dr. s. nishan silva (mbbs). at birth the spine of a newborn is c- shaped, with one curve at about...
TRANSCRIPT
Dr. S. Nishan Silva(MBBS)
At BirthThe spine of a newborn is C-shaped, with one curve
At About Six MonthsAs the infant lifts his or her head during the first few months, the neck (cervical) curve and its muscles develop
At About Nine Months As the infant learns to crawl and stand, the lower back (lumbar) curve and its muscles develop. Strong back muscles help give your child the strength and balance to walk and run.
The spinal column
The spinal column consists of individual bones called vertebrae, the building blocks, which provide support for the spine. These vertebrae are connected in the front of the spine by intervertebral discs.
The spinal column consists of:•seven cervical vertebrae (C1–C7) i.e. neck•twelve thoracic vertebrae (T1–T12) i.e. upper back•five lumbar vertebrae (L1–L5) i.e. lower back•five bones (that are joined, or "fused," together in adults) to form the bony sacrum • three to five bones fused together to form the coccyx or tailbone
The BackPosterior median furrow – vertical groove
along the midlineSpinous processes of vertebraeSpine of the scapula
Medial end is opposite T3
Medial border of the scapula
The BackInferior angle of the scapulaIliac crests
Supracristal line – intersects L4
Sacrum – superior to cleft in the buttocksCoccyx – posterior to the anus
Surface Anatomy of the Back
Figure 11.31a
12-8
Surface Anatomy of the Trunk Scapulae Latissimus dorsi muscle erector spinae muscle infraspinatus muscle trapezius muscle teres major muscle posterior axillary fold triangle of auscutation
Muscles of the BackTrapeziusLatissimus dorsiErector spinae
Surface Anatomy of the Back
Figure 11.31b
AnatomySpinal cord ends below lower border of L1Cauda equina is below L1Mid dorsal spinal cord & neural canal space are of
same diameter hence prone for complete lesion
Mechanical injury - early ischaemia, cord edema - cord necrosis
Neurological recovery unpredictable in cauda equina ie. peripheral nerves
General Anatomy Lecture
Anatomy Five lumbar vertebrae Five pairs (10 total)
facet joints Intricate ligamentous
support Anterior & posterior
longitudinal Interspinous &
supraspinous
Anatomy Intervertebral disks
Annulus fibrosus Outer zone (Sharpey’s fibers) Intermediate zone Inner zone 20 concentric collar like rings
criss-crossed for strength Nucleus pulposus
Fluid gradually changes to fibrocartilage
Spinal CurvesPosterior ViewSagittal View
PrimarySecondary
Bone PalpationPalpate L4/L5 junction (level of iliac crests)Palpate spinous processes superiorly and
inferiorlyS2 spinous process at level of posterior
superior iliac spineAbsence of any sacral and/or lumbar
processes suggests spina bifidaVisible or palpable step-off indicative of
spondylolisthesis
ANTERIOR PALPATION
Soft Tissue Palpation4 clinical zones
Midline rapheParaspinal musclesGluteal musclesSciatic areaAnterior abdominal wall and inguinal area
Vertebral arch7 vertebral processes arise from vertebral
arch3 lever-like processes - provide attachments
sites for ligaments and muscles Spinous process 2 Transverse processes
4 articular processes Arise from junction of pedicle and laminae
Vertebral ArchSpace enclosed by body and vertebral arch
is the vertebral foramenSuccessive vertebral foramen form the
vertebral canal
Facet JointFormed by articulation of inferior and superior
processes of subsequent vertebraeOrientation in lumbar spine is toward sagittal
plane, allowing flexion and extension but limiting rotation of the lumbar vertebrae
Helps to prevent anterior movement of superior vertebra on inferior vertebra
Articular surfaces are made up of noninnervated articular cartilage
Capsule and synovial membrane are innervated with pain receptors
Cervical spine anatomyAnterior column - Anterior longitudinal ligament+
Anterior annular ligament and anterior half of VB.
Middle column – Posterior long. Lig. + Posterior annular ligament +Posterior half of VB.
Posterior Column – Lig flavum + superior & Interspinous lig + intertransverse capsular lig + neural arch + pedicle & spinous process.
