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Title: Introduction to Anatomy and Anatomy of the Back
Description: These notes are for Physician Assistant Students. The first section introduces anatomy, going things such as joints and planes. The second section dives into the the anatomy of the back, explaining the major structures, muscles, and neurovasculature.
Description: These notes are for Physician Assistant Students. The first section introduces anatomy, going things such as joints and planes. The second section dives into the the anatomy of the back, explaining the major structures, muscles, and neurovasculature.
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Introduction to Gross Anatomy and the Back
Approaches
• Systemic anatomy- why not
o Body systems all work together, not good to learn them separately
• Regional Anatomy- Considers the organization of the human body as major parts/segments
o head, neck, back, thorax, etc
...
• Clinical Anatomy- Considers aspects of structure and function important to the practice of medicine as a
clinician
...
Anatomical Position: Body position upright, gaze forward, toes forward,
arms at side with palms facing forward, legs together with feet parallel
...
o Median Plane- Vertical plane (1) passes longitudinally through
the body, bisecting the body at the midline
...
o Frontal Planes (Coronal)- Vertical planes passing through the
body at a right angle to the median plane, dividing the body
into anterior and posterior
...
o Introduction- Anatomical Position with Planes
• What body action happens in midsagittal plane?
Flexion and Extension
• What joint action occurs in the frontal plan? adduction
and abduction
• Actions in transverse/axial plane: some joints will glide
Techinically: proximal and distal only refer to limb, but
some wiggle room
Anatomical Terms of Relationship
• Superior- Structure which is nearer the vertex
...
• Inferior- Structure which is nearer the sole of the foot
...
• Posterior- Structure which is nearer to the back or
dorsal surface of the body
...
• Circumduction: circular movement of a joint, usually
ball and socket joints
Terms of Movement
• Flexion- Decreasing the angle between
the bones or parts of the body
...
Primarily in posterior direction
...
• Plantarflexion- Flexion of the ankle with
inferior movement of toes/foot- toward
the ground
...
Abduction of the digits is
the exception
...
Adduction of the digits is the
exception
...
• Rotation- Revolving around a
longitudinal axis
...
• Supination- Rotates the radius
laterally, returning forearm to
anatomical position
...
• Synovial Joints- Joint capsule with outer
fibrous layer and inner serous synovial
membrane inside; most common, 6
types
o Articulating surfaces covered by
articular cartilage
o Classified: shape of the
articulating surfaces; type of
permitted movement
...
Plane- boney articulating
surfaces primarily flat
§ allows gliding
§ limited articulation due to
tight joint capsules
§ Ex: acromioclavicular
joint
o 2
...
§ Strong lateral collateral
ligaments
...
Saddle- movement in 2 different planes (biaxial) - flexion/extension and abd/adduction
§ circumduction (circular movement) also possible
§ ex: carpometacarpal joint, bodies of cervical spine?
o 4
...
Limited circumduction is also
possible; permit flexion/extension and abd/adduction; circumduction more restricted than in saddle joints
§ Ex: metacarpophalangeal joints (knuckles)
o 5
...
Pivot- rotation around central axis; uniaxial; rounded process of bone rotates within a sleeve or ring
...
§ Permits growth in the length of a bone during early life
§ Ex: pediatric long bones with growth plates
o Secondary Cartilaginous Joints (symphyses)- Strong, slightly movable, united by fibrocartilage
...
Stretch reflex serves as local negativefeedback mechanism to resist passive changes in muscle length = retain optimal resting length
§ Abnormal reflex: loss of balance in appropriate excitatory vs inhibitory input to the motor neurons
§
§
Our bodies are
doing this all the
time; while
standing à
reflexes working
to keep upright
Basic neuroexams test reflex
•
Reflex Arc Steps
o Receptor- responds to a
stimulus- pain, touch,
temperature
...
o Efferent pathway:
sends neural impulses
from CNS to effector
organs; may be
excitatory and
inhibitory (reciprocal
innervation)
...
•
The brain can modify reflexes
by overriding input from
receptors- Example?
o Overriding impulses
to antagonist
muscles; reciprocal
inhibition
o Ex: contract
quadricep and relax
hamstring
The Back- Vertebrae
• Back- posterior aspect of the trunk, inferior to the neck and superior to
buttocks
...
o Protects soft or hollow structures that travel vertically
(longitudinally)
...
o Movement is limited by multiple factors:
§ Condition of IV discs
§ Shape and orientation of zygapophysial (facet) joints
• Facet joints: between the articular processes of
two adjacent vertebrae
• Cervical facet joints are sitting in the horizontal
plane, look like stacked joints (saddle)
• Lumbar is more vertical
§ Tension of the facet joint capsules
§ Resistance of back musculature and connective tissues
§ Thoracic rib cage
§ Bulk of surrounding tissue
o Movement is freer in cervical and lumbar region- thoracic spine
is relatively immobile (connected to ribs) and herniated disc
here is rare
§ Watch out for new onset thoracic pain, with no
history of trauma
• With osteoporosis a slight fall or bump can
break a bone
• Ex: 75 yo female: osteoporosis leading
compression fracture
o Curvatures- 4 curvatures in adults, thoracic and sacral are
primary and develop in the fetus
...
§ 2 transverse processes: muscle and rib attachment,
§ 4 articular processes- 2 superior and 2 inferior, each with an articular facet, forming
zygapophysial (facet) joints
...
spondolosis or soft tissue in the back
• Facet joint injection under live flouro
•
Regional Characteristics of Vertebrae
o Cervical- CA fig
...
5
§ Smaller size and bear
less weight
...
