If you can't read please download the document
Upload
kevin-nave-rivera
View
223
Download
1
Embed Size (px)
DESCRIPTION
anatomy - credits to owner
Citation preview
BACK AND SPINE
Description
Is the posterior surface of the trunk
Borders
Inferior to the trunk
Superior to the buttocks
Pectoral & shoulder girdle
VERTEBRAL COLUMN
-AXIAL skeleton
-From CRANIUM to the tip of the COCCYX
-Length: 72-75 cm
Functions
Bony composition (33 all)
-Protects the spinal cord and nerves
Cervical
7
Lordosis
Skeleton of the neck-Supports the weight
Thoracic
12
Kyphosis
Skeleton of the thorax-Locomotion
Lumbar
5
Lordosis
-Maintains the body weight
Sacral
5
Kyphosis
coccygeal
4
Kyphosis
Remnant; non-functional
KYPHOSIS kuba
LORDOSIS liyad
SCOLIOSIS
KYPHOSCOLIOSIS-Posterior convex-
Anterior convex-Sagittal displacement of
-Kyphosis + scoliosis-Anterior concave-
Posterior concave
the vertebral column
Primary curvature (since birth)
Secondary curvature
Levo- Scoliosis= rotation to the
-Over curvature with lateral
-Thoracic kyphosis-
-
Cervical lordosis- infant
LEFT; observerib hump
deviation with rotation
common in elderly
able to raise his head
Dextro-Scoliosis= lateral deviatory
-Sacral kyphosis-
Lumbar lordosis- child
(RIGHT) movement plus rotatory
able to sit
motion
In FETUS, all kyphotic position
Thoracic lordosis- common in
TREATMENT:
(thoracic, lumbar, sacral)
pregnant women-Below the level of
maturity: can correct
(braises)
-Above the level of
maturity: braces not
applicable anymore;
surgical
TYPICALVERTEBRA
ATYPICALVERTEBRA
Anterior Element
-
Vertebral body
Atlas
C1; no spinous process
Posterior Element
-
Pedicles
Axis
C2; with DENS/ ODONTOID process
-
Laminae
-STRONGEST among the 7
-
Spinous process
cervical vertebra
-
Transverse process
Vertebral foramen
Canal
Vertebral Prominens
C7; prominent spinous process; NO
VERTEBRAL ARTERY
Articular surface
2 superior; 2 inferior
Sacrum
Vertebral notch
Small superiorly; large inferiorly
Coccyx
Intervertebral foramen
Union of the inferior vertebral
notch (L2) plus the superior
vertebral notch (L3); transmit spinal
nerve
CERVICAL VERTEBRA
TYPICAL
ATYPICAL
ATLAS (C1)
AXIS (C2)
VERTEBRAL PROMINENS (C7)
Transverse process
Transverse Process
Transverse Process
Cervical Spine- long; NOT BIFID
Cervical spine
Arch
Cervical Spine
Transverse Process
Vertebral body
Vertebral Foramen
Vertebral Body DENS ODONTOID
Vertebral foramen
Lateral Articular Surface (sup/ inf)
Vertebral Foramen
Superior Articular Surface
Vertebral Body
Superior Articular Surface
Inferior Articular Surface
Cervical Spine
Inferior Articular Surface
JEFFERSONs FRACTURE/ BURST
HANGMANs FRACTURE common
FRACTURE when hit the head and
in suicidal patient; pedicle is
displaced
dearticulated to laminae;
associated with HYOID fracture
ODONTOID FRACTURE
RUSS BAUSTISTA
THORACIC VERTEBRA
-Body is medium size and HEART-shaped
Transverse process
Thoracic spine-inclined downward
Vertebral body
Vertebral foramen-circular
Superior articular surface-backward and lateral
Inferior articular surface-forward and medial
Costal Facets (Transverse-articulate with the TUBERCLE of-T11 and T12= no tubercle; floating
Process)
the ribs (T1-T10)ribs
Costal Fascets-articulation of HEAD of the ribs
LUMBAR VERTEBRA
-Vertebral body is KIDNEY/ BEAN shaped
-Pedicle and laminae are more strong and thick
Transverse process
Lumbar spine-short, flat, quadrangular; backward
Vertebral body
Vertebral foramen-triangular
Superior articular surface-medially
Inferior articular surface-laterally
SACRAL VERTEBRA
-WEDGE- shaped
-Concave anteriorly
-5 rudimentary bones fused into ONE!
