The Back - Bones, Joints, Ligaments, Muscles

Question 1

Give three examples of what could cause backpain

Answer 1

Aortic aneurysm - swelling of the abdominal aorta
Pancreatitis - inflammation of the pancreas
Renal colic - kidney stones

Question 2

What are the functions of the vertebral column and vertebrae?

Answer 2

• Locomotion
• Supports body weight
• Protects and transmits spinal cord and nerves

Question 3

What is the primary and secondary curvature?

Answer 3

Primary curvature - concave anteriorly; remains in thoracic and sacral regions

Secondary curvature - concave posteriorly; remains in cervical and lumbar regions - develops from primary when child first stands up and walks

Question 4

What allows the formation of the secondary curvatures?

Answer 4

Intervertebral discs

Question 5

Features of a typical vertebra

Answer 5

Body
Spine
Transverse processes
Vertebral foramen/canal - for spinal cord
Neural arch
Pedicle
Lamina
Inferior/superior articular facet
Intervertebral foramen - where the spinal nerve emerges

Question 6

Features of a typical Cervical vertebra

Answer 6

Body - small
Bifid spine - two little processes
Vertebral foramen - large, triangular
Foramen transversarium - hole of the vertebral arteries and veins
Uncinate Processes - at lateral edges of body; synovial articulation with vertebra above (arthritis)
Superior articular facets

Question 7

What is the greatest movement of the Cervical vertebrae?

Answer 7

Flexion, with some later flexion

Question 8

Features of a typical Thoracic vertebra

Answer 8

Same except:
Costal demi-facets - upper for articulation with the head of its own rib
Bigger body, heart shaped
Smaller vertebral foramen
Superior articular facets face posteriorly
Transverse process has a facet for articulation with its own rib

Question 9

What is the greatest movement of the Thoracic vertebrae?

Answer 9

Rotation

Question 10

Describe the structure of the Atlas?

Answer 10

Has a pair of inferior and superior articular facets - inferior facets join onto the axis, while the superior facets join onto the Occipital Condyles of the skull
It also has a groove for the vertebral artery and a transverse process with foramen

Question 11

What is the greatest movement of the Lumbar vertebrae?

Answer 11

Extension, with some flexion and later flexion

No rotation

Question 12

What is the greatest movement of the Atlas vertebra?

Answer 12

Flexion and extension of the head at the atlanto-occipital joint (looking up at the ceiling)

Question 13

Structure of the sacrum and coccyx

Answer 13

Ala
Sacral Promontory
Anterior and posterior foramen
Crests (Median, intermediate, lateral)
Sacral Hiatus (anaesthesia)

Question 14

Structure of the Axis

Answer 14

Body with Odontoid process/dents
Transverse process with foramen
Vertebral foramen
Superior articular facets
Bifid spine

Question 15

What is the greatest movement of the Axis vertebra?

Answer 15

Rotation at atlanto-axial joint

Question 16

Main joints of the vertebrae?

Answer 16

Zygapophyseal
- between the superior and inferior articular facets

Intervertebral (secondary cartilaginous)
- between two adjacent vertebrae (intervertebral disc)

Question 17

What is the intervertebral disc made up of?

Answer 17

Anulus fibrosus - ring of fibrocartilage

Nucleus pulposus - semi-fluid

Question 18

What happens to the nucleus pulposus during herniation?

Answer 18

Compresses on the spinal cord and the nerves

Question 19

Ligaments of the vertebral column

Answer 19

• Posterior longitudinal (behind vertebral body)
• Anterior longitudinal (in front of vertebral body)
• Ligamenta flava (between vertebral laminae)
• Intertranverse (between transverse processes)
• Supraspinous (between tips of the spine)
• Interspinous (between all of the spine)
• Ligamentum nuchae (from external occipital protuberance and foramen magnum to C7
• Anterior longitudinal changes into Anterior atlanto-axial and Anterior atlanto-occipital membranes
• Posterior longitudinal changes into Tectorial membrane
• Ligamentum flavum changes into Posterior atlanto-axial and Posterior atlanto-occipital membranes
• Alar ligaments
• Superior longitudinal, transverse, inferior longitudinal bands of cruciate ligaments

Question 20

What is the blood supply of the vertebral column like?

Answer 20

• Arterial anastomosis
• Internal and external venous plexuses
• Basivertebral veins (between body and posterior ligament)

Question 21

Muscles of the back

Answer 21

Muscle 1 - most superficial, for upper limb movement

• Trapezius - Levator Scapulae, Rhomboid Minor and Major; extends neck, braces and elevates shoulders; C7-T12
• Latissium dorsi - iliac crest, lower ribs; shoulder extension and adduction; T6-T12

Muscle 2 - intrinsic proper muscles
- From the skull to the pelvis, keeps vertebral column upright
- Supplied by the dorsal rami of spinal nerves
3 layers:
- superficial: splenius cervicis, splenius capitis; together extend, alone rotate and laterally flex
- intermediate: erector spinae (iliocostalis, longissimus, spinalis; devided into capitis, cervicis, thoracis, lumborum)
- deep: transversospinalis - extend, rotate, laterally flex

Also remember abdominal muscles, e.g.: obliques and rectus