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M1 Gross Anatomy > Vertebral Column Back Muscles > Flashcards

Vertebral Column Back Muscles Flashcards

1
Q

What does the paraxial mesoderm develop into?

A

The paraxial mesoderm develops into somites, which in turn differentiate into vertebrae (sclerotome portion of somites) and axial musculature (myotome portion).

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2
Q

What drives the differentiation of somites into vertebrae and axial musculature?

A

Signaling through the sonic hedgehog (SHH) protein.

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3
Q

What embryonic tissue is the nucleus pulpus of intervertebral discs derived from?

A

The notochord

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4
Q

Anterior

A

Ventral - toward from of body

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5
Q

Superior

A

Cranial - toward the head or upper back (i.e. neck)

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6
Q

Posterior

A

Dorsal - toward the back of the body

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7
Q

Inferior

A

Caudal - toward the lower back of the back, closer to the guteal region

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8
Q

Proximal

As it relates to the back

A

Often refers to points closer to the spine

Distal refers to points farther away from spine

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9
Q

What are the curvatures of the spine?

What is the clinical relevance of these curvatures?

A
  • 1o curvatures in thoracic and sacral regions
  • 2o curvatures in cervical and lumbar regions
  • Clinical relevance
    o Kyphosis—excessive 1o curvature in thoracic region
    o Lordosis—excessive 2o curvature in lumbar region
    o Scoliosis—lateral deviation, usually due to a missing or extra portion of a vertebrae
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10
Q

Which elements are the spine are movable?

A

7 cervical, 12 thoracic, and 5 lumbar

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11
Q

What elements of the spine are immovable?

A

5 fused sacral
4 coccygeal

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12
Q

What is sacralization?

A

LV5 is fused to sacrum

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13
Q

What is lumbarization?

A

SV1 is separated from sacrum

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14
Q

Where is the vertebral pedicle?

A
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15
Q

Where are the laminae located?

A

The laminae project obliquely from pedicles to fuse with each other posteriorly

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16
Q

Where is the transverse process located?

A

The transverse process projects laterally from junction of lamina/pedicle

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17
Q

Where is the spinous process located?

A

The spinous process projects posteriorly from junction of laminae.

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18
Q

Where are the articular processes located?

A

Superior and inferior form synovial joints between adjacent vertebrae. The articular surfaces are covered by hyaline cartilage, and the joint is surrounded by a capsule.

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19
Q

What forms the intervertebral foramen for transmission of spinal nerves?

A

C, T, and L vertebrae have pedicles with superior and inferior notches which line up between adjacent vertebrae to form the intervertebral foramen.

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20
Q

What aspects of the spine supports the weight of the body?

A

The articular proccesses support ~20-25%

The vertebral bodies support ~ 75-80%

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21
Q

What radiographically important group are articular processes part of?

A

The “lateral masses”

There are regional differences in the orientation of the articular processes.

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22
Q

Describe CV1

A

CV1 (aka the atlas, becuase it supports the condyles of the skull) lacks body or spinous processes

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23
Q

**Describe CV2

A

CV2 (aka the axis, as it is a point of signifant rotation with CV1) : odontoid process (dens) was body of CV1, which is usually fused to the top of the body of CV2, and is used to stabilize pivot motions between CV1 and CV2.

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24
Q

What allows flexion, extension, lateral flexion, and rotation of cervical vertebrae?

A

The articular processes are nearly horizontal and the intervertebral discs are relatively thick, allowing for fairly extensive motions.

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24
Q

What openings in the cervical vertebrae allow for the transmission of the vertebral artery?

A

The transverse forminae

24
Q

What is a bifid spinous process?

A

A feature of the cervical vertebrae where the spinous process splits into two distally.

24
Q

What is the most prominent, palpable spinous process (vertbra prominens)

A

CV7, used to ID vertebrae above and below

25
Q

What allows for articulation between thoracic vertebrae and ribs 1-10?

A

Facets located on both sides of the vertebral bodies and on transverse processes

26
Q

What do ribs 11 and 12 articulate with on the spine?

A

Their respective vertebral bodies

27
Q

Describe the articular processes of the thoracic spine:

A

They are nearly vertical in a transverse plane

28
Q

Why is movement limited in the thoracic spine?

A

Thin intervertebral discs and the presences of the ribs/sternum, and the oblique orientation of the spines.

29
Q

What are the characteristics of the individual vertebrae of the lumbar spine that allow for easy access to vertebral canal?

A

Large vertebral bodies
Large intervertebral foramen
Block spinous processes

These permit easy access to vertebral canal for spinal tap or spinal anesthesis at a space between the spinous processes LV2-LV3 or LV3-LV4

30
Q

Clinically, how is LV4 found?