Articulations-5th lumbar vertebra
-Base
-Apex-1st coccyx
-lateral-iliac
Sacral Hiatus-failure of the 4th / 5th laminae to
fuse in the midline
Sacral Canal-transmit spinal cord
Anterior Sacral Foramina-transmit the spinal nerves
Saacral promontory-obstetrical significance-measure to check if the
baby can deliver/
perform vaginal delivery
COCCYGEAL VERTEBRA
-consist of FOUR (4) vertebra fused into ONE!
-remnant
ANATOMICAL VARIANTS OF VERTEBRAE
Cervical Rib
-C1-C12 normally have no rib
-C7 have cervical rib
Lumbarization
-L1 have rib
-Lumbarized S1
-S1 fused to L5
Sacralization
-Sacrolized L5
-L5 fused to S1
RUSS BAUSTISTAJOINTS OF THE VERTEBRAL COLUMN
JOINTSBONETYPE OF JOINTS
LIGAMENTSMOVEMENTS
COMPARTMENTS
Atlanto-Ocipital Joint-between occipitalSynovial jointAnterior atlanto-occipital membrane-Flexion- Extention
condyles andenclosed by capsulecontinuation of the ALL, which runs as a bandYES joint
superior articularwith synovial fluiddown to anterior surface of the vertebral
facet of the atlas
column; connects the anterior arch of the
atlas to the anterior margin of the foramen
magnum
Posterior Atlanto- Occipital Membrane-
similar to Ligamentum flavum; connects the
posterior arch of the atlas to the posterior
margin of the foramen magnum
Atlanto-axial JointBetween dens/Synovial jointSuperficial Ligament (TECTORIAL LIGAMENT)Rotation
odontoid and theEnclose by capsule-Upward continuation of the PLLNO joint
arch of the atlas
-Attached to the occipital bone just
between superior
within the foramen magnum
articular surface of
-Covers the posterior surface of the
the axis and inferior
odontoid process and the apical,
articular surface
alar, & cruciate ligaments
Intermediate Ligament (CRUCIATE
LIGAMENT)
-Transverse part attached on each
side to the inner aspect of the
lateral mass of the atlas and binds
the odontoid process to the
anterior arch of the atlas
-Vertical part: from the posterior
surface of the body of the axis to
the inner margin of the foramen
Deep Ligament
APICAL- median-placed structure that
connects the apex of the odontoid process to
the anterior margin of the foramen magnum
ALAR- lie on each side of the apical ligament
and connects the odontoid process to the
medial side of the occipital condyle
Joints between 2Two adjacentSurface is covered byAnterior Longitudinal Ligament (ALL)Prevents excessive
vertebral bodiesvertebral bodieshyaline cartilage-Wide, stronger, and attached to theextension
IV disc- fibrocartilage
front and sides of the vertebral
bodies and IV discs
Bone-hyaline c.-IV-Continuous bands down the
disc- hyaline c.- bone
anterior surfaces of the vertebral
column from the skull to the sacrum
Posterior Longitudinal Ligament (PLL)Prevent excessive
-Weak, narrow, and attached to theflexion of vertebrae
posterior border of the IV discs and
vertebral bodies
-Continuous bands down to the
posterior surface of the vertebral
-column from the skull to the sacrum
Joints between 2Between articularSynovial jointSupraspinous LigamentDepends on the
vertebral archessurface of adjacentEnclosed by capsule-Between the tip of the spineorientation of the
