Presentation on theme: "Vertebrae and muscles of the back Univ. of Central Florida"— Presentation transcript:
1Vertebrae and muscles of the back Univ. of Central Florida Lecturer: Dr. M. SamsamUniv. of Central FloridaPictures from: K. Moore Human anatomy andPlatzer atlas and text book of human anatomy
2Vertebral column Vertebral column forms the basic structure of the trunk.It consists of vertebrae and intervertebraldisks.There are 7 cervical, 12 thoracic, 5 lumbar, 5 sacraland 4-5 coccygeal vertebrae in human.Intervertebral disks (fibrocartilage) between thevertebrae, absorb shock, assure no frictionbetween the bones and facilitate the movementsof the vertebral column.
3Curvatures of the vertebral column: Lordotic curveKyphotic curveScoliosis
5Spinal cord and its blood vessels plus the meninges and the CSF. *Content of the vertebral canal:Spinal cord and its blood vesselsplus the meninges and the CSF.
6Cervical Vertebrae:First cervical vertebra is called Atlas, the 2nd is called Axis.The 7th is called: Vertebra Prominens.3rd, 4th,5th and 6th are similar.
7*Characteristics of cervical vertebrae: A- transverse foramen. B- bifid spinous process. C- small vertebral body.D- large and triangular vertebral canal.*Contents of the transverse foramen: Vertebral artery(C3-C7)
8Vertebral arteries: pass through the transverse Vertebral arteryVertebral arteries:pass through the transverseforamen of the 6 upper CervicalVertebrae.They enter the skull through theForamen Magnum
9Atlas (1st cervical V., C1)Has: no spinous process, no body, small anterior arch and a largerposterior arch. Anterior tubercle, Posterior tubercle, Largevertebral foramen, 2 lateral masses.Each mass has a superior and an inferior articular facet.Atlanto-occipital joint (between atlas and occipital bone).
10Axis (2nd cervical V., C2)Has an Odontoid process (dens) with an anterior articular facet to articulate withatlas, and a posterior articular facet for transverse ligament of atlas.*Hangman Fracture in the arch of axis pushes the dens posteriorlyand compresses the brain stem, leading to death.*Fracture of the dens is a typical fracture of C2.
11Atlanto-occipital articulation (upper head joint): Between superior articular facet of Atlas and Occipital condylesAtlanto-Axial articulation (lower head joint):Consists of median and lateral atlanto-axial articulations.Securing ligaments:Transverse ligament of atlas (between the two lateral masses).Apical ligament of the dens (attaches to anterior margin of foramen magnum).Alar ligaments (from dens to lateral margin of foramen magnum.Etc…
13Clinical tips: *cervical rib (20): when the costal element is preserved independently. Usually bilateral,if one sided, usually on the left side*The presence of a cervical rib may causea triad of disorders:A- Ischemic muscle pain due to compressionof the subclavian artery.B- pain in the ulnar side of the forearm & hand.C- palpable mass over the clavicle.
14Thoracic Vertebrae: There are 12 thoracic vertebrae in human. Important characteristics:Have 2 articular facets (2 and 17) on theirlateral side (one on the body and the otheron the transverse process).Spinous process is long and slopes posteroinferiorly.Costo-vertebral joints:The head of each rib articulates with 2 adjacentvertebrae and the disk between themCosto-transverse joints: between the tubercleof the rib and the transverse process of it’s ownvertebra
15Lumbar vertebrae: There are 5 lumbar vertebrae in human. Characteristics:Large body (1), kidney shape.Long transverse process (5).Relatively small vertebral foramen (15).*Lumbar puncture:Is done at L3-L5 region.The intercrestal line (iliac crests) is at thelevel of L4 approximately (safe region).
1611 and 12th ribs are floating ribs 1- head, 2- neck, 3- body Ribs: 12 ribs1-7 are the true ribsThe last 5 are false ribs11 and 12th ribs are floating ribs1- head, 2- neck, 3- body4- tubercle*Costal groove: contains the intercostalnerve and vessels.Head and the tubercle have articularsurfaces to articulate with the vertebrae
17Sternum: Consist of: Sex differences: Body is longer, narrower 1- Manubrium, 2- body, 3- Xiphoid process4- Sternal angle T4, 5- jugular (suprasternal)notch, 6- clavicular notch, 8- notch forarticulation with 2nd rib,Sex differences: Body is longer, narrowerand slimmer in males than in females*Sternal puncture:Bone marrow needle biopsy for transplantation orcytologic analysis:In the midline in the body of sternum between2-3 ribs attachmentsNever try in the lower 2/3 of the sternal body.Median Sternotomy: in coronary bypass surgeryCongenital anomalies:*Complete sternal cleft: associated withectopia cordis.*Pectus excavatum (funnel chest)*Pigeon chest*Congenital sternal (10) fissure (sternal foramen).*Aneurysm of the Aorta: pulsatile mass atsuprasternal notch (T2); arch is behind the manubrium.
18Joints of the vertebral column: *Zygapophysial joints (A-B)These are the small vertebral joints betweenthe articular processes.Uncovertebral joints:Between cervical vertebrae. They developby age and may become pathologic andpermit disk herniation especially in C5 region.
