AN 1106: CLINICAL APPLICATION (L12 - L25)

what would happen if upper cervical nerves were severed?

• would lose spatial awareness of the shoulder

spinal accessory nerve palsy

• damage to 11th cranial nerve

• asymmetric neckline

• drooping shoulder

• scapula laterally translated and downward rotated

• winging of scapula

• weakened trapezius to shoulder elevation

thoracodorsal nerve palsy

during radical mastectomy with axillary lymphadectomy 

triangle of auscultation

• borders

  • medial border of scapula

  • inferolateral border of trap

  • superior border of lat

• floor

  • iliocostalis

  • TL Fascia

• clinical significance

  • where musculature of the back is relatively thin making easier to hear lung sounds with stethoscope

inferior lumbar space

• borders

  • iliac crest

  • lat dorsi

  • ext oblique

• floor

  • int oblique

• clinical significance

  • weak spot

  • lumbar hernias can occur 

    • petit’s hernia

what would happen if a traumatic event injured the dorsal scapular nerve?

both rhomboids would be dysfunctional 

splenius capitis muscle syndrome

• neck pain

• migraine bc of abnormal posture 

• MV trauma

whiplash

• Occipital nerve neuralgia or anesthesia

  • Impingement of DRG C2/greater occipital 

cremasteric reflex

a normal bodily response in males where stroking the inner thigh causes the testicle on that same side to move upward

superior lumbar space / triangle of grynfeltt

• weak spot where lumbar hernias can occur

• superior lumbar hernia -> petit’s hernia

annular fissure of IVD L3/L4

• ‘crack’ in deep layers of annulus fibrosis

• not a bulge, therefore without nerve compression 

• diffuse pain in the back/L3 dermatome

  • (+1 level above and below)

posterolateral herniation of the IVD L3/L4 or disk bulge

• nerve compression 

  • aka neuralgia/radicular pain

• L4 spinal nerve

hemivertebra

cause: failure of one primary ossification centre

result: half (wedge-shaped) vertebra develops

clinical: scoliosis

butterfly vertebra

cause: symmetrical fusion defect

result: sagittal cleft in vertebral body

clinical: incidental finding, associated with LBP

vertebral block

cause: failure of resegmentation

result: fusion of adjacent vertebrae

clinical: klippel-feil syndrome

klippel-feil syndrome

• rare congenital condition characterized

• abnormal fusion of two or more cervical vertebrae present from birth

schuermann’s disease

• abnormal development of vertebral endplates

• increased thoracic kyphosis

spina bifida

• neural arches fail to fuse properly

• results in a midline defect

cervical rib

• develops from costal element of C7

• can contribute to thoracic outlet syndrome

os odontoideum

cause: failure of fusion between dens and body of C2

results: separate ossicle where dens should be fused

persistent ossiculum terminale

cause: failure of fusion of ossiculum terminale

result: small separate ossicle remains at tip of dens

• apical ligament not as useful

occipital vertebra

• reduced motion at AO joint

• forms

  • true occipital vertebra

    • additional vertebral element incorporated into skull bone

  • occipitalization of C1

    • atlanto occipital fusion

    • atlas becomes fused to occiput

platybasia

• abnormal flattening of the skull bone

• occiput appears to be pushed upward by cervical spine