§ Articular facets are
nearly horizontal in
orientation
...
§ Vertebral foramina: large compared to body size to
accommodate cervical enlargement of spinal cord
§ Spinous processes of C3-C6 are usually bifid in white males
§ C7 spinous process is long (vertebra prominens), and most
prominent in 70% of population
...
4
...
§ Transverse processes extend posterolaterally with diminished
length from T1 to T12 (called long and strong)
...
in recumbent position
§ T12 is transitional, with superior aspect resembling thoracic vert
...
• Adds stress to T12à most common risk for fracture
o Lumbar
§ Large kidney-shaped vertebral bodies for supporting increasing weight
...
§ Articular facets are nearly vertical, with mammillary processes on posterior surface of the
superior articular facet (attachment for multifidus and
intertransversarri muscles)
...
§ Spinous processes short, thick and broad (hatchet
shaped)
...
• Body weight is transmitted from L5 to the base
of the sacrum
...
4
...
14
o Composed of annulus fibrosis- a bulging fibrous
ring, concentric layers of fibrocartilage
§ Inserts on the vertebral body epiphysial rims
...
§ Vascular supply to anulus decreases
centrally
...
o The nucleus pulposus: core of IV disc
§ High H2O composition, flexible and resilient
...
o No IV disc between C1 and C2
...
is totally
asymptomatic
o H2O desiccates with advancing age within disc itself
Vertebral Ligaments
o Anterior longitudinal ligament (ALL)- extends from sacrum to
anterior tubercle of C1 and occipital bone; strong, broad
fibrous ban; covers and connects anterolateral aspects of
vertebral bodies and IV discs
§ Prevents hyperextension of vertebral column
...
o Posterior longitudinal ligament (PLL)- extends from C2 to the
sacrum, runs in the vertebral canal along the posterior aspect
of the vertebral bodies; weaker and narrower band
§ Attached mainly to the IV discs
§ Weakly resists hyperflexion and prevents or redirects
posterior disc herniation
...
o Interspinous and supraspinous ligaments- between spinous
processes
o Intertransverse- connecting transverse processes
...
Provides
muscle attachment sites
...
o Neck of femur, vertebral bodies, metacarpals, and radius subject to
fracture
...
o Worry if on steroids; visible on film
o Fix thoracic vertebrae: inject glue to harded
o Small wedge fracture: only need PT sometimes
• Spinal stenosis- stenotic or narrowed vertebral foramen
...
o Multiple treatments including surgical laminectomy
with decompression
...
60-70s, severe
pain during the onset of walking and then might go
away after a few minutes
• IV Disc Herniation- generally occurs due to anterior
compression of disc forcing the nucleus pulposus to
herniate in posterolateral direction
...
o Results in referred pain and paresthesia in the compressed nerve
distribution
...
• Parent arteries:
o Vertebral and ascending cervical arteries
...
§ Subcostal and lumbar arteriesabdomen
...
• Venous supply by venous plexuses (internal
vertebral venous plexuses and external venous
plexuses)
...
• Small arteries feeding body itself from equatorial
branches, with some posterior supply
Nerves of the Vertebral Column
• Zygapophysial (facet) joints: innervated by articular
branches of the medial branches of the posterior
rami
• Vertebral column: innervated by recurrent meningeal
branches of the spinal nerves
o
o
o
Branches arise from the mixed spinal nerve before its division into anterior and posterior rami, or from
the anterior ramus immediately after formation
...
lig
...
Branches which remain outside the canal innervate antero-lateral vertebral bodies and IV discs,
periosteum, anuli fibrosi, and anterior longitudinal ligament
...
§ act on vertebral column and work on posture
§ Smaller the muscle, more involved in postural
control; sends signals to brain to tell it where we are
in space
Intrinsic Deep Back Muscles: covered by fascia, three horizontal layers, laid out laterally from spine
•
•
•
Errector spinae group: muscle groups fire to stand me up right
Palpating for these guys? errector spinae lays over the entire section, palpate while they do actions, depth of
palpation will tell something
Very difficult to diagnose which one it is- depth of palpation is most accurate and anatomical location
Clinical Aspects of Back
• Vertebral Canal on your own, CA pg
...
Know what level the spinal nerves exit from
...
Column
Cervical
8 (C1-C8)
C1 (suboccipital nerve): passes superior to arch of vertebra C1
C2-C7: pass through IV foramina superior to corresponding vertebrae
C8: passes through IV foramen between vertebra C7 and T1
Thoracic
12 (T1-T12)
T1-L5: pass through IV foramina inferior to corresponding vertebra
Lumbar
5 (L1-L5)
Sacral
5 (s1-S5)
S1-S4: branch into anterior and posterior rami within sacrum,
respective rami pass through anterior/posterior sacral foramina
Coccygeal
1 (Co1)
S5-Co1: pass through sacral hiatus
•
Lumbar puncture (LP, spinal tap)- diagnostic procedure for
examination of CSF in a variety of CNS conditions
...
§ LP needle is inserted between spinous
processes of L3-L4 or L4-L5
...
4-6 cm in adults, needle enters
lumbar cistern and CSF escapes
...
§ This is spondylosis
Title: Introduction to Anatomy and Anatomy of the Back
Description: These notes are for Physician Assistant Students. The first section introduces anatomy, going things such as joints and planes. The second section dives into the the anatomy of the back, explaining the major structures, muscles, and neurovasculature.
Description: These notes are for Physician Assistant Students. The first section introduces anatomy, going things such as joints and planes. The second section dives into the the anatomy of the back, explaining the major structures, muscles, and neurovasculature.