19Intervertebral disks: Fibrocartilage tissue.They consist of an outer tense part, theAnulus Fibrosus (1) and a soft jelly-like nucleuscalled the Nucleus Pulposus (remnant of theNotochord, embryonic tissue).Function:Acts as a shock absorber, is compressible andpermits slight degree of movement of thevertebrae over each other.They build up approximately 20% of the lengthof the vertebral column (taller in the mornings).*Herniation:Mostly posterolaterally where the AnulusFibrosus is thinner.
22Ligaments of the vertebral column: Many, among them,Anterior longitudinal lig (1)Post. Longitudinal lig (2)Ligamentum flavum (5) , yellowish in colordue to Elastic fibers, facilitates movementsIntertransverse ligs (7)Interspinous lig (8)Supraspinal lig (10).
23Sacrum:Consists of 5 sacral vertebrae and theintervertebral disks that lie between them.It has a concave anterior surface (A) and aconvex dorsal surface (B).Females: sacrum is wider, shorter, more concave.Males: sacrum is longer and less wide.*Sacral hiatus, Sacral horns (cornua)*Epidural anesthesia is given through sacralhiatus to block the pelvic nerves.
25Coccyx:Four vertebrae (rudimentary).6- Cornua or horns of coccyx facingsacrum.Injury to coccygeal vertebrae:Falling on buttocks, specially in females,Painful delivery.Coccydyna: pain in coccyx
26Abnormal fusion anddefects of the vertebrae:Sacralization of L5Lumbarization of S1*Spina Bifida:Failure of vertebral arches to form or fuse.Usually In lumbar or sacral vertebraeLeading to meningocele (just meninges bulgeout of the vertebral canal) ormeningomyelocele (meninges plusspinal cord bulge out).Spina bifida Occulta:*Folic acid substitution in conception andduring pregnancy decreases the risk ofspina bifida.
29Muscles of the back: Cranial muscle inserted on the Shoulder girdle: 1- Trapezius M: has 3 parts:2- Descending part3- Transverse part4- Ascending partDescending part:Origin: from external occipital protuberance,superior nuchal line, and Ligamentum nuchaeInsertion: lateral third of the clavicleTransverse part: from C7-T3 spinous processInserted to: clavicle and scapula (acromion)Ascending part: from T3-T12 spinous processInsertion: spine of the scapula*Function: elevation, retraction and rotationof scapula.Helps in adduction and slight elevation of arm**Innervation: spinal root of Accessory nerve(CNXI) and C3-C4 (propioception and pain).
30Back muscles inserting on the shoulder girdleRhomboid Minor (1):Origin: spinous precess of C6 and C7 (2).Insertion: medial margin of scapula (3).Rhomboid Major (4): caudal to Rh. minorOrigin: spinous process of T1-T4 (5)Insertion: medial margin of scapula (3)*Function of both muscles: press the scapulato the thoracic wall, retraction of scapula medially.Nerve supply: dorsal scapular nerve (C4-C5)Levator Scapulae(6):Origin: transverse process of C1-C4Insertion: superior angle of scapulaFunction: elevates the scapulaInnervation: dorsal scapular nerve (C4-C5)
3112- Latissimus dorsi M: (coughing M) Has many parts:Origin:13:vertebral part T7-T12 spinous process14:thoracolumbar part (from fascia)15:iliac part (from iliac crest)16:costal part: 10-12th rib17- inferior angle of scapulaInsertion: crest of the lesser tubercleof humerus (18).*Function:Adduction and lowering the arm, medialrotation and extension of the arm (humerus).Raises the body toward the arm when climbing.*Innervation:Thoracodorsal N. (C6, C7, C8).
325- Serratus post. Inferior Innervation: intercostal nerves (T9-T12).12- Serratus post. SuperiorFunction: rib elevation*Both may function as accessory muscles ofrespiration (in COPD).
33Intrinsic muscles of the back (erector Spinae)2 groups:Lateral (superficial) groupMedial deep group.**Lateral group:Iliocostalis (1,2,3), lumborum, thoracis, cervicisLongissimus (4,5,6) thoracis, cervicis, capitisSplenius crvicis (11) and capitis (12)*Innervation: all by primary spinal dorsal rami*Function: for erect posture of the body andthe two splenii rotate the head.Extensors when both sides contract and flexionwhen one side contracts.
34Medial groupInterspinales Muscles (1,2,3)Intertransverse muscle (4) cervicisand lumbar (5).Spinalis Thoracis (6) and Cervicis (7) andperhaps capitis as well.Rotator brevis (8) and longus (9) thoracisMultifidus (10)Semispinalis cervicis (11) and capitis (12)All innervated by various primary dorsal rami.Function: Extensors when both sides contractand flexion when one side contracts.Some stabilize and some rotate thevertebral column.
371- rectus capitis posterior minor muscle **Suboccipital triangle2- rectus capitis post. Major3- Oblique capitis superior4- Oblique capitis inferior**Content:A- 3rd part of vertebral artery,B- Suboccipital nerve (C1) innervatingall 3 musclesC- Suboccipital plexus of veinsFunction: turning the head backward orlaterally.**Vertebrobasilar syndromeSensory innervation of the region:Greater occipital nerve (C2)