Cervical Alignment
Anterior vertebral body
Posterior vertebral body
Spinolaminal line
Spinous process tips
General Vertebral AnatomyBodyVertebral Arch
Pedicles Laminae
Vertebral ForamenSpinous ProcessFacets
Superior Articulating Surface
Inferior Articulating Surface
Transverse Process Intervertebral Foramen
Distinguishing Features of Cervical Vertebrae
Transverse foramina
C1 transverse process
Spinous ProcessesC6 and C7C3-C6 = bifurcateNone for C1
Articulating Facets
Atlas1st Cervical
VertabraeLack of BodySuperior Articular
FoveaeInferior
Articulating Foveae
Fovea Dentis
AxisC2Dens
Rotation between skull and atlas
C7BodySpinous processTransverse
ForaminaAnterior element
Articulations within cervical regionLateral Atlantoaxial
JointsSuperior facets and
inferior facets of atlasFlat and in transverse
planeRotation
Side toward rotation Side away from rotation
Median Atlantoaxial JointsDens of axis and
anterior arch of atlasTectorial membraneCruciform ligament
Articulation within cervical spineAtlanto-occipital
Occipital condyles of skull and superior articulating surface of atlas
Rotation
Articulations within cervical spineBody-to-body
articulationFibrocartilogenous
Intervertebral Disk Annulos fibrosis Nucleus puplosis
Articulations within cervical spineCervical facet
jointsParallel to frontal
plane45 degrees to
transverse planeRotation
Ligaments within cervical spine
Ligamentum Nuchae
Interspinous Ligament
Ligamentum FlavaPosterior Atlanto-
occipital membraneIntertransverse
Ligament
Curvature of cervical spineLordotic Curve
Cervical spine movement
Flexion/ExtensionAtlanto-occipital
RotationAtlanto-axial joint
Brachial PlexusNerve Roots
C5,6,7,8,T1Trunks
Upper Middle Lower
Divisions Anterior Posterior
Cords Lateral Posterior Medial
Throat Anatomy1. Thyroid gland 2. Trachea 3. Brachiocephalic
artery 4. Common carotid
artery 5. Internal jugular
vein 6. Superior vena
cava
Thoracic VertebraeBodiesPediclesLaminaeSpinous ProcessesTransverse ProcessesInferior & Superior
FacetsDistinguishing Feature
Costal Fovea T1 T2-T8 T9-12
Thoracic Vertebrae and Rib JunctionFunctions of
Thoracic SpineCostovertebral JointCostotransverse
JointMotions
All availableFlexion and
extension limitedT7-T12
Lumbar Spine BodiesPediclesLaminaeTransverse
ProcessSpinous ProcessArticular Facets
Lumbar Spine Thoracolumbar
Fascia
Lumbar SpineIliolumbar
LigamentsFunctions of
Lumbar SpineResistance of
anterior translationResisting RotationWeight SupportMotion
Spinal LigamentsAnterior
LongitudinalPosterior
LongitudinalLigamentum FlavumInterspinous
LigamentsSupraspinous
LigamentsIntertransverse
Ligaments
Intervertebral DisksRatio between
disk thickness and vertebral body height
Disk CompositionNucleus pulposisAnnulus Fibrosis
Vertebral venous plexus
Deep Muscles of the Back (Erector
Spinae)
Iliocostalis
Iliocostalis lumborumIliocostalis ThoracisIliocostalisCervicis
Iliocostalis LumborumO
Common tendon origin in sacrum, iliac crest, lumber vertebrae
I Lower borders ribs 6-12
N Dorsal rami of spinal nerves
F Bilateral
Spinal extension Maintenance of erect
posture Stabilization of spine during
flexion Unilateral
Lateral flexion Ipsilateral rotation
Iliocostalis Thoracis
OUpper borders rib 6-12
ILower borders ribs 1-6
NDorsal rami of spinal
nervesF
Bilateral Same as above
Unilateral Same as above
Iliocostalis CervicisO
Angles ribs 1-6I
C4-6 transverse processes
NDorsal rami of spinal
nervesF
Same as above
Longissimus
Longissimus ThoracisLongissimus CervicisLongissimus Capitus
Longissimus ThoracisO
Common tendon origin in sacrum, iliac crest, lumber vertebrae
IT1-12 transverse
processesN
Dorsal rami of spinal nerves
FSame as above
Longissimus CervicisO
T1-5 transverse processes
IC2-6 transverse
processesN
Dorsal rami of spinal nerves
FSame as above
Longissimus CapitusOT1-5 transverse
processesC5-7 articular processes
IPosterior mastoid process
NDorsal rami of spinal
nervesF
Extends and rotates head
Spinalis Spinalis ThoracisSpinalis Cervicis Spinalis Capitus
Spinalis ThoracisO
Common tendon origin in sacrum, iliac crest, lumber vertebrae
IT3-8 spinous
processesN
Dorsal rami pf spinal nerves
FSame as above
Spinalis CervicisO
C6-T12 spinous processes
IC2 spinous process
NDorsal rami of
spinal nervesF
Same as above
Spinalis CapitisO
Spinous processes of lower cervical and upper thoracic
I Between superiior and
inferior nuchal line on occiput
N Dorsal rami of spinal
nervesF
Same as above
Transversospinal MusclesSemispinalis thoracisSemispinalis CervicisSemispinalis Capitus
Semispinalis ThoracisO
T6-10 transverse processes
IC6 – T4 spinous
processesN
Sorsal rami of spinal nerves
FSame as above
Semispinalis CervicisO
T1-T6 spinous processes
IC2-5 spinous
processesN
Dorsal rami of spinal nerves
FSame as above
Semispinalis CapitisO
C4-7 transverse processes
T1-7 vertebraeI
Between superior and inferior nuchal lines of occiput
NDorsal rami of spinal
nervesF
Same as above
MultifidusO
Transverse processes C4-L5
SacrumPSIS
ISpinous process of vert
above originN
Spinal nerve rootsF
Extend and lateral flexion of vertebral column
Quadratus LumborumO
Iliolumbar Ligament Iliac crest
I Lower border 12th rib L1-L4 transverse
processesN
ventral branches of T12 and L1 to L4.