vertebraArticular facets areInterspinous Ligamentarticular surface
Intervertebral JointBetween twocovered by hyaline-Connects adjacent spine
vertebral archescartilageIntertransverse Ligament
-Between adjacent transverse
process
RUSS BAUSTISTA
Ligamentum Flava
-Connects the laminae of adjacent
vertebrae
Ligamentum Nuchae
Prevents excessive
-Strong ligament formed byflexion of the neck;
thickened supraspinous andflexion stretches the
interspinous ligaments at theligament
cervical region
-From the spine of C7 to the external
occipital protuberance, with the
anterior border strongly attached to
the cervical spines
Costovertebral Joint
Synovial joint
Costotransverse radiate- head of rib and
vertebral body
Sacroiliac Joint
-to be discussed in PELVIC module
INTERVERTEBRAL DISC (IV Disc)
- length of the vertebral column
-Between two vertebral bodies
-Lined by fibrocartilage (symphysis)
Nucleus Pulposus
-ovoid and gelatinous
CLINICAL CORRELATION:
-Contains large amount of water; small
amount of collagen fibers; few cartilage
INTERVERTEBRAL DISC PROLAPSE
cells
-Rupture of the annulus
-old age: water decreases
fibrosus resulting in herniation
-compression: flattened
of the nucleus pulposus
Anulus Fibrosus
-fibrocartilage
-Can result in spinal cord or
-collagen fibers arranged in concentric
nerve impringement
layers
-Patient bear weight on the
-peripheral layer connected to ALL and
other side to prevent
PLL
aggravation of the herniation
-FUNCTION: shock absorption; creates
-MANAGEMENT: content
rocking motion
brought back to center or
LAMINECTOMY
SCAPULA
part of upper limb flat, triangular bone
lies posterior to the chest wall
attached to the clavicle by the ACROMION and humerus by the GLENOID FOSSA
BORDERS (3)ANGLES (3)FOSSAE (3)PROCESSES (4)SUPRASCAPULAR NOTCH
VertebralSuperiorSupraspinous FossaSpinous ProcessArtery
AxillaryInferiorInfraspinous FossaAcromion ProcessVein
SuperiorLateralSubscapular FossaCoracoid ProcessNerve
Glenoid Fossa
MUSCLES OF THE BACK and SPINE
Superficial Muscles connects upper limb to the vertebral column
NAMEORIGIN
INSERTIONACTION
NERVE SUPPLYTrapezius1.occiput bone1.upper fibers- lateral1.upper- elevates theSpinal Accessory Nerve
2.ligamentum
thirds of clavicle
scapula(CN XI)
nuchae (except2.middle fibers-2.middle- pull scapula
C7-T12)
acromion
medially
3.thoracic3.lower fibers spine3.lower pull medial
vertebrae
od the scapula
border of scapula
downward
Latissimus Dorsi1.iliac crestFloor of the bicipital groove ofMedially rotate the armsThoracodorsal nerve
2.lumbar fasciahumerus
Adduct the arm
3.spine of C6 up to
Extensor of the shoulder joint
thorax
4.inferior angle of
the scapula
RUSS BAUSTISTALevator Scapulae
Transverse processScapula: (Medial Border)Raises the medial border of theDorsal scapula nerve
C1-C4-adjacent toscapula
supraspinous fossa
Rhomboids Minor
Spine:Scapula: (Medial Border)
C7-T1-adjacent to scapular
spine
Rhomboids Major
Spine:Scapula: (Medial Border)
T2-T6-adjacent to
infraspinous fossa
TRIANGLE OF AUSCULTATIONLUMBAR TRIANGLE
MUSCLES CONNECTING THE SCAPULA
TO THE HUMERUS
Borders:
Borders:
