FOCA 2023 Lecture 3: Back - Dunn PDF

The Back Tyler E Dunn PhD, MS, RPA 8 Aug 2023 Session Learning Objectives At the end of this session, each student will: Recognize the characteristic anatomical features of vertebrae from different regions of the vertebral column. Describe the surface features and palpable landmarks of the back and...

The Back Tyler E Dunn PhD, MS, RPA 8 Aug 2023 Session Learning Objectives At the end of this session, each student will: Recognize the characteristic anatomical features of vertebrae from different regions of the vertebral column. Describe the surface features and palpable landmarks of the back and vertebral column. Describe the range of motion of the vertebral column and its regions. Identify extrinsic and intrinsic back muscles Bones and ligaments Muscle and movements Clinical Application Axial Skeleton Overview Anterior Foramen transversarium Cervical vertebra Lamina Vertebral foramina u pright ca one epne 7 Cervical vertebrae attainment orib 12 Thoracic vertebrae Thoracic vertebra w/ rib olargest 5 Lumbar vertebrae Lumbar vertebra Sacrum Ifusedbone Coccyx Ifusedbone Common Vertebral Morphology Body- anterior portion. Vertebral foramenspace for spinal cord. Transverse processlateral bony process. Spinous processposterior bony process. Theygetlarger as one descends vertebra seized to bro Cervical Vertebrae 7 cervical vertebrae (C1 – C7) and are the smallest and lightest C3 – C7 are typical § Body CG spitin § § G hastransverseprocess Spinous processes Vertebral foramen C7 with longest spinous process vertebraprominens Transverse processes have foramens that transmit the vertebral arteries and veins; unique feature I osmall and Ushope o oral 0 vertebra Allcervical have q this brain shape in the cervicalregion C1 (Atlas) Flexon Lacks a body & Thegridthetheit spinous process Supports the skull Superior facets – fits the occipital condyles large Flexion & extension of head, nodding Korement Thiswherethedensfit Of articulates wlocepte a Largestvertebra foramen superior facets article w the condyles on inferior occipital aspectof Atlas– Greek god supporting the globe. C2 (Axis) cervical vertebrae Has body & spinous process Transverse process & foramen Dens projects superiorly Pivot for rotation of the atlas & skull Ligament holds the dens of the axis to the atlas Functions in rotating the head, shaking O Lumbar Vertebrae L1-L5 Bodies are thick and robust; vertebral foramina are triangular found in lower back shortand blunt transverse process Transverse processes are thin and tapered Spinous processes are thick, blunt, and point posteriorly hugebody b c of that is held weighty s Is I Sacrum and Coccyx Sacrum: Formed from 5 fused vertebrae in adults Articulates with L5 above and coccyx below Coccyx: 3-5 fused vertebrae - "tailbone” in adults monianian 9 fusion spingFocess Joints of Vertebral Column Cervicalvertebra only bone getspurs could Craniovertebral joints 1. Atlanto-occipital Cl occipitalcondyle 2. Atlanto-axial CI C2 causeneck p Joints of vertebral bodies 3. Uncovertebral cervicalverbreaonly 4. Intervertebral Ivdisceslocated movement some Joints of articular processes 5. Zygapophysial between articularprocess superior andinferior joint synovial sonora Intervertebral Joints Between the intervertebral discs and the vertebral body shockabsorves Symphysis joints semimoveablejoint IV disc composed of: – Annulus fibrosus – Nucleus pulposus outer circular Jelly like substance Annulus fibrosus from protectsnucleuspurposes outpulposus falling Nucleus Movement of the Spine movement Most cervical lumber in regions Vertebrae Movements Cervical Flexion, Extension, Lateral flexion to right and left limited Thorax movement Right and left rotation Lumbar Flexion, Extension, Lateral flexion to right and left Ligaments of the Vertebral Column Ligamenta flava – Connect adjacent laminae of vertebrae – Limits flexion Anterior longitudinal ligament – Anterior bodies & IV discs from skull to sacrum – Prevents hyperextension leaning anthewayback Posterior longitudinal ligament – Posterior bodies & IV discs from C2 to sacrum within spinal canal – Prevents hyperflexion Ligamenta flava oinbetween the lamina Posterior longitudinal ligament Anterior longitudinal ligament o on surface of runsposterior themebodies orunsrightonthespinalcord theanterior runningon surfaceof the bodies Abnormal Curvatures Excessive Kyphosis rimery curvature of the spine firstto develop n earlyembryo thoraticand sacralregions excessive thoaric Hunchback Excessive Lordosis Excessive lumber preying Scoliosis Clinical Correlate: Herniated Nucleus Pulposus IV Surface Anatomy Nuchal lig C7 SP Site of external occipital protuberance Spinous processes T1 SP T2 SP Supraspinous lig T4 SP Dimples overlying posterior superior iliac spines (PSIS) Muscle Layers of the Back Superficial o innervated ram