
Superior articular facet and the inferior articular facet.
What is the function of the superior articular facet on the atlas?
To articulate with the occipital condyles.
What are the occipital condyles?
Each of the two rounded knobs at the base of the skull which articulate with the first vertebra.
What is the function of the inferior articular facet?
To articulate with axis.
What is the groove in the atlas regional vertebra for?
The vertebral artery.
What are the part of the axis regional vertebra?
Body and superior articular facets.
What is the body of the axis regional vertebra associated with?
The Odontoid process or Dens.
What is the function of the body of the axis regional vertebra?
For articulation with the anterior arch of the atlas
What is the function of the superior articular facets in the axis regional vertebra?
They are flat to articulate with inferior facets of the atlas.
What movement is the axis regional vertebra involved in?
Rotation of the head and neck at the atlanto-axial joint.
What are the parts of the thoracic regional vertebra?
Superior articular facets, transverse process and costal demi-facets.
What is the structure of the superior articular facets in the thoracic regional vertebra?
Flat and facing postero-laterally, on the arc of the circle.
What is the function of the superior articular facets in the thoracic regional vertebra?
Allows rotation.
What is the transverse process in the thoracic regional vertebra?
Long and with a facet for articulation with the tubercle of its own rib.
What is the function of the costal demi-facets in the thoracic regional vertebra?
Upper for articulation with head of own rib, and lower with the rib below.
What is the shape of the thoracic vertebra?
Heart shaped body and circular vertebral canal.
What orientation are the thoracic vertebrae in?
Long, downward projected, overlapping spinous processes.
Which regional vertebra has the largest body?
The lumbar regional vertebra.
What are the properties of the lumbar regional vertebrae?
Spine, sturdy, stumpy and quadrangular.
What is the function of the superior articular facets in the lumbar regional vertebrae?
They are concave and facing posteromedially, interlocking with inferior facets.
What movements do the lumbar regional vertebrae permit?
Extension is the greatest movement. Allows for some flexion and lateral flexion, but no rotation.
What forms the sacrum regional vertebrae?
Formed by the fusion of 5 vertebrae.
What is the sacral promontory?
The anterior projection of S1 regional vertebra.
What is the median crest of the sacrum regional vertebra formed of?
Union of spinous processes.
What is the intermediate crest of the sacrum regional vertebra called?
Articular processes.
What is the lateral crest of the sacrum regional vertebra called?
Transverse processes.
What is the n shaped cleft at the bottom of the sacrum regional vertebra?
The sacral hiatus.
What are the zygapophyseal (facet) joints?
Synovial joints between articular processes.
What is the joint between endplates and the intervertebral discs?
Symphysis or secondary cartilaginous joint.
What emerges through the intervertebral foramen?
The spinal nerve.
What is the intervertebral disc formed by?
Superior and inferior vertebral notches, with contribution from the disc.
What is the overall structure of the intervertebral disc?
Consists of an outer annulus fibrosus, which surrounds a central nucleus pulposus.
What is the composition of the nucleus pulposus?
Gelatinous, 70-90% water.
What is the function of the nucleus pulposus?
Absorbs compressive forces between vertebrae.
What happens to the collagen content in the nucleus pulposus?
Relative collagen content increases with age.
What is the structure of the annulus fibrosus?
Very strong, concentric lamellae of fibrocartilage.
What keeps the annulus fibrosus in place?
Attached and kept in place by anterior and posterior longitudinal ligaments.
What is the function of the anulus fibrosus?
To contain and protect soft material located in the centre of the disc.
What does articular cartilage form in the intervertebral disc?
The symphysis between adjacent vertebral bodies on each vertebral body.
How much of the length of the column do the intervertebral discs contribute?
20-25%.
What do the intervertebral discs contribute to?
To the shape of the spinal curvatures.
How is the outside of the intervertebral disc supplied with nutrients?
The periphery is supplied by neighbouring capillaries.
How is the inside of the intervertebral disc supplied with nutrients?
Centre is nourished by diffusion from the body of the vertebra.
When might the discs deform?
To allow movement between vertebral bodies
What is the effects of deformation of the intervertebral discs?
Deforms and puts pressure on the nucleus pulposus as well as weakening the annulus fibrosus.
What would happen if the nucleus of a disc is herniated or prolapses?
Compression of the spinal cord, cauda equina and emerging spinal nerve.
What is the cauda equina?
A bundle of spinal nerves and spinal nerve rootlets.
What does the cauda equina arise from?
The lumbar enlargement and the conus medullaris of the spinal cord.
What does the cauda equina consist of?
2-5 lumbar nerve pairs, 1-5 sacral nerve pairs and the coccygeal nerve.
Which direction are most disc herniations?
Posterolateral, towards the intervertebral foramen
Why is the herniation of a disc posterolateral?
The central position of the posterior longitudinal ligament.
Which aspect of the foramen does the disc form?
The anterior aspect.
Can the spinal nerve escape injury in a prolapsing disc?
Yes, the spinal nerve is inferior and emerges above the prolapsing disc.
What is the position of the anterior longitudinal ligament?