-Lateral border of Trapezius-Inferior border of Latissimus-Rotator Cuff Muscles (fixators)
muscle
dorsi
(SITS muscles)
-Superior border of Latissimus-Posterior border of external-Deltoid (posterior)
dorsi
oblique
-Medial border of scapula-Iliac crest
-Teres Major
Intermediate Muscles chest wall muscle involved in RESPIRATION
NAMEORIGIN
INSERTIONACTIONNERVE SUPPLYSplenius capitisSpine:
Capitis: Temporal bone andActing alone:Posterior Rami of SpinalSplenius CervicisC7-T4
Occipital Bone
Nerve
Cervicis: Transverse Process ofActing together:
C1-C4
Serratus Posterior1.Lower cervicalUpper RibsRaises ribs:
Superior
spine
Muscle of INSPIRATIONIntercostal Nerves
2.Upper thoracic
spine
Serratus Posterior1.Lower thoracicLower RibsDepresses the ribs:
Inferior
spine
Muscle of EXPIRATION
2.Upper Lumbar
Spines
Deep Muscles muscles that moves the vertebra
SUPERFICIAL VERTICALLY RUNNINGINTERMEDIATE OBLIQUE RUNNING MUSCLEDEEPEST MUSCLE
MUSCLES (ERECTOR SPINAE)(TRANSVERSOSPINALIS)
-Iliocostalis-Semispinalis-Interspinales
-Longissimus-Multifidus-Intertransversarii
-Spinalis-Rotatores
I LOVE SHAWARMA (LateralMedial)
ARTERIAL SUPPLY OF THE BACK
Occipital ArteryBranch of External carotid artery (face
Cervical Region
and posterior area)
Vertebral ArteryBranch of subclavian artery (arises from
the aorta)
Deep Cervical ArteryBranch of costocervical trunk
Thoracic RegionPosterior Intercostal ArteriesBranch of Thoracic Aorta (part of
descending aorta)
Lumbar Region
Subcostal arteryBranch of abdominal aorta
Lumbar artery
Iliolumbar Artery -only muscle notBranch of internal iliac artery (pelvis and
Sacral Regionsupply the perineal________perineum)
Lateral Sacral Artery
RUSS BAUSTISTAVENOUS DRAINAGE OF THE BACK
Venous Drainage of the vertebralExternal Vertebral Venous Plexus
column- Drains the external vertebral
plexus
Internal Vertebral Venous PlexusBasilar Veins
- Lies within the vertebral canal,
outside the dura mater
Intervertebral Veins
- Drains the spinal cord and
meninges
Main Venous Drainage of the BackVenae Commitantes
- Counterpart of the arterial
supply of the back
LYMPHATIC DRAINAGE follows the veins of the back
Cervical Region
Deep Cervical group of Lymph nodes
Thoracic Region
Intercostal Lymph Nodes
Posterior Mediastinal Lymph Nodes
Lumbar Region
Lateral Aortic
Sacral Region
Sacral Nodes
NERVOUS SUPPLY
POSTERIOR RAMI of the 31 pairs od spinal nerves supplies the muscles of the back and skin
ANTERIOR RAMI- follows the course of the limb, thoracic wall & thoracic chest (intercostal nerve)
DERMATOMAL SUPPLYMYOTOMAL SUPPLY- Innervation of the SKIN- Innervation of the MUSCLEArea of the skin supplied by the somatosensory fibers from a single spinal nerve ; useful in localizing the levels of lesions
C2-C5NeckC1-Supplies the deep muscle of the
C6-C8Posterior shoulderC6
T1Tip of axillaC7
back and DO NOT supply the
SKIN.
T4Inferior angle of the scapulaC8
T10umbilicusL4
L5
NEUROANATOMY BOOK:
C2
Back of head
C5
Tip of shoulder
C6
Thumb
C7
Middle finger
C8
Small finger
T4-T5
Nipple
T10
Umbilicus
L1
Inguinal
L4-L5
Big toe
S1
Small toe
S5
perineum
ANIMO LA SALLE!
RUSS BAUSTISTA