Intermediate Deep orespiration * vertebralcolumn oinnervatedby the dorsal ram * Extrinsic mm. Extrinsic mm. Intrinsic mm. Extrinsic vs. Intrinsic Muscles Extrinsic development Migrated from ventral surface of the body & carried innervation with them Innervated by VENTRAL primary rami (or CN XI) Intrinsic Theydevelopon the posteriorside Originated developmentally in the dorsum of the back & remained “true” or “intrinsic” Innervated by DORSAL primary rami Muscle Layers of the Back Superficial Intermediate Deep * * Extrinsic mm. Extrinsic mm. Intrinsic mm. Scapulothoracic Movements Trepicus ateralboarder Rhomboid f Traps ratty Trapezius muscle Trapezius m. O: Superior nuchal line, external occipital protuberance, ligamentum nuchae, spinous processes (SP) C7-T12 I: lateral 1/3 clavicle, acromion, spine of scapula Inn: accessory n. (CN XI) Action(s): elevate, adduct/retract, and depress scapula; assists in rotating the scapula during abduction of humerus Latissimus dorsi muscle Latissimus dorsi m. Swimmer O: SP T6 to T12, thoracolumbar fascia, iliac crest, ribs 9/10 to 12 I: floor of intertubercular sulcus (bicipital groove) Inn: thoracodorsal n. I Action(s): extends, adducts & medially rotates humerus muscle Levator scapulae muscle Levator scapulae m. i O: transverse processes (TP) of C1C4 I: superior portion of medial border of scapula Inn: dorsal scapular n. Action(s): elevates scapula rotates glenoid cavity inferiorly Rhomboid muscles Rhomboid minor O: nuchal ligament, spinous processes C7-T1 I: medial border of scapular spine Rhomboid minor m. Rhomboid major m. Rhomboid major O: spinous processes T2T5 I: medial border of scapula from spine to inferior angle Inn: dorsal scapular n. Action(s): Elevates scapula Rotates glenoid cavity inferiorly Fix scapula to thoracic wall Innervation & Blood Supply of Levator Scapulae & Rhomboids Dorsal Scapular n. Superficial branch of transverse cervical a. Deep branch of transverse cervical a. (aka dorsal scapular a.) Triangles of the Back Triangle of Auscultation Lumbar Triangle Boundaries: Boundaries: Superior: Trapezius m. Medial: Latissimus dorsi m. Inferior: Latissimus dorsi m. Lateral: Rhomboid major m. Floor (deep): 6th intercostal space Lateral: External oblique m. Triangle of Auscultation Lumbar Triangle Inferior: Iliac crest Floor (deep): Internal oblique m. Muscle Layers of the Back Superficial Intermediate Deep * * Extrinsic mm. Extrinsic mm. Intrinsic mm. Intermediate Extrinsic Back mm. Serratus posterior superior Serratus posterior superior Serratus posterior inferior O: nuchal lig. & SP of C7T3 I: superior border of ribs 2-5 Inn: 2nd-5th intercostal nn. Action(s): elevates ribs Serratus posterior inferior O: SP T11-L3 I: inferior border ribs 9-12 Inn: T9-T12 ventral rami Action(s): depresses ribs Muscle Layers of the Back Superficial Intermediate Deep * * Extrinsic mm. Extrinsic mm. Intrinsic mm. Intrinsic (Deep) Back Muscles Superficial Deep 3 layers 1. Superficial Spinotransversales mm. Splenius capitis m. Splenius cervicis m. 2. Intermediate Erector Spinae mm. Iliocostalis m. Longissimus m. Spinalis m. 3. Deep Transversospinales mm. Semispinalis group Multifidus group Rotatores group Intermediate Splenius mm.- Spinotransversales mm. 1. Splenius capitis Splenius capitis m. Splenius cervicis m. I: mastoid process & lateral 1/3 of superior nuchal line of occipital bone 2. Splenius cervicis I: TP of C1-C3 O: ligamentum nuchae & SP of C7-T6 Inn: posterior rami of spinal nn. Action(s): Bilaterally: extends head and neck Unilaterally: laterally flexes (bends) neck and rotates face to the side with active mm (ipsilateral side) Erector Spinae mm. 1. Iliocostalis I: angles of lower ribs & cervical TP 2. Longissimus I: between tubercles & angles of ribs, TP of thoracic & cervical vertebrae, mastoid process 3. Spinalis Iliocostalis m. Longissimus m. Spinalis m. I: SP of upper thoracic region & cranium O: Posterior sacrum, iliac crest, sacroiliac ligaments, & SP of lower lumbar & sacral vertebrae, & supraspinatus ligament Inn: dorsal rami of spinal nn. Action(s): Bilaterally: extends vertebral column & head & when back flexed, controls movement via eccentric contraction Unilaterally: laterally flexes vertebral column Semispinalis group Semispinalis capitis m. Semispinalis thoracis m. Semispinalis cervicis m. Transversospinales mm. Semispinalis capitis, semispinalis cervicis, & semispinalis thoracis O: TP of C4-T12 I: occipital bone, SP in thoracic and cervical regions, span 4-6 segments Inn: dorsal rami of spinal nn. Action(s): extends head and thoracic and cervical regions of vertebral column & rotates them contralaterally For Thursday and Friday TBL Structure: Prework (before class) ~20 minutes on Osmosis IRAT Individual Readiness Assessment TRAT Team Readiness Assessment Application Group based discussion on clinical application Questions?