A

Palpating the iliac crest

31
Q

Describe the motion of the lumbar spine:

A

Flexion/extension (thick intervertebral discs - especially at the lumbosacral joint) and lateral flexion

Rotation is limited and should be avoided when bending (the articular processes are vertical, nearly in the sagittal plane - limiting rotation)

32
Q

Describe the sacral vertebrae:

A
  • Comprised of five fused elements (unless lumbarization or sacralization is present)
  • Have anterior and posterior formina for exit of ventral and dorsal rami, respectively
  • Articulates with the ilium of the os coxae (hip bones), and is tightly attached by strong sacro-ilia ligaments
33
Q

Where is the anterior longitudinal ligament located?

A

Runs the full length of the vertebral column on the anterior aspect of the vertebral bodies

34
Q

Where is the posterior longitudinal ligament?

A

Runs the full length on the posterior aspects of the vertebral bodies (anterior to the spinal cord). Does not fully protect the spinal cord or spinal nerves from a posteriorly herniated disc, which affects the anterior part of the spinal cord predominately.

35
Q

What ligament connects adjacent lamina?

A

The ligamentum flavum

36
Q

What is the supraspinous ligament in the neck?

A

The supraspinous ligament in the neck is thickened and called the ligamentum nuchae.

37
Q

Where are the supraspinous and interspinous ligaments located?

A
38
Q

Describe intervertebral discs

A

Fibrocartilaginous structures between bodies of vertebrae forming symphysis joints.

Have outer anulus fibrosus and inner nucleus pulposis (inner nucleus can rupture through outer fibrous ring, esbecially in lumbar region, where pressure is great on the posterior aspect of the disc)

Discs comprise 1/4 to 1/3 length of the column, discs have high water content (85%) which decreases with time and age (b y 60 y/o 60% water)

95% of “sciatica” neuritis, or radiculopathy (66% of us have recurring back pain) occurs between LV4 –LV5 (usually affecting L5) or LV5—SV1 (usually affecting S1).

39
Q

What is the clinical relationship between the vertebral column, intervertebral discs, and spinal nerves?

A

Any trauma, abnormality here can affect the spinal nerve (i.e. bulging disk will affect the nerve exiting the intervertebral foramen below the bulge)

For example, LV4/LV5 intervertebral disc herniation will affect L5 spinal nerve. Reason—spinal cord ends at LV1/LV2 and as the fetus grows nerves are pulled down to exit lower than the end of the spinal cord.

40
Q

What are the classes of extrinsic back muscles and their general functions?

A
  1. Superficial - anchor and move the upper extremities
  2. Intermediate - very thin and assist deep breathing

The extrinsic back muscles are innervated by ventral rami

41
Q

What are ventral rami?

A

Anterior branches of spinal nerves (usually named)

42
Q

List the layers of the intrinsic back muscles:

A

These are the “true back muscles”

Arranged in three layers: superificial, intermediate, and deep

Innervated by dorsal rami

43
Q

What are dorsal rami?

A

Segmental, usually unamed posterior branches of spinal nerves.

44
Q

What are the superifical extrinsic muscles of the back?

A

Trapezius

Latissimus dorsi

Rhomboideus major/minor

Levator scapulae

45
Q

What are the attachments, nerve supply, aterial supply, actions and clinical test for the trapezius muscle?

A

i. attachments = From superior nuchal line and spines of cervical, and thoracic vertebrae (CV7-TV12), it extends out to lateral clavicle, and scapula (spine and acromion)

ii. nerve supply (nn) = CNXI spinal accessory (motor), and C3, 4 (sensory) (N174)

iii. arterial supply (aa)= superficial branch of the transverse cervical a. (off the thyrocervical trunk, a branch of the 1st part of the subclavian a.)

iv. actions =Upper division elevates scapula, moves glenoid fossa superiorly, and flexes head laterally. Middle division retracts scapula to elevate glenoid fossa. Lower division depresses and helps rotate scapula.

v. Test: shrug shoulders against resistance

46
Q

What are the attachments, nerve supply, aterial supply, actions and clinical test for the latissimus dorsi?

A

i. attachments = via thoracolumbar fascia from spinous processes of TV6-LV5, and iliac crest, the muscle extends out to attach in the intertubercular groove of the humerus

ii. nn. = thoracodorsal (C6, 7, 8) off posterior cord of brachial plexus (N171A)

iii. aa. = thoracodorsal br. of subscapular a. (off 3rd part of the axillary a.)

iv. actions = extends, adducts and medially rotates the humerus

v. Test: pull up

This muscle helps delineate two anatomical regions:

  1. Triangle of auscultation (“to listen”)- bounded medially by trapezius,
    laterally by scapula, inferior by latissimus
  2. Lumbar triangle - potential hernia site: bounded medially by latissimus,
    laterally by external abdominal oblique, inferiorly by the iliac crest
47
Q

What are the attachments, nerve supply, aterial supply, and actions for the rhomboideus major/minor?