F Pelvis elevation Trunk extension Trunk lateral flexion Pulls down rib 12 to fix
origin of diaphragm
RotatoresO
Transverse processes from axis to sacrum
ILaminae of vert above
NDirect branches over
spinal nerve rootsF
Spine extensionRotation to opposite
side
Range of Motion
FlexionExtension
Lateral BendingRotation
Flexion - 80º
Extension - 35º
Side bending - 40º each side
Twisting - 3-18º
Neurologic Exam: Sensory Sensory dermatomes C2-C3: Occipital area and angle of
jaw C4: Supraclavicular area Axillary Nerve Patch: Lateral aspect
of shoulder C5: Lateral upper arm C6: Lateral forearm, thumb, and
index finger C7: Middle finger and palmar aspect
of hand C8: Small finger, ring finger, and
medial portion of palmar surface
Neurologic Exam: Sensory Sensory dermatomes T1: Medial side of forearm and elbow T2: Medial aspect of upper arm T3: Medial aspect of upper arm T10: Umbilicus L2: Medial mid-thigh L3: Superior aspect of medial knee
(vastus medialis) L4: Knee and medial arch L5: Dorsum of the foot S1: Lateral border and lateral aspect
of foot S2: Popliteal fossa
Neurologic Exam: Motor C1-C2: Neck flexion C1-C2: Neck extension C3: Neck lateral flexion C4: Shoulder elevation C5: Shoulder abduction and external rotation C6: Elbow flexion and wrist extension C7: Elbow extension and wrist flexion C8: Thumb abduction and ulnar deviation
Neurologic Exam: Motor T1: Finger approximation L2: Hip flexion L3: Knee extension L4: Dorsiflexion L5: Great toe extension, ankle dorsiflexion,
ankle eversion S1: Plantarflexion S2: Knee flexion
Neurologic Exam: Reflexes Biceps (C5-C6) Supinator (C5-C6) Triceps (C7-C8) Upper abdominal (T8-T10) Lower abdominal (T11-T12) Patella (L3-L4) Achilles tendon (S1-S2) Babinski
Myotomes
Map of Dermatomes – Anterior View
Figure 14.17a
Map of Dermatomes – Posterior View
Figure 14.17b
Cervical
Read
Back Pain
Common Sources of LBP
Somatic dysfunction
Muscle in “spasm”
Nerve root
In somatic dysfunction, some muscles become overactive (“spasm”)and other muscles become inactive.
Joint receptors
vasculature
viscera
Connectivetissues
Muscles
Internal organs
Blood vessels
Bones and ligaments
Joint Receptors
Muscle Spindles
NocioceptorsPressure, temperaturechemical
Humoral Factors circulating hormones (gender-specific response)
immune proteins cortisol
Disc Diseases
Radicular SignsPain radiation to
buttocks – SciaticaPosterior thigh painParasthesia – nerve
root impringement
Lower Spinal conditions
Spondylolysthesis
Spondylolysthesis
Spondylolysis
Spinal injuriesWatch video
Atlas Fractures
Type Odontoid Treated with external orthrosis
Spinal Column InjurySubaxial (C3-C7) #
Whiplash injury:Traumatic injury to
the soft tissue in the cervical region
Hyperflexion, hyperextention
No fractures or dislocations
Most common automobile injury
Recover 3-6 months
Hangman’s Fracture