It is a broad band on the anterior surfaces of the bodies of vertebrae.
Where does the longitudinal ligament extend to?
Between atlas to the sacrum.
What is the function of the anterior longitudinal ligament?
Limits extension.
What do the anterior atlanto-axial and atlanto-occitital membranes form?
They continue downwards as anterior longitudinal ligament.
Where does the tectorial membrane extend?
Between the foramen magnum and C2.
What is the position of the posterior longitudinal ligament?
A narrow band on the posterior surfaces of bodies of vertebrae.
Where is the posterior longitudinal ligament?
Between C2 to the sacrum.
What is the function of the posterior longitudinal ligament?
Resists hyper-flexion.
Where is the ligamenta flava?
Between vertebral laminae.
What is the function of the ligamenta flava?
Limits sudden flexion and support the curvatures.
What does the ligamenta flava becoma?
Continues superiorly as the posterior atlanto-axial and atlanto-occipital membranes.
Where are intertransverse ligaments?
Between all transverse processes.
Where are supraspinous ligaments?
Between tips of spines and run between sacrum to C7.
Where is the ligamentum nuchae?
Extends between external occipital protuberance and posterior edge of foramen magnum, down to C7.
What is the function of the ligamentum nuchae?
Limits flexion and provides muscle attachment.
Where are the interspinous ligaments?
Between all spinous processes.
Where are the alar ligaments?
From sides of dens to sides of foramen magnum
What is the function of alar ligaments?
Prevent excessive rotation.
What is the function of the transverse ligament?
Keeps the dens close to the anterior arch.
What forms the cruciate ligament?
Transverse ligament and superior and inferior longitudinal fascicles.
What do arteries form?
Anastomotic rings.
Where do the anastomotic rings arise from?
The vertebral arteries and posterior intercostal and lumbar branches of the aorta.
What is the structure of the vein system in the vertebral column?
There are the internal and external venous plexus.
What do the venous plexuses do?
Coalesce and drain to the veins equivalent to the arteries.
What are the types of muscle in the back?
Extrinsic or intrinsic based on embryological origin and innervation.
Where are the extrinsic muscles?
Superficial.
What are the extrinsic muscles involved in?
With movements of the upper limbs and thoracic wall.
What innervates the extrinsic back muscles?
Anterior rami of spinal nerves.
Where are intrinsic muscles located?
Deep, between the spinous processes and the angle of the ribs.
How are the intrinsic muscles adapted?
To provide support and movement in resistance to the effect of gravity.
What do the intrinsic muscles move?
The vertebral column and participate in moving the head.
What innervates the intrinsic back muscles?
The posterior rami of spinal nerves.
What movements is the trapezius involved in?
Extends neck, retract scapulae, upper fibres elevate, shoulders in abduction and lower fibres depress shoulder.
Where is the trapezius?
Skull, ligamentum nuchae and spines of C7 to T12, to scapula and clavicle.
What movements is the latissimus dorsi involved in?
Shoulder extension and adduction.
What nerve supplies the trapezius?
Accessory nerve.
What does the latissimus dorsi cover?
Iliac crest, fascia, spines T6 to T12, lower ribs, to humerus.
Which nerve supplies the latissimus dorsi?
Nerve to latissimus dorsi- thoracodorsal.
Which muscle is involved in scapular elevation?
Levator scapulae.
What muscle is involved in scapular retraction and elevation?
Rhomboid major and minor.
Which muscle is involved in inspiration?
Serratus posterior superior.
Which muscle is involved in expiration?
Serratus posterior inferior.
What muscles are in the superficial layer of the neck?
Splenius capitis and cervicis.
Acting together what action do the superficial muscles of the neck do?
Extend the neck.
Acting alone what action do the superficial muscles of the neck do?
Rotate and laterally flex.
What is in the intermediate layer of muscle in the back?
The erector spinae arranged in 3 columns.
What are the 3 columns of the erector spinae?
Iliocostalis, longissimus and spinalis.
What are the 3 parts of the transversospinalis?
Rotatores, multifidus and semispinalis.
What are the muscles deep to the semispinalis capitis?
Obliquus capitis superior and inferior and rectus capitis superior and inferior.
What is the function of the sub-occipital triangle?
Transmits vertebral artery and veins as well as the suboccipital nerve.
Adequacy
can you see all seven cerviacl vertebrae + the top of T1
Alignment
Draw three vertical “parallel” lines along the anterior + [ (posterior border of the 7 vertebral bodies and a third through the base of each spinous spinous process
Asymmetery
Look for any abnormalties between the 7 vertebrae
What is the ligament which extends down the lamina of the verteabral column?
Ligamentum flavum
what is Listhesis (spondylo)
Forward movemetn of the body of one vertebrae on the vertebra below it
Ligaement the holds the dons in place in the atlas
Transverse ligament
what does DEXA stand for
Dual energy x-ray absotptiometry
important questions relating to (back) pain PQRST
- Provocative and palliatve factors
- Quality of pain: Burning, dull, sharpetc
- Radation
- Severity and systematic symtoms
- Timing (how long?)
What does DEXA do
measures bone mineral density