A

Rhomboideus major attachments: spinous processes of TV2-TV5 to medial border of scapula inferior to spine

Rhomboideus minor – attachments: spinous processes of CV7- TV1 to medial border of scapula at level of spine

i. nn. = dorsal scapular n. (C5), off C5 root of the brachial plexus (N174A-drawn in)
ii. aa. = transverse cervical a., deep branch, or a separate dorsal scapular a, off the subclavian (N174A-drawn in)

iii. actions – retracts scapula, rotates scapula to depress glenoid fossa

48
Q

What are the attachments, nerve supply, aterial supply, and actions for the levator scapulae?

A

i. attachments – transverse processes of CV1-4 to medial border of scapula above spine

ii. nn. = C3, 4 nerves to levator scapulae, off the cervical plexus, (and/or sometimes the dorsal scapular n.)

iii. aa. = transverse cervical a, deep branch, or dorsal scapular artery

iv. action = elevates scapula

49
Q

What are the intermediate extrinsic muscles of the back?

A

Serratus posterior suprerior

Serratus posterior inferior

50
Q

What are the attachements, nerve innervation, artery innervation, and actions of the serratus posterior superior?

A

i. attachments = spinous process of CV7-TV3 to ribs 2-4

ii. nn = intercostal n. (N168)

iii. aa = branches of intercostal aa. (N168)

iv. actions = aid with inspiration (elevates upper ribs)

51
Q

What are the attachements, nerve innervation, artery innervation, and actions of the serratus posterior inferior?

A

i. attachments = spinous processes TV11-LV2 to ribs 8-12

ii. nn = intercostals

iii. aa = branches of intercostals

iv. actions = aid with expiration (depresses lower ribs)

52
Q

What are the intrinsic muscles of the back?

A

The superficial or transversospinalis muscles
splenius capitis muscle
splenius cervicis

The intermediate or erector spinae muscles are divided into three columns, from medial to lateral
spinalis
longissimus
iliocostalis

The deep intrinsic muscles run from transverse proccesses to spinous processes of vertebrae one to several vertebral levels superiorly
rotatores
multifidus
semispinalis
levator costarum

53
Q

Describe the superficial intrinsic back muscles:

A

From spinous processes CV7-TV6 to mastoid process or transverse processes of CV1-4

a. splenius capitis m.
b. splenius cervicis
i. nn = dorsal rami of C3-C4 (capitus)
ii. aa = branches off intercostals
iii. action – unilaterally = flex to the same side laterally at the neck; bilaterally = extend at the neck

54
Q

Describe the intermediate intrinsic back muscles:

A

a. spinalis – spinous process of lumbar and inferior thoracic regions to spinous process several vertebral levels superior

b. longissimus – transverse process to transverse processes several vertebral levels superior

c. iliocostalis – attaches from the iliac crest or transverse processes to ribs several vertebral levels higher

i. nn – dorsal rami of thoracic and lumbar spinal nn. for all three muscle groups
(N174)
ii. actions – acting unilaterally, these mm bend the vertebral column to the same side. Acting bilaterally, they extend the vertebral column

55
Q

Describe the deep intrinsic muscles of the back:

A

a. rotatores – deepest of the group, extend one or two vertebral levels

b. multifidus – (regionally named: thoracis and lumborum, heaviest in lumbar region, fibers extend a few levels (2 to 4)

c. semispinalis – most superficial of the group – fibers extend several vertebral levels. regionally named – capitis, cervicis and thoracic

d. nn. = segmental dorsal rami
e. aa. = branches off intercostals
f. actions = extend vertebral column and rotate it to the opposite side

Levator costarum mm (N173)

a. Attachments = transverse processes of CV7-TV11 to ribs 1 vertebral level (brevis) or 2
vertebral levels (longus) lower. They are related to external intercostal mm.
b. nn = dorsal rami of C8-T11, aa. Branches of intercostals
c. action = assist with elevation of the ribs

56
Q

Semispinalis

A

Insertion - spinous processes of CV/TV

Innervation -

Thoracic blood supply - Dorsal branches of posterior intercostal arteries

57
Q

Multifidi

A

Thoracic blood supply - dorsal branches of posterior intercostal, subcostal, and lumbar arteries

58
Q

Levator Costarum

A

Insertion - Subjacent ribs between tubercle and angle

Innervation - dorsal rami of lower thoracic nerves

59
Q

Rotatores

A

Blood supply - dorsal branches of segmental arteries

M1 Gross Anatomy (16 decks)

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